4
SYSTEMS OR HEAD TO TOE EXAM
Head and Neck (EENT/Mouth)
Compare both sides of face and head for symmetry.
Assess eyes for size, position, discharge – lids, conjunctiva, sclera, pupil, cornea, lens
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Note discharge, inflammation, redness, uneven/abnormal pupil size, corneal clouding, squinting
Evaluate nose and nares for symmetry, conformation, and evidence of discharge
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Classify discharge: (serous, purulent, hemorrhagic, mucoid or mucopurulent)
Examine oral cavity - lips, mucous membranes, teeth, hard and soft palate, tongue, pharynx, tonsils
Evaluate carriage and position of ears, thickness/malleability of pinnae and cleanliness of ear canals
Palpate the submandibular lymph nodes
Palpate salivary glands (normally palpable), larynx and thyroid gland (not normally palpable)
Palpate the trachea – note coughing, swelling,
Trunk and Limbs (INTEG, M/S, PLN)
Inspect body for symmetry, masses, tenderness, etc.
Palpate each limb and joint: Note abnormalities in angulation, deformities, swelling, bleeding, bony
protrusions, obvious fractures or joint luxations, range of motion, atrophy, knuckling, crepitus, etc.
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Assess all limbs in weight-bearing and non-weight-bearing positions
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Note the condition of the feet, nails or hooves
Evaluate muscle mass and tone
Examine skin and haircoat for alopecia, masses, parasites, dryness, excessive oil, matting, etc.
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Include identification of ectoparasites (fleas, ticks, lice)
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Given the high incidence of mange in many of the communities RAVS serves, animals
exhibiting clinical signs of sarcoptes (generalized alopecia, intense pruritis) are generally
treated with ivermectin according to the appropriate protocols. Skin scrapings can be
performed if warranted and time/resources permit.
Palpate pelvic region for conformation and symmetry
Palpate vertebral column to assess for deviations and pain
Palpate peripheral lymph nodes (PLN): submandibular, prescapular, axillary, inguinal and popliteal
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Normal lymph nodes should be firm, and freely moveable. Enlarged or asymmetric lymph
nodes may indicate a local or systemic infection, allergy or neoplastic disease
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Normally palpable: submandibular, prescapular, popliteal, inguinal (prescapular and inguinal
can be difficult to locate in small or overweight animals). Not normally palpable: axillary
Thorax
Observe and palpate the thorax for conformation, symmetry, masses, etc.
Cardiac auscultation (CV)
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Palpate the area between the fourth and sixth intercostal spaces on both sides of the thorax for
the point of maximum intensity (PMI) of the heartbeat and any cardiac thrills.
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Evaluate heart rate (HR) and rhythm (count beats for 15 seconds and multiply by 4)
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Normal heart sounds:
‘Lub-Dub’ = Should be a short time gap between heart sounds
S1 = loud, long, low pitch (closure of AV valves) ; S2 = closure of semilunar valves
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Abnormal heart sounds:
Arrhythmia = e.g. sinus arrhythmia, atrial fibrillation, heart block, premature ventricular
contractions, gallop rhythm (three or four sounds instead of two)
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Sinus arrhythmia = Slight increase in heart rate during inspiration and decrease with
expiration. Normal finding. More common in the dog than in the cat.
Murmur (see ‘Evaluating Heart Murmurs’ below)
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Prolonged series of audible vibrations during normally silent part of cardiac cycle.
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Often heard as a soft, swooshing sound.
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Murmurs are described on basis of location, timing, duration, character and grade
Muffled heart sounds may be a result of fluid in the chest – if having difficulty hearing the
heartbeat do not assume it is just you – it never hurts to get a second opinion.