The Physical Examination
The physical examination (PE) is the cornerstone of veterinary medicine. It consists of general observation and hands on examination. The examiner must use the senses of sight, hearing, smell, and touch throughout the examination. The combination of the animal's signalment, history, and PE can often reveal the diagnosis within minutes of presentation.
The Exam consists of evaluating:
- General Condition
- General observation includes assessment of body condition, posture, gait, and behavior.
- assessing eye position and movement, vision, eyelids, conjunctiva, pupillary response to a penlight, palpebral and menace response (direct and consensual),and lens position and clarity (using an indirect lens or ophthalmoscope).
- Mouth and Teeth
- Examine the mucous membranes for color, petechiae, dryness
- A slow capillary refill time (>2 seconds) may indicate poor peripheral perfusion. Check the gums and hard and soft palate for color and integrity. Check the teeth and palpate them for pain or looseness. Evaluate dental occlusion, and assess for tartar presence;if tartar is present, grade the degree.
- examine the ear canals for discharge, then use an otoscope to examine the internal canal and tympanic membrane
- Auscultate the thorax while simultaneously palpating the pulse to identify normal vs abnormal heart andpulmonary sounds and to assess heart rhythm and rate.
- Auscultate the lung fields in a systematic manner, covering all areas of the chest.
- Using a light but forceful touch, palpate the abdomen by moving in a cranial-to-caudal and dorsal-to-ventral direction. Some animals, even when they are not painful, tense the abdominal muscles in response to the procedure. Use the tips of the fingers to sense the size and shape of the organs or to detect any masses.Note any abdominal distension, apparent pain, or masses.
- Lymph Nodes
- Palpate the muscles, joints, and long bones to evaluate for joint effusion, swelling, pain, or heat.
- Skin and Haircoat
- Run both hands over the entire surface of the body to assess the condition of the skin and haircoat.
- Examine the external vulva, prepuce, and scrotum for discharge, swelling, and redness.