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History taking
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Exam room edicate
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Introduce yourself
Be polite
Be respectful
Be happy!
Enjoy your work
Be neat
Be professional
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History taking: asking the right questions
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History taking is important for
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condition is chronic?
severity of the disease
the client is observant
The “patient” cannot verbally communicate.
Physical Exam
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Signalment
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Species,
Breed,
age,
color,
Signalment
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Gives us a place to start to determining etiology of
a particular disease.
Age : old vs young
Breed
Sex (male vs female disease states)
Reproductive status:
Distinguishing characteristics
activity
Chief complaint
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*Reason for today’s visit.
Most important in the history.
Anamnesis (history)
(present illness)
Detailed information about the chief
complaint and related problems
 Duration
 Severity
 Progression
 Frequency
 Triggering event
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History
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When does it occur in the day or night
Nature or character of the problem
Character: dry, hacking cough, deep cough…
History: medical history
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Any other ongoing medical problems aside
from the CC?
A history of previous diseases (master list)
Previous lamenesses: grade scale ?
Previous diseases: diarrhea, coughing, colic,
bloat, LDA,RDA, toxicosis, garbagitis
History: surgical
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Any previous surgeries:
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SA: cruciate, patella, foreign body
LA: LDA,RDA, C-section,
Equine: Neurectomy, stringhalt, colic, tt wash.
History: environment
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What is the environment that the animal lives
in. conditions indoor / outdoor.
How many in the herd/flock.
Confinement rearing, feedlot, pasture raised,
pasture rotation?
Additional pasture: grass clippings
History: medication
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Drug reactions
Ongoing disease states that require Rx
Pharmacological side effects.
How often is the animal dewormed, with
what?
When was the animal vaccinated? What is
the vaccine schedule?
History: medication
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Is there an ectoparasite control program in
effect?
History: dietary
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What kind of forage is the animal eating at
this time, how often, how much.
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Chemical composition of the roughage
Protein content, calcium content,…
What kind of grain is the animal eating? How
often, how much.
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Protein make up, fat composition, CHO,
History: dietary
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Food additives/ supplements
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How much and how often
What is the animals predisposition for
ingesting foreign materials?
Character of the animal’s appetite
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Voracious, finicky
History: misc
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How valuable is the animal?
Is it worth treating?
Systems overview
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*A complete system review should include at
least one question from each organ system
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General questions: does the animal stay with
the herd? Is it alert? Where does it reside?
Record keeping
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Must be kept legibly in ink.
It is a legal document and should be signed
by the person documenting the information
The abbreviations need to be limited to
medically (veterinary) accepted
abbreviations. If not, they can be written out
and then abbreviated eyes, ears, nose and
throat (EENT). DX,DDX, R/O, DX testing,
RAD, RACLR,
Habitus
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General or external aspect or appearance of
the patient.
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Attitude; posture, head, relaxed, stiff, shifting
weight, difficulty rising, recumbent, restless, gait
Habitus
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Condition; rotundity, thin, cachexia
Conformation; build, bloat,
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Hydrops (dropsy), ascites,
Temperament; mental attitude
Physical exam
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Physical examination:
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Allen Roussel dvm texas A and M
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Examination at a distance
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Musculoskeletal
neurological
At rest: check for awareness of surroundings
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Vocalizing, head pressing, wandering, abnormal
behavior, respiration rate, jugular pulse (RHF),
Abdominal pain: bruxism restless, muscle
fasciculation
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If recumbent; look for how it gets up and then
observe in motion
Allow the animal to move freely, without
coercion. Examine for ataxia and dysmetric
ambulation.
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TPR, rumen motility, lung sounds( they are
quieter in cattle than horses or small
ruminants
After thoracic and abdominal exam move to
the head and asses dehydration
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Asses dehydration in calves (javma1998)
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Skin tent: 2 sec=0, 3 sec=2%, 4sec=4%,
5sec=6%, 6sec=8%, 7sec=10%, 8sec=12%,
9sec=14%
Eyeball recession: 1mm=2%, 2mm=4%,
3mm=6%, 4mm=8%, 6mm=10%,
7mm=12%,8mm=14%
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Cold ears indicate hypocalcemia or shock
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Check for otitis externa
Oral exam: rabies?
