Performing the Small Animal Physical Examination

The authorRyane E. Englar, DVM, DABVP (Canine and Feline Practice), is Assistant Professor of Small Animal Primary Care at Midwestern University College of Veterinary Medicine in Glendale, Arizona, USA.

�Performing the Small Animal Physical Examination provides a very detailed overview of how to complete a comprehensive physical examination in dogs and cats�.Although the text contains many medical terms, it is easy to read and follow. The best part of this book is the vast amount of color photographs it contains that complement and reinforce information provided in the text and provide comparisons of normal versus abnormal�.This book will be an excellent resource for veterinary and veterinary technician students and new graduates. It will also be appropriate for experienced large animal veterinarians who are transitioning into small animal medicine and desire information on current low-stress examination techniques for dogs and cats.� JAVMA, January 2018

• About the Author xiiiPreface xivAcknowledgments xvPart One Performing the Feline Physical Examination 11 Setting the Stage: Feline-Friendly Practice 31.1 Challenges Faced in Feline Practice 31.2 The Emergence of Feline-Friendly Practice 41.3 Key Principles of Feline-Friendly Practice 41.4 The Role of Sound 81.5 The Role of Tactile Stimulation 81.6 The Role of Scent 81.7 The Role of Advance Preparation 91.8 Examination Room Etiquette: Accessing the Cat 101.9 Recognizing Body Language 121.10 Feline-Friendly Handling 161.11 Other Feline Handling Tools 202 Assessing the Big Picture: the Body, the Coat, and the Skin of the Cat 242.1 Forms of Identification 242.2 Body Condition Scoring 252.3 Assessing Hydration 292.4 Inspecting the Coat: First Impressions 302.5 Identifying Coat Colors and Coat Patterns 322.6 Assessing Coat Quality 342.7 Inspecting the Skin 403 Examining the Head of the Cat 523.1 Skull Shape and Facial Symmetry 523.2 The Eyes and Accessory Visual Structures 523.2.1 A Systematic Approach to the Eye Examination 523.2.2 Evaluating the Adnexa of the Eye 533.2.3 Evaluating the Globe 583.2.4 Evaluating the Sclera 603.2.5 Evaluating the Cornea 613.2.6 Evaluating the Iris 613.2.7 Evaluating the Pupils 623.2.8 Assessing Ocular Reflexes 623.2.9 Assessing the Anterior Chamber 643.2.10 Assessing the Lens 653.2.11 Introduction to Fundoscopy 663.2.12 Fundoscopy and Direct Ophthalmoscopy 673.2.13 Fundoscopy and Indirect Ophthalmoscopy 673.3 The Ears 683.4 The Nose 723.5 The Extra-Oral Examination 733.6 The Intra-Oral Examination 753.6.1 Assessing Mucous Membrane Color 753.6.2 Assessing Capillary Refill Time 763.6.3 Examining the Mucosa 763.6.4 Examining the Gingiva 783.6.5 Assessing the Dentition 783.6.6 Assessing the Occlusion 793.6.7 Assessing for Calculus 813.6.8 Opening the Mouth 813.6.9 Examining the Tongue 823.6.10 Assessing for Periodontal Disease 823.6.11 Feline-Specific Dentistry 844 Examining the Endocrine and Lymphatic Systems of the Cat 904.1 Evaluating the Thyroid Gland 904.1.1 The Pathophysiology of Hyperthyroidism 904.1.2 The Etiology of Hyperthyroidism 914.1.3 The Art of Palpating an Enlarged Thyroid Gland 914.2 Assessing the Lymphatic System 934.2.1 Examining the