Clinical examination - logical approach:

• Logical approach = sequence of steps to work up cases in order to diagnose and treat patients.
• Logical approach order = 1. signalment, 2. presenting complaint, 3. history, 4. physical examination, 5. problem list, 6. differential diagnoses, 7. diagnostic tests, 8. final diagnosis, 9. treatment plan and 10. prognosis.
• Signalment = basic horse information.
• Presenting complaint = why the vet has been called.
• History = relating to the symptoms or importance.
• Physical examination = assessing the horse.
• Problem list = areas identified from the examination.
• Differential diagnoses = what may be wrong.
• Diagnostic tests = narrow down the answers.
• Final diagnosis = what is found to be wrong.
• Treatment plan = how to treat/resolve the issue.
• Prognosis = expected outcome/recovery - short/long-term.
• Things to consider when working a case = what's the problem, when was it noticed and when was the horse last "normal".
• General status = previous disease, feeding, routine, vaccinations, dental, deworming and intended use.
• General examination evaluates all the organ systems in a systematic order.
• Initial assessment = preferably unrestrained, assess general condition (coat, skin, nasal discharge and BCS), behaviour/demeanour and nose to tail exam for abnormalities.
• Respiratory rate = 8-16 breaths per minute.
• Respiratory function = check nasal airflow (uni/bilateral) and nasal discharge (blood, colour and consistency).
• Mucous membranes check = (gums + eyelids), colour, moisture and capillary refill.
• Capillary refill = 1-2 seconds.
• Yellow mucous membranes = icterus indicating liver damage.
• Purple mucous membranes = petechia indicating capillary damage.
• Bad breath can indicate mouth abscesses.
• Palpating the lymph nodes to check swelling - can't feel them at a normal size.
• Pulse = 28-40 beats per minute.
• Palpating the jugular vein for refilling.
• Check sinuses for any reaction - tap for sounds on both sides, facial symmetry and attitude/expression.
• Palpating the larynx for laryngeal hemiplegia and asymmetry.
• Palpating the trachea for damage or swelling.
• Auscultation = abnormal sounds.
• Digital pulse = indicates: distal limb temperatures, foot temperature and signs of laminitis or abscesses.
• Abdominals = firm/upwards pressure of the ventral thorax on the midline, looking for ventral oedemas.
• Ventral oedemas = fluid build-up. Can tell fluid type, pressure indents and worm burden.
• The heart is auscultated in 3x locations = pulmonic, aortic and mitral valves on the cranial ventral thorax.
• Lung auscultation = sound comparison for: ventral, dorsal and mid thorax. Compare left/right - right and inspiration are usually louder.
• GIT sounds = frequency, duration, intensity and location. No sound is usually negative e.g. colic and a high pitch can indicate bloat.
• Hindlimbs/temperature = condition or swelling, check anus, stallions - check testicles, geldings - check scrotal remnants and mares - check mammary gland.
• Temperature = 37.2-38.2 degrees Celsius.
• Working diagnosis = can't yet be final for a treatment plan.
• Prognosis should consider ethics and horse welfare.