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PPE should be worn when examining an animal
displaying neurological disease
Lips, gingiva, dental pad, hard palate, tongue,
color, vesicles, ulcerations
Examine tongue muscle tone: pulling on it
Smell the breath for ketones, ammonia, foul odor
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Examine the cheeks for impacted cud.
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If a problem is suspected, you need equipment;
endoscope, speculum
Cranial nerve exam:
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Menace response; CN II( optic), cerebrum, CN VII
(facial)
PLR puppilary light reflex; CNII, retina, and
CNIII(occulomotor)
PLR and no menace: lead toxicosis,
polioencephalomalacia
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Eye movement: Occulomotor, trochlear (CN
IV), abducens (CNVI). Strabismus
Trigeminal (CNV) sensation to face
Palbebral when the lashes are touched, the
animal should blink
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(Menace -, PLR-, palpebral+) = CNII or retina
(Menace-, PLR+, palpebral +)= Cerebral
cortical defect
(Menace-, PLR+, palpebral-)=CNVII(facial)
(Menace+, PLR+, palpebral-)=
CNV(trigemminal)
Facial n paralysis: droopy ear, ptosis, atonic
lips
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Vestibular: head tilt, circling, loss of balance
Nystagmus:
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Horizontal: vestibular
Vertical or rotational: CNS
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Lymph nodes:
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Submandibular
Prescapular:
Prefemoral: rear legs
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Move hand over back to check for
subcutaneous emphysema, parasites,
neoplasia, skin lesions
Rectal exam
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Pelvis: pay attention for fractures of the
boney pelvis
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Pelvic lymph nodes may feel like ovaries
Left dorsal quadrant: dorsal sac of rumen
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Size consistency, gas cap,
Medial displacement may indicate a LDA
Left kidney may be palpable
Rectal exam
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Right dorsal quadrant:
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Right ventral quadrant
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Right kidney is cranial to left
Abdominal aorta and caudal vena cava
Distended intestines may be palpable (intestines
are not palpable unless they are distended)
Cecal distension and or torsion is easily palpable
Left ventral: ventral sac of rumen,
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urinary bladder may not be palpable
Physical examination
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Subjective: subject to opinion
Objective: not subject to opinion
Assessment: assesment of the animal’s
condition or disease state
Plan: what is the next step in determining in
finding the definitive diagnosis: diagnostic
testing procedures.
Habitus
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General or external aspect or appearance of
the patient.
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Attitude; posture, head, relaxed, stiff, shifting
weight, difficulty rising, recumbent, restless, gait
Habitus
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Condition; rotundity, thin, cachexia
Conformation; build, bloat,
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Hydrops (dropsy), ascites,
Temperament; mental attitude
Objective
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Temperature: taken rectally
Pulse
Respiration
Weight
Body temperature
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Biothermic range: the range that the animal
can tolerate temperature changes
Homothermic: maintain their body
temperature independent of their
environment (biothermic range)
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Normal variations (Hyper/hypothermia)
Physiological increases in body temperature
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Diurnal variation:
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lowest in early morning, higher in mid day and highest
at 6:00 PM (1800hrs)
Post prandial, after exercise, excitement
Day of parturition (except in the bitch- subnormal)
Exposure to higher atmospheric temperatures
Body temperature
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Species:
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Equine:
Porcine:
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100.5 F
101.0 F
( 99.0-100.8)
(100-102)
Piglets can have up to 104 F
Bovine:
101.5 F
(100.4-102.8)
Ovine:
102.3 F
(100.9-103.8)
Caprine:
103.8 F
(101.7-105.3)
Avian: chicken: 105-107 F
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Stockman’s handbook 7th ed. p664
Pulse rates
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Equine:
Porcine:
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Adult
Young
32-44 bpm
60-80 bpm
70-80 bpm
100-130 bpm
Young:
Bovine:
Ovine:
Caprine:
(use femoral a.)
60 bpm (40-80)
70-80 bpm
70-80 bpm
100-120 bpm
pulse
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Nature of pulse:
Hard bounding pulse
Weak soft pulse
Cold extremities
Locations: next slide
Pulse
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Locations of pulse:
Sheep and Goats: femoral a.