Submandibular Lymph Nodes 934.2.2 Examining the Superficial Cervical or Pre-Scapular Lymph Nodes 934.2.3 Examining the Popliteal Lymph Nodes 944.2.4 Feeling for Lymph Nodes That Should Not Be Present 945 Examining the Cardiovascular and Respiratory Systems of the Cat 985.1 The Cardiac Patient 985.2 Assessing the Cardiovascular System Prior to Auscultation 995.2.1 Attitude 995.2.2 Respiratory Rate 995.2.3 Respiratory Effort 995.2.4 Respiratory Route 995.2.5 Mucous Membrane Color 995.2.6 Capillary Refill Time (CRT) 995.2.7 Jugular Pulse 995.2.8 Palpating the Ventral Neck 1005.2.9 Palpating the Limbs for Warmth and Assessing the Extremities for Color 1005.2.10 Assessing Femoral Pulses 1005.3 Cardiothoracic Auscultation 1015.3.1 Recalling the Cardiac Cycle 1015.3.2 Normal Heart Sounds 1015.3.3 Abnormal Heart Sounds: Murmurs 1015.3.4 Other Heart Sounds 1025.3.5 Ausculting the Heart 1025.3.6 Understanding How the Stethoscope Is Built to Facilitate Auscultation 1055.4 The Respiratory Patient 1055.4.1 The Upper Airway Patient 1055.4.2 The Lower Airway Patient 1055.4.3 The Patient with Thoracic Cavity Disease 1075.5 Assessing the Respiratory System Prior to Auscultation 1105.5.1 The Nose 1125.5.2 The Larynx and the Trachea 1135.5.3 Thoracic Compliance 1135.5.4 Thoracic Percussion 1135.6 Understanding Normal Airway Sounds 1145.7 Ausculting the Airway 1145.8 Understanding Adventitious Airway Sounds 1155.9 Using Airway Sounds to Corroborate Percussive Findings 1165.10 Purring as an Obstruction to Auscultation 1166 Examining the Abdominal Cavity of the Cat 1206.1 Overview of the Digestive Tract as It Pertains to Presenting Complaints 1206.2 The Esophagus 1226.3 Visual Inspection of the Abdomen 1226.4 Superficial Palpation of the Abdomen 1226.5 Deep Palpation of the Abdomen 1246.5.1 The Liver 1266.5.2 The Stomach 1276.5.3 The Spleen 1276.5.4 The Pancreas 1276.5.5 The Small Intestine 1286.5.6 Mesenteric Lymph Nodes 1296.5.7 The Large Intestine 1296.5.8 The Rectal Examination 1306.6 The Upper Urinary Tract 1326.7 The Lower Urinary Tract 1346.8 The Male Reproductive Tract 1356.9 The Female Reproductive Tract 1376.10 Being Presented with a Female of Unknown Sexual Status 1386.11 Neonates 1387 Examining the Musculoskeletal System of the Cat 1457.1 Muscle Condition Score (MCS) 1457.2 The Skeleton as a Whole 1467.2.1 Key Components of the Axial Skeleton to Appreciate on Physical Examination 1487.2.2 Key Components of the Appendicular Skeleton to Appreciate on Physical Examination 1507.2.3 Additional Components of the Skeleton to Appreciate on Physical Examination 1537.3 The Appendicular Skeleton: The Forelimb 1537.4 The Appendicular Skeleton: The Hind Limb 1608 Evaluating the Nervous System of the Cat 1748.1 Assessing Behavior and Mental Status 1748.2 Assessing Posture 1768.3 Assessing Coordination and Gait 1778.4 Assessing Postural Reactions 1788.5 Assessing for Other Abnormal Movements 1808.6 Evaluating the Spinal Reflexes 1818.7 Assessing the Cranial Nerves 1838.7.1 Reviewing the Ocular Reflexes Associated with the Cranial Nerves 1838.7.2 Reviewing the Cranial Nerves Associated with Ocular Movement 1858.7.3 Reviewing the Cranial Nerves Associated with Tactile Sensation 1858.7.4 Reviewing the Cranial Nerves