Clinical Diagnostics Small ad large animals GQ = General Questions SMP= Small Animal Practical q LAQ= gENERAL ANIMAL QUESTIONS

GQ 11. Secondary skin lesions.

Secondary skin lesions: Alopecia evolve from primary lesions or are artifacts induced by the patients or by external factors such as trauma and medications. Def: Alopecia: loss of hair and may vary from partial to complete; A) *1: endocrin disorders, follicular dysplasias. B) *2: to trauma or inflammation EEUSCLCN= 8 1) Epidermal collarettes (reminding of the coerin of a rupturedvessivle/pustule) caused by a point source of inflammation as seen with papules and pustules. 2) *Excoriation' scratching, biting or rubbing. They are self They are self-produced and usually result from produced and usually result from pruritus; they invite secondary bacterial infection. *erosions*= a shallow epidermial defect that does not penetrate the basal laminar zone and consequently heals without scarring. It generally results from epidermal diseases. 3) Ulcer (deep degect): notice edges: neoplastic, cant tell, thickened necrossis etc. break in the continuity of the epidermis, with exposure of the underlying dermis. A deep pathologic process is required for an ulcer to form. 4) Scar (cicatrix, fibrous tissue replacement) area of fibrous tissue that has replaced the damaged dermis or subcutaneous tissue. Scars are the remnant of trauma or dermatologic lesion. 5) Cheap, fissure (fissure:line form deeper defection) linear cleavage into the epidermis, or through the epidermis into the dermis, caused by disease or injury. besingle or multiple tiny cracks or large clefts several centimeters long. They have sharply defined margins and may be dry or moist and straight, curved, or branching. ear, ocular, nasal, oral... 6) Lichenification (extensive thickening) a thickening and hardening of the epidermis characterized by an exaggeration of the superficial skin markings. Lichenification areas often result from friction. often hyperpigmented.ex chronic atopic dermatitis 7) Callus (thickened, rough, hyperkeratotic, alopecic, often lichenified plaque) thickened, rough, hyperkeratotic, alopecic, often lichenified plaque that developes on the skin. Most commonly, calluses occur over bony prominences and result from pressure and chronic low-grade friction. grade friction. 8) Necrosis (death of skin cells bc diaese/infe, gangeraenosa, humida, sicca) Below is both 1&2 1. Scales (squamae: loose flakes of keratin) accumulation of loose fragments of the horny layer of the skin (cornified cells). The corneocyte is the final product of epidermal keratinization. Normal loss occurs as individual cells or small clusters not visible to naked eye. Abnormal scaling is the loss in larger flakes. Flakes vary greatly in consistency; they can appear branny, fine, powdery, flaky, platelike, greasy, dry, loose, adhering, or „nitlike". The color varies from white, silver, yellow, or brown to gray. primary: color dilution alopecia primer idiopathic seborrhoa, follicular dysplasia secondary: chronic inflammation 2. Crusts (keratin+dried exudate) formed when dried exudate, serum, pus, blood, cells, scales, or medications adhere to the surface. Unusually thick crusts are found in hairy areas because the dried material tends to adhere more thightly than in glabrous skin. primary: primary idiopathic seborrhea, Zn primary: primary idiopathic seborrhea, Zn-responsi responsive dermatosis ve dermatosis secondary: pyoderma, fly strike, pruritus (Scabies: dry,yellow: papulocrusta) adhere more tightly than in glabrous skin. - Brown or dark red: haemorrhagic crust in pyoderma; - yellowish green: crusts appear in some cases of pyoderma; - tan, lightly adhering crusts are found in impetigo; - dark crusts imply deeper tissue damage or hemorrhage: traumatic wounds, furunculosis, fly strike dermatitis, and vasculitis; - honey-colored crusts are more commonly infectious in colored crusts are more commonly infectious in nature; - thicker dry yellow crusts: typical of scabies and zink responsive dermatosis; - tightly adherent crusts are typical in zinc tightly adherent crusts are typical in zinc-responsive responsive dermatosis and necrolytic migratory erythema, seborrhea. 3. Comedones (plugs of keratin and sebum) a dilated hair follicle filled with cornified cells and sebaceous material. It is the initial lesion of feline acne and may predispose the skin to bacterial folliculitis. primary: initial lesion of feline acne and may predispose the skin to bacterial folliculitis, infection with Demodex and dermatophytosis, vitamin A-responsive dermatosis, Primary or secondary skin lesions dermatophytosis, vitamin A-responsive dermatosis, Schnauzer comedo syndrome, Cushing's disease, sex hormon dermatoses, idiopathic seborrhea disorders secondary: to seborrheic skin disease, to occlusion with greasy medications, or to the administration of systemic or topical corticosteroids 4. Follicular cast (an accumulation of keratin and follicular material) an accumulation of keratin and follicular material that adheres to the hair shaft extending above the surface of the follicular ostia. 1*: vitamin A-responsive dermatoses, primary responsive dermatoses, primary idiopathic seborrhea, sebaceous adenitis 2*: demodectic mange and dermatophytosis 5. Pigmentary changes (colouring of the skin) hypo-, hyperpigmentation , hyperpigmentation skin coloration caused by a variety of pigments but most commonly melanin, which is responsible for many skin colors: - black: melanin present throughout the epidermis (lentigo) - blue: melanin within melanoc. and melanophages in the middle and deep dermis (dermal melanocytoma) - gray: diffuse dermal melanosis or superficial dermal melanosis from pigment incontinence - tan, brown, black: various shades of normal skin color in breeds are due to melanin - brown: hemochromatosis is due to primarly to melanin, not hemosiderin -red, purple: hemorrhagein the skin is red at first, becoming dark purple with time (bruises) - yellow-green: accumulation of bile pigments (icterus) Hypopigmentation (hypomelanosis): loss of epidermal melanin 1*: vitiligo primary: vitiligo-like disease 2*: postinflammatory change - Leukoderma: is a general term for white skin, whereas vitiligo refers to a specific disease. - Leukotrichia, achromotrichia: lack of pigment in hair Hiperpigmentation (hypermelanosis, melanoderma): incr. epidermal & occasionally, dermal melanin. Melanophages may be found in the superficial dermis. 1*: endocrine - diffuse. 2*: postinflammatory, chronic, traumatic - latticework appearance latticework appearance - Melanotrichia: excess pigment

GQ 30. Auscultation of the heart, the characteristics and changes of the heart sounds.

1) Auscultation: o Go round whole area left and right, not just apex, Stay in each area a few seconds. o S1 and S2 are usually heard - S1 • The 1st sound is produced by the closing of the mitral and tricuspid valve. - S2 • The 2nd is produced by the closing of the aortic and pulmonic valve o Needs to be silent and quiet - panting stop by closing mouth, purring by gently pressing on larynx. o 4 normal heart sounds, but hear usually first two 2 in most species. In horse may hear 4. - 1st sound is start of systole. Ventricle contracts - aortic and pulmonary valves (semi lunar valves) open, bi and tri-cuspid valves close. - 2nd sound is end of systole. Aortic and pulmonary valves close as less pressure - 3rd sound is start of diastole... bi and tri cuspid valves open (as artia full of blood) - 4th sound is end of diastole - weak atrial contraction o If increase in rate can't distinguish between the sounds. o Galloping rhythm - Can be seen in sick horse with colic or fever. - Is abnormal unless horse is exercising very hard 2) Change in heart sounds - FRIDA A) Frequency (heart rate) o Physiologically coincides with that of the pulse rate. Cattle - 60-80 Horse - 28-42 Dog - 60-140 Cat - 140-180 o Normal to have a high rate if excited and frightened in clinic of dog and cat - So cat with 200 in clinic or dog with 140 not abnormal. - below 140 in cat in clinic may be abnormal in cat. - Bradycardia is often easier to pick up. - Sleeping dog at home may be 20 beats per minute. o If abnormal frequency do an ECG o Also each cycle should generate and coincide with a pulse - if not pulse deficit - To check pulse deficit, auscultate the heart and palpate the pulse at the same time o Changes: bradycardia, tachycardia (physiological or abnormal) 3) Rhythm - normal is regular o Heart rate can decrease during expiration as vagus more active (vagus effect). o Horse - Respiratory arrhythmia can be more pronounced - Can get conduction disturbance ('intermissio cordis) and second degree AV block - Or dropped beat - no ventricular contraction. - This is normal, particularly in fit competition horses, but is pathological in other species o Arrhythmia: pathological rhythm, often with pulse deficit B) *Intensity* - normal is strong and even o If the intensity is even but very strong - increased contraction (and vice versa) o Pounding beat - Increasing of the first and/or second sound (slight variation over different valve areas) o Reduced heart sounds: - Decreased cardiac output - pericardial or pleural effusion, obesity C) *Demarcation* (distinctness) of the cardiac sounds o Horse: LUB-LUB-DUP-DUP - possibly hear 4 o Other species: normally two - 1st.,2nd. heart sounds: distinct and unique. o Changes: different species and heart rate e.g. - galopp sounds: three heart sounds can be heard: 1.,2.,3. Or - Cardiomyopathies can hear- 4.,1.,2 o Splitting of heart the sounds e.g. the 2nd heart sound - Closure of the aortic and pulmonary valves in different time, due to cor pulmonale causing increased pulmonary arterial pressure. D) *Adventitious* sounds: murmurs o Endocardial murmurs (caused by turbulence): Functional • Innocent murmurs in racehorses - strong heart activity produces lots of turbulence but heart is fine • Anaemia - Decreased blood viscosity Morphological - valve deformities, septal or vessel malformation. Use these 4 as a description always: • Location - puncta maxima - point of maximum intensity • Intensity - • Relation to the phase of the cardiac cycle o Systole o Diastole o Systole and diastole • Pitch (frequency) - low, medium or high o Or pitch: blowing, whistling murmurs Also character • Continuous, crescendo, decrescendo Conduction (yes/no) o Extracardial murmurs - Pericardial splashing, (frictional) rubbing, pleuropericardial/pleuropleural rubbing - Valsalva probe or compression test - stop breathing and let the animal take a deep breath • If it pleuropericardial/ pleuropleural, rubbing disappears if breathing stopped • If it is pericardial, rubbing increases if breathing stopped at the end of inspiration (increased intrathoracic pressure) - Traumatic pericarditis in cattle • Distended jugular vein, sternal edema, abnormal cardiac • Auscultation (pericardial splashing sounds) and percussion findings - Location and intensity can be heard during different phases of the cardiac cycle

GQ 33. Principles of blood pressure measurement.

1) Blood pressure o Consists of: - Systemic arterial blood pressure - Central venous pressure - Systemic arterial blood pressure o Normal systemic arterial is 120/ 80 for all species - Gets lower and lower as the it travels to smaller vessels - Lowest pressure = right side of the heart o Systemic arterial pulse pressure does not equal blood pressure! BP can't be measured by palpation. o BP is cardiac output x peripheral resistance (vessel diameter, wall elasticity and viscosity of blood). o Pulse pressure = systolic - diastolic. o Arterial mean pressure = diastolic pressure + pulse pressure divided by 3. B) Central venous pressure (jugular vein is the most important) o Can be measured Directly • Via catheterisation in jugular vein in anaesthesia - accurate but invasive o Can give fluid replacement Indirectly • Determination of venous congestion • Via examination of peripheral veins - jugularis, saphena etc • Dogs: lateral recumbency collapse of v. saphena about 5 cm above zero point o Can do the hepatojugular reflux test to check for right sided heart failure o Hepatic vein and vena cava caudalis are visible on x ray and ultrasound. If they are dilated = increased in central venous pressure B) Indications in small animal practice - hypertension • Although don't need machine to tell you - can feel no pulse and see mucus membranes are very pale. • Causes of hypertension o Half the time renal disease o Endocrine - Cushings disease, hyperthyroidism, hyperaldosteronism o Rarely obesity o Pheochromocytoma • Consequence is ocular problems in cats, CNS problems, hypertrophy of heart and renal problems o Always do BP if you think a problem may be due to high BP - e.g ocular problems in cat. Cat eye very sensitive to hypertension, so if cat goes blind suddenly, check BP - can save sight. o When using drugs that lower the BP • In case of using ACE-inhibitors or B blockers and hypotensive drugs o In case of severe diseases, shock o Anaesthesia monitoring o Animal with known pre-disposing factors - not heart disease, usually renal disorders - so kidney patient or hormone problems e.g Cushings o Thrombosis 6) Blood pressure measurement - arterial pressure: -Direct o Arterial puncture, inserting pressure catheter ->Accurate but painful and invasive o Indirect: ->Automatic (oscillometric method) - systolic and diastolic • Arterial mean pressure measurement § Doppler method - measures systolic pressure only dog, cat: a. sacralis mediana, a. radialis - How is it done? o Calm environment, examiner, owner present o Acclimatization needed o Mean of 3-5 measurements (maximum 10- 20 mmHg changes) o If high to be repeated (min. 30 minutes or another day) o Cuff size is 30-40% of limb or tail circumference - Doppler method o Forelimb behind the paw, tail, (hind limb behind the paw) -> aa. digitales palmares communes., a. caudalis mediana o Only systolic value o At any sized animal o Needs training (technically more difficult than oscillometry) - Oscillometric method o Measures both Systolic, diastolic - Mean blood pressures o Dog: Forelimb - Radial artery Tail - a. caudalis mediana, Hind limb - saphenous o Cat: Tail - a.caud. med Forelimb - Brachial artery o Automatic, technically simpler but easily produces false measurements o Its not reliable in very small animals (less than 8 kg)

GQ 8. Examination of skin condition. Condition of the epidermis. The colour, smell and temperature of the skin.

1) Condition of the *epidermis* (ok= intact) Recognize of skin lesions and their location and pattern *1 and *2 lesions 2) *Color*&presence of *hemorrhages* 3) *Odor*>> sex hormones, appocrine sweat gl produce smell, Urelmia(Urea in blood)= Ammonia smell, DiabetesM. = acetone/Kiton Bodies. Male goats smel distinct 2 4) *Temp* by extremities & body . bc haricoat take temperature not like in humans 5) Moistness - Ex: Apocrine sweat gl - horse have them everywhere (thermoregulation) RU on lateral neck, behind ear, near groid and udded. Sheep/goat on side of tights. *Exocrine* *sweat* *gl* are on *footpads*, *nasal* *plane* + *lower* *eyelids* of K9/Fel 6) Greasiness - Sebatious gl. palpate n smell. Increased prod aka seborrhae oleosa (skin disease seen in dogs and rarely in cats. It is characterized by a defect in keratinization or cornification), Less production aka Seborrhae sicca 7) Thicness K9 - .5-5 mm fel - .4-2mm thickest @ bacck/rump/base of tail/dorsamneck/thorax. Thinnes@pinnsr, ingunl/perianal areas 8) elasticity : Tugor/dehy/collagen/elastic fiber content ex old K9/fel has less mayb bc <Cushigs 9) Sensitivity 10) Ectoparasites: Fleas, Lice, 11)Skin lesions (enanthema,Efforestenia 13) Skin swelling Primary skin lesion: is the initial eruption that developes spontaneously as a direct reflection of underlying disease. They may appear quickly and then disappear rapidly. Secondary skin lesions: evolve from primary lesions or are artifacts induced by the patients or by external factors such as trauma and medications 1* leasions: 1. Macules(not elevated/cant palpate, differs in colour) patch(larger then>1cm) patch(larger>1cm) - 2vascular: redness: functional (Active or Passive Hyperaemia) Anatomical (hyperplastic or Aplastic) 2. Papules (small, solid elevation< 1 cm), (crusted pap.) Scabies or Superf. Bacterial folliculitis 3. Plaques (extensive, relatively flat: Fel= Esosinophil granuloma complec) 4. Nodules (solid mass >1 cm, ofte infiltration of Inflam/neoplstic cells into dermis/subcutis) Tuber: inflam elecations of papillary zone of skin or mm. w/diff shape&size 5. Wheals (urticarial lesion-flat surface),angiooedema; Leasion consisting of edema; usually appears/dissap within min/h. Angioedema: Huge hive of sistensible region; Lips or eyelids Type 1 hypersensitive reaction 6. Vesicles (circumscribed elevation filled with fluid), often viral & autoimmune dermatoses, or dermatitis caused by irritans. upto 1 cm diameter Bulae: Diameter greater then 1cm. 7. Cysta (an epithelium-lined cavity) smooth, fluctuans 2 solid mass. 8. Pustules (elevation of epidermis filled with pus): are: intraepi, subepi, and follicular in location. green/red color. 9) Absesses: demarcated fluctuation leasion resulting from dermal/subc occumulation of pus. *2dary: 1. Scales (squamae: loose flakes of keratin) 2. Crusts (keratin+dried exudate) 3. Comedones (plugs of keratin and sebum) 4. Follicular cast (an accumulation of keratin and follicular material) 5. Pigmentary changes (colouring of the skin) hypo-, hyperpigmentation , hyperpigmentation

GQ 5. The basic clinical values and their pathological changes in dogs and cats.

(cont on 3 and 4) Basic clin valius: 1) Temperature (rectum Normal K9:38.2-39.1) (FEL: 38.5-39.3) 2) Puls/min: Pulse is the mechanical pulse of blood flow through the capillaries caused by the contractions of the heart per minute - Increase= Tachypnoe/polypnoe, - Decrese= Oligopnea/Bradypnea Eq: facal/transverse facal/digital med&lat Artery) (Fel/K9; Femoral A.) 3) Heartrate - beats per minute (k9: 60-140) (fel: 140-180) (also do Respiratory rate/breaths per min: K9: 15-30, Fel: 20-30 eart rate is the number of times per minute that the heart contracts - the number of heart beats per minute (bpm) 4)CRT (capillary refil t..)

GQ 39. Examination of the oesophagus.

- Inspection, palpation, Additional methods o X- ray - Plain or contrast (BaSO4) o Oesphagoscopy Remarks o Indicated if regurgitation problems. o Endoscopy often preferred for small and large animals. o In horses can also examine the guttural pouch etc at the same time. o Oesophagus passes to the left of the neck and is covered by muscles so is not easily palpable unless there is a problem o If there is a foreign body and the oesophagus is distended this can sometimes be palpated. . o If using endoscopy look for any inflammation/redness, dilated blood vessels, vesicles, ulceration etc. o If there is excess mucus, take a sample. Can also take biopsy and remove foreign bodies. o X rays can be useful too e.g. for megaesophagus. o 3 sites of obstruction in oesophagus - thoracic inlet (left side of neck), base of heart and distal oesophageal sphincter between base of heart and diaphragm.

GQ 26. Percussion of the thorax. The origin, characteristics and parts of the percussion sound. Normal percussion sound of the thorax.

-Acoustic percussion= obtain info about surrounding tissues (create sound waves, resonancy resonancy) thorax, paranasal sinuses, abdominal, subcutaneous emphysema • border estimation (lung border) with proper order: from back to the dront, from up2down. • assessment of a tissue density to a depth of 7 cm & lesion at least 5 cm in diameter -pain percussion -weak, superficial, stong&deep. • methods: - direct (finger to finger amall animals) - indirect (plessimeter and percussion hammer) 1. Crackling sound of tapping the hammer and the plessimeter 2. Sound of the thoracic wall or the wall of any organ 3. Resonant sound of gas (lung) or other or other organ filled with gas • Characteristic percussion sound volume/loudness vibrations amplitude: Sharp/dull frequency/pitch= # of vibrations pr min High 2 low 1) Resonans= homogen/ Øhomogen from resonant 2 2) dampened: fairly low, strong resontant (ex normal lungs containg air) Duration=short2long. damped/ull= shourt sound low intensity (liver heard M, dont containg gas) 3) Tympanic (stronger, longer, higher then sonorous, higher pitch= organs containg gas under prssure ec gastric volvus) other= (4-metallic, 5-cracked pot, 6- hollow sound) Normal percussion shound: - Medium-sized and large animals (40-500 bwkg): sharp, low, (non)sonorous (non)resonant and short percussion sound - Small animals (25-40 kg bwkg): sharp, high or low, sonorous (resonant) and long percussion

GQ 32. Examination of the pulse in small animals. The quality and alterations of the pulse.