Equine:
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Submaxillary a, Tail, Medial (medial to elbow).
Posterior digital
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Location:
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Bovine:
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ventral coccygeal a (caudal tail a)
Submaxillary, Facial a., Femoral a
Porcine:
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Young thin pig: femoral a.,
adult: caudal auricular v?, auscultation
Pulse rate
Condition of heart and circulatory system
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Factors affecting pulse rate
Specie ( smaller the specie, the faster the
pulse)
Size: higher in smaller than larger animals
Age: higher in younger
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Neonate calf: 120 bpm. Yearling: 80 bpm, adult 40-80
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Physiological condition: the more athletic, the
slower the rate.
Sex: the males have a slightly lower pulse
rate
Lactation: lactating animals have a higher
pulse rate
Pulse rate
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Excitement
Exercise
Ingestion of food: eating a large quantity of
food will increase the heart rate.
Jugular pulse
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In many animals, engorgement of the jugular
v, produces movement which can be
appreciated at the jugular furrow.
Respiration rates
Adult
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Equine:
Porcine:
Bovine:
Ovine:
Caprine:
8-16 rpm
16 rpm (8-13)
15 rpm (10-30)
12-20 rpm
12-20 rpm
young
What is healthy?
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Contentment: healthy animals show
contentment.
Alertness: respond to environmental stimuli
Eating well, chewing cud (cudding)
Shiny hair coat, elastic and pliable skin.
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Dry, scurfy, lack luster: illness
Bright eyes and pink conjuctival membranes
Normal feces, urine, TPR
Organ systems (integument)
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Anatomy; two layers
Sweat
Color: pigmented vs. non- pigmented
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Erythema
Petechia
ecchymosis
Physical examination
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PE are initially directed to address the entire
body through the different organ systems.
It must be comprehensive enough to include
all of the different systems in the body
including the general attitude (psychological)
Report forms page 80
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Record keeping is needed to document the
normal and abnormal findings
Includes the following
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Chief complaint
History
Past history: medical, surgical, trauma, vacc…
Environmental history
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Exam form: System review
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General
Skin (integument)
Head and neck
EENT
Respiratory
Cardiovascular
Gastrointestinal
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Exam Form:
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Urinary
Reproductive
muskuloskeletal
Form page 82
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PE form: incorporates the entire organ
system.
Difficulty is that it does not provide enough
room for adequate documentation.
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Integument
Respiratory
Cardiovascular
Gastrointestinal
Urogenital
Muskuloskeletal
Nervous
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Eyes
Ears
Nose
Lymph nodes
integument
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Changes in tissue thickness
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Swellings
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Papules: A small, circumscribed, solid elevation on the
skin. Pimple
Abscess: A circumscribed collection of purulent
exudate appearing in an acute or chronic localized
infection, caused by tissue destruction and frequently
associated with swelling and other signs of
inflammation and pain.
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Integument:
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Vesicles: small, circumscribed elevation of the skin
containing fluid. Blister, bulla, bleb
Edema: An accumulation of an excessive amount of
watery fluid in cells, tissues, or serous cavities.
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Pitting edema,
cellulitis
Angioedema: Recurrent large circumscribed areas of
subcutaneous edema of sudden onset, frequently as an
allergic reaction to foods or drugs
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Nodule: a circumscribed swelling
Papule:
Crust: hard outer layer or covering;
cutaneous crusts are often formed by dried
serum or pus on the surface of a ruptured
blister or pustule.
