This page has all the information you need on how to gather the database you’ll need to reach a diagnosis for your case. Click the topics below to see detailed information.
The Physical Exam is one of the most important aspects of any real case. However, by definition, it is also one of the weakest points of a paper case. This paradox simply reflects the fact that you do not actually have the affected animal in front of you to examine.
Nevertheless, you need to be very systematic and complete in your approach to the Physical Examination. Try to imagine that the animal is present. The Case Facilitator will be your hands, eyes, and ears and will provide answers to your physical exam questions.
If you do not ask specifically to examine part of the animal, you may miss an important observation.
As you prepare for your DC physical exam, check out these resources
To remind yourself how the initial client interview operates and how the physical exam will work, you can watch this video:
Other Physical Exam resources:
HIGHLY RECOMMENDED- from your required textbooks
- Chapter 1: The Physical Exam of the Dog and Cat. (8 pages) Ettinger – Textbook of Veterinary Internal Medicine.
- Chapter 1: Ruminant History, Physical Exam, and Records. BP Smith – Large Animal Internal Medicine.
- Chapter 2: Equine Physical Exam. BP Smith – Large Animal Internal Medicine.
- Chapter 1: Clinical Examination and making a diagnosis. Radostits – Veterinary Medicine – A textbook of the diseases of cattle, sheep, pigs, goats and horses.
Online Resources:
- From Dr. Parish – PE of Ag Animals
- VM 568: Physical Exam and History for Dogs and Cats – WARNING: a bit long
Or just use your favorite online search engine (e.g. Search: physical exam dog)
Submitting Lab Tests
There are 3 to 4 potential laboratory submissions in each Diagnostic Challenge. You may not need to use them all.
Expectations: It’s up to you –
- Use the correct WSU VTH form.
- Fill out the request appropriately and completely.
- Describe the specimen submitted – {e.g. lavender top tube, culturette, etc.}
- Be very specific and indicate what you want exactly. Never assume that the diagnostic lab will know what you want.
WARNING: As in practice, failure to submit the correct sample, request the appropriate test, etc. may result in no results or a significant delay.
If you’re not sure, look it up in a text, use the WADDL User’s Guide, check the Clinical Pathology sample guide, or ask your case facilitator.
The appendices in Greene’s Infectious Diseases of the Dog and Cat are a very good reference for small animal microbiology and serology.
In general, you will be using the same laboratory resources you will use in your clinical blocks at WSU.
- The WSU-VTH- Clinical Pathology Service
- The Washington Animal Disease Diagnostic Laboratory (WADDL)
- Additional laboratory resources may be available but it will take longer to get results since samples would have to be transported to another location.
- For example, samples for a TLI test (Trypsin-like Immunoreactivity) are shipped to Texas A&M University.
Table: Basic Laboratory Capabilities:
WSU Clinical Pathology Laboratory | Washington Animal Disease Diagnostic Lab (WADDL) |
---|---|
Hematology Clinical Chemistry (e.g. panels) Hemostasis Acid-Base Urinalysis Endocrinology (many are sent out) Fecal floatation Cytology & Fluid Analysis Cross-matching | Bacteriology & Mycology Virology Parasitology Immunology / Serology Toxicology Histopathology Immunohistochemistry Necropsy Abortion screening |
Immunology: The DC Group has designed a Serology and Antigen Detection Form.
- If you need to make a serology submission, be sure to be specific and indicate what you are looking for (e.g. antibodies to Mycobacterium paratuberculosis) and the test you want (e.g. Complement Fixation, ELISA, etc.).
- Be sure the test you’re requesting is actually available to veterinarians in practice.
Running Tests “In-House”
In real life, some tests can be run “in-house,” thereby reducing the time that it takes to get the results and sometimes saving money. However, it is very difficult for us to simulate this aspect of practice in the DC’s, especially since we have to respond individually to each request from all 4 clinics.
Therefore, you must always have explicit permission from your facilitator BEFORE you submit a request for an “IN HOUSE” test or procedure.
The “in-house” testing capabilities of your clinic will be described to you at the beginning of DCs. If you aren’t sure whether or not you can run a test in-house, you can always ask your facilitators.
Examples of in-house tests include (but are not limited to) SNAP tests and radiographs.
- To get the results from tests in the DC’s, you must always submit the appropriate WSU request form – regardless of whether the test is to be performed “in house” or at an outside lab.
- In general, you can only request “in-house” tests at a submission deadline – at the same time you submit your medical record and other paperwork.
Be sure to also indicate ALL procedures and tests you are performing or requesting under PLAN in your Medical Record.
- Indicate clearly if the test or procedure you are requesting is to be performed “in-house.”
- Performing a test in-house may decrease the time it takes to get a result back, but you must be realistic in the kinds of tests you propose to do in-house. More likely, deciding to run a test “in-house” in the Diagnostic Challenges will affect the cost, but the return time for you will be unaffected or little affected. It’s just an inherent limitation of the exercise.
- Results of in-house procedures will be returned with your clinical updates and other test results at the regularly scheduled times.
- Sometimes (on a case by case basis) it may be possible to get a result more quickly by speaking directly with your Case Facilitator (the best example is radiographs). Remember that you must have client permission to perform any test or procedure.
Radiology, Ultrasonography, Contrast Radiographs
How to Request an Imaging Procedure
- Remember, you must first obtain your client’s permission to perform an imaging procedure.
- When you submit your medical record, also submit a completed WSU-VTH radiology request form.