Associated with Muscle Movement Other Than Ocular 1868.7.5 Reviewing the Cranial Nerves Associated with Digestion 1868.7.6 Reviewing the Cranial Nerves Associated with Maintaining Posture 1868.8 Assessing Nociception 186Part Two Performing the Canine Physical Examination 1919 Setting the Stage: Canine-Friendly Practice and Low-Stress Handling 1939.1 Challenges Faced in Canine Practice 1939.2 The Concept of Low-Stress Handling 1949.3 White Coat Syndrome 1969.4 The Role of Scent 1989.5 The Role of Advance Preparation 1999.6 Examination Room Etiquette: Setting the Tone for Initial Veterinary Interactions with the Dog 1999.7 Recognizing Body Language 1999.8 Creative Approaches to Challenging Interactions with Canine Patients 2059.9 Other Canine Handling Tools 20610 Assessing the Big Picture: the Body, the Coat, and the Skin of the Dog 21310.1 Forms of Identification 21310.2 Body Condition Scoring 21410.3 Assessing Hydration 22110.4 Breed Designation 22210.5 Inspecting the Coat: First Impressions 22310.6 Identifying Coat Colors and Coat Patterns 22510.7 Assessing Coat Quality 23310.8 Inspecting the Skin 23710.9 Primary Skin Lesions 24010.10 Secondary Skin Lesions 24510.11 Miscellaneous Skin Lesions 24610.12 Hyperkeratosis 24910.13 Skin Folds 25010.14 Nails and Paw Pads 25110.15 Skin Incisions 25210.16 Mammary Glands 25511 Examining the Head of the Dog 26111.1 Skull Shape: Function Versus Cosmesis 26111.2 Facial symmetry 26511.3 The Eyes and Accessory Visual Structures 26511.3.1 A Systematic Approach to the Eye Examination 26511.3.2 Evaluating the Adnexa of the Eye 26511.3.3 Evaluating the Globe 27411.3.4 Evaluating the Sclera 27511.3.5 Evaluating the Cornea 27711.3.6 Evaluating the Iris 27811.3.7 Evaluating the Pupils 28011.3.8 Assessing Ocular Reflexes 28111.3.9 Assessing the Anterior Chamber 28111.3.10 Assessing the Lens 28211.3.11 Introduction to Fundoscopy 28211.3.12 Fundoscopy and Direct Ophthalmoscopy 28311.3.13 Fundoscopy and Indirect Ophthalmoscopy 28311.4 The Ears 28411.5 The Nose 28911.6 The Extra-Oral Examination 29111.7 The Intra-Oral Examination 29511.7.1 Assessing Mucous Membrane Color 29511.7.2 Assessing Capillary Refill Time 29611.7.3 Examining the Mucosa 29611.7.4 Examining the Gingiva 29611.7.5 Assessing the Dentition 29711.7.6 Assessing the Occlusion 30111.7.7 Assessing for Calculus 30211.7.8 Miscellaneous Acquired Tooth-Related Defects 30311.7.9 Opening the Mouth 30411.7.10 Examining the Tongue 30511.7.11 Assessing for Periodontal Disease 30612 Examining the Endocrine and Lymphatic Systems of the Dog 31212.1 Thyroid Gland Neoplasia in the Dog 31212.2 The Typical Presentation of Thyroid Gland Neoplasia in the Dog 31312.3 The Pathophysiology of Hypothyroidism 31312.4 The Typical Presentation of a Hypothyroid Dog 31412.5 The Atypical Presentation of a Hypothyroid Dog 31512.6 Assessing the Lymphatic System 31512.7 Examining the Submandibular Lymph Nodes 31612.8 Examining the Superficial Cervical or Pre-Scapular Lymph Nodes 31612.9 Examining the Popliteal Lymph Nodes 31612.10 Feeling for Lymph Nodes That Should Not Be Present 31713 Examining the Cardiovascular and Respiratory Systems of the Dog 32013.1 Congenital Heart Disease in the Dog 32013.2 Acquired Heart Disease in the Dog 