Pet Clinical Examination

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Pet Clinical Examination IVSA Standing Committee on Veterinary Education (SCoVE)

Plan of the Consultation 1. Greet the owner 2. Ask how you can help today?

3. Take a history 4. Physical exam

How to perform Physical Examination?

5. Ask further questions about animal lifestyle 6. Diagnostic plan 7. Differential diagnosis and possibly treatment options 8. What the owner can do to support the animal e.g. nutrition, exercise etc.

9. Clarify with the owner if they understand you, and how they would like to proceed.

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Recommended Physical Examination Guide: http://www.ruralareavet.org/PDF/Physical_ Examination.pdf

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The outline of the lung fields is triangular shape:

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From the caudal angle of the scapula to the tuber coxae as a dorsal line;

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From the caudal angle of the scapula to the olecranon as a vertical line;

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From the olecranon to the dorsal aspect

Head to tail approach?

You can examine an animal based on organ systems or start with area that is likely to be the cause. Or you can examine the animal from head to tail. The main aim it to perform a full general clinical exam.

General Most physical exams start with weight checks and checking vitals––temperature, pulse rate, respiratory rate, etc.––but also include immediate impressions along the lines of "bright, alert and responsive" (abbreviated as BAR) or depressed, quiet, recumbent and/or unresponsive. It is good to check the ‘body condition score’, i.e. the pet's degree of heaviness or thinness, as the case may be.

Head On the head check ears, eyes, nose, mouth and teeth.

Check for ocular and/or nasal discharge, normal appearance of structures, details on dentition and periodontics, character of the mucous membranes to assess hydration, etc. Also check for hyper-salivation, pain on palpation, bleeding gums, which can all be indicative of genetic/congenital disorder, infections, foreign body or neoplasia.

Skin and Coat Check the condition of the hair and skin. Finding fleas, ticks and lumps, especially if they have a large surface area. Most vets will also check for hydration here by "tenting" the skin at the shoulders. If tenting of the skin is prolonged it can indicate >5% dehydration. See below for further details on checking hydration status.

Chest Use a stethoscope to auscultate the chest. Try to alter the pet’s breathing pattern with your hands on the nose and mouth and feel the pulses as they relate to the beats of the heart.

Auscultate the lung fields (20-40 breaths per minute) and if there is crackling sounds (shows pulmonary oedema), wheezing (bronchospasms in i.e. asthma), and check for upper respiratory tract obstruction or laryngeal problems via palpation of ventral neck.

Auscultate the heart on the left side, on the ventral chest right next to elbow. The normal heart rate for dogs is 60-160bpm. Smaller dogs will have a higher heart rate than larger dogs.

Cat’s normal heart rate is between 140-240bpm. But be-aware cats are often stressed during consultation and their heart rate will be higher than at rest. Cats often purr or dogs growl, so ensure the animal is calm to avoid this so better auscultation of the heartbeat and lung sounds can be heard.

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Circulatory Check the mucous membranes of the upper respiratory tract and mouth. You can also check Capillary Refill Time on the gums; it should be less than 1-2 seconds. Feel for the femoral pulse (on the medial proximal surface of one of the hind legs) during the chest exam to make sure the pulse synchronizes well with the heartbeat.

Orthopedics The orthopedic portion of the exam includes a variety of steps: Assessing the symmetry and/or lack of the musculature, observing how the pet moves/ambulates and physically manipulates the limbs and their joints. Particularly look for symmetry of muscle in the face and pelvic region (gluteal and lumbar muscles).

Most vets will also address the spine individually, feeling down every intervertebral junction to identify painful spots or increased hypersensitivity.

Abdomen Palpating the abdomen is not easy in some cases. Some pets hold their abdomens tightly, refusing to allow you a good feel. Feel for the size and texture of the organs and the possible presence of abnormal masses. Place palm of hands on either side of abdomen and feel upwards/dorsally and press with some pressure in the abdomen for small intestines. If you feel more cranially and dorsally you can palpate the liver and kidneys. Caudal abdomen you should be able to palpate the full bladder.

Lymph Nodes Feel for lymph nodes in the neck, in front of the shoulders, and behind the knees. Check for enlarged lymph nodes, which indicate inflammation/tumour/infection.

Lymph nodes: • Mandibular- angle of jaw and normally pea sized shape.

• Prescapular- just dorso-cranial to scapula.

• Popliteal- found caudal to stifle and should be smaller than a pea in size. https://www.youtube.com/watch?v=TSM D0C8pY5I

Neurological Exam Evaluate the cranial nerves as part of the head exam and address some basic reflexes, including the menace response, palpebral/corneal and pupillary light reflex. You can check for strabismus/nystagmus of the eye or facial paresis and asymmetry. Check for proprioceptive reflexes (flexing the dorsal surface of the toe onto ground surface and seeing if animal corrects posture). Check for mentation, posture (ataxia and paresis), spinal reflexes (patella reflex, withdrawal reflex, perineal reflex, cutaneous trunci reflex). Gag reflex, swelling/atrophy of muscles and check for superficial or deep pain. https://en.wikivet.net/Neurological_Examination_-_Dog_&_Cat 3

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Perform a Body Condition Score

As a vet it is important to practice Body Condition Scoring of animals. It is a quick indicator of health and owners should be encouraged to do this too.

How to perform BCS: 1. Palpate the chest and feel for ribs. Feel if it is easy to feel the ribs or not. If it is hard, then its likely the animal has a BCS>3.

2. Palpate the transverse processes of the lumber vertebrae and ventral abdomen.

The more fat cover, the harder it is to feel the bones.

Here are some YouTube videos on how to perform a General Physical Examination‌ https://www.youtube.com/watch?v=mN030pQ_zNk https://www.youtube.com/watch?v=q0lHXK_z38I https://www.youtube.com/watch?v=T-HB1k5sP54 https://www.youtube.com/watch?v=LF1bd-JYhyo https://www.youtube.com/watch?v=S8f9-GPW9IE https://www.youtube.com/watch?v=LF1bd-JYhyo 4

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Hydration assessment

If over the animal is over 10% dehydrated, then put them on IV fluids, here is a IV fluid calculation table!

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IVSA SCoVE hope you enjoyed this short but useful leaflet on Pet Clinical Examinations.

SCoVE is here to support you on your veterinary educational journey. We always appreciate feedback and if you would like us to produce leaflets on other topics then please do not hesitate to contact us via our Facebook Page! We also have the IVSA Vet Education Forum group on Facebook to connect with students globally and to share and support one another with educational material.

Good wishes from SCoVE Committee!