1. Chapter 16
Testing Testing

2. Physical Examination Terms
Physical Examinations are performed to assess a patient’s condition.
Medical Records are important written documents.
assessment = evaluation of a condition
an examiner's evaluation of the disease or condition based on the patient's subjective report of the symptoms and course of the illness or condition and the examiner's objective findings, including data obtained through laboratory tests, physical examination, medical history, and information reported by family members and other health care team members
signalment = description of the animal
example of a signalment:
12-yr-old, F/S DLH
2-yr-old Arabian colt
4-mo-old barrows

3. Bell Work Monday, Feb 3 What do the following abbreviations stand for?MM
CRT HR RR PE

4. History
obtaining information useful in formulating a diagnosis and providing medical care to the patient.
Signalment
Chief complaint (what is wrong)
Duration of complaint (how long)
Past medical problems
Medications (including OTC, Holistic herbs, Supplements)
Diet
Review of all organ systems (brief or extensive?)

5. Vital Signs
Vital signs are parameters taken from the animal to assess its health.
Temperature (T)
febrile versus afebrile
pyrexia
Hypothermia
Where measured: Rectal vs ear canal vs other?
Pulse (P)
Weak (heart failure, low blood pressure, shock)
Strong
Bounding, Regular, Irregular
Where measured: femoral artery most common
Respiration (R)
Fast (panting)
Labored (increased effort to breathe-heart disease/ can’t get enough oxygen)
Abdominal (pleural effusion-lungs are impaired)
How measured

6. Vital Signs Heart Rate Blood Pressure Too high Too low
Rhythm- irregular
Sounds – whooshing, muffled, non existant
Blood Pressure
Too high/ Too low
Unstable
150/95 ( / ) Systolic/Diastolic
Cardiovascular, renal, ocular pressure

7. Vital Signs Mucous Membranes Capillary Refill Time Pink (bubble gum)
White – pale
Blue – cyanotic
Red - (bright red or brick red)
Yellow - jaundiced
Capillary Refill Time
1-2 seconds is normal
<1 second (less than 1 second)
>2 seconds (greater than 2 seconds)
slow, dehydration, shock, poor perfusion

8. Types of Examination Auscultation Palpation (NOT palpitation!)
the act of listening to body sounds
Heart, gut sounds, lungs
Palpation (NOT palpitation!)
examination by feeling
Limbs, abdomen
Percussion
examination by tapping the surface to determine density of a body area
For example, since the heart is not resonant and the adjacent lungs are, when the examiner's fingers strike the chest over the heart the sound waves will change in pitch.

9. Shock
Lack of adequate blood volume to perfuse the body’s tissues. Results can be fatal as multiple organs fail.
Symptoms:
Mm = pale, white, gray
Hr=very high (or very low)
Rr=very high or very slow and labored
Difficulty breathing
Pulse is weak and very high
Confusion, stupor, weak, depressed

10. Examples Blunt trauma Penetrating trauma Poison/toxin
HBC, high rise syndrome
Penetrating trauma
Gunshot, knife, stick impalement
Poison/toxin
Hyperthermia/hypothermia
Bloat
Massive infection (septic shock)

11. How shock is treated
Shock is called hypovolemic shock decreased blood volume (blood and fluid /plasma)
Heart is unable to pump blood to the tissues
To correct hypovolemia you must replace the blood /fluid
Medications to increase blood pressure
Dopamine, epinephrine, norepinephrine

12. Determine the order of triage for the following critical cases:
8 yr, M/N dog, HBC. Has a wound in back left leg. MM are pink and the dog is walking.
4 yr, M/N cat. Extremely weak and not walking. Hx of straining in the litter box the day prior and not passing urine. Gums are pink.
2 yr, F/S Golden Retriever. Playing in the backyard and came inside with a swollen face. Difficulty breathing, gums are pale pink. Dog is a little depressed but alert, HR is 120, RR is panting
7 week old Chihuahua puppy. Hasn’t eaten all day. Wobbly when walking, T=99.9°, mm=pale pink. No hx of vomiting or diarrhea