1) Methods: -Digital palpation -Blood pressure measurement direct, indirect (sphygmomanometry) - Blood flow registration: o Doppler ultrasound (just systolic)- red and blue - colour coded: Red - blood is flowing to the transducer Blue - opposite away from the transducer • However cant distinguish between the vein and the artery so have use spectral doppler chart o Oscilloscope 2) Digital Palpation: Palpate on both sides - should be symmetrical, pulse and heart rate should be the same (can be physiologic that the horse has a different pulse rate) - Horse o Facial artery o Transverse facial o Medial and lateral digital arteries (usually weak - used to check strength of pulse) - Cattle o Facial o Transverse facial o Coccygeal (ventral midline) - Small Ru o Femoral - Swine o Coccygeal o Caudal auricular 3) Examination of the arterial pulse, parameters: a- Frequency b- Rhythm, c-Quality o Size, strength, and duration of the pulse wave and degree of fullness of the artery d- Normal: symmetric, physiological rate, regular rhythm, and even and normal size, strength and duration. e- Abnormal findings of pulse quality: o Irregular pulse o Uneven pulse o Size: - Large, hyperkinetic - pulsus magnus - Small, hypokinetic - pulsus parvus o Strength: - Strong or weak (related to cardiac function) - Hard or soft (related to the vascular tone) o Duration: sluggish or skipping o Size + duration = full or empty 4) Pulse quality o Size = difference btw systolic and diastolic BP - Systolic BP = 120mmHg - Diastolic BP = 80mmHg • So difference is 40mmHg § - Increase systole and will increase pulse - faster, more frequent, larger waves and vice versa for decrease in systole - If both systole and diastole change together won't feel a change. - If only diastole goes down and systole stays the same get huge pounding pulse waves. o Determined by - Heart rate (if HR is high àdecrease pulse quality) - Stroke volume (if SV is increase àincreased pulse) - Peripheral R (if increased à decrease pulse) • Blood (anaemia) • Vessel (tone, compliance) • Vascular bed 5) Abnormal findings of pulse quality o Small, brief, hard = wiry o Small, prolonged, weak = thready o Skipping and large (caused by PDA or aortic insufficiency) = bumping o Paradox pulse = change with respiration - Pulse rate is not even - During inspiration pulse gets weaker - Pericardial tamponade o Pulsis alternans: alternating btw strong and weak beats - Arrhythmia and cardiomyopathy o Aortic insufficiency - diastolic murmur -Occurs in the horse more frequent - If aortic valve does not close properly, e.g. endocarditis, blood flows backwards during diastole. Can hear systolic murmur after second sound and get a huge pulse. o Patent Ductus arteriosus (PDA) - If the ductus arteriousus stays open, there will be blood flow between the aorta and pulmonary artery - Blood goes into the pulmonary as well as systemic circulation in systole and diastole. Get huge pulse and heart murmur

GQ 28. Examination of the heart. Physical and additional methods. Examination of the veins.

1) Order and methods of CV examination • History (fatigue, dyspnea, coughing, Ascites = right sided heart failure, edema, fainting = CV failure). Respiratory problems (dyspnea, coughing) = Left sided heart failure • General condition: impression o Animal will loose weight so obese animal less likely with CV failure § E.g. Cardiac cachexia • Detailed examination on the CV system a- Heart b- Blood Vessels ( 1-Arterial System 2-Venous System 3- Capillary system) 2) Physical examination of heart • Inspection (heart, vessels), Palpation (heart, vessels), Percussion (heart), Auscultation (heart) • Make sure every angle, from each side and each sense is checked • Heart Cranial is right side, apex ventrally (ventrocaudally), left side is caudally. o Horse almost vertical heart, pig most horizontal. o Heart is covered by lung lobes o On left side cranially- right ventricle, caudal - left atria (dorsal) and left ventricle ventral o In dog and horse (absolute dullness) - The apex is in direct contact with the thoracic wall hence absolute dullness o In ruminant, swine, cat - The apex is not in contact with the thoracic wall and lung is between the heart and the thoracic wall • In heart failure, the peripheral BV constrict, to increase BP, so the mucosa should appear pale. If they are cyanotic = really bad case! - Inspection o Abnormalities in the thorax (injury, malformation) o Heart beat: location and intensity - increased or decreased (also examined with palpation) - Palpation (see table below) o 3-5 intercostal space. Can feel heart beat with hands. o Dog and horse, heart in contact with thoracic wall so can palpate both left and right side and feel beat. o Others just left side. Cats and very small animals, can palpate both sides with fingers. o Can feel activity of the heart. 1) Strength can be increased (exercise, hypertrophy, dislocation) or 2) Decreased (cardiac insufficiency, thickened chest wall). o Location can be changed by tumour, abscess, pneumothorax, o May feel fremitus - palpable thrill or vibration of thoracic wall - Abnormal, like fizzy drink in a balloon = Is it endocardial, pericardial or extrapericardial? 3) Percussion (see table below): o Detection of pain in the cardiac area o Area of cardiac dullness - Diernhofer's triangle a- Horse and dog on left side, get absolute dullness where heart in contact with thoracic wall (dog larger than beagle). Then relative dullness where lung lobes are in the way b- Cat, Ru, Swine - just relative dullness o Diernhofer's triangle - between the caudal border of the heart and the diaphragm o Enlargement of cardiac dullness - cardiac hypertrophy, cardiac dilation, cardiac dislocation, pericardial effusion o False enlargement: dullness in neighbouring organs, detect rubbing auscultation o Decrease of cardiac dullness - pneumothorax, cardiac dislocation, lung emphysema, skin emphysema 4) Auscultation: o Go round whole area left and right, not just apex, Stay in each area a few seconds. o Needs to be silent and quiet - panting stop by closing mouth, purring by gently pressing on larynx. o 4 normal heart sounds, but hear usually first two 2 in most species. In horse may hear 4. a- 1st sound is start of systole. Ventricle contracts - aortic and pulmonary valves (semi lunar valves) open, bi and tri-cuspid valves close. b- 2nd sound is end of systole. Aortic and pulmonary valves close as less pressure c- 3rd sound is start of diastole - bi and tri cuspid valves open (as artia full of blood) d- 4th sound is end of diastole - weak atrial contraction. Additional Methods (in order after history physical exam- see lecture for picture): 1. Thoracic x -ray (radiograph) o Differentiate heart failure and respiratory disease. o Size of heart and lung lobes. o Also large vessels such as aortic arch, caudal v. cava. o Useful for enlargement but can't see inside the heart 2. Echocardiography - ultrasound, Doppler method o Very good for heart problems - can see inside heart o Check flow in chambers, thickness of muscles and valves working o Shape of heart o Blood flow - Doppler o Doesn't tell you if arrhythmia 3. ECG o Can be normal electrical activity but severe heart problems. o Do if notice arrthymia but not to see morphology o AV block, tachycardia, bradycardia, premature contractions 4. Blood pressure measurement o Not for heart failure patients as may be normal or low. o May help prevent worsening of heart disease though o More useful for endocrine or kidney disorders. SO if old dog with kidney problems and perhaps a heart murmur - keep an eye on BP as it may increase More complex tests: • Further examination: o Phonocardiography (electronic stethoscope) - recording of the sounds and murmurs made by the heart o Cardiac catheterization: treatment mainly: dilate stenotic valves, obstruct some vessels -intracardiac pressure measurement - Oxymetry - Selective angiocardiography - contrast material added o CT, MRI o Blood test measure valves - ANP: atrial natriuretic peptide - BNP: b type natriuretic peptide - Cardiac Troponin - Endothelin o Serology - Dirofilaria, Lyme disease, ANA (antinuclear antibody test), Trypanosome

GQ 43. Examination of the spleen and the hormonal glands.

1) spleen • Palpation, percussion, rectal examination. • Dog, cat and pig = palpate through abdomen only if enlarged. o Normal spleen cannot be palpated. o Is behind stomach on left side and is tongue shaped. o Enlarged liver and spleen can feel the same so need ultrasound to distinguish. • Horse o Rectal exam in front of and under left flank. o Is parallel with costal arch, triangular shaped, 2-4cm in thickness, sharp edged, smooth surface and is moderately tense, homogenous structure. o only animal you can palpate the normal spleen. • Cattle o Usually can't reach spleen rectally. o Behind diaphragm on craniolateral part of the rumen Enlarged spleen: => Splenomegaly. infectious etiology, immune mediated disorders, tumour, torsion • Additional exams o Complete blood count, radiography, fine needle aspiration/cytology. o Ultrasound is very important (Can see if homogenous, enlarged, cysts etc. The spleen is most equigenic organ. If enlarged or cysts can do fine needle aspiration using ultrasound to guide you.) o Biopsy causes more tissue damage but can get a better result. o Can completely remove spleen if you have to and animal can survive Examination of the hormonal glands • Hypothesis, thyroid, parathyroid, adrenal, pancreas (Langerhans islets), genital (testes and ovaries) • Only thyroid and testicles can be directly examined by palpation. Usually examine whole system then look at specific examination of the glands. • Hypophysis o Less ADH - central diabetes insipidis. o Increased STH - acromegaly, central Cushings syndrome. • Thyroid gland - Hyper and hypo thyroidism o Hypothyroid k9: Symmetrical alopecia and rat tail (in puli), dull and depressed. Obese and likes warm places. Neuropathy and myxoedema. o Hyperthyroid Fel: (particularly old male cats) Cat becomes thin and may be aggressive. May have hypertrophy of heart. High BP and does not tolerate exercise. o Try to palpate thyroid gland along trachea. Sit cat and hold head up and turn head to side. o Dog - the thryroid gland is on 1st tracheal ring, but on cat is more moveable and may slip down trachea ventral to larynx o Additional tests - T4, TSH. Ultrasound, scintigraphy, CT scan • Parathyroid gland. Hyper and hypo. • Adrenal glands - hyper and hypo adrenocorticism. o *Hyperadrenocorticism* - Cushings syndrome. Can be adrenal or hypophysial tumour • If hypothesial tumour get bilateral enlargement of adrenal gland. Polyurea and polydipsia, increased appetite and obesity - pot belly and ascites. Atrophy of hair follicles and alopecia [horse can have curly mane and tail]. Muscle atrophy and may see spinal processes even though fat. Fat accumulation in liver. O o *Hypoadrenocorticism* - Addison's disease o Additional tests. Complete blood count. - Biochemistry • ALKP, SIAP (steroid induced alkaline phosphatase), Na/K ratio. - ACTH (adreno-cortitropic hormone) stimulation test, LDDS (low dose dexamethasone test), - Ultrasound, CT test • Pancreas o Diabetes mellitus (water intake will increase). o Insulin deficiency. o Tests - blood glucose, frunctosamine, insulin

GQ 47. Examination of the nervous system (history, materials and methods, general considerations).

1. ASK - history!!! (more important than in any other examinations) (nationale) o Exceptionally important as often animal excited at clinic. Need to know undisturbed state at home (video). Symptoms may be transient o Onset of signs (motor activity i.e. ataxia/muscular weakness, or behavior, or pain sensation) o Environmental/housing conditions - indoor/outdoor o Vaccinations o Breed-predisposition o Age 2. WATCH - general impressesion (no physical contact to the patient) o Posture - head, body, spine, locomotion. o Mental state o Behaviour o Movement: o Towards away from you - slowly and quickly o Circling both ways - small and large circles (you stand still, dog circles round you) o Up and down stairs o Sitting down and standing up from that position 3. TOUCH - examinations by direct contact to the patient without causing pain 4. PAIN - examination of pain perception Physical examination • Watch: inspection (in standing and moving animals) • Touch: o Palpation - sensitivity of skin and mucus membranes, percussion. Start with touching skull, spine and extremities o Postural reflexes for body position o Cranial nerve examination • Pain perception o Manipulation o Percussion o Limited benefit as animal can't tell you it's feelings. Some breeds are very tough and can withstand a lot of pain e.g Rottweiler other breeds show a lot of pain/make a huge fuss when there is little pain e.g toy breeds. CNS may be infectious/non infectious causes Minimal necessary instruments • Reflex hammer • Needle/arterial clamp • Penlight for checking pupil reactions. Additional examinations • X-ray , EEG (electroencephalography), • CT (computed tomography) allows one to see the internal structure of the body and has higher resolution than routine radiography. o Indications for CT imaging include evaluation of the brain or other structures of the head, thoracic imaging etc. • MRI (magnetic resonance imaging) o 1* use MRI is brain and spinal cord imaging, provides improved anatomic detail of the brain and is more sensitive for lesion detection than CT. However, CT provides better imaging of bone. o Cross sectional imaging - but it does not use radiation. • Laboratory examinations a- Cerebrospinal fluid Rate it comes out is important - drops per minute. If high can be increased intercranial pressure. Should be clear, transparent watery Contamination by blood is possible, if not there may be a problem! b- Blood count/chemistry, detection of pathogens

GQ 16. The abnormalities of the visible mucous membranes, their diagnostic significance.

Abnormal: 1. Pale / anaemia, Dry, Cyanotic, Sticky.Yellow staining. Injected Dull. Livid. Haemorrhage (petechiae, suffusions, echymosis). Dirty red. Lesions: papules, ulcers etc Diagnostic significant: - Diff grades of color can help diagnose systemic disease ex: yellosorange=icterus, Pale=anaemia, Cherryred=CO pois, Dirtyred=intoxication Purple=Cyanotic, - Dry/shyny - any secreation describ amount, color, smell consistency. -Haemorrhases - couagulation prob. Hyperaemia-if goes away when presh, or stays. petchial=might b DIC¨ -CRF -Lesions - locaiton, #, shape, saze consistnecy, color, boarders

GQ 36. Examination of the anus, defecation and faeces.

Anus (observation, palpation): • Rectal (digital palpation), constipation (obstipation - sever form of constipation), bones, prostate, ln, rectoscopy, mm o Prostate always a problem in male dog • An open anus is sign of rabies, innervation problem or chronic diarrhoea. • Prolapse of anus too - very bad enteritis (cattle). • On finger can see faeces and smell it - parvo characteristic smell. • Look to see if anal sacs overfilled, fibrosis, tumour Defecation: • Look for posture, pain, frequency, amount, incontinence. • Owner will say animal has diarrhoea. Systemic problem - determine if small or large intestine diarrhoea. o Small intestine. Little frequency (2-3 x a day) but lots of it and it is watery. Usually no blood or mucus. Animal poor condition and combined with vomiting. o Large intestine. Great frequency (tenesmus) but small amount. Creamy like consistency. May have blood or mucus in it. Defecation is painful. No weight loss and little vomiting. • Ask to see video of animal defecating if possible. Faeces • Quantity, quality (form, colour, smell, consistency, abnormal composition) - Can help diagnosis. • Faecal digestion test o Test for carbs (iodine - lugol), fats (sudan staining) proteins, fatty acids. • Smell - melted butter like - exocrine pancreatic insufficiency. • Test for parasites and parvo using faeces. • Bacteriology too though not so useful (unless looking for antibiotic resistance)

GQ 25. The bronchial breathing sounds, the bronchial tone of the lung sounds, alteration of the bronchial breathing sounds.

Bronchial respiratory sound I. • it can be heard above the trachea under physiological conditions • it is produced by a stenotic effect of the relatively solid (cartilagineous cartilagineous) airway of the larynx, trachea and , trachea and bronchi bronchi • it is due to vortex formation of the inhaled air within the gradually narrowing passages of the upper respiratory tract • it is blowing in character • it resembles a prolonged syllable "ch" Normally audible: • over the larynx and trache • in small animals and in very thin large animals • in other large animals less distinctly heard Best heard over anterior part of respiratory area where larger bronchi are relative near 2 suface Abnormally audible: • during rapid respiration (the turbulence is so intensified that the borders of turbulence are extended, therefore it can be heard morecaudally) • when peribronchial lung tissue contains less air (increased structural density) e.g. • bronchitis • pneumonia • dorsal to the pleural fluid level • pulmonary neoplasia • over air-containing cavities Alveolar (vesicular)= Normal resp sound: Soft, blowing sound Stronger in carnivores, sometimes bronchial like Bovine: strong, rugged "f" sound (air sucking) contition= Physiologic Bronchial sound (laryngotracheo- bronchial): has Strong, audible blowing sound, isimilar 2 "h" sound during ex/inspiration conditi= Above the normal trachea Lung contains less air (peribronchial infiltration) Bronchial like (tracheo- bronchial) sound Deeper, softer, harsher than the bronchial sound. Similar 2 "f" - "h" sounds together. Conditio= As the bronchial sound, carnivores: physiologic

GQ 24. Adventitious respiratory sounds.

Can never be heard under normal conditions. describe: a)place, b)strenght c)type d) respiratory phase when heard Tpes: 1 - *Nonmusical* *rhonchi* These are crackling sounds (crepitation) at the end of inspiration, sometimes continouing to the beginning of expiration. They occur in areas that are not adequatelly filled with respiratory gases but are infiltrated with fluid. These sounds are caused by the abrupt opening of previously closed small bronchial branches. 1.1. crepitation 1.2. Crackling 1.3. Rattling sound, stertor (sub)divisions: - early inspiratory or expiratory crepitation and crackling: obstruction of bronchi that are more than 2 mm in diameter (e.g. bronchopneumonia, COPD) - late inspiratory crepitation and crackling: compression of the bronchi < 2 mm in diameter (pulmonary edema, interstitial pneumonia, neoplasms, pulmonary emphysema) 2- *Musical* *rhonchi* These are sounds with beeping or wheezing character. They occur in patients with obstructive lung diseases that result in active expiration. Partly due to the Venturi effect, the larger airways sometimes become so narrowed that the opposite walls almost come into contact. The walls begin to vibrate between the open (inspiration) and almost closed (expiration) state and then produce a musical tone. Types: 2.1 whistling sound (higher, monophon/polyphon) 2.2 wheezing sound (lower, monophon/polyphon) - Rhonchi (wheezes) during late inspiration: originate from bronchiaal compression caused by „enlarged" lung parenchyma - Rhonchi (wheezes) during expiration: originate from obstruction of the bronchioli (e.g.COPD, bronchopneumonia) These sounds can be better heard after exercise, after nasal occlusion, or injection of lobelin. Stridor=strong stenotic sound =Upper airways stenosis Rubbing= Rubbing/scratch/friction= rubbing pleural surface Splashing=gas/fluid Metallic= Fluid drops on fluis=ichorous exudate in caverns End! Extra here on... K9/fel = Strongest Inspi/ex Eq= Almost silent, soft I, weak e Cattle= strong rugged blow I, Weak E pIg= strong rugged I, Strong Blow E Rabbit= see k9, not as strong Bird: Strong &blow like 1 Abnormal changes a) Weaker then noraml = condition= decreased arising/conduction ex=shallow breathing infiltration. 2 Missing nilrespir Condit= no arising/no conduc Ex= lung consolidation, Pleural fluis 3 Louder/harser vs nor cond= incre airflow/conduction Ex= excercise dyspnea, cbronchitis

GQ 55. Examination of cranial nerves I-VI. Signs of their dysfunction. https://www.youtube.com/watch?v=6ENCJkXJvio video to help remember Cran Nerves!