32113.3 Assessing the Cardiovascular System Prior to Auscultation 32213.3.1 Attitude 32213.3.2 Respiratory Rate 32313.3.3 Respiratory Effort 32313.3.4 Respiratory Route 32313.3.5 Mucous Membrane Color 32313.3.6 Capillary Refill Time (CRT) 32313.3.7 Jugular Pulse 32413.3.8 Assessing Femoral Pulses 32413.4 Cardiothoracic Auscultation 32513.4.1 Normal Heart Sounds 32513.4.2 Abnormal Heart Sounds 32613.4.3 Other Heart Sounds 32613.4.4 Ausculting the Heart 32613.4.5 Understanding How the Stethoscope Is Built to Facilitate Auscultation 32613.4.6 Understanding the Limitations of Cardiothoracic Auscultation 32613.5 The Respiratory Patient 33013.5.1 The Upper Airway Patient 33013.5.2 The Patient with Laryngeal Disease 33213.5.3 The Lower Airway Patient 33213.5.4 The Patient with Thoracic Cavity Disease 33313.6 Assessing the Respiratory System Prior to Auscultation 33413.6.1 The Nose 33413.6.2 The Larynx and the Trachea 33413.6.3 Thoracic Compliance 33513.6.4 Thoracic Percussion 33513.7 Understanding Normal Airway Sounds 33513.8 Ausculting the Airway 33513.9 Understanding Adventitious Airway Sounds 33613.10 Panting as an Obstruction to Auscultation 33714 Examining the Abdominal Cavity of the Dog 34214.1 Overview of the Digestive Tract 34214.2 The Esophagus 34214.3 Visual Inspection of the Abdomen 34314.4 Auscultion and Superficial Palpation of the Abdomen 34414.4.1 Auscultation of the Abdomen 34414.4.2 Superficial Palpation of the Abdomen 34414.5 Deep Palpation of the Abdomen 34614.5.1 The Liver 34814.5.2 The Stomach 34814.5.3 The Spleen 35014.5.4 The Pancreas 35114.5.5 The Small Intestine 35214.5.6 The Mesenteric Lymph Nodes 35414.5.7 The Large Intestine 35414.5.8 The Anal Sacs 35414.5.9 The Rectal Examination 35514.6 The Upper Urinary Tract 35714.7 The Lower Urinary Tract 35814.8 The Male Reproductive Tract 36114.9 The Female Reproductive Tract 36414.10 Being Presented with a Female of Unknown Sexual Status 36714.11 Neonates 36815 Examining the Musculoskeletal System of the Dog 38015.1 Muscle Condition Score (MCS) 38015.2 The Skeleton as a Whole 38215.2.1 Key Components of the Axial Skeleton to Appreciate on Physical Examination 38215.2.2 Key Components of the Appendicular Skeleton to Appreciate on Physical Examination 38315.2.3 Additional Components of the Skeleton to Appreciate on Physical Examination 38615.3 The Appendicular Skeleton: The Forelimb 38615.4 The Appendicular Skeleton: The Hind Limb 39216 Evaluating the Nervous System of the Dog 41216.1 Assessing Behavior and Mental Status 41216.2 Assessing Posture 41316.3 Assessing Coordination and Gait 41516.4 Assessing Postural Reactions 41516.5 Assessing for Other Abnormal Movements 41816.6 Evaluating the Spinal Reflexes 41916.7 Assessing the Cranial Nerves 42116.7.1 Reviewing the Ocular Reflexes Associated with the Cranial Nerves 42116.7.2 Reviewing the Cranial Nerves Associated with Ocular Movement 42216.7.3 Reviewing the Cranial Nerves Associated with Tactile Sensation 42216.7.4 Reviewing the Cranial Nerves Associated with Muscle Movement Other than Ocular 42316.7.5 Reviewing the Cranial Nerves Associated with Digestion 42316.7.6 Reviewing the Cranial Nerves Associated with Maintaining Posture 42316.8 Assessing Nociception 423Index 432