13. Instruments used in Physical Exam
Stethoscope
Parts of stethoscope
Diaphragm
Bell
earpieces
Auscultating body sounds
Heart
Lungs
Digestive system
Borborgamus
Ileus

14. Otoscope Light and an ear speculum
Battery operated
Allows visualization of the ear canal
Also allows visualization of other areas

15. Ophthalmoscope
Used to look at the retina

16. Laryngoscope View the pharynx Assists in lowering epiglottis
Access to trachea for intubation

17. Speculum Ehances visualization of an opening Many kinds of specula
Ear speculum (“cone”)
Mouth speculum

18. Centrifuge
Spins fluid samples (blood, urine, feces in solution) to separate fluid from heavier solid particles
Should always be a counterweight to balance

19. Microhematocrit Centrifuge
Small thin tubes of blood
Separates red blood cells (heavier) from the plasma
Hematocrit =
Ratio of red blood
cells in blood
Normal would be
>40%
Also called PCV

20. Refractometer Measure specific gravity of
(concentration of solutes) in body
fluids such as urine.

21. Soap: A way to organize
Subjective
Objective
Assessment
Plan

22. Subjective Personal Opinion Open to interpretation
Definition of Subjective
Personal
Opinion
Open to interpretation
Not necessarily facts
Something perceived by someone else (client)
This section should capture your subjective evaluation of the animal, herd, or problem, the client’s observations, the client can be asked directed questions about any complaints – current or reportedly resolved -- and ask appropriate follow-up questions and document all responses.
(e.g. BAR – bright, alert, responsive; depressed; improving; getting worse, no change, etc.)

23. Objective Definition of Objective Facts
Unbiased or uninfluenced by another person including yourself
It is what it is
This section is compiled from the physical exam and diagnostic test or procedures;
it typically summarizes measurable data
(e.g. rectal temperature, blood glucose, echocardiography, etc.)

24. Assessment Evaluation Judgement
This section is an analysis of the subjective and objective data
For this component, the veterinarian pulls together the subjective
information gathered during the interview with the client and the objective findings of the physical exam (and, possibly, laboratory or other study results) and consolidates them into a short assessment.
The assessment portion usually shows processes by which you arrived at a conclusion or diagnosis…Includes “rule outs”
Is written very specific and concise

25. Plan Detailed Decisive Action (or no action)
A plan would include anything that will be done as a consequence of the assessment and could include:
Laboratory tests, hospitalization, treatment, medications, follow up instructions to client, next appointment

26. Some videos, PE https://www.youtube.com/watch?v=LF1bd-JYhyo
Animated dog exam
(30 min long-cow)
Cow exam
For fun (11 min…vet student)

27. Bell Work Monday, Feb 10
An example of a subjective component of a SOAP would be:
An example of an objective component of a SOAP would be:
The assessment portion would include:
The plan would include:

28. Tomorrow: Tuesday in the Lab
You might want to bring an old shirt to cover clothing
There will be a short worksheet-You will need to have a pen or pencil
Be aware that you may need to assist a classmate if they unexpectedly get ill…
Be interested! Not grossed out! Yes, stuff smells, but you may never see the inside of a cow stomach again!

29. Bell Work Tuesday, Feb 18 What is a disease? What makes it a disease?
Name some animal diseases.

30. Pathogenic Organism and Disease Terms
microorganism that produces disease
A living organism of microscopic dimensions
Not all microorganisms are pathogens
The microorganism in the pictures is not a pathogen- does not produce a disease, in fact…

31. Pathogenic Organism and Disease Terms
deviation from normal
infectious disease
noninfectious disease
contagious (communicable) disease
iatrogenic disease
idiopathic disease

32. Koch’s “germ” Theory (simplified)
Defines an infectious disease
The infectious agent should be detectable in sick animals but not healthy animals
It should be possible to isolate and culture (grow) the organism
Organisms taken from the culture and introduced into a healthy animal should cause the same disease
The same organism should be isolated from the second animal as well