Erythema: redness in the skin due to capillary
dilation
integument
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All species
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Mycotic dermatitis Dermatophilus congolensis
Equine, ovine, bovine
Staphlococcus aureus
Ringworm
Photosensitive dermatitis
Chemical irritation
arsenic
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Integument: Ectoparasitism
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Mange: sarcoptic, psoroptic, chorioptic, demodectic
Biting insects, face flies, horse flies, culicoides
Strongyloides
Bots
protozoal
integument
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Cattle:
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Cowpox
Ulcerative mammillitis
Lumpy skin
Fmd
Rinderpest
Sweating sickness
integument
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Sheep
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Strawberry footrot
Sheep pox
Cantagious erythema
Rinderpest
Blowfly infestation
Lumpy wool
Itch mite
integument
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Pigs
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Vesicular exanthema
Fmd
Sunburn
Contact with fresh parsnip tops, celery
Exudative epidermitis(staph hyicus;greasy pig)
Mange
integument
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Horse
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Staph hyicus ;greasy heal
Horsepox
Actinomyces viscosum
Ear plaque
Viral papular dermatitis
Vs vesicular stomatitis
Dermatophytes
integument
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Scald constant wetting
Queensland itch; sensitivity to culicoides
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Sand flies
Pemphicus, lupus erythematosis
integument
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Alopecia; complete absence of hair or wool
Hypotrichosis; less than normal
Follicle failure
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Inherited
Cicatricial alopecia
Congenital hypothyroidism (goiter) due to iodine
deficiency in the dam
integument
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Neurogenic alopecia; peripheral nerve
damage
Psychogenic alopecia
Folliculitis
Alopecia areata of horse
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Spontaneous disappearing , non-scarring
alopecia over the face, neck, shoulders and
brisket
integument
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Disease of horns and horny lamina
Laminitis
Severe edema due to limb lymphangitis
Burns from grass fires
Coronitis from pemphigus in the equine
Mushroom poisoning in the equine
Disease of subcutis
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Subcutaneous edema
Angioedema
Subcutaneous emphysema
Panniculitis
Hemorrhage:
Necrosis
gangrene
Derm history questions
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Signament
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Breed
Age
Chronicity of illness
Progression of illness
Pruritic
Location of lesions
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Seasonality of condition
Concurrent clinical signs
What is the animal’s diet
How many in the herd or flock
Any of the workers have skin problems
Was any medications tried?
Ectoparasite control?
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Will the animal get better when the
environment is changed?
Identification of the lesions
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Primary lesions
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Macule
Papule
Pustule
Vesicle
Wheal
Nodule
tumor
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Primary abnormalities
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Hyperpigmentation
comedo
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Secondary lesions
Alopecia
Scale
Crust
Follicular casts
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Secondary lesions
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Epidermal collarette: remnant of a pustule
Erosion
Ulcer
lichenification
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Other conditions
Partial hairloss
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Hypotrichosis
Hypopigmentation
Diagnosing skin lesions
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Cytology
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Skin scraping
Aspiration of a nodule
Impression smear
Tape preparation
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Stain with Wright’s stain (diff Quick)
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Microscopic analysis
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Yeast buds
Cocci (staphylococcus)
Rods (pseudomonas)
Inflammatory cells (Eosinophils)
Neoplastic cells
Acantholytic cells
skin scraping
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Superficial skin scraping:
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For lesions which are pruritic
Mange: cheyletiella, Sarcoptes (scabies)
Deep skin scraping
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Demodectic mange live deep in the skin
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Wood’s lamp
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Check for Fungal infection
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Ringworm
Pseudomonas may also cause flourescence, but it is
not associated with the hair shafts
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Fungal culture
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Used for clinical signs of alopecia, pustules and
papules, and crusts
Easy to use in house
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Incubate for 2-3 weeks
Color change (pH) change indicates the present of
some fungi colonies
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Trichogram
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Microscopic examination of the hair
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Hair is plucked from the lesion
Identifies the hair growth stage (growing or resting)
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Telogen (resting) or Alogen (growing)
Identifies broken shafts versus epilated
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Biopsy
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For lesions that don’t resolve to treatment.
Should include some normal skin as well
Ulcer or erosion should not be biopsied as the
diagnostic portion of the skin may be lost
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Bacterial culture
Used to identify the causative agent
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Anerobic organisms
Aerobic organisms
Fungi
Antibiotic sensitivity test
MIC
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Serum testing for hypersensitivity
Patch testing
Diagnostic trials
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Food elimination trial
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Can be used in large animals
Takes a long time
Parasite control
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Fly spray vs other methods
Masks
Fly sheets…
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Treatment
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Cost of treatment vs animal cost
Client compliance
Topicals
Systemics