Cranial nerves: Stimulation of the receptors abruptly produces response in healthy animals. Centres of these reflexes are found in the cortex and the brain stem. Cranial motor nerves are LMNs. I - Olfactory nerve - smelling: • Involves the examination of the sense of smelling • Method: Using strong stimulatory compounds or food. Make sure the animal does not see food, so must smell it. Substance should not irritate the nasal mucosa otherwise can activate the n. trigeminus - V (motor part) a- Hyposomia - Partial loss of smell b- Anosomia - Complete loss of smell II - Optic nerve - examination of vision. • History is very important. Tested By: A) Falling cotton ball test (tracking) o Cotton makes no sound - animals eyes should follow ball - make sure object doesn't cause vibration e.g. dropping keys onto table not good B) Pupillary light reaction o May need to dilate eye first so cover animal's eyes before test. o Direct pupillary light reaction= Direct light shone on one eye - that eye should constrict o Consensual pupillary light reaction= After shining the direct light into one eye, the contralateral pupil in the other eye should rapidly constrict o Sensation is the optic nerve but the III (oculomotor) is also involved as the efferent (motor) part. o Anisocoria - uneven size of pupils. o Afferent is II and Efferent is III. C) Menace/threat reflex o Blink at approach of hand to eye. o May not be present in very young kitten/puppy. o Careful not to produce air current that may hit cornea. o Also careful if cats have long eyelashes! o Afferent is II, efferent is facial nerve (VII) as blinks! D) Optical placing test o Leading animal to object - should step over or avoided. III - OculomotorN. IV - Trochlear N. and VI- AbducensN. - Examination of the position and movement of the eyeballs: A) Provocation of physiological nystagmus o Turn head from side to side and up and down. o Cat - hold and physically turn cat around. o This elicits involuntary eye movements - eye should follow movement gradually. o Also tests vision - if no reaction may be blind B) Pathological (spontaneous) nystagmus: horizontal, vertical or rotatory o If it appears spontaneously - sign of ataxia C) Strabismus: uni- or bilateral abnormal position of the eyeballs (they are not parallel) n. oculomotorius paralysis: str. divergens (ventrolateral str.) n. trochlearis paralysis: medioventral strabismus n. abducens paralysis: str. convergens (medial str.) + exophtalmus (eyeball protrudes) D) Examination of the pupils innervated by the n. oculomotorius (III.) Anisocoria: uneven size of pupils. Mydriasis: dilation of pupils. Miosis: constriction of pupils. Pupillary light reaction Afferent is II and Efferent is III. NB: discuss with owner what eyeballs previously like - esp brachycephalic dogs as may have congenital problems with eye - eyeball not parallel but can move eyeballs simultaneously so normal for that dog. • Horner's syndrome (affects the left side) o Loss of sympathetic innervation results in: Miosis (Would be overall classed as anisocaria as the left pupil is constricted (miosis) and the right is normal). Ptosis (sagging of the upper eyelid caused by facial nerve paralysis). Enophthalmus (Eyeball is drawn into socket which can also cause prolapse of the third eyelid) V - Trigeminal • Mixed nerve having sensory and motor fibres • Testing of the Sensory part, which is involved in development of: o Palpebral (eyelid) reflex: § Touch eyelid and should blink § Touch inside (ophthalmic branch) and outside (maxillary branch). The efferent is the facial nerve (VII) to cause the blink. Innervation • Afferent - V - Trigeminal • Efferent - VII - Facial o Corneal reflex Touch with finger on corneal surface or use Q tip. Blink and may retract eyeball into orbit so see third eyelid. Stay outside vision field as much as possible or may provoke menace reflex. Innervation • Afferent - V - Trigeminal • Efferent o Facial (VII) for blink o Abducent (VI) for eyeball movement Motor part: Prehension of food, drinking and chewing. Consequences of motor malfunction: Tic - repeated contractions of chewing muscles. -Sagging lower jaw (Paralysis - caused by central/peripheral injury of the nerve. Can be a sign of rabies. Also wont be able to eat and drink.) -Trismus= tonic spasm of chewing muscles. Might also be due to myositis. Might also be tetanus

GQ 51. Classification of seizures.

Def: A state with inclountary M. contractionsresulting from abnormal brain function. Classifications: 1) acording to M. Function a- Tonice = Charactereze by spasm of the entire Muscelture b-Clonic= Chaec. by rapi invluntary alternating muscular contraction and relaxation. c-Tonico-clonic: mixture of the above forms 2) According to the Origin of Sezure: A- Generalized cerebral = Having diffuse origin within the cortex, thalamus, brainstem followed by "general" symptoms (alterations of consciousness- overexcited or unsciousness) B- Focal (partial) cerebral= Thefocus of the convulsion could be localised i.e. "temporal/parietal lobe epilepsy" etc., followed by "special" symptoms, i.e.:Tail-‐‑chasing C- Extracerebral= Metabolic or transduction origin --> Metabolic - hepatic encephalopathy- increased NH3 in blood (give lactulose) • Uraemia and kidney failure, hypocalcaemia too Epilepsy: Def: Epilepsy i a syndroe of recurring seizures of cerebral origin. o Frequent syndrome in dogs, less common in other species Types o Petit mal- transient loss/disturbance of consciousness and increased muscle tone.Rare in animals. o Status epilepticus: a condition when seizures occur continuously with minimal or no normal periods Other forms of convulsions NOT necessarily connected to CNS: 1- Tetanus - sustained muscle contraction but no twitching. o Clostridium tetani. Horse lifts tail and keeps it lifted from body. Cow stargazes. Dog, very stiff and legs won't bend. Difficulty of breathing as paralysis spreads to respiratory muscles. Puppy with tetanus - characteristic expression - sardonic grin - ears forward, wrinkled forehead, eyes narrowed. Jaw locks. 2- Tetani - violent, muscle twitching over entire body. o Hypocalcaemia. Stiff contracted muscles and panting o Cats can see flexion of fore limbs ventrally. o Also tetani from hydrocephalus. 3- Tremor. Mild form of tetani - can be excitement. o If seen at home when calm is pathological. o Regular, rhythmic trembling of muscles 4- Tic - repetitious, non rhythmic contraction of a muscle o Can see in neurologic form of distemper. Put hand on head and can feel temporal muscle has a tic 5- Myoclonia o abrupt rhythmic contraction on one group of muscles. 6- Fibrillation o Non co-ordinated twitching of individual muscle fibres.

GQ 13. The importance and methods of lymph node and lymph vessel examinations.

Def: Moves lymph fluid/wast/nutrients. Lymph nodes= filter for pathogens (bacto, virus) B-Lymphoc, T etc cells are foudn in LN. So enlarrgemnet of lymph nodes is usually sign of infection Method: Inspection Palpation (rectal) adittional: Aspiration, biopsy, excicison (sm cut), extripation (large/all) xray, ct ultras. Description: Location, # nodes, compare both sides! 1)Size >1.5 suspicious. 2) Shape (ellipso/round/special) 3) Consistency (soft rubber/firm/harder-softer) 4)Structure (homogeous/Øhomog.) 5)Painful(ø) 6)Moveabil (unattached 2 surrounding tiss/øadhesion) 7)Surface (smooth/regular) 8) Skin above (temo/elasticity/intactness)

GQ 1. Objective and methods of Clinical Diagnostics. The diagnosis. Diagnosis types. The causes of misdiagnoses. Part 1

Diagnosis: Identify a medical condition by its symptomps PURPOSES • 2 recommend specific treatment • provide an accurate prognosis • make recommendations for cost effective control • prevention of new cases when groups of animals are at risk Methods: (History/anamnesis; Phys exam; further meoth) 1) Inspection (skin/posture/beh/gait) 2) Palp (direct/indir/inside/outs/supf/deep)(alternation in location Shape/size/border/structure/pain/moveability/surrounding/consistency) Coered skin/temp/undulation/ballotation 3) Asculation: with stetscope! (dir/indir/order.) keep animal still 4) Pecrussion; acustin 2 localize pain (thorax/abdom/nasal cav) Determine lung borders (tissue density 7cm can detect lesions 5cm diam) use chrackling hammer+plessmeter, finger2finger (sound of thoracic wall, gas filled tissues; *loudness* *Frequ* *duration* *resonant* (air ex lung) *dull* (tissue/heart;) *tympanic* (strong/longer/higher vs resonant (hollow organs w gass under pressure) *special* steel like/cracke drum... 5) Smell (expirated air, oral cavity skin) 6) Measuring (termom, tape calliper) 7) Additions (Non instu= biopsy/aspiratio) (instrumet=ECG/Ultrasound) (lab exams= blood/feaces/urine)

GQ 58. ECG examination of the dog and the cat, the technique of the examination, ECG evaluation, the principles of form and rhythm analysis

Electrocardiograph: Measurement in amplitude and time of potential differences of electrical current generated through depolarization and repolarization of cardiac structures. 1- Intracardiac recording 2- Epicardial recording 3- Measurement on the surface of the body (ECG) Electrical conduction of impulse going through the heart causes it to contract. The sinoatrial node is the pacemaker and starts the electrical conduction. The impulse goes to the AV node and then the to bundle of His (2 branches like a cable - end of bundle are purjkinge fibres), to apex of heart, then through ventricles via purjkinge fibres. This is in small animals, large animals, the purkinje fibres run through the myocardium and there is lots of branching, making ECG less useful (just useful for heart rate measurement) Screen ECG, see 3 waves - how they look like depends on how the electrodes have been attached. Usually use Einthoven's triangle to evaluate. ECG leads have 3 ways of setting up: 1) Einthoven's triangle (bipolar limb leads) - monitoring anaesthesia - alligator clips used and wetted. Red - right forelimb. Yellow left forelimb. Green left hind. Black right hind. Like traffic lights. 2) Goldberger's (augmented) unipolar limb leads. 2 leads on each limb - diagnostic 3) Willson's unipolar precordial leads; Extra leads on thorax - diagnostic ECG can be used to count heart beats and also specialists can determine the heart rhythm; ECG produced in right lateral recumbency, sternal recumbency, standing positions; Movement, respiratory, electrical interference can hinder results Importance and diagnostic value of ECG: 1) Exact diagnosis and evaluation of cardiac arrhythmias (Arrythmias, bradycardia, tachycardia). 2) Detection of the enlargement of cardiac chambers 3) Cardiac effects (detection) of electrolyte disturbances and systemic diseases (Ca++, K + ) 4) Monitoring during anesthesia and surgery 5) Prognosis of some cardiac diseases (Cardiac enlargement, arrhythmia, myocardial damage) 6) Indication and evaluation of therapy-mainly cardiac drugs- Digitalization (digitalis glycosides), antiarrhythmic medication, electrolyte substitution Arrthymias: are impulse conduction disturbances and can be: 1)Nomotopic - in the sinus node (sinustachycardia, sinusbradycardia, sinusarrhythmia) or 2)heterotropic - outside the sinus node. see AV blocks clearly on ECG; A) 1st degree AV block - delayed AV conduction seen as a longer PQ interval B) 2nd degree AV block - no AV conduction, seen as a missing QRS complex (P followed by another P) C) 3rd degree AV block - Ventricular contraction is controlled by the local pacemaker tries to compensate- will auscultate a very slow beat=Seen as regular P waves and regular but slow QRS (each has their own rhythm) 3 abnormal beats in a row are called tachycardia irrespective or rate Heart is faster on inspiration, slower on expiration Usage in animals Small animals - ECG like humans - same waves etc Horses and cow - ECG not effective due to different structure of horse/cow heart. (Purkinje fibres go through all of the myocardia and there is a lot of branching. ECG only useful to check the heart rate, cannot use for diagnostic evaluation waves etc.) Evaluation of ECG - look at diagram • Determination of the heart rate; - Determination of the heart rhythm - Regularity of the R-R intervals - P wave o QRS complex Cardiac arrhythmias - see lecture

GQ 31. The endocardial and extracardial murmurs. Characteristics of the heart murmurs.

Endocardial murmur should be same location, same intensity and same place in cycle. Small animal can be hard to tell where in cycle as no space between systole and diastole. - Systole is where you can feel beat with your hand. - Should also feel pulse on systole. - Small animal can be hard to say where puncta maxima is so just say murmur above heart base. Can always tell if it is an endocardial from extracardial as can always hear endocardial at same location, same intensity and same part of cycle. Where as, extracardial the location and intensity can be heard during different phases of the cardiac cycle 1) *Adventitious* sounds:murmurs o Endocardial murmurs (caused by turbulence): Functional • Innocent murmurs in racehorses - strong heart activity produces lots of turbulence but heart is fine • Anaemia - Decreased blood viscosity Morphological - valve deformities, septal or vessel malformation. Use these 4 as a description always: • Location - puncta maxima - point of maximum intensity • Intensity - • Relation to the phase of the cardiac cycle o Systole o Diastole o Systole and diastole • Pitch (frequency) - low, medium or high o Or pitch: blowing, whistling murmurs Also character • Continuous, crescendo, decrescendo Conduction (yes/no) o *Extracardial* murmurs Pericardial splashing, (frictional) rubbing, pleuropericardial/ pleuropleural rubbing - Valsalva probe or compression test - stop breathing and let the animal take a deep breath • If it is pleuropericardial/ pleuropleural, rubbing disappears if breathing stopped • If it is pericardial rubbing increases if breathing stopped at the end of inspiration (increased intrathoracic pressure - Traumatic pericarditis in cattle ' • Distended jugular vein, sternal edema, abnormal cardiac • Auscultation (pericardial splashing sounds) and percussion findings - Location and intensity can be heard during different phases of the cardiac cycle Points of maximum intensity and audibility of heart sounds: On left side: ● 3rd intercostal space is Pulmonary Artery ● 4th intercostal space is Aorta (highest point) ● 5th intercostal space is Mitral Valve (Bicuspid Valve) - lowest point. On right side - 4th intercostal space is tricuspid valve Grading of heart murmurs. ● Grade 1 - very soft - only hear after a few seconds in a quiet room. ● Grade 2 - very soft but easily heard directly on auscultation. ● Grade 3 - moderate intensity with good audibility. ● Grade 4 - loud murmur, good audibility but no precordial thrill (fremitus). ● Grade 5 - very loud murmur with precordial thrill, ● Grade 6 - loudest murmur - can hear with stethoscope lifted from chest wall The „good, old" auscultation method in a modern form: o Digital sound recording and phonocardiograph

GQ 62. Gastrointestinal endoscopy.

Equipment 1) Flexible endoscope a- Fiberscrope b-Videoendoscope 2) Fforeign body forceps 3) Biopsy foreceps Gastrointestinal endoscopy 1-Esophagoscopy 2-Gastroscopy 3-Duodenoscopy 4-Colonoscop Esophagoscopy Indications I)Dysphagia II) Regurgitation, III)Removal of esophageal foreign bodies, IV) Balloon catheter(Dilation of esophageal strictures) Diseases 1)Megaesophagus (Fermenting food and fluid may be seen) 2)Esophagitis 3)Foreign body 4)Esophageal stricture 5)Persistent right aortic arch Technique for esophagoscopy and gastroscopy; Fasting for 12-24 hours before endoscopy. General anesthesia is essential. Intubation. Left lateral lateral recumbency. Animals neck is extended dorsally - esophagoscopy Gastroscopy Indications 1)Evaluation of dysphagia 2)Regurgitation 3)Chronic vomiting 4)Gastric foreign bodies 5)Hematemesis, melena 6)Placement of percutaneous gastrostomy tube (PEG tubes) • Diseases I)Chronic gastritis - prominent rugal folds II) Ulcers III)Neoplasia IV)Foreign body, Hiatal hernia Pyloric obstruction. Gastric motility disorder • Inspection of the body, fundus, incisura angularis, antrum, pylorus. Normal stomach is small amount of clear/yellowish fluid. Bright pink to red colour is normal Duodenoscopy Indications -Chronic vomiting -Chronic diarrhoea -Melena, hematemesis • Diseases 1)Inflammatory bowel disease (Eosinophilic enteritis § Lymphocytic - plasmacytic enteritis ) 2)Lymphangiectasia •Examine the descending duodenum, flexure and the ascending duodenum Colonoscopy • Indications 1) Large bowel diarrhoea 2)enesmus o Hematochezia (blood in feces) o Dyschezia (pain during defecation) 3) Palpable rectal masses o Increased fecal mucus • Diseases 1)Colitis: -Histiocytic ulcerative colitis -Inflammatory bowel disease - Trichuris vulpis (Whipworm Whipworm) § Bacterial colitis 2) Lymphoma 3) Adenocarcinoma 4) Cecal inversion • Technique; Fasting for 24 to 48 hours, Multiple water enemas,General anesthesia, Left lateral recumbency. Digital rectal examination before colonoscopy. The scope is advanced using insufflation, the lumen should always be visible • Examination of the rectum, colon descendens, transversum, ascendens, cecum, ileocolic junction • Normal colon is smooth, glistening, pink and easily dilated

GQ 53. Examination of the body position, postural reflexes, ataxia.

Examination of proprioception: Postural reactions: • Complex responses involving spinal reflexes and central co-ordination for normal movement and posture. • Will see lots of weakness (ataxia) if there is a spinal cord problem: Tests for postural reflex and body position: 1-Wheelbarrow test - small animals. 2-Hopping test: On one leg - do each leg one at a time (small animals). Large - just hold up one leg at a time. 3-Hemi-hoping (hemiwalking) test (legs on one side) E.g. both left side fore and hindlimbs. 4-Correction test: Knuckling over •a-Knuckle over paw - animal should move foot to correct position. Most important. b-Crossing over • Cross legs and see if animal puts to correct position o 5-Tactile and optical placing reaction. Small animals: A-Tactile - hold animal - cover eyes then carry to table and touch leg on table edge - see if animal reacts and put leg on table B- Tactile and optical placing - as above but let animal see table C- Optical placing in large animals- horse • Put object in front and see if they walk over or around it • Tests optic nerve 6- Extensor postural thrust reaction. Hold to face like baby, lower hindlegs to ground . Animal should step back with hind limbs o 7- Reflex stepping. Put foot on piece of paper then slowly draw paper away (laterally) - animal should step off paper onto ground (not just leave foot on paper) 8- Pushing/swaying reflex - Push sideways. 9-Tonic neck reaction. Lift head and neck up and down Problems: 1- Cortical a brain stem lesions cause bilateral deficit in animals, while 2- Cerebellar, spinal cord and peripheral nerve lesions cause ipsilateral deficits of the test (ipsilat- 2 one side where lesion) Ataxia: Ded: incoordination of posture and movement; in pure form there is NO muscular weakness. o CNS is involved, not the peripheral nerves • Classification by signs: 1- Static; Most severe case. Can see that the animal is simply standing and not moving 2- Locomotive: Can see signs in movement only 3- Intentional - Rare. See nothing in standing or normal motion, but only see if head needs fine adjustment for example reaching out for some food - see trembling of head • Classification by anatomical origin: 1- Cortical/cerebral/proprioceptive. Often seen with behaviour changes. Involuntary circling. May also be muscle weakness. Rare, except old animals. Good prognosis though - often ok after a few days. 2- Brain stem lesions. Sways from side to side, rolling, involuntary movements, wide based stance 3- Cerebellar. Most easily recognised. Dysmetria-Hypermetria = Abnormally exaggerated steps, legs move very high and long strides • Goose stepping. No muscle weakness. Nystagmus - involuntary movement of eyeballs 4- Vestibula. Ipsilateral head tilt (to side with lesion). Always have nystamus. Animal leans and falls to affected side - Easy to identify. 5- Spinal damage. Paresis/paralysis. Severe muscle weakness, always hind limbs. Incoordination present. Daxi prone to this. • Note - spinal v cortical. Spinal lots muscles weakness, cortical not. Cerebellar still strong muscles - tries to right itself but can't. Vestibular head tilt. If no tilt and only circling is cortical!

