Physical Examination

I. History A. Signalment - information that does not change often on the patient or client. Example: owner’s name, address, phone number, etc

B. Ask specific questions: Example: owner says the dog has diarrhea You ask: How long?, How often?, Color and consistency of the stool; changes in the food or environment?, etc.

C. Avoid leading questions that sway the owner to answer the way you want them to answer. Example: You do want to get blood work on Freckles, don’t you?

D. Avoid putting a diagnosis. Diagnosis - name to the problem Symptoms/Signs - things a patient does or doesn’t do that indicates they are sick

E. Age of the animal - put the month and year if possible, not 3 years old.

F. On the vaccination history, put the month and year.

G. Sex - indicate if they are male or female and if they have been neutered M, F. NM. SF

II. Physical Exam - always do a visual examination prior to doing a hands on examination. Start at the head and work towards the back of the animal.

A. TPR (Temperature, Pulse, Respiration) - if an animal is stressed or excited the values will increase slightly. If an animal is hypothermic or in shock, the TPR values will decrease.

The larger the animal, the slower the heart and respiratory rate will be. The smaller the animal the faster these values will be.

1. Temperature - hold on to the thermometer in large animals and stand to the side while taking the temperature. You can take rectal or ear temperature.

2. Heart rate - To take a heart rate you will count 1 “lub-dub” as 1 beat. Count for 10 seconds and multiply by 6 or 15 seconds and multiply by 4 to get beats per minute. If you are unable to hear the heart of a cat because of purring, place the cat near a sink and turn the tap on to a slow steady drip. The dripping noise will drown out the purring. If a dog is panting so you cannot hear the heart, gentle close the mouth.

Auscultation: listening to sounds (heart, lungs, gut) with a stethoscope

Stethoscope: Diaphragm - used for high pitch sounds Bell - used for low pitch sounds (young animals, gut sounds)

Rhythms: Normal sinus rhythm Normal sinus arrhythmia -Commonly seen in brachycephalic breeds Bradycardia Tachycardia

3. Pulse Obtain the pulse in a small animal through the femoral artery. Obtain the pulse in a large animal through the mandibular artery. Pulse deficit - pulse rate is lower than the heart rate can suggest a cardiac problem or blockage.

4. Respirations - To take a respiratory rate you will count 1 inhale + 1 exhale as 1breath. Count for 10 seconds and multiply by 6 or 15 seconds and multiply by 4 to get beats per minute.

Watch the abdomen or chest move in and out to obtain a respiration. You can also place your hand on the chest to feel it rise and fall or watch the nostrils move with respirations.

Listen to the chest for respiration noises and indicate what you hear. Indicate if the breathing is shallow, panting (open mouth breathing), shallow, and dyspnea (painful/difficult breathing).

Apnea - no breaths Dyspnea - difficult breathing Tachypnea - fast breathing

B. Attitude - mental attitude a. BAR - bright, alert, and responsive b. QAR quiet, alert, and responsive c. Lethargic d. Depressed

C. MM - Mucous Membranes Normal color in mammals: pink Normal color in reptiles: white Blue (cyanotic) - lack of oxygen

Pale/white - shock, anemia, dying

Yellow (icteric/jaundice) - liver problems Bright red - toxic (septic), inflammation

On black pigmented mm, you will need to pull down the lower eyelid to look at the color

D. CRT - Capillary Refill Time Press on the gums with your finger and time how long it takes for the color to come back. Normal CRT is 1-2 seconds. Prolonged CRT reflects circulation problems.

E. Integumentary - skin/hair coat Dry/flakey or oily - usually a result of diet, husbandry problems or parasitic

Alopecia - hair loss

Lumps or Bumps Abscess - pocket of pus from a wound or foreign body Cysts - a pocket filled with clear fluid or white crusty substance (usually a damaged hair follicle or blocked glands/follicles Warts - virus Lipoma - fatty tumor (usually subcutaneous and moveable)

Ectoparasites - fleas, ticks, lice, mites

Wounds

F. Eyes/Ears Ocular discharge Clear - indicates pain or irritation Yellow/green - infection Color change to the eye Blue – glaucoma

Cloudy – cataract

Pupil size

Ear discharge Dark brown (looks like coffee grounds) - ear mites

Yellow/brown and creamy - bacteria or yeast infection

Odor to the ear usually indicates yeast infection - common in animals with lots of hair around the opening to the ear and animals that like to play in water

G. Leg/Hoof Check for any lameness problems, obvious wounds or deformities. Lift up the horses’ foot to check the hoof area for tender spots, bruises, foreign bodies, or soft areas on the foot.

