EAR EXAMINATION: Principles

1) Know thy anatomy

2) Apply clinical methods of examination
-observation, inspection, palpation
-use different sense: sight and smell
3) Apply diagnostic methods of examination
-ear swab: direct exam, stained smears
4) General examination
5) Otoscopic examination
6) Pure ear problem or sign of other systemic
problems/diseases
-basis for treatment
General examination
Compare one ear with the other
Check external ear for any signs of
inflammation
o Swelling
o Redness
o Desquamation of epithelium
Handling of normal pinna should not produce
any pain (normal)
Abnormal discharges: pus, blood, brownishblack cerumen
Presence of foreign bodies: ticks
Epithelial growth associated with chronic
irritation of ear lining
Ear examination: Otoscope
Examination of the auditory canal
Instrument is an otoscope
Otoscope head used to examine an infected ear
should not be used to examine a non-infected ear
Examine normal ear first
Draw ear flap caudally then insert otoscope
cone carefully in a rostroventral direction
Always watch the progress of the tip by
looking through the otoscope
When angle of meatus is encountered, draw
ear laterally and turn tip of otoscope
medially to straighten meatus
Use largest tip that will fit the ear canal
Check for foreign bodies in the ear canal:
o Mites
o Ceruminoliths
o Exudates
Check tympanic membrane (ear drum)

If ear drum has been recently

ruptured, a blood-stained discharges
may be seen around the membrane
Check for loss of translucency,
swelling, redness
SOME DISEASES BASED ON ANATOMY
External ear
1) Otitis externa
Causes:
Actinomyces bovis
Psoroptes communis
Notoedres cati
Otodectes cyanotis
Octobius megnini
2) Inflammatory polyps
-may become relatively large and fill the external
auditory meatus, which are usually seen in cats and dogs
3) Neoplasms
-adenomas and adenocarcinomas of the ceruminous
glands in dogs and cats
-equine sarcoid in horses and mules
-chondromas and chondrosarcomas
Middle Ear
Otitis media
-seen as an extension of otitis externa in mite infestation
and with penetrating foreign bodies (Grass awns)
-inflammation is usually purulent
-it spreads to the inner ear and may cause meningitis
Inner Ear
1) Otitis interna/Labyrinthitis
-clinically it causes disturbance in the equilibrium
2) Congenital deafness
-results in degenerative changes in the organ of corti
EYE EXAMINATION: Principles
Know thy anatomy: gross and microscopic
Adnexa: eyelids
Eye parts: Lens
Wall/tunics
Fluid regions: anterior and posterios
chambers and vitreous humor cavity
Apply clinical methods of examination
Apply diagnostic methods of examination
Layers/Tunics
1) Outer fibrous tunic
a) Cornea: transparent
b) Sclera: white
2) Middle vascular tunic- Uvea
a) Choroid

b) Ciliary body
c) Iris
3) Inner nervous tunic
a) Retina

Cornea
Pannus:

Clinical signs/Conditions

-Infectious keratitis/Keratoconjunctivitis: Pink eye

-Pigmentary keratitis: deposition of melanin pigment in
corneal epithelium and underlying stroma

Epiphora:
Photophobia:
Strabismus:
Nystagmus:

excessive tear formation

abnormal intolerance to light
abnormal alignment of the eye
rapid eye movement

Eyelids:
Entropion:
inversion of the upper or lower eyelid
Ectropion:
eversion of the upper or lower eyelid
Ptosis:
drooping of upper eyelid
Blepharitis:
inflammation of the eyelids
Blepharospasm:
spasms of the muscularis
orbicularis of the eyelids
Lagophthalmos:
inability of the eyelids to close
properly
Trichiasis:
ingrowing of the cilia/eyelashes in the
upper eyelid
Distichiasis:
double row of cilia which touches the
cornea
Conjunctiva:
Symblepharon: adhesion of conjunctiva to itself
Chemosis:
edema of the conjunctiva
Hordeolum:
purulent inflammation of sebaceous
glands of conjunctiva
Conjunctivitis: inflammation of the conjunctiva
Eyeball:
Exophthalmos:
Enopthalmos:
Panophthalmitis:

outward displacement
inward displacement into orbit
inflammation of all eye
structures
Microphthalmia:
congenitally small globe
Phthisis bulbi:
shrinkage of eye due to loss of
contents
Ophthalmoplegia:
paralysis of the globe
Coloboma:
apparent absence/defect of ocular tissue
Iris and Ciliary apparatus
Synechia:
adhesion of iris to cornea (anterior) or
lens (posterior)
Persistent papillary membrane: absence of pupil

Keratitis:

corneal lesion in which granulation

tissue extends from limbus over cornea
inflammation of the cornea

Chambers:
Hypopyon:
Hyphema:
Glaucoma:

pus in the anterior chamber

blood in the anterior chamber
increase in intraocular pressure

Lens:
Aphakia:
Microphkia:
Ophthalmolith:
Anisocoria:

absence of lens
small lens
lacrimal calculus
difference in the size of the pupil

Cataract:

partial or complete opacity of the lens or

its capsule
-cortical cataract: results from disorganization of lens
-nuclear cataract: results from transparency of old lens
-congenital cataract: failure of closure of primary lens
vesicle
Retina
Retinal atrophy: hereditary
Central ganglion cell degeneration of retina
Retinal cone atrophy
Central retinal degeneration
Optic nerve
Atrophy
Congenital hypoplasia
Papilledema: Choked disc: denotes edema of the optic
papilla and adjacent retina