GQ 37. Methods and order of digestive tract examination.

History • Eating (appetite), o Weight loss - anorexia; Picking up food, chewing, swallowing • Vomiting - regurgitation o Questions on difference between vomiting and regurgitation and type of diahorrea are important! • Defecation o position (posture), frequency pain, tenesmus, incontinence • Anus (observation, palpation) • Faeces o Quantity, quality (form, colour, smell, consistency, abnormal composition), faeces digestion test • Distended abdomen Additional examination methods • Laboratory examination o Blood, urine, faeces, gastric content, abdominal fluid) • X - ray - plain, contrast (BaSo4), gastric emptying • Ultrasound • Endoscopy (laparoscopy) • Fluoroscopy • Abdominocentesis • Laparotomy • Biopsy • CT, MR Order of examination: • Head - see previous o External o Internal • Oesophagus • Abdomen: Inspection , Palpation, Percussion, Auscultation • Anus o Digital rectal palpation Head - see previous Oral cavity Teeth - Incisors, Canines, Premolars, Molars o Dog Upper - 3I 1C 4P 2M Lower - 3I 1C 4P 3M o Cat Upper - 3I 1C 3P 1M Lower - 3I 1C 2P 1M o Check teeth: Number of teeth, shape, occlusion/closure, surface, Tartar (plaque/cremor/calculus) colour (line from distemper) Movability, pain, percussion sound Cats - Feline odontoclastic resorptive lesion (FORL) = Teeth become functionally destroyed Tongue o Shape, size, surface (lesions, pappilas), colour, consistency, movability, hard and soft palate, pharynx, tonsils o Lesions à bovine viral diarrhoea, F &M disease (notifiable) o Offer food to animal or put drop of water on nose - tongue ok if animal can lick it off. Gingiva (Gum) mm o Colour, moistness, surface (intactness, lesions), membrane vessels, CRT o Painful in uraemia Salivary glands o Parotid, Mandibular, Sublingual, buccal. Size, colour, surface and salivation (increase = inflammation) Odour o Bad odour can indicate dental diseases + Other remarks o Can animal open and close its jaws - if not - could be rabies, Damage to trigeminal etc. o The pharynx connects mouth with oesophagus and nasal cavity with larynx. It can be examined in the dog if the base of the tongue is pressed down. The tonsils are hidden by the semi lunar folds and will only be visible if enlarged. With the cat you can't see pharynx and tonsils without sedation and pulling out the tongue Examination of the OESOPHAGUS Inspection, palpation, -Additional methods o X- ray - Plain or contrast (BaSO4) o Oesphagoscopy - Remarks o Indicated if regurgitation problems. o Endoscopy often preferred for small&large animals. o In horses can also examine the guttural pouch etc at the same time. o Oesophagus passes to the left of the neck and is covered by muscles so is not easily palpable unless there is a problem o If there is a foreign body and the oesophagus is distended this can sometimes be palpated. o If using endoscopy look for any inflammation/redness, dilated blood vessels, vesicles, ulceration etc. o If there is excess mucus, take a sample. Can also take biopsy and remove foreign bodies. o X rays can be useful too e.g. for megaesophagus. o 3 sites of obstruction in oesophagus - thoracic inlet (left side of neck), base of heart and distal oesophageal sphincter between base of heart and diaphragm. Examination of the abdomen - Regions of the abdomen o Epigastric: from diaphragm to costal margin o Mesogastric: from costal margin till pelvis o Hypogastric: from pelvis backwards - Inspection o Size and form. o From both sides, above and from front o Ascites in cat can be FIP. Also cushings. - Palpation - slowly and carefully - most important o Watch reaction of patient. o Standing position (should be changed), from cranial to caudal. o Superficial and deep palpation -> Look at location, size, shape, relation to neighbouring organs, painfulness, surface, consistency, temp of skin, thickness of abdominal wall. o Palpable digestive organs: -> *Stomach* • Can sometimes be palpated if full not usually though • Gastroscopy *Liver* • Can only palpate liver in certain positions in some dogs as in general it is enclosed within the ribcage • Try dog in sitting position, ventrally at xipohoid process, though really need ultrasound to examine liver. • Cats the caudal border of the liver can often be palpated. *GI* loops • The main areas palpated in the abdomen along with the kidneys and urinary bladder. • Can't differentiate small and large intestine. Can feel foreign bodies and constipation - pencil like. *Kidneys* • Cat can palpate both. Just under last rib. Bean shaped, cherry like, surface is smooth, not painful, consistency is firm like muscle, slightly moveable, structure is homogeneous, and they are symmetrical. • Dogs can only palpate left kidney. U § *UrinaryB* • Lay cat down (or standing), stretch hind legs out and use hand on one side to press bladder to wall and the other to feel it. • Dog palpate urinary bladder in standing position or lying down § Spleen, mesenteric lymph nodes and pancreas can't be palpated Percussion o Finger to finger Tap muscle - dull - long, damp, low intensity. Tap lung - resonant - high and short. Tap abdomen and see difference - if gas filled should be dull resonance (so in-between) - longer and duller than resonant.. Can be tympanic (higher and longer) if lots of gas - volvus. try to find organ filled with gas or fluid or enlargement using this method. o Also use undulation test - hand on one side and tap on other - see if vibration goes right to other hand->Pseudoundulation Auscultation o Small animals, Borborygmi sounds are normal sounds of GI tract, requiring the presence of fluid and gas. • Sounds are intermittent, infrequent, low toned and not very loud. • Frequent and loud indicates strong peristalsis. Abnormal sounds are splashing or crepitation. Frequency gives an indication about peristalsis. A totally empty abdominal tract can be silent. Examination of the anus - see before Examination of the anus - see before

GQ 45. Principles, methods and diagnostic value of ultrasonography.

Importance of Ultrasonography: • Ultrasound is useful for the parenchymal and fluid filled organs, such as the abdominal cavity and the heart. • It is not useful for the lungs or bone or gas filled organs. • Combine with physical examinations and other diagnostic methods. Results should be evaluated with the findings of other examinations. Principles of ultrasonography • 'Ultrasound' refers to sound waves with a frequency too high for humans to hear. • Ultrasound images (sonograms) are made by sending a pulse of ultrasound into tissue using an ultrasound transducer (probe). • The sound reflects echoes from the tissues and a part of them will be reflected to the probe; these echoes are recorded, processed and displayed on the US machine as an image to the operator. • Typical diagnostic sonographic scanners operate in the frequency range of 1 to 18 megahertz (MHz) , lower frequencies produce less resolution but image deeper into the body and vica versa. • A sound wave is typically produced by a piezoelectric transducer (encased in a plastic housing of the probe) elicited by electrical impulses received from the US system • Strong, short electrical pulses from the ultrasound machine drive the transducer (i.e. the crystals) at the desired frequency. • The sound wave returned from the tissues vibrates the transducer and the transducer turns the mechanical vibrations into electrical pulses that travel to the ultrasonic scanner (machine) where they are processed and transformed into a digital image. • Acoustic impedance = density of the material x speed of the ultrasound within the given material o The greater the difference between the acoustic impedances of the neighboring materials, the larger (brighter) the echo on the screen is • FLUID is always BLACK (as no echoes will be reflected) and TISSUE is GREY. o The denser the tissue, is the brighter white it will appear in ultrasound the brightest white being bone. • Lower frequencies produce less resolution but image deeper into the body and vica versa. o Therefore for different sized animals need different probes e.g. horse v dog v hamster o Man and small animals between 1-10MHZ. o 1-2 MHz for horse and cow • On screen left is cranial and right is caudal Technique of ultrasonography I • Look and see if organ is anatomically correct and then any lesions or abnormalities. • Use sector transducer for the heart, and linear probes for tendons • Need good contact between skin and transducer - shave hair and use ultrasound gel • Echocardiography is a sonogram of heart using ultrasound

GQ 48. Examination of the skull and the spine.

Inspection Head and body position/posture • Abnormal head position o Lateral head turn o Stargazing: opisthotonus o Extension o Paresis of the neck muscles o Head tilt Can only be classed as a head tilt when the vertical axis of the head changes. Otherwise is 'turning the head' - when the vertical axis of the head does not change o Head rotation due to Newcastle disease is birds • Curved spine (these are NOT primary neurological disorders): o Kyphosis -Being humpbacked, dorsal deviation. Pseudokyphosis if abdominal pain e.g. cattle - reticuloperitonitis o Lordosis - concave curvature of the spine, ventral deviation o Scoliosis - lateral curvature of the spine. More common in humans than animals. Students! Examination of skull: • Shape - symmetrical or asymmetrical • Mobility - can head be easily turned in different directions - active (use food - testing olfactory also) and passive. o Can jaws open and close? • Ears - drooping and pointing - movability (blow on them). o Mixed breed and puppies may have odd ears. • Signs of pain by palpation • Abnormalities: o Hydrocephalus (bulging skull) - sutures in skull not closed-> Accumulation of CSF in the brain o Drooped ears and lips • Examination of the face o Facial expression - eyelids, nostrils, o Ears: function of the of facial muscles o Bilateral or unilateral changes o Abnormalities ->EQ, when facial paralysis - upper lip deviates - first clinical sign. -> Left sided facial paralysis o Detailed examination of the eyes . Position and mobility of the eye balls & pupils. Anisocoria - uneven pupil sizes!! VERY IMPORTANT Examination of spine Inspection: abnormal shape, position or luxation. o Muscles - symmetrical or wastage. • Sensitivity - Palpation and careful bending to see signs of pain. Cervical concentrate on lateral processes, lumbar on dorsal processes. • Definition of a reflex (cranial or spinal): o An involuntary movement or other, immediate response of an organ to an appropriate stimulus, without the aid of the will or without even entering consciousness • A reflex arc - message travels into spinal cord and out again without reaching the brain o Arrival of the stimulus and activation of the receptor o The receptor activates the afferent (sensory) neuron which travels to the spinal chord crossing the dorsal root ganglion via the dorsal root o A relay neuron relays the stimulus to the motor (efferent) neuron which then passes via the ventral root causing activation of the motor neuron - response by effector Examination of spinal reflexes • Evaluation of a reflex 0 = areflexia - no reflex 1 = hyporeflexia 2 = normoreflexia 3 = hyperreflexia 4 = hyperreflexia with clonus -> A series of rapid contractions of a muscle in response to one stimulus Abnormal reflexes o Reflex irradiation: a reflex elicited in a larger area / muscle group than expected o Contralateral (crossed) reflex: a reflex elicited in response to a stimulus applied to the other side of the body • Propioceptive (myotactic, stretch) reflexes: a reflex that is initiated by a stimulus to a proprioceptor (mechanoreceptor) o Thoracic limb reflexes -> 1)Extensor carpi radialis reflex (important) • Afferent and efferent nerve: n.radialis • Gently support the limb at the elbow with the carpus in flexion. Tap the muscle belly of the m. extensor carpi radialis with the reflex hammer 2)Triceps reflex (Afferent and efferent nerve: n.radialis) • Use your hand to gently support the thoracic limb with the elbow in flexion. Tap the tendon of insertion of the m. triceps brachii with the reflex hammer. • Some animals will display extension of the elbow but this might be more subtle in other animals, requiring that you rely on feeling the reflex contraction of the m. triceps brachii with the hand supporting the limb. 3) Biceps reflex • First approach: o A finger is placed on the tendons of biceps brachii muscle, cranial and proximal to the elbow. o The finger is struck! • Second approach: Tendons are directly struck. • Afferent and efferent nerve: musculocutaneus o Pelvic limb reflexes a- Patellar (quadriceps) reflex (most important) • Only one that is reliable. • Reflex centre between L4-L6. • Afferent and efferent nerve: *Femoral* N. • Hitting tendon of quadriceps femoris (afferent and efferent). Hit just above patella on tendon of quad, should kick. b- Achilles (gastrocnemius) reflex • Rarely examined • Afferent and efferent nerve: sciatic. Can also check tone and strength of tail - bend tail over back - be careful c-Nociceptive (painful) reflexes o Anal/perineal reflex (important). Gentle squeeze skin round anus or squeeze vulva - see anus contract and tail may lower. Afferent and efferent is n. pudendalis, Tail movement is n. rectalis caudalis o Panniculus reflex (important) Afferent: spinal segments . Reflex Center: C7-T1. Efferent: m. cutaneus trunci. Technique • Use forceps to grab skin along back - should twitch, caudal to cranial - skin should twitch - tests m. cutaneus trunci • Also use needle to scratch spine skin - is afferentation from each spinal segment & reflex centre is C7-T1. • Spinal cord injury o No reflex caudally from injury, if no reflex at all, injury is at reflex centre - localise this way. o Flexor (withdrawal) reflexes of limbs (important) a)Forelimb • Reflex centre forelimb is C6-T1 • Squeeze interdigital skin on forelimb - animal should pull away. • If unconscious - pain sensation (check the heart rate maybe) 2)Hindlimbs • Same test but reflex centre is L4/6 to S1 Examination of pain perception - last step of spinal exam • Superficial (cutaneous) pain perception o Assessed mainly by pinching/pricking with a pencil/needle or light pressure of skin - done via panniculus, perianal or flexor reflex o Normal response: § a) skin twitch, leg withdrawal: panniculus and flexor reflex § b) behavioural - crying, biting, turning to direction of pain via long pathways: receptor-spinal ganglion-thalamus-cortex o Evaluation: normaesthesia, hyperaesthesia, anaesthesia, paraesthesia • Deep pain perception o Testing is not necessary if superficial pain perception is present o Assessed by squeezing a digit or the rim of a nail with a haemostat (arterial clamp) or with a strong pressure in large animals (tread on rim of coronary band) o If deep pain absent - bad prognosis • Percussion of vertebral column with hammer. Palpate as detailed above. o Also can examine spine § Cervical - active bending (offer food) then passive bending with hands. § Then can palpate vertebrae - cervical concentrate on palpating lateral processes, with lumbar palpate dorsal processes. § Can also use hammer for pain percussion. § Can bend tail over back to check for pain too.

GQ 50. Body position, involuntary postures and movements.

Involuntary postures and movements: 1) Involuntary (compulsive) postures (Sometimes these are accompanied with changes of consciousness): o Lateral head turn o Stargazing: opisthotonus o Extension o Paresis of the neck muscles o Head tilt => Can only be classed as a head tilt when the vertical axis of the head changes. Otherwise is 'turning the head' - when the vertical axis of the head does not change. Vestibular abnormalities - vestibular ataxia. Turns towards effected side o Head rotation due to Newcastle disease is birds o Circling, walking in circles, Clockwise/anticlockwise (Circling disease in sheep - Listeriosis) o Involuntary walking (pacing) (Pacing is often accompanied by dementia in dogs) • Special behaviour abnormalities 1- Hallucination - looks behind itself when nothing is tehre 2- Paraesthesia; Psychogenic dermatitis - animal repeatedly scratching itself 3- Automutilation (semimutilation) Body positions: • Know correct posture for each species, breed - differences in body position & postural reactions • For detail on body position see topic 53 • Curved spine (these are NOT primary neurological disorders): o Kyphosis= Being humpbacked, dorsal deviation. Pseudokyphosis if abdominal pain e.g. cattle - reticuloperitonitis o Lordosis - concave curvature of the spine, ventral deviation o Scoliosis - lateral curvature of the spin. More common in humans than animals. Students are especially affected

GQ 27. Physiological lung borders in different animal species. Alterations of the lung borders and the percussion sounds.

K9/fel= 13 ribs, 12 back M. 11tuber cox, 10 Ischiadic tuber, 8 Point of shoulder Cattle= 13, 12, 11, -, 8 Swine= 14, 12, 11, 9, 7. EQ= 18, 17, 16, 14, 10 Abnormal shift of lung borders 1. Displacement of the caudal border backwards and downwards: •alveolar and interstitial lung emphysema 2. Decrease of the percussion area of the lungs: abdominal distention due to •distention of stomach or intestine •enlarged liver •pregnancy •ascites •large intraabdominal tumor 3. „Elevation" of the caudoventral border: • increase of the cardiac dullness (cardiomegaly or pericardial effusion) Ex: COPD/RAO => caudal shoft of lung borders *Altered* *percussion* sounds within the lung borders 1.1 Relative or incomplete dullness (damping): weak, high, short, nonmusical sound 1.2. Absolute (complete) dullness: even weaker and shorter sound Can be caused by: thickened thoracic wall (edema, pleural adhesions, ++ conjective tissue decreased gas content of the lungs (pneumonia, edema, neoplasm) pleural effusion (horizontal dorsal border!) caused by hydrothorax, pleuritis, haemothorax or chylothorax atelectatic abdominal organs (full stomach, spleen, liver) atelectatic solid masses or masses filled with fluid within the thorax 2. Tympanic sound (intensive and high resonancy sound) Forms: - sharp (intensive) - weak (dull) - high - low Caused by: - atelectatic parenchyma around the normal lung cavern in the lung open pneumothorax - eventrated abdominal organs filled with gas - ichorous pericarditis (fluid and gas in the pericardium) - emphysema localised subcutaneously 3. Hollow (box) sound (low, more intensive, shorter and more nonmusical than the tympanic sound) - in wasted animals with thin chest and severe lung emphysema 4. Metallic sound (steel band effect) - pneumothorax - large cavern within the lung - prolapsed stomach or intestine in the thoracic cavity - subcutaneous emphysema 5. Cracked-pot sound - if there is a cavern filled with gas and located under the chest wall which communicates with a bronchus - small subcutaneous emphysema

GQ 19. Examination of the larynx and the trachea. 1. nose and paranasal sinuses 2. coughing 3. *larynx* and *pharynx* 4. *trachea* 5. thorax

Larynx: 1) External exam = inspect (skin, deformity/swelling) palpat (form/outline/M./surface laryx/Abnorm Masses) compresseabilit/pressure sesitivity of arytenoids ? temper/painfulnes Ausculation (weak stridor under inspir/expi) 2) Internal Ex. Open K9/fel mouth ØEq=need endoscopy. Laryngoscopy a) Epiglottis b) nasopharyns (symetry/synchronized movement of arytenoids) c)Tima glottis d) Color/capillaries/defamation of mm e) Tonsibls bw Oral&laryngeal cavity (shape/size/semilunar fold/color/surface/symetry) trachea 1) Extern: Insp/palp/asculation (further examin= Xray/endoscopy/tracheal fluid samply&analysis) Ex: Trachea hypoplasia=narrovm trachea collapse.

