Both veterinarians and technicians perform physical exam. It is the most common thing we do to every pet patient we see. Because it’s the most common procedure we perform, it’s easy to get complacent with performing a physical exam. The best way to make sure we don’t miss anything is to ensure we don’t skip steps.
Tip #1: START AT THE FRONT & WORK TOWARDS THE BACK
Say Hello & Look at the Eyes: The eyes tell you a lot about the patient. Neurological and mentation status, disease/illness and even the age of the pet can all be seen by really looking at the eyes and seeing how the patient interacts with you. Make sure the pet can focus on you, can visually see, has same size pupils responsive to light and appears to be neurologically appropriate.
During this introduction look at the hair/fur coat of your patient. Does it look healthy? Is there a lot of dandruff, dry hair coat, hair loss or patchy hair? Further examination of the integument system may be needed if the answer is yes.
Look in the Ears: If your patient will allow, perform an exam with an otoscope to look for signs of infection or disease. If your patient will not tolerate, do the best visual exam possible.
Check Out The Mouth: Be sure to check the four important parts in the mouth: Mucous membranes, capillary refill time, health of the teeth and guns and check the palates for disease (tumors). The hardest part about the mouth is sometimes our pet patients simply won’t allow us to perform that part of the physical exam.
Palpate the Lymph Nodes: In a typical physical exam we will palpate 3 sets of lymph nodes; submandibular, pre-scapular and popliteal. Give the dog or cat a nice neck scratch or rub those ears and then work your way down the neck and shoulders feeling for the lymph nodes.
Feel the Front Legs: Work down each leg feeling for lumps or bumps and any obviously areas of pain for the pet. Pick up each foot and look at the nails and pads. Make sure the pet is able to quickly place the foot back down in a correct position.
Feel the Chest and Spine: Palpate the entire spine working my way down along each vertebrae, looking for areas of any pain that may be indicated by the pet flinching, turning it’s head towards the pain source or vocalizing. Feel the chest and sternum for masses. You should easily feel the ribs, but not see them. Palpating the chest area will allow you to make recommendation to the owner for weight loss or weight gain and allow you to assign a body condition score.
Auscult the Heart/Lungs and Palpate Pulses at the Same Time: The more time you dedicate to truly listening to the heart, the better you will become over time at detecting arrythmias or murmurs. Too many times I see someone listen for less than 10 seconds. Take the time to listen and get a heart rate. When you have listened, palpate the femoral pulse. Feel for pulse strength and a matching rate.
Be sure when you listen to the lungs, you listen to the cranial and caudal fields in both the right and left chest. I frequently see this being rushed. The more normal lung sounds you hear, the easier it will become to hear one that is abnormal.
Palpate the Abdomen: Some of our pet patients are very tense for this, but usually even the most tense will allow you to feel the bladder, kidney and maybe even the liver and spleen. Palpation is performed to feel for any obvious masses in the abdomen or areas of pain where the pet reacts. Don’t forget to feel along the side of the pet for masses and check to make sure your pet has a visible waist line so you can score the pet’s body condition.
Feel the Hips and Hind Legs: Start by giving your patient a good scratch on its rump. Feel the pelvic bones for any obvious pain areas. You should be able to easily feel the hips, but not see them. This is a good indication if the pet has a good body score. In older dogs consider extending the hind legs forward and back to check for range of motion and any obvious pain like arthritis.
As you move down the legs feeling for any masses and be sure to check the popliteal lymph nodes. Similarly,, to the front legs, pick up each foot and look at the nails and pads. Make sure the pet is able to quickly place the foot back down in a correct position.
Feel the Tail & Look Under It: Be sure to palpate the tail and then lift it to look at the rectum. If the pet is intact, look at the genital areas and feel testicles for uniformity, masses or pain.
Maybe Take the Temperature: This use to be done during every physical exam and should be done if the pet is exhibiting any signs of illness or injury. The more recent thought is to skip the temperature if the patient has come in for a routine physical exam. If the pet looks unhealthy then taking a temperature is warranted.
Hopefully this blog jogs your memory about all the steps needed to perform a thorough physical exam. Take your time and don’t skip steps avoid missing anything in your pet patient.