- For radiographs, it is very important to clearly indicate the views you are requesting (e.g. ventrodorsal & lateral thorax, lateral & dorsopalmar views of right-front fetlock, ultrasonic evaluation of liver, etc).
- In addition, be sure to indicate in your Medical Record under PLAN exactly what procedure you are requesting.
- If sedation or anesthesia will be used, indicate this clearly as part of your written plan.
Diagnostic Procedures
Including anything that will involve anesthesia
As always, you must first obtain your client’s permission for such a procedure.
Especially a procedure that is likely to require some intraoperative interpretation or decision making.
- Be forewarned that your client will expect to know why you want to perform this procedure, what you expect it will reveal (or not reveal), and approximately how much it will cost.
- You should have an idea of what the anesthesia will entail as is appropriate for your standing in veterinary school. For example, we do not expect 2nd year students to know induction protocols and anesthetic dosages.
- Under PLAN, explain what you will do, how you will do it, and what you will be looking for or at.
Be explicit!
The detail should be sufficient to allow the DC facilitator to appreciate that your clinic understands the procedure and to allow the facilitator to provide you with the information you are seeking.
For example, if you want to do a laparotomy (exploratory surgery of the abdomen), what are you going to actually do or examine when the abdomen is open?
You should provide descriptive detail (e.g. surgical approach, etc.) that is appropriate for a veterinary student at your stage of training. If you’re not sure what’s appropriate, ask your Case Facilitator for more specific instructions.
Examples of Diagnostic Procedures:
- Laparotomy (exploratory)
- Thoracotomy
- Percutaneous Needle Biopsy
- Endoscopy
- Contrast radiography
- Ultrasonography
- Prostatic massage
- CSF Tap
- Bone marrow aspirate
- Fine needle aspirate
- Abdominocentesis
- Thoracocentesis
- Joint tap / arthrocentesis
- Skin scraping
What happens next:
Typically, there will be a “time compression” wherein DC time will be slowed down. Your facilitator will then respond in writing to your directives (i.e. they will describe what is seen, palpated, etc. at the sites you’ve directed them to).
You will then be asked to indicate what you want to do next – based on your interpretation of the described findings.Possible courses of action include, but are not limited to:
- Nothing
- Euthanasia
- Surgical Excision
- Sample Collection
If you elect to collect samples, you MUST indicate what samples you will obtain, how you will obtain them and what you will do with the samples.
If there is a problem or you are unclear about anything, see your Case Facilitator.
The DC’s are meant to be an independent learning experience.
UNLESS you first obtain permission from the DC facilitator, You should NOT consult any WSU faculty, resident or intern. You should NOT discuss your case with a private practitioner or online (such as VIN).
Instead, you should work with the associates in your clinic and the assigned DC facilitator.
Your case facilitator will sometimes arrange consultations with other faculty.
This is most commonly done when you are presented with data, such as a radiograph, that you are not yet trained to interpret. Please respect these faculty members’ time and be careful not to disrupt their other teaching and service activities.
- It is very important that the DC does not interfere with the normal activities of clinical faculty and the Veterinary Teaching Hospital (VTH).
- The DC’s are meant to be an independent learning experience.
DO NOT post your case on the Internet to solicit outside help.
If you find yourself in a consultation situation with a “DC-approved” specialist:
- It is your responsibility to be adequately prepared when you meet with a consultant.
- You should have devoted some critical thought to the situation and done the appropriate reading.
- Do not show up just expecting easy answers.
- Don’t be surprised if your consultant raises as many questions as he or she answers.
- Inform your consultant at the onset that you are working on an exercise – NOT an actual live case.
- Be sure you give the consultant ALL the information you have.
- Otherwise you may get advice that is based on incomplete facts and is, therefore, not appropriate.
- You should NOT allow a consultant to make decisions for you.
- In the DC cases (as in real life), it is ultimately up to YOU to make the final decision and live with the consequences. Also, be forewarned that opinions can vary even among highly qualified experts. The fact that someone said something does not necessarily make it true – especially for your particular case.
Treatment is NOT a focus for DC cases.
However, there may be times when you will want to initiate treatment. In addition, your DC case can definitely change in response to treatment (or a lack thereof).
If you treat your DC case:
- You must first gain your client’s approval.
- You must clearly indicate the treatment under PLAN in your Medical Record.
- You must be very specific and include the name of the drug, dose and route.
If you want to start any immediate treatment (e.g. outside the regular submission deadlines – such as after receiving your initial lab results on Day 1), it is your responsibility to get your completed Medical Record containing explicit instructions into the hands of the your case facilitator. Don’t just leave your record in the submission box and expect them to find it.
In the “Plan” section of your medical record, your treatment information might look something like this:
Example:
□ start IV LRS – Maintenance rate □ NPO for 24 hours □ Update TRP @______□ Ampicillin 250 mg tabs PO at 6 PM, 12 AM, 6 AM (always provide specific drug name, route, and dose)
Veterinary Teaching Hospital Pharmacy
In general, the information you need regarding treatment is available in the veterinary literature, including appropriate textbooks.
However, the staff in the VTH Pharmacy may also be a good resource for information regarding drugs, drug dosages, and drug costs.
If you go over to the VTH Pharmacy:
- Please DO NOT disrupt the ongoing business of the hospital pharmacy – which is to dispense medication for real patients.
- You should send a single representative of your clinic to stand in line and speak with the on-duty pharmacist.
- At the onset, identify yourself as a student who is working on a DC case.
- Please be patient and polite or you will jeopardize our future abilities to use this excellent resource.
- Do not block access by clinicians and senior students. Likewise, step aside if you are creating a significant delay for those who have more pressing business.