GQ 20. Examination methods of the thorax. Examination of the respiration (breathing). 1. nose and paranasal sinuses 2. coughing 3. larynx and pharynx 4. trachea 5. *thorax*

Methods: Inspece, Palp(temp skin/fremitus pectoralis/painfulness/deformities), Ascultat (Indirect=statscope min 5 different places, Direct=ear, fron2back,up-down) , Percussion (ausustic &localizedd pain, surrounding tissue information, localised lung boardeds, assessment tissue dencity (7cm) Lesions (5cm) finger2f/ham/plessimeter=inifect. Sm animals= sharp/high/low resonsns & lg, LA sharp/low resoant short. Further= Xray/ultrasonography/endoscopy /brocnia fluid sample/analysis, Traacocentesis/biopsy, CT/MR/Scintigraphy, Thoracotomy, Lung function testing, Blood count/A.Base analysis. 1) Inspect: Skin(intact), Size/shape/bilatt symetry/local deformities) 2) Resp. Movement: 1- frequenty. 30/min, Increase (polypnea or tachypnea) Normal: under movement, excitement, work, high temperature, obesity,pregnancy Abnormal:fever, hypoxia, hypercapnia, pain in respiratory organs Decrease (olygopnea or bradypnea) Abnormal: CNS diseases, barbiturate toxicosis, shock, agony 2- Rythem: Normally: Periodic rhythmical inspiration and expiration, inspiration is a little bit longer Held inspiration -narrowed upper airway's -higher abdominal pressure (pregnancy, ascites, meteorism) Held expiration -decreased lung elasticity -microbronchitis Shorter inspiration or expiration -inhibition about pain Asymmetric breathing -one main bronchus obstruction -pain in one chest Intermittent inspiration -normally during excitement, long exhausting work -abnormally:at painy chest disorder 3) TYPE Nomal: costoabdominal in equids and dogs and cats mainly abdominal in ruminants Abnormal -Costal respiration -the function of the diaphragm is lost (abdominal pain caused by inflammation) - increased abdominal pressure, (pregnancy, meteorism, ascites) -narrowed upper airways, compression of the lung -Abdominal respiration painy chest diseases and paralysis of intercostal muscles 4- Depth: Normal: medium deep Abnormal -Shallow (superficial) respiration -cases of severe dyspnea -painy diaphragm and chest diseases -respiratory centre damage -Deep respiration -after fast movement -at hypoxia -may the characteristic sign of dyspnea 2)Examine respir/breath: - watch for a couple of cycles Fequency (increas/decreas) rythem, Type, deth

GQ 1. Objective and methods of Clinical Diagnostics. The diagnosis. Diagnosis types. The causes of misdiagnoses. Part 2 Diagnosis types misdiagnosis

NASB= Nationale, Anamnesis, State praesens, Basic Clinical Values! 1) Symptom: changes which are observed by the owner 2) Sign: which are abnormal findings of the vet during the physical examination -specific (pathognomic) nonspecific -permanent temporary -main accessory 3) Syndrome: spesial symptoms group, together highly specific for disease 4) DIAGNOSIS (the name of a disease) = PDetect clinically significant abnormalities of function & 2 indetify body systems involved. => 5) Purpous: spesific tratment, accurat prognosis, cost efective, prevent. 6) Types: How to develop a correct diagnosis: • Deductive diagnosis (dg. per deductionem) pathognomic symptoms • Excluding diagnosis (dg. per exclusionem or dg. differencialis) • Diagnosis obtaining from the therapeutic results (dg. ex juvantibus) • TYPES • causal, ethiological diagnosis (e.g. parvovirus enteritis) • topographical diagnosis (concerning an organ e.g. hepatitis) • symptomatic diagnosis (e.g. jaundice, fever) • functional diagnosis (e.g. lameness of the urinary bladder) • tentative diagnosis (e.g. sarcoptes) • main and additional dg (e.g. enteritis and flea allergy) Comparing with the reality: • exact- diagnosis vera, certus • objective- diagnosis objective • presumtive- diagnosis verosimilis • undetermined- diagnosis incerta • false- diagnosis falsa 7) False Diagnosis: no exam, not accurate, missunderstanding symptopms, neglecting repeated exam, wrong tools/equiptment, wrong interp lab data.

GQ 2. Describing an animal, the importance and parts of the nationale.

Nationale: - owner (name address # emai..) - Permanent data animal (species breed sex color, color pattters, nose/muzzel impression, blood group, marks,) - transition data aniaml (age, kg, marks, tattoo, eat tag, microchil, ear docking?!?) - K9/fel (coat; long curly, smooth wired. Form of ears; pendulous, erect cropped. Tailstate; docked/natural) - Transient date - Passport ?!? General impression of animal 1. Body size 2. Body shape and development state 3. Nutritional condition 4. General condition, grooming 5. Consciousness and behaviour 6. Posture 7. Locomotion 8. Obvious abnormalities

GQ 38. Examination of the oral cavity and the pharynx. The findings of the oral examination in healthy animals.

Oral cavity Teeth - Incisors, Canines, Premolars, Molars o Dog Upper - 3I 1C 4P 2M Lower - 3I 1C 4P 3M o Cat Upper - 3I 1C 3P 1M Lower - 3I 1C 2P 1M o Check teeth: Number of teeth, shape, occlusion/closure, surface, Tartar (plaque/cremor/calculus) colour (line from distemper), Movability, pain, percussion sound, Cats - Feline odontoclastic resorptive lesion (FORL) • Teeth become functionally destroyed Tongue o Shape, size, surface (lesions, pappilas), colour, consistency, movability, hard and soft palate, pharynx, tonsils o Lesions à bovine viral diarrhoea, F &M disease (notifiable) o Offer food to animal or put drop of water on nose - tongue ok if animal can lick it off. Gingiva (Gum) mm o Colour, moistness, surface (intactness, lesions), membrane vessels, CRT o Painful in uraemia Salivary glands o Parotid, Mandibular, Sublingual, buccal o Size, colour, surface and salivation (increase = inflammation) Odour o Bad odour can indicate dental diseases Other remarks o Can animal open and close its jaws - if not - could be rabies, Damage to trigeminal etc. o The pharynx connects mouth with oesophagus and nasal cavity with larynx. It can be examined in the dog if the base of the tongue is pressed down. The tonsils are hidden by the semi lunar folds and will only be visible if enlarged. With the cat you can't see pharynx and tonsils without sedation and pulling out the tongue

GQ 14. Examination of the lymph nodes in carnivores.

Palpable 1.Mandibular/submandibular lnn (lnn. mandibulares) 2. Prescapular lnn (lnn. cervicales superficiales) 3. Popliteal ln (lnn. poplitei superficiales) Palpated only when pathologically enlarged 4.Retropharyngeal lnn (lnn. retropharyngei) 5. Parotid lnn ( lnn. parotidei) 6. Axillary lnn (lnn. axillares) 7. Superficial inguinal lnn (lc. inguinale superficiale) 8. Mesenteric lnn ( lnn. mesenterici)

GQ 29. Percussion of the cardiac region, determination of the cardiac boundaries.

Percussion (see table in previous topic): o Can't really tell cardiac boundaries as the heart is covered by lungs. o Detection of pain in the cardiac area o Area of cardiac dullness - Diernhofer's triangle - Horse and dog on left side, get absolute dullness where heart in contact with thoracic wall (dog larger than beagle). Then relative dullness where lung lobes are in the way - Cat, Ru, Swine - just relative dullness o Diernhofer's triangle - between the caudal border of the heart and the diaphragm - Diernhofer triangle is normally filled with air, but in case of free fluid in the abdomen it will disappear. Even in heart enlargement it remains. - If free fluid in thorax will get a line of horizontal dullness o Enlargement of cardiac dullness - cardiac hypertrophy, cardiac dilation, cardiac dislocation, pericardial effusion o False enlargement: dullness in neighbouring organs, detect rubbing auscultation o Decrease of cardiac dullness - pneumothorax, cardiac dislocation, lung emphysema, skin emphysema Areas of caridac dullnes Normal Eq = Absol Left 3-5 R3-4 Cat/sm Rum= rel L 3-4 Rnormally not detected Swine=relat L2-3 Rnormal Ødet K9=Absolute L4-6 R4-5 Fel=relativeusually not/hard Normal place apex/heard beat (intercostat space) Eq: Left 3-6 R3-4 Catt: L3-5 R-

GQ 41. Examination methods of the liver and the pancreas. Physical and additional methods.

Physical examinations are difficult. Liver. ● Cannot be palpated in dog, as mainly sits within costal arch. When enlarged it may be possible on some deep chested dogs. greyhound it can never be palpated. In a cat it is also very difficult unless enlarged - Cats the caudal border of the liver can often be palpated. It cannot be in the cow and horse ● Generally a survey x-ray is no longer done on the liver o Ultrasound examination is favoured, which can provide more details as to size, shape, and any tumours etc. ● Lab exams. Liver enzymes - ALT [and AST] useful for dogs and cats. ALT is specific for carnivores. GGT (specific for cats) and ALKP (not specific in cats) used for bile duct obstruction enzymes ● Liver also has other functions too, producing many proteins such as albumin, coagulation factors (II, VII, XI and X), apolipo-proteins and acute phase proteins ● Can measure protein synthesising ability - total protein, albumin (refraco/spectrophotometry) and fibrinogen (thrombin time) ● Ammonia concentration as a liver function test. Increased ammonia can be ruminal alkalosis, increase in ammonia producing bacteria (horse, rabbit, ruminants, pigs and carnivores) and also impaired liver function. ● Liver metabolism can also change due to impaired liver function. Increased free fatty acids and decreased total cholesterol concentration. ● Lastly a liver biopsy and aspiration cytology can be used - lipid, protein, glycogen content of liver. Pancreas. ● The pancreas cannot be palpated even if enlarged. ● Survey x-ray followed by ultrasound are often used for the pancreas. ● Lab tests are very important. Usually pancreatic enzymes are only in a low level in the blood ● Alpha amylase (kidney failure, FIP, acute pancreatitis can also increase alpha amylase values) o Starch digestion test o P nitrophenol - yellow intensity is proportional to alpha amylase ● Lipase - more pancreas specific than alpha amylase o Best test is ELISA pancreas specific lipase test for dogs and cats ● Also - alpha amylase creatine ratio ● Trypsin like immunoreactivity (TLI)- need to use RIA. Not so good for dogs, but useful to detect acute pancreatitis in cats ● Exocrine pancreatic insufficiency - TLI, BT-PABA (N-benzoil-L-tyrozilparaaminobenzoicacid), lipid absorption, faecal tests

GQ 58. ECG examination of the dog and the cat, the technique of the examination, ECG evaluation, the principles of form and rhythm analysis.

Principles and parts of the ECG: ->Electrocardiograph: Measurement in amplitude and time of potential differences of electrical current generated through depolarization and repolarization of cardiac structures; Intracardiac recording, Epicardial recording , Measurement on the surface of the body (ECG). -> Electrical conduction of impulse going through the heart causes it to contract. The SA node is the pacemaker and starts the electrical conduction. The impulse goes to the AV node and then the to bundle of His (2 branches like a cable - end of bundle are purjkinge fibres), to apex of heart, then through ventricles via purjkinge fibres. This is in small animals, large animals, the purkinje fibres run through the myocardium and there is lots of branching, making ECG less useful (just useful for heart rate measurement) On screen of ECG, see 3 waves - how they look like depends on how the electrodes have been attached. Usually use 1) Einthoven's triangle to evaluate. ECG leads have 3 ways of setting up: Einthoven's triangle (bipolar limb leads) - monitoring anaesthesia - alligator clips used and wetted. Red - right forelimb. Yellow left forelimb. Green left hind. Black right hind. Like traffic lights. 2) Goldberger's (augmented) unipolar limb leads. 2 leads on each limb - diagnostic 3) Willson's unipolar precordial leads. Extra leads on thorax - diagnostic ECG can be used to count heart beats and also specialists can determine the heart rhythm; a- ECG produced in right lateral recumbency, sternal recumbency, standing positions b- Movement, respiratory, electrical interference can hinder results. NB and diagnostic value of ECG: • Exact diagnosis and evaluation of cardiac arrhythmias o Arrythmias, bradycardia, tachycardia • Detection of the enlargement of cardiac chambers • Cardiac effects (detection) of electrolyte disturbances and systemic diseases (Ca++, K +) • Monitoring during anesthesia and surgery • Prognosis of some cardiac diseases o Cardiac enlargement, arrhythmia, myocardial damage • Indication and evaluation of therapy (mainly cardiac drugs) o Digitalization (digitalis glycosides), antiarrhythmic medication, electrolyte substitution • Arrthymias are impulse conduction disturbances and can be: o Nomotopic - in the sinus node § sinustachycardia, sinusbradycardia, sinusarrhythmia or o heterotropic - outside the sinus node. • Can see AV blocks clearly on ECG o 1st degree AV block - delayed AV conduction seen as a longer PQ interval o 2nd degree AV block - no AV conduction, seen as a missing QRS complex (P followed by another P) o 3rd degree AV block - Ventricular contraction is controlled by the local pacemaker tries to compensate- will auscultate a very slow beat. § Seen as regular P waves and regular but slow QRS (each has their own rhythm) • 3 abnormal beats in a row are called tachycardia irrespective or rate • Heart is faster on inspiration, slower on expiration Kishen Parekh Usage in animals • Small animals - ECG like humans - same waves etc • Horses and cow - ECG not effective due to different structure of horse/cow heart. o Purkinje fibres go through all of the myocardia and there is a lot of branching. ECG only useful to check the heart rate, cannot use for diagnostic evaluation waves etc. Evaluation of ECG - look at diagram • Determination of the heart rate • Determination of the heart rhythm o Regularity of the R-R intervals o P wave o QRS complex • Cardiac arrhythmias - see lecture

GQ 34. Principles and diagnostic value of the ECG examination.

Principles and parts of the ECG: 1) Electrocardiograph: Measurement in amplitude and time of potential differences of electrical current generated through depolarization and repolarization of cardiac structures. o Intracardiac recording o Epicardial recording o Measurement on the surface of the body (ECG) 2) Electrical conduction of impulse going through the heart causes it to contract. o The sinoatrial node is the pacemaker and starts the electrical conduction o The impulse goes to the AV node and then the to bundle of His (2 branches like a cable - end of bundle are purjkinge fibres), to apex of heart, then through ventricles via purjkinge fibres. o This is in small animals, large animals, the purkinje fibres run through the myocardium and there is lots of branching, making ECG less useful (just useful for heart rate measurement) 3) On screen of ECG, see 3 waves - how they look like depends on how the electrodes have been attached. 4) Usually use Einthoven's triangle to evaluate. 5) ECG leads have 3 ways of setting up: o Einthoven's triangle (bipolar limb leads) - monitoring anaesthesia - alligator clips used and wetted Red - right forelimb Yellow left forelimb Green left hind Black right hind. Like traffic lights. o Goldberger's (augmented) unipolar limb leads -> 2 leads on each limb - diagnostic o Willson's unipolar precordial leads -> Extra leads on thorax - diagnostic 6) ECG can be used to count heart beats and also specialists can determine the heart rhythm o ECG produced in right lateral recumbency, sternal recumbency, standing positions o Movement, respiratory, electrical interference can hinder results 7) Importance and diagnostic value of ECG: • Exact diagnosis and evaluation of cardiac arrhythmias o Arrythmias, bradycardia, tachycardia o Detection of the enlargement of cardiac chambers • Cardiac effects (detection) of electrolyte disturbances and systemic diseases (Ca++, K +) • Monitoring during anesthesia and surgery • Prognosis of some cardiac diseases o Cardiac enlargement, arrhythmia, myocardial damage • Indication and evaluation of therapy (mainly cardiac drugs) o Digitalization (digitalis glycosides), antiarrhythmic medication, electrolyte substitution • Arrthymias are impulse conduction disturbances and can be: o Nomotopic - in the sinus node -> sinustachycardia, sinusbradycardia, sinusarrhythmia or o heterotropic - outside the sinus node. • Can see AV blocks clearly on ECG o 1st degree AV block - delayed AV conduction seen as a longer PQ interval o 2nd degree AV block - no AV conduction, seen as a missing QRS complex (P followed by another P) o 3rd degree AV block - Ventricular contraction is controlled by the local pacemaker tries to compensate- will auscultate a very slow beat. -> Seen as regular P waves and regular but slow QRS (each has their own rhythm) • 3 abnormal beats in a row are called tachycardia irrespective or rate • Heart is faster on inspiration, slower on expiration Usage in animals • Small animals - ECG like humans - same waves etc • Horses and cow - ECG not effective due to different structure of horse/cow heart. o Purkinje fibres go through all of the myocardia and there is a lot of branching. ECG only useful to check the heart rate, cannot use for diagnostic evaluation waves etc

GQ 61. Principles of endoscopic examinations, respiratory endoscopy.

Principles of endoscopic examinations ● Use of an endoscope to look into a hollow organ/place inside the body ● Types of endoscopy ● Rigid or flexible tube and light delivery system. Imager and eyepiece and also instruments e.g. for taking biopsies. o Rigid endoscope - only for rhinoscopy - nostrils, pharynx and larynx, trachea and oesophagus (to remove foreign bodies). Do not use stomach, duodenum, rectum or colon. o Flexible endoscope - for all else - fibroscope or video endoscope ● Size of the scope, length and diameter are important. Colonoscope is longer with a wider diameter than a gastroscope for example. ● Hold handpieec in left hand and turn knobs on scope with right hand ● Bronchoscope has no deflection knobs on the endpiece - you can only turn the tip up and down. Others go side to side too ● Cystoscopy (urinary bladder) can only be used for male dogs and female dogs and cats. Not for male cats! ● Endoscopy is done under a general anaesthetic so is generally not done on animals with heart problems. It is semi invasive so can cause bleeding. ● Can use to take samples, remove foreign bodies etc. as well as to examine the internal structures=Sometimes it is the only option . Respiratory Endoscopy • Generally; Don't use if heart problems, severe hypoxemia, tendency to bleeding. Technique; Under anaesthesia, Dog/cat usually in sternal/lateral recumberancy. Horse is standing. Rigid or flexible endoscope used o Only use rigit in rhinoscopy Rhinoscopy - Nasal cavity and frontal sinuses. Use if : 1) sneezing, reverse sneezing, nasal discharge, epistaxis. 2) Chronic undiagnosed disease that has not responded to conservative treatment. Diseases: I) Rhinitis (viral, bacterial, fungal, polyp, neurogenic, allergic) II) Neoplasm ( adenocarcinoma, squamous cell carcinoma) III) Foreign body o Look at shape, size, contours and number of turbinates. Look out for blood clots, inflammation, foreign bodies, mucus, fungal colonies, exudate. If see plaque take a swab. Start endoscopy at healthy side so don't spread problem. Laryngoscopy / Pharyngoscopy Indications; I) Laryngeal dysfunction= Exercise intolerance/ respiratory distress,; Inspiratory noise/stridor II) Difficulty in swallowing (gag reflex) III) Regurgitation IV) Look into guttural pouch of horse - Diseases: I) Foreign body (Bones), neoplasm, II) Elongated soft palate (often in bulldogs)= Extending into the larynx III)Tonsilitis/laryngitis, IV) Laryngeal paralysis, laryngeal collapse V) In deep anaesthesia the larynx is paralysed so make sure it is not too deep - don't use inhalational anaesthetics - diazepam and propofol is a good combination. Laryngeal collapse and paralysis are common so this is important as need to see o Look at epiglottis, symmetry or arytenoids, vocal folds • Tracheobronchoscopy. Indications = 1) Acute cough if an inhlaed foreign body is suspected 2) Chronic cough (unknown cause or does not respond to therapy) 3) Unexplained abnormal breathing pattern, 4)Tracheal collapse / segmental stenosis 5) Chronic bronchitis 6) Stridor 7) Feline asthma 8) Persistent halitosis • Look at trachea - collapse, shape and amount of mucus. Brachiocephalic dogs are prone to tracheal hyperplasia where the rings overlap - narrows the lumen. • Look at carina where the trachea bifurcates, and also at the bronchi • Samples; a) BAL - broncheo-alveolar lavage can be used; I- Sterile saline introduced then immediately aspirated. II- Do in two different locations in the lung lobes oTracheal wash: flushing tube to collect bacterial cultures

GQ 10. Primary skin lesions.