33. Infectious Disease
Caused by microorganisms that gain entry into the animal’s body
How does a microorganism gain entry?
Transmission
Bloodborne – blood/ body fluids
Airborne – respiratory droplets
Fecal-oral transmission – eating, drinking, licking contaminated food, water, objects
Vector-borne- bloodsucking arthropods (insects such as mosquitoes, ticks, mites) that carry the disease from one to another
Direct contact

34. Bell Work Wed Feb 19 True or False
A pathogen is a microorganism that produces disease.
True
Not all microorganisms are pathogens.
True-example of microbes in rumen
Transmission has to do with whether or not a disease is disease.
False-transmission has to do with how a microorganism gains entry
According to Koch’s Germ Theory (aka Koch’s Postulates) a healthy animal could become sick if a pathogen from a sick animal were introduced into the healthy animal.

35. Assignment: due Wed Feb 19
Find an example of each of the following:
A bloodborne disease (keyword-secretions)
Felv, FIV, FIP, Canine Herpesvirus (CHV),
An airborne disease
Kennel Cough, Feline Viral Rhinotracheitis
A vector-borne disease
Heartworm, WNV, (Hantavirus, plague-animals as vectors)
A disease transmitted by the fecal- oral route
Parvovirus, roundworms, Cryptosporidosis
Direct contact- touch, bite, scratch
Anthrax, coronavirus, mersa

36. Bloodborne disease Example: Hepatitis B and C in humans FIV, FIP, FeLV
Definition: Disease-producing microorganisms transmitted by means of blood, tissue, and body fluids containing blood
Blood borne transmission is also considered Direct (or Indirect Contact?) Could be Droplet?
Transmission of Pathogens
Potential exposure occurs through contact with blood, bloody saliva, vaginal secretions, semen, and other potentially infectious bodily fluids.
Sources of Infection
Pathogens can be transmitted through open cuts, blisters, sores, acne, body piercings, new tattoos, amniotic fluid, joint fluid, brain and spinal cord fluid, fluid from around the heart, and body cavity fluid.
Example: Hepatitis B and C in humans
FIV, FIP, FeLV

37. Contagious vs Noncontagious
Contagious diseases are spread animal to animal
Contagious diseases are also called communicable diseases and are spread through direct or indirect contact
An inanimate object that is contaminated with a contagious disease is called a “fomite”
Fomites are sources of infection for other animals
Water and food bowls, kennels, clothing and shoes
Not all infectious diseases are contagious
Tetanus

38. Infectious Diseases
4 classes of agents (an agent is something that produces an effect)
Bacterium/Bacteria
Virus/Viruses
Fungus/Fungi
Parasites

39. 1. Bacteria Staphylococci- (cocci means round) – round, clusters
Skin infections, wounds, food poisoning
Streptococci-round, chains
Strangles
Bacilli – rod shaped
anthrax
Spirochetes – spiral
Leptospirosis
Endospore – oval body inside, resistant
clostridium
Rickettsia –rod shaped, small
ehrlichia

41. Examples of Infectious Bacterial Diseases
Rabbit
Pasteurella (Snuffles)
Tuleremia (vector-ticks, flies)
Horse
Tetanus
Strangles
Cat
Enteritis
Cystitis
Swine
Yersinia
Cattle
E Coli
Mastitis
Anthrax
Canine
Leptospirosis (Lepto)
Ehrlichiosis (Tick Fever)
Bordatella Bronchiseptica (kennel cough)

42. 2. Examples of Infectious Viruses
Cattle
Bovine Viral Diarrhea (BVD)
Cats
Feline Panleukopenia
Calicivirus
Feline Leukemia Virus
Feline Immunodeficiency Virus
Rabies - most warm blooded animals
Dogs
Parvovirus
Distemper
Horses
West Nile Virus
Equine Encephalomyelitis

