Clinical Examination: Review Melissa R. Finley, DVM, PhD, DACVIM Sandia National Laboratories And George McCommon, DVM Georgia Animal Development Team October 2011 Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. Department of Energy's National Nuclear Security Administration under contract DE-AC04-94AL85000.SAND 2011-6536P
Components of a Complete Clinical Evaluation Evaluation from a distance Collection of a meaningful history Thorough physical examination Produce a problem list Based on the problems, develop a list of differential diagnoses Conduct ancillary tests to arrive at a final diagnosis 1
Evaluation from a Distance General condition Mentation bright, alert, responsive Posture Gait Head position Abdominal shape Respiration Discharge Obvious injuries or wounds Edema Jugular vein distention 2
Collection of a Meaningful History Include questions that address the primary complaint Include standard questions related: Feed and water intake General condition or loss of condition Vaccination status Reproductive status Additions to the herd or flock Remember to always consider the information obtained from the owner 3
Physical Examination Veterinarian s most valuable tool Be consistent Perform the examination the same way every time Examine the entire animal Subtle problems may help you arrive at a final diagnosis Do not forget to look inside the mouth, auscult both sides of the thorax and abdomen, and perform a rectal examination Be aware of potential zoonotic diseases that good compromise your health Use gloves, sleeves, protective eyewear, keep your mouth closed while performing rectal examinations 4
Problem List Develop a list of problems that you identified via: History Observation from a distance Physical examination Group the problems such that they will help you develop a list of differential diagnoses Update your problem list as new observations are made 5
Develop a List of Differential Diagnoses Create a list of differential diagnoses with the below problems: Not eating or drinking Lethargic/depressed Approximately 5% dehydrated Calved 7 days prior Reduced milk production / calf is hungry Heart rate is 96 beats per minute Respiratory rate is 50 breaths per minute Weak rumen contractions are heard, approximately one per two minutes Temperature of 103.5 degrees F (39.7 degrees C) Uterus is slightly enlarged upon palpation 6
Differential Diagnosis Differentials Gastrointestinal disease Infectious or noninfectious Diseases Reproductive disorder Related to calving Diseases Respiratory Infectious disease Diseases Body as a whole Infectious disease 7
Ancillary tests What tests can be used to differentiate Gastrointestinal Reproductive Respiratory Systemic 8
Develop a List of Differential Diagnoses Create a list of differential diagnoses with the below problems: Not eating or drinking Lethargic/depressed Approximately 5% dehydrated Heart rate is 100 beats per minute Respiratory rate is 70 breaths per minute Bronchial sounds cranial and ventral thorax Weak rumen contractions are heard, approximately one per two minutes Auscultation and percussion reveals a tympanic sound on the left side in the paralumbar fossa Temperature of 104 degrees F (40 degrees C) 9
Differential Diagnosis Differentials Respiratory Infectious disease Diseases Gastrointestinal disease Infectious or noninfectious Diseases Body as a whole Infectious disease 10
Ancillary tests What tests can be used to differentiate Gastrointestinal Respiratory Systemic Infectious versus noninfectious 11