Recognize of skin lesions and their location and pattern Primary skin lesion: is the initial eruption that developes spontaneously as a direct reflection of underlying disease. They may appear quickly and then disappear rapidly. MPPNWVCPA=9 1. Macules(not elevated, differs in colour) patch(>1cm) a circumscibed, nonpalpable spot up to 1 cm in diameter and characterized by a change in the color of the skin; result from: A) Pigment a- Melanin pigmentation: melanoderma, vitiligo, b - Local haemorrathcih: petechia (pinpoint), purpura (bleeding into skin) B) Patch: a macule larger than 1 cm in size vascular (erythema=redness) - Functional: active Or passive hyperaemia. - Anatomical: hyperplastic or aplastic 2. Papules (small, solid elevation< 1 cm), (crusted pap.) small solid elevation, up to 1 cm in diameter, palpated as a solid mass. pink or red swelling produced by *tissue* *infiltration* or *inflammatory* cells in the dermis, (by *intraepidermal* and *subepidermal* *edema* or by *epidermal* *hypertrophy*). may or not involve hair follicules. e.g.: erythematous papules: scabies, FAD, superficial bacterial folliculitis, allergic contact dermatitis 3. *Plaques* (extensive, relatively flat) a larger, flat-topped elevation formed by the topped extension or coalition of papules.(e.g.: cat: eosinophil granuloma complex: eosinophil plakk) 4. *Nodules* (solid mass >1 cm ) circumscribed, usually extend into deeper layers of the skin. from massive *infiltration* of *inflammatory* or *neoplastic* cells into the *dermis/subcutis*. Deposition of fibrin or crystalline material also produces nodules. *Tube*r: inflammatory elevation of papillary zone of skin or mucous membrane with diferent shape and size. tumor - a large mass that may involve any structure of the skin/subcutaneous tissue. Most tumors are neoplastic/granulomatous in origin (fibroma, mastocytoma, melanoma, lipoma). 5. *Wheals* (urticarial lesion-flas surface), a sharply circumscribed raised lesion consisting of edema that usually appears and disappears within minutes or hours. *Angioedema:* is a huge hive of a distensible region such as the lips or eyelids. (Type I. hypersensitivity reaction). 6. *Vesicles* (circumscribed elevation filled with fluid), bulla. a sharply circumscribed elevation of the epidermis filled with clear fluid. rear in K9/fel (auroimmuneor dermatitis due 2 irritans) Bullae: Those with a diameter greater than 1 cm are called bullae (Bullae are blisters larger than 1 centimeter wide ) E.g.: bullous pemphigoid, (pemphigus vularis) 7. *Cysta* (an epithelium-lined cavity) lined cavity)an epithelium-lined cavity containing fluid or a solid material. It is smooth, well solid material. It is smooth, well-circumscribed, fluctuant to solid mass. Skin cyst are usually lined by adnexal epithelium (hair follicle, sebaceous, or epitrichial) and filled with cornified cellular debris or sebaceous or epitrichial secretions. 8. *Pustules* (elevation filled with pus), abscess a small, circumscribed elevation of the epidermis that is filled with pus. Pustules may be intraepidermal, subepidermal and follicular in location. Their color is usually yellow but may be green or red. 9. *Abscess*: a demarcated fluctuant lesion resulting from a dermal or subcutaneous accumulation of pus. The pus is not visible on the surface of the skin until it drains to the surface. Abscesses are larger and deeper than pustules.

SAP 33. Evaluate the given X-ray pictures!

SEE VIDEO ON DROPP BOX!

GQ 21. The origin of the normal and abnormal respiratory sounds. The normal respiratory sounds.

Sound origion= air goes higher->lover Pressure & narrowing of the airways- get turbulence (depends on airways Diameter&speeed airstream) Resunant sound (from lung2 chest wall diminishes as some of it is reflecte bc acoustic impedance (density of materialxspees of sound) Origion of resp.sound= upper airways. Gets weak stenotic noise from nose&pharynx. &weak blow noice from tubulence before bifurication(trachea). Alveoli/bhrocy=Øsound, after bifurication=laminar flow=Øvibration. K9/fel = Strongest Inspi/ex Eq= Almost silent, soft I, weak e Cattle= strong rugged blow I, Weak E pIg= strong rugged I, Strong Blow E Rabbit= see k9, not as strong Bird: Strong &blow like Physiological sounds 1) Norm= soft blowing sound, Similar to air sucking 'f' sound 2) Bronchio= Strong audible blowing sound. 'h' @I&E 3) Bronchial like= deeper/stronger/harsher vs bronchial sound 'f' & 'h' sound together. Normal sm K9/fel above base as bifurication Bronchi sound by stenotic effect of Larynx,trachea&bronchi. it audible over larynx and trachea. Abnormal=wen peri-bronchi tissue has less air (bc bronchitis, pnemon, nepl)

GQ 57. Examination of the spinal reflexes.

Spine Examination 1- Inspection: abnormal shape, position or luxation. M. - symmetrical or wastage. 2- Sensitivity - Palpation and careful bending to see signs of pain. Cervical concentrate on lateral processes, lumbar on dorsal processes. 3- Defof a reflex (cranial or spinal): An involuntary movement or other, immediate response of an organ to an appropriate stimulus, without the aid of the will or without even entering consciousness 4- A reflex arc - message travels into spinal cord and out again without reaching the brain a) Arrival of the stimulus and activation of the receptor b)The receptor activates the afferent (sensory) neuron which travels to the spinal chord crossing the dorsal root ganglion via the dorsal root c) A relay neuron relays the stimulus to the motor (efferent) neuron which then passes via the ventral root causing activation of the motor neuron - response by effector Examination of spinal reflexes • Evaluation of a reflex 0 = areflexia - no reflex 1 = hyporeflexia 2 = normoreflexia 3 = hyperreflexia 4 = hyperreflexia with clonus ; A series of rapid contractions of a muscle in response to one stimulus • Abnormal reflexes ; a)Reflex irradiation: a reflex elicited in a larger area / muscle group than expected b) Contralateral (crossed) reflex: a reflex elicited in response to a stimulus applied to the other side of the body *Propioceptive* (myotactic, stretch) reflexes: a reflex that is initiated by a stimulus to a proprioceptor (mechanoreceptor). Thoracic limb reflexes; a-Extensor carpi radialis reflex (important) • Afferent and efferent nerve: n.radialis • Gently support the limb at the elbow with the carpus in flexion. Tap the muscle belly of the m. extensor carpi radialis with the reflex hammer. b- Triceps reflex (Afferent and efferent nerve: n.radialis) • Use your hand to gently support the thoracic limb with the elbow in flexion. Tap the tendon of insertion of the m. triceps brachii with the reflex hammer. • Some animals will display extension of the elbow but this might be more subtle in other animals, requiring that you rely on feeling the reflex contraction of the m. triceps brachii with the hand supporting the limb. c- Biceps reflex • First approach: A finger is placed on the tendons of biceps brachii muscle, cranial and proximal to the elbow. The finger is struck! • Second approach: Tendons are directly struck. • Afferent and efferent nerve: musculocutaneus o d-Pelvic limb reflexes; I) Patellar (quadriceps) reflex (most NB!!) • Only 1 reliable. • Reflex centre between L4-L6. • Afferent and efferent nerve: Femoral nerve • Hitting tendon of quadriceps femoris (afferent and efferent). Hit just above patella on tendon of quad, should kick II) Achilles (gastrocnemius) reflex • Rarely examined • Afferent and efferent nerve: sciatic III) Can also check tone and strength of tail - bend tail over back - be careful Nociceptive (painful) reflexes - Anal/perineal reflex (important); Gentle squeeze skin round anus or squeeze vulva - see anus contract and tail may lower. Afferent and efferent is n. pudendalis, Tail movement is n. rectalis caudalis - Panniculus reflex (important); Afferent: spinal segments. Reflex Center: C7-T1 Efferent: m. cutaneus trunci. Technique; Use forceps to grab skin along back - should twitch, caudal to cranial - skin should twitch - tests m. cutaneus trunci. Also use needle to scratch spine skin - is afferentation from each spinal segment & reflex centre is C7-T1. Spinal cord injury (No reflex caudally from injury, if no reflex at all, injury is at reflex centre - localise this way.) -Flexor (withdrawal) reflexes of limbs (important) A) Forelimb: Reflex centre forelimb is C6-T1 • Squeeze interdigital skin on forelimb - animal should pull away. • If unconscious - pain sensation (check the heart rate maybe) B) Hindlimbs: Same test but reflex centre is L4/6 to S1 Upper motor neurons Centres (brain, spinal cord). Stay in CNS. Extra pyramidal tract important. 2plexuses in spinal cord, synapse with lower motor neurons - brachial plexus and lumbar plexus. Responsible for fine control. Problem with UMN manifestation (Reflexes - Hyperactive. Tone - increased ) Lower motor neurons are the spinal and cranial nerves. - Problem with LMN manifestation (muscle weakness): Reflexes - Diminished or absent. Tone - Decreased or absent

GQ 42. Physical and additional examination of the urinary system. Abnormalities of urination.

Urinary system divide into 2 sections : 1) Upper - kidney and ureter o Palpation is not easy. Cannot palpate ureters, 2) Lower - urinary bladder and urethra (+ prostate) o Always urination problems - get history (and video if possible!) o Can palpate urinary bladder in all species. o A urine and a blood sample is required History • -Kidney functions o Signs of reduced concentrating ability - polyuria, polydipsia o Signs of uraemia - anorexia, vomitus, soporose o Signs of protein loss - oedema, ascites-> Glomerular function impairment • - Urinary tract functions - something wrong with urination itself o Signs of decreased reservoir function - retention or incontinence o Signs of dysfunction of micturition - dysuria • - Abnormal urine (color, odor) • - Miscellaneous o Lamness due to kidney disease, Thrombosis (pulmonary-dyspnoe, aorta- lameness) , Thromoembolism, Mainly due to PLN o Hypertension (CNS, blindness, nasal bleeding), Blindness in cat usually due to kidney diease Examination techniques Abdominal palpation (small animals), Rectal palpation (large animals), Digital palpation (dogs) Percussion (large animals) Description of the palpatory findings of abdominal organs: -Location, size, shape, relation to their neighbourhood, painfulness, surface, consistency, structure, symmetry Upper urinary tract • Measure BUN, creatine, electrolytes etc. o A BUN test can reveal whether your urea nitrogen levels are higher than normal, suggesting that your kidneys or liver may not be working properly. • Vomiting, diarrhoea, CNS signs, convulsions, coma etc. as build-up of toxins • Kidneys o Cat can palpate both, Just under last rib. Bean shaped, cherry like, surface is smooth, not painful, consistency is firm like muscle, slightly moveable, structure is homogeneous, they are symmetrical. o Dogs can palpate only left kidney. Much depends also on the BCS of the animal. o Horse and cattle kidneys can be palpated rectally. o Goat and sheep - only the left kidney is palpable o Pigs - not or poorly palpable o Kidney is often painful when diseased. Also palpate and percuss the rest of the abdomen. o Abnormal findings: - Kidney Enlargement: • Acute nephritis • Pyelonephritis • Hydronephrosis (swelling) • Tumor (asymmetric enlargement) - Smaller size • Renal fibrosis - almost always • Chronic nephritis • Renal dysplasia - Pain • Renal stones • Tumour • Acute nephritis • Pyelonephritis Additional exams o Cystocentesis - for a pure urine sample, or owner can give you a sample o Urine analysis § pH, Specific gravity, Ketone, Glucose, Protein, Puss, Blood/haemoglobin, Bilirubin, Urobilinogen, Sediment o Blood analysis - BUN o X ray using contracts techniques - can see ureters. o Ultrasound - can see cortex, medulla etc. Diseased kidney often has a brightening of the cortex. Renal pelvis can't usually be seen (as it is filled with fat) unless there is a problem. o Lower urinary tract • Urinary bladder o Inspection, Palpation Lay cat down (or standing), stretch hind legs out and use hand on one side to press bladder to wall and the other to feel it. Keep dog standing and use one hand to palpate bladder Normal condition - empty Palpation mainly determines size and painfulness (tenderness) (not really wall thickness) o Undulation test. o The size of the bladder of very dependent on how full it is. o Horse and cattle = rectal palpation o Unless uroliths are big, they cannot be palpated. o Abnormal findings: Dilatation • Acute - urethral obstruction (urinary bladder will be tense) • Chronic (neurogenic problem) • Thickened wall - cystitis, tumor • Pain - cystitis, stones • abnormal surface - tumors Urethra o Males: Longer and thinner in males and obstruction is more common. Rectal examination (excepts cats) • Palpation (pelvic part) Male can palpate perianal area Examination of the prepuce and penis • Inspection (penile part and opening of the urethra) • Palpation (penile part and opening of the urethra) o Females Vaginal examination • Can visualise entrance - opening of the urethra • Prostate o Problem of Male dogs o Palpation - Via rectal examination, Size, shape, symmetry, consistency, pain o Imaging methods (X-ray, US) o Urinalysis o Examination of prostatic fluid (prostatic massage) o Examination of semen o Cytology, biopsy • Additional exams: o Catheterisation - only to see if urethra is free of obstruction - NOT to obtain urine as can introduce bacteria. o X ray - usually use double contrast to see bladder - air and dye. Used for filling defect, rupture, stones etc. o Ultrasound is very good. The bladder is easy to visualise and you can see stones that do not show on x ray etc. Also for prostate. • Uroliths can be very large. Use x rays - often a contrast x ray using air is used. Be careful with catheterisation if there is a danger the ureter is blocked. • Neutered older males cats are prone to uroliths - struvite - alter diet to be more acidic as struvite crystals form in alkaline urine • Urination abnormalities - may be many conditions which can cause this: o Diabetes mellitus o Kidney failure o UTI - particularly female dogs. o Also after neutering female (and male!) dogs due to decreased oestrogen levels o Liver problems o Cushing's or Addison's disease • Do a urine test - see below. Also complete blood panel. • Terms: o Polyurea - urinating a lot at one time. May by seen with polydipsia (drinking a lot). o Polakiurea - frequent urination in small quantities o Anurea (no urine) is potentially very serious and should be treated immediately! o Dysurea abnormal urination o Strangurea - painful urination o Haematurea - blood in urine o Peri urea - cat urinating outside litter box - behavioural! • Know the characteristic posture for each species urinating - dog cocks leg, bitch squats, stallion stretches out back legs, pigs have pulsating urination etc. Posture may be abnormal due to locomotion problems

GQ 56. Examination of cranial nerves VII-XII. Signs of their dysfunction.

VII - Facial nerve: Mixed, mainly motor nerve. • Uni/bilateral paralysis of the nerve is known. involved in: o Sensory -> Caudal third tongue taste sensation o Motor (Palpebral (Eyelid reflex). Threat (menace) reflex. Corneal reflex. The facial nerve is used to move the muscles of the facial expression (not chewing muscles)) The following investigations are necessary to diagnose facial paralysis: o Position of the ears: Drooping at the affected side. Test by calling name or blow ear - ear should move to sound location. o Position of the upper eyelids: Ptosis, paralysis of the orbicular eye muscles o Displacement of the nostrils; Muscle tone loss on affected side so turns away from the affected side (turns too healthy side). First sign of facial paralysis in horses o Sagging of lips on the affected side Forms of facial paralysis: Severe (intracranial, intrapetroseal lesion): Drooping ear, lip. The nose pulled toward the normal side (Most obvious in the horses) Mild (peripheral lesion): Pointing ear, +/- ptosis, Sagging lips VIII - Vestibulocochlear nerve - hearing and postural reactions: Examination of hearing - cochlear division o Tested by calling name, whistling or make noise outside vision field. o Deafness § Can be congenital - blue eyed cats § Acquired Examination of the vestibular system 1) Peripheral vestibular system (vestibular division of the nerve) -Pars staticus - semicircular canals of the petrosal bone -The mental status and the postural reactions are regularly normal -Dysfunctions • Abnormal positioning of head - ipsilateral head tilt • Falling to affected side • Nystagmus (Usually horizontal. 2 stages - slow to affected side then quick back to normal side) • Strabismus • Horner's syndrome - Examination of the dysfunction of the Central vestibular system (cerebellar and brain stem lesion) (Severe asymmetric ataxia (circling, hypermetria) IX - Glossopharyngeal and X - Vagus Test together as responsible for swallowing, larynx, pharynx and gag reflex. -Glossopharyngeal is afferent - Sensory -Vagus is efferent - motor - Malfunctions cause dysphagia: weak/absent gag (swallowing) reflex, laryngeal paralysis Tests: 1) Swallowing/gag reflex; Small animal= Provoked by fingers reaching to the base of the tongue. Make sure don't have rabies Large animals= Nasogastric tube (in large animals). • Alternative: little water from syringe. 2) Laryngeal paralysis (recurrent laryngeal nerve of n. vagus). Important in horses (roaring), dogs. Unilateral - change in vocalisation - lose/altered voice. Bilateral - can be risk of suffocation and severe inspiratory dyspnoea XI -Accessory N. Deficits from injury to this nerve are not frequently recognised in animals. • Motor M. movement for M. trapezius, sternocephalic and brachiocephalic muscles should be palpated for atrophy. o Check sagging of head XII - Hypoglossal N. - tongue Responsible for protruding and retracting the tongue • Bilateral lesion=Protrusion of the tongue with weak retraction • Unilateral lesion=Tongue hangs from corner of mouth - ipsilateral deviation (to damaged side) • Look at position and movability of tongue. • Horse - grab tongue, retraction is tested • Small - offer food or water - will lick nose afterwards. If can lick nose ok is normal. Retraction is also tested • Systemic problem like botulism can paralyse tongue

GQ 23. Dyspnoe.

dyspnea caused by difficulties of respiration (compression, obstruction of the air passages, decreased lung compliance). During resting or better at works the muscles working in respiration seem to do their work forcedly TYPES 1. Inspiratory dyspnea - Caused by -narrowed upper airways (stridor) (laryngeal edema, laryngeal paralysis, stenotic nares, etc) -pneumothorax -pleural effusions -diffuse pneumonia Signs(prolonged and labored inspiration) Inspiratory phase is longer, extension of the head and neck, nostril dilatation, labial respiration, spreading of the scapules,exaggerated intercostal activity, slack or sunken flanks and sagging belly 2. Expiratory dyspnea Caused by -compression or obstruction of lower air passages -microbronchitis -(pulmonary emphysema) -fibrous pleuritis -rarely neoplasms in larynx and pharynx Signs (prolonged and labored exspiration) Expiratory phase is longer, the work of abdominal muscles is more severe, extension of the head and neck, thorax very fasten collapsed during expiration. Expiratory dyspnea is abdominal, duplicate or strongly held "heave line" 3. Mixed dyspnea Caused by -decreased compliance -pulmonary edema -pulmonary emphysema -neoplasma -compressed diaphragm Signs Forced inspiration and expiration

Normal finding of Nose region

outline of the nose is characteristic on the breed, symmetrical. The temperature is the same as the surroundings, the palpation is not painful. The percussion sound is sharp, bone-like above the bones Faint regular noise during expiration. The expired air is medium strong, warm, symmetrical, the odor is characteristic on the breed. The nostrils have regular shape and symmetrical width. The nasal alae are not moving during in- and expiration. The outer inspection and palpation of the paranasal sinuses don't prove any abnormalities, any sign of swelling or asymmetry, the skin is intact, the temperature is the same as the surroundings, the palpation is not painful, the percussion sound of the paranasal sinuses is sharp, bone-like sound. The nasal plane is moist, intact, has black color, there is no nasal discharge. The soft and hard palate are intact, moist, pinkish red. The mm of the nose is intact, smooth, shiny, light pink.