43. Bacteria vs viruses Is a living cell Prokaryote cell – No Nucleus
Made up of cytoplasm, DNA, ribosomes, flagella

44. Virus
Not a living cell! But are considered alive because the reproduce, grow, develop, adapt, use energy sources from their environment
Made up of genetic material/ nucleic acid (DNA or RNA) enclosed in a protein shell
All sorts of shapes, but are extremely tiny/ cannot see with a regular microscope
What about Retroviruses (Feline Leukemia and FIV):

45. Viruses insert their genetic material into a living cell
The cell becomes the virus’ host
The virus DNA/RNA becomes a part of the cells DNA
so that during cell division the virus is being replicated and passed on
Eventually the virus’ DNA takes over, completely changes the host cell/ kills it’s host cell and continues to replicate and create lots more viruses

46. Bacteria/Viruses Ribosomes: Present / Absent
Living attributes: Living organism - Opinions differ on whether viruses are a form of life or organic structures that interact with living organisms.
Number of cells: Unicellular; one cell / No cells; not living
Structures: DNA and RNA floating freely in cytoplasm. Has cell wall and cell membrane / DNA or RNA enclosed inside a coat of protein.
Treatment: Antibiotics / Vaccines prevent the spread and antiviral medications help to slow reproduction but can not stop it completely.
Enzymes: Yes / Yes, in some
Nucleus: No / No
Virulence: Yes / Yes
Infection: Localized / Systemic
Benefits: Some bacteria are beneficial (e.g. certain bacteria are required in the gut) / Viruses are not beneficial. However, a particular virus may be able to destroy brain tumors (see references). Viruses can be useful in genetic engineering.
Reproduction: Fission- a form of asexual reproduction / Invades a host cell and takes over the cell causing it to make copies of the viral DNA/RNA. Destroys the host cell releasing new viruses.
Size: Larger (1000nm) / Smaller ( nm
Cell wall: Peptidoglycan/Lipopolysaccharide / No cell wall.Protein coat present instead.

47. Prions Are proteins Not alive They do not have DNA or RNA
They have an ability to reproduce
Can cause inherited or transmissible diseases

48. Prions
Prion diseases are fatal and cause progressive, neurodegenerative problems
literally, holes in the brain
The brain resembles a sponge / diseases are called spongiform
Examples of spongiform encephalopathies are….
1) Scrapie….in sheep and goats
2) BSE ….”Mad Cow Disease”
3) Chronic Wasting Disease…wild deer and elk
Transmitted by inherited disease, or ingested from tissue of infected animals (brain, spinal cord)

49. 3. Examples of Infectious Fungi (mycoses)
Dermatophytes (Ringworm)
Thrush (? Fungus caused by anaerobic bacteria and mositure)
Coccidioidomycosis (Valley Fever)
Blastomycosis (South East)
Histoplasmosis
Candida (yeast infection)

50. 4. Examples of Infectious Parasites
Heartworm (Dirofilaria immitis)
Trichinella…Trichinosis
Hookworm (Ancylostoma), Whipworm (Trichuris vulpis), Roundworm (Toxocara)
Giardia (protozoan)
Coccidiosis (protozoan)

51. Noninfectious Disease Classifications
Classifying diseases helps aid the veterinarian in obtaining a diagnosis
Helps the diagnostic process
Clinical signs and symptoms could be the result of several different disorders
Differential diagnosis-a list of possible causes of disease
Rule Outs-ruling out possible causes of disease through diagnostic testing, observation, trial treatment

52. NonInfectious Disease Classifications
Metabolic-disruption of normal chemical reactions
Diabetes, hypothyroidism, hyperthyroidism, Cushings, Addisons
Anomalies – Congenital Birth Defects
Cleft palate, deaf, retinal dysplasia, dwarfism
Degenerative – progressive, permanent, longterm deterioration
DJD (osteoarthritis), Bovine Spongioform Encephalopathy (BSE)
Trauma –
Traumatic reticuloperitonitis, high rise syndrome, sucking chest wound, diaphragmatic hernia, peritonitis, prolapsed uterus
Toxins - ingestion, inhalation, contact
Antifreeze, misapplication of flea and tick products, warfarin (rat poison), toads,
OTC medications, illegal drugs, plants
Immune
Immune Mediated Hemolytic Anemia (IMHA), System Lupus Erythematosus (SLE)
Pruritis and Atopy (itchiness and hairloss) [allergies]