Trimming a toenail on a reptile or bird, you will use a dremel. Trimming a cat or dog’s toe nails you will use nail trimmers. Cut the nail from the bottom up to prevent splintering of the nail. Cut in front of the quick where the blood supply and nerves are to the toe. If you “quick” a nail you can use silver nitrate sticks, kwik stop powder, cornstarch, or flour/water to stop the bleeding. This does hurt the animal and may cause them to hate to have their nails trimmed in the future. If an animals nails are really long, you may have to quick them to get the blood and nerve supply to recede back on the nail. On white colored nails, you can see the quick. It will appear red. On black nails you can sometimes see the overgrowth. On the end of the black nails as you get closer to the quick, it will appear darker.

Nail trimmers: Whites, Rescoes, fingermail trimmers, dremel, wire strippers

H. Urogential system (urinary/reproductive organs)

If it is an intact male, check the testicles for enlargements, lumps, skin problems, if both are the same size and if both are descended. If one testicle is descended and the other is not in the testicle pouch, this is called cryptorchid (crypt - hidden, orchid - testicle).

Check the penis for obvious wounds or discharge on or around the penis. Check for swelling around the sheath. In horses this would indicate that the horse will need a sheath cleaning.

On females check the vaginal area for discharge or swelling. Check for swelling or tumors on the mammary glands.

Palpate the area of the bladder (in the middle of the pelvic area) to check for tenderness

I. Oral Cavity

Gingivitis - inflammation of the gums Tartar - the brown build-up on the tooth Discolored teeth Black or grey - dead tooth Pink - dying tooth Check the mouth for anything obvious wrong

J. Gastrointestinal (stomach/intestines - GI)

Palpate the abdominal cavity to check for tenderness or pain. Check for any lumps as you palpate. In horses, listen to the 4 quadrants for gurgling sounds.

K. Central Nervous System (CNS)

Check how the animal is standing, sitting, walking and carrying their head. Check the size of the pupils. L. Anal Sacs

These are tiny sacs located about 4 o’clock and 8 o’clock on the sides of the rectum that excrete smelly liquid to mark territory. The sacs can also secrete when the animal is stressed. The odor is strong and hard to wash off. Some animals have problems with these anal sacs. This can be caused by allergies, groomers expressing them often, and diet.

Symptoms that indicate anal sac problems: 1. Scooting on their rear end 2. Constant licking around the rectum 3. Abnormal tail carriage

If the animal is showing signs of anal sac problems, they will need to be expressed. Take a gloved finger and go inside the rectum with one finger with the thumb at 4 and 8 o’clock of the rectum. Gently squeeze the fingers together to express each sac contents into a paper towel. Normal secretions will be a liquid brown.

M. Lymph nodes

These should be palpated during the exam to check for enlargements. Most of the time you should not be able to feel them or they will be the size of a pea. Enlarged lymph nodes can indicate illness. Example: Strep throat - the lymph nodes behind the mandible become enlarged and makes it harder to swallow. Lymph nodes are tissues in the body that house the cells that contain the memory on how to fight off disease in the body.

III. Grooming

A. Bathing Prior to bathing an animal, it should be brushed or combed to remove the majority of the dirt and mats. If you take a comb and get underneath a mat, you can usually comb it out carefully without cutting it out. Common place for mats are usually around the legs and behind the ears.

Be careful of the bony areas of the body when brushing the animal. Cats and rabbits have the most sensitive skin of most species.

Remove collars and place cotton balls in the ears to prevent moisture from going down the ear canal.

B. Shampoos

1. Mild shampoos a. dish soap - joy, palmolive Great for removing oil/grease out of the hair coat

b. baby shampoo Good for young animals

c. general pet shampoos

2. Medicated shampoos - wear gloves when using most of these shampoos so they don’t absorb through your skin

a. Blue snow - whitening shampoo to get rid of the yellow coloration of white fur and brighten up the colors of a colored hair coat. b. collodial oatmeal - antipruritic (dry/flakey skin and irritation ) c. tar-sulfur - dry and flakey skin d. benzoyl peroxide - bacterial skin infections e. iodine - fungal (ringworm) f. lindane/mitaban - ectoparasites (lice, mites)