GQ 35. Intake of feed and water, the abnormalities of chewing and swallowing. Examination of the vomitus, its diagnostic significance. Vomitus and regurgitation.

• History: o Need to do a basic complete physical exam first o Appetite, water intake, mastication, picking food up, chewing, swallowing, defecation, pain - Why isn't your animal eating? • Ulcer or painful tooth • Neural issue? Can't chew(trigeminal), smell (olfactory), and see the food(optic)? • GI problem à lost its appetite (ileus, gastric or duodenal ulcerations) • Check head externally and internally. o Externally -> Check symmetry, chewing musculature (cheeks), pain, lips, facial bones. Drooping jaw, ear, nostril can be signs of nerve damage (facial). Can animal open and close its jaws - if not - could be rabies, Damage to trigeminal etc. See tests for cranial nerves below - for trigeminal and facial o Internally Look at teeth. • Some species teeth grow and get sharp edges - horse and rabbits. • Horse - examine with mouth gag and file rough edges. • Look for food in sides of cheeks. • Old horses may have loose/no teeth so need to be fed very soft food. • Rabbits may need teeth checked and clipped • Other species also check teeth are not loose and painful. Also check for painful gums - uraemia. Cats - Feline odontoclastic resorptive lesion (FORL) • Teeth become functionally destroyed - Check tongue can move. • Offer food to animal or put drop of water on nose - tongue ok if animal can lick it off. - Cheeks, MM, hard and soft palate, pharynx, tonsils, salivary glands and salivation (increased salivation = inflammation) • Other feed and water related problems o Swallowing - offer food. § Check for blocked oesophagus • Check for foreign bodies - x ray • Botallo - Strangulation • Puppy at weaning may start to regurgitate due to oesophageal problems - milk could trickle past but hard food can't get past. • Check no foreign bodies - x-ray o Animal may refuse food or water if it has great pain elsewhere e.g-> colic, volvus, ileus, gastric or duodenal ulcers o Refusing food may be physiological e.g before giving birth. o Intake of water will increase in hot weather. -> Animal may decline water in cold weather if water not correct temperature or horses travelling may decline 'foreign' water. o Animal may eat more in cold weather and some species food intake is determined by energy requirement such as cats. o Other such as dogs will eat all they can and can be prone to obesity Vomiting and regurgitation - see phone • Regurgitation - passive o Content comes back from the oesophagus shortly after eating. o Gagging is characteristic of an oesophageal disorder. o Content is mixed with saliva, not stomach content so has a higher pH than vomit. o Puppy at weaning may start to regurgitate due to oesophageal problems - milk could trickle past but hard food can't get past. • Vomiting - active o Contraction of muscles - vomit comes from stomach or GI tract. o Vomit pH is low if from stomach. o If from GI tract will be mixed with bile. o Natural phenomenon of bitches to feed their young o Examination - look at pH, look for parasites, blood (stomach ulcers, cancers), undigested food. o Often vomiting is for reasons unrelated to GI tract such as pancreatitis, toxins, liver disease, kidney disease -use blood tests: Liver cell enzymes • ALT (Carnivore liver specific) • AST (herbivore liver specific). • Bile duct obstruction enzymes - GGT (liver specific in horses and cats) • ALKP - not liver specific in cat. • Increases if tubular cell damage Kidney, urea = • Protein/creatinine ratio Pancreas - amylase, lipase o Causes= 1) Obstruction • Foreign body • Tumor - Mast cell tumors can cause vomiting due to histamine release 2)Gastrointestinal inflammation • Inflammotory bowel disease, helicobacter gastritis • Pancreatitis

GQ 44. Physical and additional examination of the genital tract in female and male animals

• Unless a breeding animal most owners don't notice repro problems, unless linked to a systemic problem e.g. pyometra or mammary gland tumour • Nationale - age is important. Older dogs prone to neoplasms. Every male dog above 7 years will have prostatic enlargement. Testicle tumours are common too. • History. Is the animal neutered? Bitches spayed before 1st heat, much less prone to mammary gland tumours. Male animals - was it a cryptorchid and was the testicle successfully located and removed (otherwise cancer). Male castrated cats are more prone to UTI problems. Examination of Male Genital Tract • History - ask about mating, libido, urination problems, prepuce discharge. • Physical exam - inspection, palpation (and percussion) • Examine scrotum and testicles. o Location, size, shape, structure, skin, surface, painfulness, temperature, symmetry, movability, content, consistency o Look out of scrotal hernia. o Testicles look out for inflammation, tumours, and cryptorchidism. -Testicles should have descended within one month, and no longer than 6 months. - Certain drugs can be attempted to make them descend (HCG, GnRH) but are these ethical as cryptorchids should NOT be bred from? - Sertoli cell tumour will produce estrogen (hyperoestrogenism), so can have male dog producing milk, symmetrical hair loss and secondary female sexual characteristics (gynecomastia). - Also examine epididymis. • Penis o Shape, size, mucosa, painfulness, consistency o If urine clear but blood from prepuce - injury to penis • Prepuce o Size of the orifice, discharge, mucosa, skin • Prostate gland via rectal examination. o Location, size, shape, structure, surface, painfulness, symmetry, movability, consistency. o Look for hyperplasia, tumour, abscess, cyst. o Animal will cry if exam is painful. Can use ultrasound probe for more information o If prostate problem will be blood in urine - VERY IMPORTANT • Inguinal ring is not a common part of male genital tract exam unless a hernia is suspected • Additional exams: o Ultrasound is useful for testes and prostate. Radiography for penis and prostate but not very specific. o Urinary catheter can be used to see if urethra is blocked. o Also cytology, laparotomy, bacterial culture if prostate abscess Female genital tract • - History o Vulvar discharge, oestrus cycles, mating, pregnany/pesudopregnancy, o Parturition and postpartum period o Hormone therapy, neutering, abdominal distension • -Physical exam - Inspection and palpation. o Vulva and perivulvar area o Vagina o Abdomen (uterus and ovaries) o Mammary gland/udder • Vulva and perivulvar area o Vulvar discharge, skin, size, shape, vulvar opening, mucosa. o Is discharge mucopurulent - yellowish, or haemopurulent - chocolate like a-Colour, consistency, smell. b-May only get discharge after abdominal palpation • Vagina and vestibulum o Mucosa, surface, painfulness, consistency, deformities, presence of fetus/neoplasm o Can examine outer parts but need a vaginascope for inner parts. • Uterus and ovaries o Cattle, horse: Rectal - even in physiologic finding. Shape, size, symmetry, uterus content o Dog, cat: through abdomen, only if enlarged. pyometra (dog), mucometra(cat), pregnancy, tumour. Ovaries are situated at the third lumbar vertebrae behind the kidney - normally can't palpate • Mammary gland/udder o Location, shape, size, painfulness, consistency, skin temperature, structure, deformities, milk. o Always check mammary gland as part of any physical exam as it is prone to tumours, particularly in intact bitches. o Can be malignant and metastise to the lungs. Neoplasms tend to have sharp edges and to be firm and circumscribed. • Additional exams o If suspect tumours get a CBC (complete blood count) and biochemistry, o Cytology (vaginal smear), microbiology (discharge/milk) o Hormone measurements (oestrogen/progesterone), o Ultrasound (uterus, ovaries), radiography, vaginoscop

GQ 4. Parts of the current clinical state (status praesens). The order of organ system examinations. General state (General clinical impression).

(continuation from 3) Status praesens (current state): 1) General impression (Body shape, size, development state, nutritional condition, general condition/grooming/foopats, nails/claws), Contiousness/behaviour, posture, locomotion, obvious denormaltied. 2) Nutritional condition/M./fat- BCS: ( 5.obese, 4.Sout, 3. Normal, 2, Undeweight, 1, emieted/coud b EPI) 3) Contiousness/behaviour ( bright alert, normal reponse to external stimulation (pathological beh; poor/sleepy, Stupor (not very resposive, come) self mutulation, aggression, tail cheweing, convulsive, fly biting) 4) Posture loocomotoon ( Head, neck, ear, trunk, spinal cord, lect, tail, weight baring) stand; equal on all legs, (Spinal cord: lying on sternum, side, recumbet, sitting: Kryphosis, Lordosis, scoliosis) (gait; laimness) 5) Obvious abnormalties - opisStoToNus head pressing

GQ 9. The thickness, elasticity, greasiness, sensitivity and humidity of the skin.

1) Condition of the epidermis (ok= intact) 2) Color&presence of hemorrhages 3) Odor>> sex hormones, sebatious gl/appocrine sweat fl produce smeell, Urelmia(Urea in blood)= Ammonia smell, DiabetesM. = acetone/Kiton Bodies. Male goats smel distinct 2 4) Temp by extremities & body . bc haricoat take temperature not like in humans 5) *Moistness*/Humidity - ((sweating, sudation=sweat glands of the skin secreting a salty fluid;, hidrosis=Act of swetting, hypohydrosis , hyperhydrosis)) Ex: Apocrine sweat gl - horse have them everywhere (thermoregulation) RU on lateral neck, behind ear, near groid and udded. Sheep/goat on side of tights. Exocrine sweat gl are on footpads, nasal plane + lower eyelids of K9/Fel 6) *Greasiness *- (seborrhoea sicca / s. oleosa, *palpate+smell!!!)* Sebatious gl. palpate n smell. Increased prod aka seborrhae oleosa (skin disease seen in dogs and rarely in cats. It is characterized by a defect in keratinization or cornification), Less production aka Seborrhae sicca 7) *Thicness* K9 - .5-5 mm fel - .4-2mm thickest @ bacck/rump/base of tail/dorsamneck/thorax. Thinnes@pinnsr, ingunl/perianal areas 8) *elasticity* : Tugor/dehy/collagen/elastic fiber content ex old K9/fel has less mayb bc <Cushing. 9) *Sensitivity*(pruritus (an unpleasant sensation that provokes the desire to scratch) , hyperaesthesia (oversensitive skin) . hypoaesthesia 10) Ectoparasites: Fleas, Lice, 11)Skin lesions (enanthema,Efforestenia 13) Skin swelling

GQ 7. Examination of the hair coat, accessory parts of the skin and ear.

1) Density: Alopecia - lack of hair, 2 types a) Primarry - Endocrine/congenital. Easy 2 pull our hair, Symetrically often Hypothyroid or Cushings b) Secondary - Trauma/inflam. Hard to pull out harid. not symetrically. c) Hyperkeratosis - increased harir. Alopasia can B= localised/generalised, single/multipl, Continour/circumscribed, patchy/diffuase, Multifocal/focal 2) Color - Species n breed differe 3) Gloss - grooming, nutrition 4) Clousure - how skin sits next to the coar 5) How loose is hair - hypothricosis: excessive harid Hyperthrcosis 6) Stiffness (can differe bw breeds ex Wire haired terrier vs yorki) 7) Localisation of abnormalities, 8) Parasites (puritis-flies? look for them by aroudn face) Accessory parts of the skin include: - Food pads nasal plane (nasal planum is the pigmented, hairless, rostralmost surface of the external nose. The philtrum is the midsagittal external crease in the nasal planum) , cutaneour appenages (claws/nails/hooves/horns) Perianal & circumanal - lots of very small glands round the anus Paraproctal (ex the 2 big glands around anus) external ear - Look: Swellings, lesions discharge, dirty, gritty substaces? might b mites

GQ 3. History-taking, parts of the history.

1) Inquires concerning animals (5) : A- Health status (ill how long, abnormal observed, any changes in state since observed disease, Same/other symptomps previously obsered, yes? what time?) B- Prev vet vissit (vet intervention, previous treatment, immunity, operation, diagnostic process,f vaccines) C- Reproduction state (fem= Oestrous, parturation, bres, contraceptives etc) (male=mating neutered) D- Productivity (utilizing) E- Treansport (stress, injusry, crouding- Different diseases might b present) 2) Inquire of Envioment A- Health state of animal population ( # species 2gether w sick one, How # ill? sim/different? loss in population? yes? how many? Lab instrumental examinations preformed, general epidermilogy; parasited state of group/hers) B- Hustbendry (houseing, Hyggine control, possiblility of toxins ngestem Change in people working there?) C- Nutrition (quality/ quantity, feedign technology.. h20 intake, way they drink, fecies) D- Changed owner?

GQ 54. Examination of pain sensation.

1) Nociceptive (painful) reflexes -Anal/perineal reflex (important). Gentle squeeze skin round anus or squeeze vulva - see anus contract and tail may lower. Afferent and efferent is n. pudendalis. Tail movement is n. rectalis caudalis - Panniculus reflex (important) Afferent: spinal segments Reflex Center: C7-T1. Efferent: m. cutaneus trunci. Technique • forceps to grab skin along back - should twitch, caudal to cranial - skin should twitch - tests m. cutaneus trunci • Also use needle to scratch spine skin - is afferentation from each spinal segment & reflex centre is C7-T1. • Spinal cord injury= No reflex caudally from injury, if no reflex at all, injury is at reflex centre - localise this way. Flexor (withdrawal) reflexes of limbs (important) A) Forelimb: • Reflex centre forelimb is C6-T1 • Squeeze interdigital skin on forelimb - animal should pull away. • If unconscious - pain sensation (check the heart rate maybe) B) Hindlimbs • Same test but reflex centre is L4/6 to S1 Examination of pain perception - last step of spinal exam 1- Superficial (cutaneous) pain perception o Assessed mainly by pinching/pricking with a pencil/needle or light pressure of skin - done via panniculus, perianal or flexor reflex o Normal response: a) skin twitch, leg withdrawal: panniculus and flexor reflex b) behavioural - crying, biting, turning to direction of pain via long pathways: receptor-spinal ganglion-thalamus-cortex Evaluation: normaesthesia, hyperaesthesia, anaesthesia, paraesthesia 2- Deep pain perception o Testing is not necessary if superficial pain perception is present o Assessed by squeezing a digit or the rim of a nail with a haemostat (arterial clamp) or with a strong pressure in large animals (tread on rim of coronary band) o If deep pain absent - bad prognosis 3- Percussion of vertebral column with hammer. Palpate as detailed above. o Also can examine spine. Cervical - active bending (offer food) then passive bending with hands. Then can palpate vertebrae - cervical concentrate on palpating lateral processes, with lumbar palpate dorsal processes. Can also use hammer for pain percussion. Can bend tail over back to check for pain too

GQ 12. The swellings of the skin.

1) Oedema (excess fluid under skin bc; oesdema inflamation=swelling bc of injury, O. Stagnation=swelling of lower limbs, from fetlock 2 ground! , O.Hydraemica) 2) Emphysema (subcut emphysema= gas/air is trapped in subcutis skin. bc Trama..bitewound.. can be brepitate when touched) 3) Haematome (collection of blood in tissues) Fel prone of Haematomas on ear. 4) Tumor (abnormal C. growth) Localization, #, size, temp, Pain, consistency, percussion, contain. Fel prone 2: - Basal C. tumor: Hairless masses - Squamous C. Carcinoma - Arise from hair follicle, see tips of eats/eyelids/nose/lips. -Mast C. T. nodule under skin -Fibro Sarcoma - Malignant soft tissue tumor. K9: - Papilomas - Lipoma (mature fat C. in subcut tissue Mast c. tumor Eq: (Sarcoid, squamous C. carcinoma, Melanomas especually gray 1)

GQ 52. Classifications, causes and signs of paresis/paralysis.

Def: abnormal posture or movement due to reduced or increased muscular tone without incoordination o Paresis - lacks muscular strength o Paralysis - has no muscular strength o Spastic paresis is increased muscle tone. Hyperplagia is rare. o Extraneural forms are frequent. Diagnostic methods: o Inspection, palpation, evaluation of muscle tone: o Atony, hypotony reduced muscular tone. Atony being worse o Hypertony - increased muscular tone o Schiff-Sherrington phenomenon= Can be seen in acute trauma to the spinal cord between T2 and L3. The rear limbs are atonic (paralysed) and the thoracic limbs have extensor rigidity Classification of paresis/paralysis (plegia) 1. By severity: • Paresis and paralysis/plegia (partial or complete loss of strength) 2. By the affected limbs of the body: • Monoparalysis (-plegia, -paresis): one limb • Tetraparalysis (-plegia, -paresis): all limbs • Paraparalysis (-plegia, -paresis): rear/hind limbs • Hemiparalysis (-plegia, -paresis): ipsilateral limbs 3. By muscle tone: • Rigid, spastic • Atonic, flaccid 4. By origin: • Upper motor neuron. o Injury above spinal nerve nucleus (spinal reflex centre). o Front legs lose inhibitory activity and muscle tone is increased on affected leg. o Spinal reflexes are over-responsive o Manifestation overview a- Reflexes - Hyperactive b- Tone - increased • Lower motor neuron o Injury is in spinal nerve nucleus or below that. o Brachial plexus or lumbosacral plexus - affected leg(s) with loss of muscle activity and tone. o Spinal reflexes are reduced on that leg (muscle weakness) o Manifestation overview: a- Reflexes - Diminished or absent b- Tone - Decreased or absent • General conditions o Paraplegia -both hind limbs paralysed - common in Daxi re discus hernia. o Botulism can cause tetraplegia - not a CNS disease. o Rabies - flaccid tetraplegia. Dies 5-7 days later.

GQ 18. Examination of the cough, cough induction. STEPS of the EXAMINATION 1. nose and paranasal sinuses 2. *coughing* 3. larynx and pharynx 4. trachea 5. thorax

Def: reflex, respiratory system protects itself vs injury/foreign materials. - Reflex can occur via stimulation of the airways anywhere from the larynx to the larger bronchi Start w: -origin (spontaneous or stimulated) -frequency (rare, frequent, paroxysmal) -strength (weak, medium intense, intense, with or without snap) -tone (sharp, dull, barking, rattling, roaring, hoarse) -occurrence (during night, mornings, in the daytime, continuously, only in special environment) -duration (short, medium long, long, held) -secretion content (dry, medium wet, wet) -painful or painless -deepness (superficial or deep) -*localization* of origin: *Larynx* - episodical, heavy, gagging / retching, tendency to vomit - Larynx paralysis: deep, long, hars *Trachea* - Tracheitis: loud, explosive barking like - trachea collapse: goose honking cough *Bronchi* - acute phase: pattern = tracheitis - chronic phase: mucus, pus, wet, rough *Lung* *emphysema* *chronic* bronchitis: - short, weak, dry *Pneumonia* - soft • Cardiac disease -wet, hacking cough -the quality of sputum Induce couthing: Sm. Rum/k9/fel pressing the tracheal rings or pressing the thorax very rapidly during expiration Healthy= sheep and goat Stimulated cough is weak, deep, groaning-like, dry, medium held, painless, does not recur dog and cat Stimulated cough is medium held, unsnapping, medium intensive, medium deep, dry, painless, does not recur EQ- press the larynx with one hand or two hands if it unsuccessful, press the tracheal rings near to the larynx Healthy= Ø cough spontaneously, cough stimulation is difficult, hardly done. Stimulated coughing is intensive, sharp, high, short, dry, painless, snapping, does not recur Cow: close mouth and nasal occlusion with hands or plastic bag until air hunger Healthy= healthy cow doesn't cough spontaneously, cough stimulation is difficult. Stimulated coughing is medium intensive, medium deep, more dull, held, dry, painless, unsnapping, does not recur

GQ 15. Examination methods of the visible mucous membranes, their examination in carnivores.