53. NonInfectious Disease Classifications
Iatrogenic- a condition that develops as a result of treatment
Hyperadrenocorticism (Cushings)- can be caused by treatment for a severe allergy problem
Surgery-excision of Thyroid glad to treat hyperthyroidism in cats…parathyroid may also be removed causing iatrogenic hypoparathyroidism.
Idiopathic- no explanation for underlying cause of the disease
Idiopathic seizures
Idiopathic renal hematuria
Neoplasm - benign or malignant tumor
Nutrition –
Acute acidosis in ruminants, malnutrition, skeletal disease, hypoglycemia, obesity

54. 3 SEIZURE CASES
Seizure Case 1:
A 3 month old male toy poodle. The dog is strictly a house dog and does not run free, In addition to the seizures, it has had intermittent diarrhea and is quite thin.
Differential Diagnosis (DfDx):
Developmental Disorder- brain malformation
Hypoglycemia-could be secondary to poor diet, diarrhea, intestinal parasites
Head Trauma- not likely with indoor dog
Toxins-potential for ingesting medications or illegal drugs, chocolate
Infectious causes of encephalitis- Distemper
Idiopathic epilepsy-very unlikely due to age of dog

55. Seizure Case 2:
A 2 ½ year old male golden retreiver. This dog is in excellent physical condition and has been eating well. This dog is free to roam the neighborhood and recently had one episode of vomiting and one episode where it was limping and stiff.
DfDx:
Idiopathic epilepsy-this is high on the list because of age and breed of dog at the onset of seizures.
Head Trauma-the recent limping and stiffness raises this possibility
Toxins- the list is long, but possibilities include insecticides, chocolate
Liver Disease-definitely needs to be ruled out but dog has been doing well otherwise
Infectious Encephalitis

56. Seizure Case 3:
A 14 year old female schnauzer. This dog had its first seizure and since that time has not been acting normal. There has been some weight loss and a poor appetitie, and the owners feel the dog can no longer see. The dog is strictly an indoor dog with no history of trauma.
DfDx:
Metabolic Disease-liver dx, hypogylcemia (insulinoma in the pancreas), Diabetes
Neoplasia- the age of the dog, the blindness, lack of normalcy after the seizure make this a high likelihood
Ideopathic epilepsy-very unlikely with the age of the animal

57. Pathogenic Organism and Disease Terms
Disease terminology
Transmission- how pathogens gain entry
Morbidity versus Mortality
Morbidity- diseased animals
Mortality –diseased animals that die
Moribund – near death
Prevelance - amount/ number of diseased at a given time (within a population)
Susceptibility – lacking resistance

58. Noscomial Infections Noscomial- hospital (clinic) acquired infection
Nosocomial infection—An infection occurring in a patient in a hospital or other healthcare facility in whom it was not present or incubating at the time of admission; or the residual of an infection acquired during a previous admission. Includes infections acquired in the hospital but appearing after discharge, and also such infections among the staff of the facility. (Synonym: hospital-acquired infection
Hygiene,
cleaning, disinfecting, antimicrobial,
infection control,
isolation
Often resistant type, ex: MRSA,
Highly contagious potential for fatality
ex: Parvovirus, Distemper, respiratory viruses

59. Prophylaxis Prophylaxis-prevention of disease and spread of disease
Environmental-ventilation, cleanliness of facilities, insects, cleanliness of objects (preventing fomites), bedding, pens
Health/ Nutrition
(healthy animals remain resistant to most diseases)
Stress releases cortisol and epinephrine/lower immunity
Overcrowding, feeding frenzy, climate, noise, rough handling
Minimize exposure or susceptability to pathogens
Vaccinations-increase animals immunity
Pets vs Herd, value/costs, allergic reactions, fibrosarcoma
Testing prior to obtaining
Quarantine (incubation)

