6.2 The Physical Examination

Overview

The physical exam or wellness exam is a checkup by a veterinarian to assess the overall health of an animal. This exam is usually performed once the animal is adopted, prior to initial vaccinations, then every 6 months to a year afterwards. If the animal is ill or needs procedures done, these exams will also be necessary. Prior to the exam, a history is taken by the VOA and/or RVT. After the examination, the information is recorded on a medical record. The SOAP (subjective, objective, assessment, and plan) format is one of the most commonly used medical record formats.

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Step 1: Taking a History

History: Past and current information about the animal from the owner’s perspective

The history includes the following:

• Signalment: Complete description of the animal
  • Species
  • Breed
  • Age
  • Sex, male or female
  • Reproductive status, such as male neutered or female spayed
  • Other distinguishing characteristics
• Past and present medical issues or treatments including vaccination status
• Housing: Any relevant information regarding their physical environment
• Diet: What they are eating, how much food they consume, and water consumption
• Behaviour: The way they are acting
• Any changes in their environment

Step 2: Presenting Complaint

Presenting complaint: The complaint or the reason the animal is in the clinic; the problem seen by the client. Some questions to ask the client to better understand the problem are the following:

• When did it occur?
• How long has it been going on for?
• How often does it happen or has it happened?
• Where is it located?
• Has it changed or moved?
• Has it been better or worse?
• Has it been treated before? If so, with what types of treatments?

This is the beginning of recording what is known as clinical signs: the owner’s observations, physical exam observations, or results from imaging and tests. For example, a clinical sign could be weight loss, drinking more, or limping. You are probably familiar with the term “symptoms” in humans – clinical signs are the equivalent to this in veterinary medicine. Since our patients cannot tell us how they feel, we only have access to what we witness.

Step 3: The Physical Exam

Physical exam: The examination of the animal to determine vitals and health concerns

The beginning of the actual examination starts with a general observation of the patient. This is what is known as a distance exam, where the animal is observed as it walks around the exam room. The distance exam allows the veterinarian to assess gait and mental status of the patient. It also gives clues as to the animal’s behaviour and fear levels, which the veterinarian can take into consideration throughout the exam.

Following the distance exam, this author likes to start their exam at the head of the animal and gradually work their way to the bum. Every system described in Chapters 3 and 4 is evaluated in this exam.

• Watch
  • Gait, behaviour, consciousness, and attitude
• Listen (auscultate)
  • Lungs, trachea, heart, and abdomen
• Palpate
  • Lymph nodes, abdomen, masses, body condition score, and rectum
• Visualize
  • Eyes, ears, and mouth
• Other
  • Neurological exam (reflexes, proprioception)
  • Mobility exam (manipulation and palpation)

What About Large Animals?

The large animal exam for horses, cows, goats, and sheep is a bit different than the one described above, which is the norm for small animals.

 

 

The principles of checking each organ system still apply, but some of the steps are a bit different.

• Generally, otoscopes are not used on farm animals.
• Farm animals are too big to accurately palpate their abdomens, so that is not done in the same way as in small animals.
• Auscultation of gut sounds occurs in farm animals – listening to gauge the volume and frequency of gut sounds is important in large animals.
• Range of motion of limbs is not done in farm animals in the same way. In horses, we can do lameness exams which includes some range of motion principles, but this is not done regularly on production animals.
• Rectal exams are generally only conducted as a further diagnostic tool, and not as part of the regular physical exam.

Vitals (TPR)

Vitals are taken to determine the animal’s health and measure basic functions. In animals, this includes taking their temperature, pulse (heart rate), and respiration rate. Vitals may be obtained by the RVT prior to the DVM’s arrival, which are then reassessed by the veterinarian.

Temperature: Obtained by a rectal or ear thermometer to determine core body temperature. Different species have different normal temperature ranges.

Pulse: Heart rate obtained via auscultation with a stethoscope, or palpation of a pulse via an artery. This is recorded as the number of times the heart beats per minute. The quality and rhythm are evaluated.

Respiration: Observed with the naked eye to determine how many breaths are taken in one minute, along with listening to the respiration sounds with a stethoscope for quality and sound.

Physical Exam Supplies

It is important to prepare the room before the patient arrives. Basic supplies include the medical record, a towel (for restraint or exam table), a patient scale (for small species), stethoscope, ophthalmoscope, otoscope, and thermometer. Additional supplies may be required.

While room preparation is important in a clinic, not all patients come to see veterinarians in a physical building. Many rural and large animal practices actually have a vehicle that is licensed for mobile practice because cows, goats, and horses are harder to get to the clinic. Therefore, having a properly stocked truck is extremely important. Since these exams and treatments take place away from the clinic, the truck should be packed beforehand with any necessary equipment.

Additional Physical Exam Terms

Capillary refill time: The time it takes the gums (skin in the mouth) to return to a normal colour after being pressed on, as seen in Fig 5.2. It is recorded over two seconds. If it returns to a normal colour before two seconds, it is considered to be good peripheral perfusion.

 

 

Body condition score: Scoring system for determining the weight and fat cover of a patient. Generally on a scale of either 1–5 or 1–9, where 1 is severely underweight and the highest number is obese. On a scale of 1–5, 3 is ideal, while 4 or 5 are ideal on a scale of 1–9. Normally a 5-point scale is used in large animals, and a 9-point scale is used in cats and dogs.

Body condition score cat

Body condition score dog

Grimace Scale: Assessment of pain using a DVM developed chart with different facial expressions. Canine and feline pain scales

Feline grimace scale

Canine grimace scale

Diagnosis: Cause of clinical signs (e.g. disease name)

Differential Diagnosis: Potential cause of clinical signs (unconfirmed to be true, generally something the veterinarian is considering could be causing the clinical signs)

Prognosis: Prediction of outcome (good, poor, guarded, etc.)

Findings: Results

Acute: Rapid onset of signs and/or disease

Chronic: Ongoing or long-term disease

Asymptomatic: Showing no clinical signs

Epidemic: Outbreak of disease in a group

Pandemic: Outbreak of disease over a large geographical area

Syndrome: Set of signs occurring together

 

Verton-Shaw, S. (2023, July 21). Scoring for health. University of Guelph. https://ovcpetnutrition.uoguelph.ca/2021/10/25/scoring-for-health/,

WSAVA Global Nutrition Committee. (2013). Body condition score. WSAVA. https://wsava.org/wp-content/uploads/2020/01/Body-Condition-Score-Dog.pdf

Wiese, A. J. (2018, October). Canine & feline pain scales. Clinician’s Brief. https://www.cliniciansbrief.com/article/canine-feline-pain-scales

Image Credits (images are listed in order of appearance)

Adult ambulance background care by Chokniti Khongchum, Pixabay licence

Cows curious cattle by Peggy and Marco Lachmann-Anke, Pixabay licence

Stethoscope by StockSnap, Pixabay licence

Horse dog animal by SorcerySoap HocusPocus, Pixabay licence

Mucous membrane by Kelly Robertson, NorQuest College. Used with permission.