MUCOUS MEMBRANES • METHODS -inspection -palpation -(smelling) • ADDITIONAL EXAMINATIONS -endoscopy -US -X-ray, contrast X-ray -discharge, secretion: quantitative, qualitative, microbiology, cytology MM 2 test: 1)Conjunctivae, 2)Oral mm, <Nasal, anal genital EXAMINATIONS 1. Color 2. Moisture (mucus, quantity, quality) 3. Membrane vessels-haemorrhages 4. Surface: lesions, smoothness 5. Capillary refill time (<2 sec) Normal findings MM: light pink (pigmented), smooth, (conjunctiva: moderately ruffled), shiny, moist, no lesions (intact), blood vessels can be slightly recognized, CRT: 1"

GQ 49. Changes in behaviour/sensorium: excitation and depression.

Mental state • Part of the brain responsible for mental status is the *thalamocortex* • The brainstem influences the mental state o ARAS: Ascending Reticular Activating System • Normal status a) Consciousness: Components: being aware of the surroundings, ability to learn and remember & Manifests in the reactions to enviromental (optical, acoustical sound, pain) stimuli (behavior) b) Level of consciousness (mental status): Normal level: alert or attentive. Pathological levels: decreased or increased. Differences exist between species, even between breeds! • Reduced mental state: o Dementia. Alert but inappropriate behaviour, stupidness e.g. forgets food is in mouth. Often paces and is restless at night (dogs) o Stupor - only reacts to strong stimuli o Indolentia - not interested in anything o Somnolentia - drowsiness o Delirium - as if drunk o Coma - loss of consciousness, cannot be awoken (Should still have corneal reflex) • Increased mental state: o Excitement - pain - colic o Aggression - Rabies, Pseudorabies - Aujeszky's disease • Rage - red cocker - rage syndrome

GQ 40. Examination methods and findings of the abdomen in small animals.

Regions of the abdomen o Epigastric: from diaphragm to costal margin o Mesogastric: from costal margin till pelvis o Hypogastric: from pelvis backwards Inspection o Size and form. o From both sides, above and from front o Ascites in cat can be FIP. Also cushings. Palpation - slowly and carefully - most important o Watch reaction of patient. o Standing position (should be changed), from cranial to caudal. o Superficial and deep palpation -> Look at location, size, shape, relation to neighbouring organs, painfulness, surface, consistency, temp of skin, thickness of abdominal wall. o Palpable digestive organs: Stomach • Can sometimes be palpated if full not usually though • Gastroscopy Liver • Can only palpate liver in certain positions in some dogs as in general it is enclosed within the ribcage • Try dog in sitting position, ventrally at xipohoid process, though really need ultrasound to examine liver. • Cats the caudal border of the liver can often be palpated. GI loops • The main areas palpated in the abdomen along with the kidneys and urinary bladder. • Can't differentiate small and large intestine. Can feel foreign bodies and constipation - pencil like. Kidneys • Cat can palpate both. Just under last rib. Bean shaped, cherry like, surface is smooth, not painful, consistency is firm like muscle, slightly moveable, structure is homogeneous, and they are symmetrical. • Dogs can only palpate left kidney. Urinary bladder. • Lay cat down (or standing), stretch hind legs out and use hand on one side to press bladder to wall and the other to feel it. • Dog palpate urinary bladder in standing position or lying down § Spleen, mesenteric lymph nodes and pancreas can't be palpated Percussion o Finger to finger. Tap muscle - dull - long, damp, low intensity. Tap lung - resonant - high and short. Tap abdomen and see difference - if gas filled should be dull resonance (so in-between) - longer and duller than resonant. Can be tympanic (higher and longer) if lots of gas - volvus. Try to find organ filled with gas or fluid or enlargement using this method. o Also use undulation test - hand on one side and tap on other - see if vibration goes right to other hand -> Pseudoundulation Auscultation o Small animals Borborygmi sounds are normal sounds of GI tract, requiring the presence of fluid and gas. • Sounds are intermittent, infrequent, low toned and not very loud. • Frequent and loud indicates strong peristalsis. Abnormal sounds are splashing or crepitation. Frequency gives an indication about peristalsis. A totally empty abdominal tract can be silent.

GQ 59. Ultrasonography of the heart (echocardiography

See topic 45 for intro on US - Only sector transducers can be used. The number of windows are limited, and the examination planes differ from abdominal ultrasound. - Echocardiography is useful for: Examination of the cardiac chambers (wall, cavity), Recognition of valve disorders, Shunts with contrast echocardiography (e.g. PDA - patent ductus arteriosis and septal disorders), Quantative exams (and functional) examinations (e.g. fractional) shortening. Detection of blood flow disorders (Doppler echo in colour) = Direction, Speed and abnormal flow/turbulence Methods echocardiography: 1) M- mode (Unidirectional) echocardiography; Old fashioned and rarely used - movements of left ventricle (fractional shortening) o Two dimensional (B mode) echocardiography o Doppler echocardiography; 1) Color flow (CF) Doppler technique 2) Pulsed-wave (PW) Doppler technique 3) Continuous-wave (CW) Doppler technique 4) How it works: Get info from red blood cells and direction of flow. Red is flow towards transducer and blue away from transducer. Principle of Doppler is that if an object reflects waves, the frequency will be different (ex: sound of ambulance approaching you and going away from you). => Far away sound waves are spaced and get low freq, passing you sound waves closer together and get high freq.. See topic on computer for DCM and HCM • When carrying out echocardiography is it good to have a table with a cut out for ease of access. • Short and long axis are standard views. • Doppler lets you see the blood flow. I) The machine can even count and calculate the difference between RBC. II) If there is turbulence the difference in flow can be calculated. III) Different colours are plotted on a bar on the side of the display. IV) Is also possible to switch to spectral Doppler which gives the speed of the flow and can often by synchronised with an ECG. V) Flow to probe is positive, away from the probe is negative

GQ 6. Significance, methods and order of the skin examination.

Skin = largest organ of body 3NB: 1) Elasticty of skin/Hydration status 2)Less elastic/poos sparse haricoat & comedo foud on an old dog could be Cushings 3) Plaques indicates Eosinophil granuloma complex in Fel. Methods of examination 1) Inspection- general-local 2) Palplation pulling out hair/feather-> skin condition 3) Smelling 4) Additional examination a- Skin scraping (scalpel, superfishial just the skin, Deep scarpe until 1st capillary bleeding. takefrom diff areas NB:include borders of leasions!" pull out hari put into same syringe, push out follicle content (ex pus) b- Lab exams (culture bacto/fungy. use microscops) c- Otoscopy exam (external ear, look for any materials/ inflamation/greasyness/dirt might b mites d- Cytology (aspirate 22g 5ml syringe used, swab, smear, impression scraping. Helps w/if u are dealing w Inflam or Neopl. is not conclusive aspiration, do a biopsy (alwasy do if u have no idea but not needed for parasite diagosis) e- Blood tests (hormone function tests etc, T4/t3, sex hormones..) f- Histopathology - Immunoflouresence, Immunobiochem (more in human med) g- Special testsa (ANA test/ auto immune diease) Order of examination 1) Hair coat a) Density, B) Color, closure, occurance, stiffness, localisation/abnormalities, External parasites. 2) condition of the skin 3) Physicalexamination of skin leasions, 4) swellings, 5) cutaneous appendages, 6) external ear Folicular issus normally bc: Staph, Dermatophytes & Demodx.

GQ 46. Examination of the locomotor system.

• Bones, muscles, tendons, joints, and ligaments • Why should we examine? o Check for lameness and pain o Breed predisposition (e.g. Hip dysplasia is GSD) o Legal issues (sales and purchase), Traumatology (surgery), Disease of the locomotor organs. 1-Bone: fracture, inflammation, neoplasia 2-Muscles: hematoma, abscess, inflammation 3-Joints: septic arthritis, degenerative joint disease o Metabolic/systemic/other organ diseases with locomotor manifestation, Cushings (muscle, bone), Hyper and hypothyroidism (muscles), Diabetes mellitus (joints and muscles), Autoimmune disease (joints), Catabolic state: heart, kidney, septic disease->muscle. CNS PNS ->muscles. Tetanus->M. spasms caused by C. tetani. Hydrocephalus • Parts of the examination 1) Nationale: permanent and transient data of the animal 2) History: Any lameness, reluctance to get up from lying down, doesn't want to go for walks, doesn't want to climb stairs etc. 3) Physical Examination. a- General impression • Look at posture. Watch animal walking up and down, in a circle, up a hill or off a step. Can it sit and lie down then get up from that position easily. Usual general impression - poor haircoat in a cat - if it can't groom may be thiamine deficiency etc. b-Organs. c-Locomotor system • Order of the examination o Is it locomotor or another disease? o If it is locomotor ->localization o Other areas of the locomotory system? o Additional examination? o Treatment • Bones: skull, mandible, vertebral column, forelimb, hindlimb o Bone: shape, size, consistency (firm?), structure, skin above (intactness, temperature), pain, abnormal movement (crepitation - sound when fracture), symmetry, percussion (sound, pain), o Trauma o Congenital or developmental anomalies (e.g. prognathia inferior) o Neoplasia o Metabolic disorders (rubber jaw disease -> high PTH -> high phosphorous) o Skull: hydrocephalus, craniomandibular osteopathy, high rise syndrome in cats, neoplasia in nasal or paranasal sinuses, dental issues *Vertebra*: nutritional osteopathy, dislocation, hernia Look to see it the bones correct in alignment or are there abnormalities e.g. lordosis in very old Eq is normal a dipped back Hryphosis-upwards curvature of spine. Scoliosis-lateral deviation. Spondylosis-degenerative osteoarthritis of the joins. - Thiamine deficiency in the cat can cause malformation of the cervical spine and problems with movement and ataxia. o Limbs: longer bones, neoplasia - painful and malignant. Young dogs - Panosteitis. Old dogs - Acropachia (paraneoplastic) - hypertrophic osteodystrophy e.g. in GSD's. Additional examination; Xray, CT (cranium, spine, sinus), Scintigraphy - malignancies, Lab: Ca, P, vit D, PTH, kidney function, Osteolysis ->ALKP. Septic diseases = complete blood count, inflammation (globulins). Cytology, histopathology, microbiology, Larger animals = rectal examination= broken pelvis • Joints: Temperomandibular, Atlantoaxial, Intervertebral, Ileosacral, coccygeal, Limbs. o Degenerative Joint Diseases (breed predisposition; typically affected joints- hip dysplasia GSD; symmetry?) o Traumatic injuries (a penetrating injury may cause septic inflammation!) o polyarthritis: often septic or immune mediated o Standpoints:Shape (swelling= bone/joint fluid?, angle). Skin: intactness, temperature. Pain. Range of motion = ROM (increase/decrease) • Extension, flexion, rotation. Symmetry, crepitation? o Additional exams: Diagnostic imaging: • Radiography, CT, MRI, arthroscopy • Ultrasonography Arthrocentesis: Cytology, microbiology. Laboratory examination: • septic process suspected: CBC, inflammatory markers (globuline, CRP...) • Immunmediated process suspected: CBC, proteinuria o Joint fluid tapped. Normal: very small amount, clear, (light) straw coloured, viscous (sticky) • Muscles (and tendons) o Masticatory muscles, epaxial muscles of spinal chord, muscles of the front and the rear limb o Inspection - is the dog's musculature symmetrical? Is there muscle wastage? o Spastic paresis o Selenium deficiency= Deficiency can cause severe muscle breakdown called rhabdomyolysis o Myositis eosinophilica o Myoglobinuria paralytica equorum (Monday morning sickness)= Check urine o Standpoints 1)Volume: increase/decrease (hypertrophy/swelling, atrophy) 2)Consistency 3)Structure (anything inside? haematoma, abscessus, neoplasma) 4)Tone (flaccid, rigid, force - resistance for passive motion, ) 5)Pain 6)Skin: intactness, temperature, sensitivity 7)Symmerty 8)Fibrillar contractions, tic, clonus o Additional exams -Diagnostic imaging: • Ultrasound (rupture, abscess...) • MRI § Laboratory: • Blood: enzymes: CK, LDH, AST, ALT (myocyte injury) • blood: Ca, Mg, myoglobinaemia • Urine: myoglobinuria Functional: • EMG (elektromyographia) Other: • Biopsy (muscle, endplate) • • Serology: Neosporosis, Toxoplasmosis • Normal findings - posture, gait and musculature characteristic for the breed. All four limbs weight bear equally. Bone contour has a flowing line. No crepitation, looseness or pain. Temperature should be same as surrounding areas. Percussion on bones is bone like. By palpation can be easily flexed, extended and rotated. Joints and bones are symmetrical. Muscles are also flowing and continuous. Should be no rhythmic contractions and temperature is the same as the rest of the body. Consistency is muscle like and no abnormal tone. Deep palpation does not cause pain. Should be symmetrical.

GQ 17. Examination of the nose and the paranasal sinuses. Nasal discharge, breath, the examination of the respiratory sounds around the nostrils.

• CASE HISTORY - what signs (nasal discharge, coughing, abnormal sounds associated with breathing, abnormal vocalization, dyspnoe, sneezing, stridor-- /excact compliments, duration, progression). Did u see any nasal discharge/sound/couth/wheezing/abnormal vocalis/dyspnoea. vaccination hist, deworming enviroment, meds, other animals • PHYSICAL EXAMINATION - Nose+paranasal sinuses Examine internal&exter. Inspaction, Pal, percusionn smelling. 1)Nose Shape - Symetry/intact skin/consistency/temp/painful/moveab 2) Occurance of Nasal Strior - normal w faint regular noice @expiration (pig&breackaseph dogs) Abnorma if stridor Inhal/exhal. or snoring, reverse sneezing, singulation (hickups) purringm pain noises, alterations of voice (rabis) noiseless &panting. Stridor • Nasal stridor sniffing sound • Pharyngeal stridor snorring sound • Laryngeal stridor soft „sawing" sound • Collapsed trachea expiratory! tooting sound • Larynx paralysis inspiratory stridor • Narrow trachea, bronchus mixed stridor 3) expired air: strenght, symmetry (hands/mirror), temp, smell 4) Nasal discharge - Continuity (permanent/priodic) color, quality, quantiry, consistence, smell. side: before chonae=1 side behing=doubble (coagulopathy sys. inflam) = bactriological/cytolog/mycology/parasite exam. Xray 5) Nasal plane - Surface (intact) color/pigment, moistyre, K9/fel= have nasal plane, Eq/sheep=ø.) 6)nasal openings & nostriles: Shape, with, moveability, symmetrical. MM! 7)Palate, nasopharyn- w/w/o toops. EQ=only w Endoscopy &sedatied. K9/fel= open mouth look. 8) paranasal&frontal sinus- inspection, palpation , percussion (Xray/endoscopy in Eq.) (Maxilary+frontal=lacremal/spenoid+palentine. Sphenoplaentine+Ethmoid eq: guttural pouch - LOCATION EXAMINE(inspect/palpat/percussion-endoscopy/xray) borders: cran=caudal mandibule, Ventral=lingofacial v. Caudal=tendon of insertion of Sternocephalic)

GQ 22. Alterations of the normal respiratory sounds.

describe plac, strength, type, respiratory phase when heard. 1) Adverse resp sound a- crepitation - sounds like hair rubbing/broncho-pnemonia b- crackling-burning wood Broncho-pnem c- Rattling - Sucking coack wstraw. moving fluid in trachea/bronchi 2) Musical sound (dry) obstructive lung disease w/active expiration a- Whistling - high soud, accelerated airflow huih'sound b- Wheezing - low sounds, vibration of ariways 'bbuuuu' 3) other abnormal a- stridor - upper airways stenosis b- Rubbing . like snow crackling c- splashing gas/fluid movement like shaking a botte of water d- metallic 'plom plom' Paradoxical breathing • normal respiration: both the abdomen and chest move in and out together, allowing maximum expansion of the lungs. • Paradoxical respiration: • Chest movement is restricted, not able to expand properly - The intercostal muscles may collapse inwards with inspiration as they fatigue, and as greater negative pressures are created within the thoracic cavity; • Abdominal wall move in the opposite direction to that expected • reason: pleural fluid, pneumothorax, diaphragma paralysis, broken ribs etc

GQ 60. Ultrasonographycally detectable common abnormalities of the abdomen.

• Need good history and careful physical examination before an ultrasound. • See topic - 49 for intro • Can only do one section/organ at a time. More sound reflected the brighter is the image. Image continuously updated so can see peristalsis. • Use abdominal ultrasound when lab test and physical exam indicate more information is required. Also can be used for screening congenital diseases and elderly patients. Need a well trainer operator. • Position, size, shape, contours, echostructure, echogenicity (compared to other organs) • Liver - ultrasound is often used. Free abdominal fluid often occurs near liver lobes. Also see gall bladder (is fluid filled so it is black) and vessels. Can see lesions but range of differential diagnosis - tumour, abscess etc. Can use ultrasound to guide needle into lesion to take sample. • Spleen -Most echogenic organ - horse, is used to check the nephrosplenic space as the nephrosplenic ligament can entrap the large colon called 'nephrosplenic entrapament of the large colon -> causing colic. If liver is the same echogenicity as spleen could be connective tissue infiltration • Kidneys - diffuse changes may be bright - poisoning. -See medulla and pelvis (can't see pelvis in a normal dog) =Only see renal pelvis if there is a problem e.g. filled with fat, Can see ureters. Urinary bladder - including wall thickness and lumen - stones etc • Genitals; Uterus - can see pyometria - pus filled uterus. Just see black fluid though can't say what type of fluid it is. Also ovaries, prostate, testicles - shape, size, echostructure • GI tract and Pancreas - Intestinal invagination, ileus etc. • Stones - in intestines, urinary bladder etc. Even radiolucent stones not shown on x-ray can be seen on ultrasound. See stones as a reflection and a shadow. • Lymph Nodes - if enlarged and fluid filled are apparent. • Horse - abdominal exam often done intra-rectally due to problems with resolution. o As higher frequency get better resolution but worse penetration. So need to use low frequency with better penetration for horse and cow. • After a gas containing organ - can have a dark area of shadow as all sound waves have been reflected. Also at border between bone and soft tissue. • Ultrasound can see morphological changes so change in size, shape etc. • Different diseases look different as they progress - for example a fresh haematoma see fluid (dark) but later it gets fibrinous so may be bright.