2. Other dogs
Owner/Caretaker
1. Owner/Caretaker: disease manifestations

Alopecia
Yes
Focal/Mul
tifocal

No
Erosion

Skin
thickenin
g

Patchy
Regionali
zed
Generaliz
ed

Scaling
Exfoliativ
e
dermatosi
s

NO: maculo
papular
pattern

YES:
indurated
dermatosis

GENERAL APPROACH to DERMATOLOGIC DX

Emphasis on
o Signalment: breed, age, sex
o Clinical history: signs, duration,
occurrence, diet
o Physical examination: derma form
Diagnostic test: timely and accurate
Chief complaint: 4 BASIC
o Pruritus
o Alopecia
o Skin lesions
o Lumps
BREED
Color mutant alopecia
-blue, red and fawn: Doberman pinschers
-fawn: irish setters
-blue dachshunds
-standard poodles
-whippets
-chowchows
AGE
-young:
-~1 year:
-Old:

Question the owner:

-Ears
Sarcoptic mange
-Head
Demodectic mange
-Caudal dorsum

Flea allergy

demodicosis
atopy
neoplasia

CLINICAL HISTORY
Questionnaire for the owner: time constraints
Systematic questioning
Dog
1. Clinical signs: description, onset, duration, other
systems involved, contact
2. Diet: nature, changes
3. Vaccination history
4. Previous diseases and medications
5. Medications
Environment
1. Cage, indoor, outdoor

Are others affected (human and animals)?

-If yes, must be contagious
Questions
o When were fleas last seen?
o What measures were taken to control them?
o How is the appetite?
-Is the diet satisfactory?
-Is digestion apparently normal?
-Increased:
~Diabetes mellitus
~Hyperadrenocorticism
-Decreased:
~Liver disease
~Kidney disease
~Hypothyroidism
-Is your dog abnormally thirsty?
-Increased:
~Diabetes mellitus
~Hyperadrenocorticism
~Liver and kidney disease
o Is there exercise intolerance?
-Lethargy:
~Hypothyroidism
-Weakness:
~Hyperadrenocorticism
o If female, how is estrous cycle?
-Absent:
~Hypo/hyperadrenocorticism
o Is there sneezing?
-Occasionally seen:
~Atopic dogs
Clinical sign: pruritus
o Latin word prurire
~ itch
o Unique sensation different from pain, touch,
heat, cold
o Manifestations: biting, chewing, sucking,
licking, scratching, rubbing, pressing hard on
objects
Clinical sign/lesion
Possible diseases
Pruritis
Scabies
Dermatophytosis
Allergies (food environment, flea
bite contact)

Alopecia

Atopic dermatitis
Malassezia dermatitis
Congenital
Hair growth problem
Endocrine/Metabolic
Parasitic/fungal/trauma
Bacterial

-Ulcer VS Erosion
Primary
lesion
Macule

Brief description

Remarks

Small flat discoloration

Less than 1 cm

Patch

Small flat discoloration

More than 1 cm
Small solid elevation
Less than 1 cm

Pigment
Erythema
Hemorrhage
Big macule

Papule
PHYSICAL EXAMINATION
Good lighting: a MUST!
Examine entire animal
-not just the lesions
Feel the skin
-Thickened:
hypothyroidism
-Atrophic:
hyperadrenocorticism
-Inflamed:
allergic
-Cool:
hypothyroidism
Examine the lesions
1) Characterize lesion
2) Describe the pattern
3) Identity the distribution of the lesion
-focal
-multifocal
-generalized
-symmetrical/asymmetrical
Record lesions
-Use dermatology form for EVERY visit
-To check for:
~development/progress of condition
DERMATOLOGIC LESIONS
Know the ABCs: recognize:
1) Primary lesions
2) Secondary lesions
3) Miscellaneous lesions
Know the words/phrases: determine lesion
pattern
1) Maculo-papular
2) Vesiculo-erosive
3) Ulcerative
Know the PARAGRAPHS: record lesion
distribution
1) Focal/multifocal
2) Generalized (more than half of the body)
3) Symmetrical
4) Assymetrical
Know extent of LESION: superficial or deep
differentiate from reactions

Plaque

Solid flattened elevation

More than 1 cm

Pustule

Small elevation filled

with pus

Edema
inflammation
Epidermis only
Edema
Inflammation
Epidermis only
Tiny abscess:
yellow, pink, red

Vesicle
Bulla
Wheal
Nodule
Tumor
Diagnosis Based On Lesion Distribution

Diagnostic Methods and Applications

TEST
APPLICATIONS
Woods lamp
Fungal: M. canis detection
Tape strip
Parasitic: Cheyletiella,
Sarcoptes sp.
Fungal
Bacterial
Hair trichogram
Skin scrapings
Mange: Demodex sp.
Sarcoptes sp.
Bacteria
Neoplasms: inflammation
Hair (KOH preparations)
Fungal
Trichogram: hair
morphology
Hair growth problems
Fungal culture
Dermatophytosis
Bacterial culture
Bacterial: pyodermas
Diagnostic cytology
Inflammatory: pyodermas
Neoplasms
Bacterial yeast

Histopathology

Serology
Hematology
Organ function test
Therapeutic Trials
(Diet elimination trials)
Intradermal testing

(Malassezia)
Confirm neoplasms,
inflammatory: all
dermatosis
Scabies
General screener for all
conditions
Endocrine disorders
Metabolic disorders
Allergies
Undiagnosed cases
Atopy
Allergies

GENERAL APPROACH TO Dx
To consider first:

First rule-outs: secondary infections such as:

o Bacterial overgrowth: pyoderma
o Malassezia overgrowth:dermatitis
o Dermatophytosis
o Parasitic disease: demidicosis and
sarcoptic mange

For recurrent infections, consider probably

underlying diseases:
o Allergies
o Canine atopy
o Hormonal
o Genetic