60. Zoonosis
Zoonosis-disease that can be transmitted between animals and humans
Hosts
Vectors (carry)
Sentinels (watch/ warn)

61. Zoonoses
Zoonosis-disease that can be transmitted between animals and humans (under natural conditions)
How? Exposure of human to the infection of the animal
If an animal has a disease and a human could get it, the disease is said to be zoonotic
Transmission may occur through
Direct contact with the animal
Through a vector such as fleas or ticks
Through food contamination
Most at risk: young or immune suppressed (sometimes old), also occupations that require working with diseased or possibly diseased animals…such as veterinarians, lab researchers, farmers and ranchers, slaughterhouses

62. Examples
Avian Flu
Transmitted by direct contact with infected birds/poultry
In birds symptoms are illness, decreased production, death
In humans typical flu syptoms, can be severe enough to cause death
At risk population
Backyard flocks
Poultry business
Veterinarians

63. Examples Visceral Larva Migrans (larva of roundworms)
Fecal-oral transmission
In animals (dogs) worms can invade the liver, the lungs, the uterus…parasitic and rob the hosts food
In humans the larvae migrate through body tissues-lungs, liver, eyes
Dog, cat, racoon is host
eggs pass through intestines, dogs ingest (cycle)
Zoonosis occurs when larvae are unknowingly “consumed” by humans

64. Host
A host is a person or other living animal that contributes “food and lodging” to
an infectious agent.
*Primary host/ definitive host- organism / parasite gains maturity
*Secondary/intermediate host- organism/parasite is in a larval stage
*Transport host/ Vector – a carrier in which the organism remains alive but does
not develop
Example of a disease with an intermediate host:
Neospora Caninum coccidian parasite that causes disease in cattle: Definitive host is dog/ coyote/ fox, intermediate host is cattle: Oocysts in feces from dogs, cattle graze, oocyst finish in cattle

65. Vector / Carrier
A vector is a carrier, especially the animal that transfer an infective agent from one host to another
Example: Heartworm Disease
Vector is the mosquito
Carries the infective agent from one dog to another dog
The dog is a host to Heartworms because the Heartworm completes its growth cycle in the dog
Carrier does not become infected-no sign/symptoms of infectious disease (the mosquito does not get Heartworm Disease)

66. Zoonosis Rabies Ringworm Toxoplasmosis Cats are host
Oocysts (“eggs”) pass through intestines
Oocysts are ingested-toxoplasma organisms can invade brain, fetus (pregnant women)
Infected cats infect other animals –oocysts form cysts in muscle tissue-if food animal, human can become infected
Cats become infected by eating rats

67. Zoonosis West Nile Virus BSE Anthrax Leptospirosis
Bartonella Henselae (bacteria (bacillus) that causes cat scratch fever)
Equine Encephalitis
Brucellosis
Tuberculosis
Avian Influenza

68. Etiology and Epidemiology
Epidemiology-study of relationships determining frequency and distribution of diseases
disease etiology, outbreak investigation, disease surveillance and screening, biomonitoring, and comparisons of treatment effects such as in clinical trials.
Etiology-study of disease causes/origination
The etiology of scurvy is a good example. With scurvy, sailors going to sea often lacked fresh vegetables. Without knowing the precise cause, Captain James Cook suspected scurvy was caused by the lack of vegetables in the diet. Based on his suspicion, he forced his crew to eat sauerkraut, a cabbage preparation, every day, but he had no idea, precisely, why it prevented scurvy. It was only about two centuries later - in 1926 that it was discovered that it was the lack of vitamin C in a sailor's diet that was the base cause of scurvy.

69. Testing Methods Endoscopy Centesis
visual examination of the interior of any cavity of the body by means of an endoscope
Centesis
surgical puncture to remove fluid for diagnostic purposes or to remove fluid or gas

70. Testing Methods Imaging techniques radiography computed tomography
magnetic resonance imaging
fluoroscopy
ultrasound