Studies in human medicine show that the physical examination identifies the correct diagnosis in approximately 73% of cases when combined with a thorough history, often before any laboratory or imaging tests are performed. In veterinary medicine, where patients cannot verbalize symptoms, a meticulous physical examination is even more critical. Use the Vital Signs Reference for species-specific normal ranges and the Pain Scale AI for objective pain assessment.
The examination begins the moment you see the patient. Before touching the animal, observe from a distance: Mentation (bright/alert/responsive, quiet, obtunded, stuporous, comatose), body posture (prayer position suggests abdominal pain, head pressing suggests neurological disease), gait (lameness, ataxia, paresis), breathing pattern (increased effort, abdominal component, orthopnea), and general body condition (obesity, cachexia, muscle wasting).
Note any obvious discharge (nasal, ocular, vulvar), skin lesions, masses, or asymmetry. The patient's interaction with owners and the environment provides information about temperament, pain level, and neurological status.
The vital signs triad is recorded at every examination and provides essential baseline data.
| Parameter | Dog (Normal) | Cat (Normal) | Clinical Notes |
|---|---|---|---|
| Temperature (rectal) | 100.0-102.5°F (37.8-39.2°C) | 100.5-102.5°F (38.1-39.2°C) | Stress-induced hyperthermia common in cats (up to 103.5°F) |
| Heart rate | 60-140 bpm (size-dependent) | 160-220 bpm | Giant breeds: 60-100; small breeds: 100-140; puppies: up to 220 |
| Respiratory rate | 10-30 breaths/min | 20-40 breaths/min | Panting is normal in dogs but NOT in cats; cat open-mouth breathing is an emergency |
Record pulse quality (strong, bounding, weak, thready), pulse rhythm (regular, irregular), and pulse synchrony with the heart (assess for pulse deficits suggesting arrhythmia). Evaluate mucous membrane color (pink, pale, cyanotic, icteric, injected) and capillary refill time (CRT; normal 1-2 seconds).
Warning: A cat breathing with an open mouth is ALWAYS abnormal and indicates severe respiratory distress. Minimize handling, provide oxygen, and stabilize before continuing any examination. Restraint-related stress can cause respiratory arrest in severely dyspneic cats.
Record accurate body weight at every visit; unexplained weight changes are often the first sign of systemic disease. The Body Condition Score (BCS) uses a 9-point scale: 1-3/9 is underweight, 4-5/9 is ideal, 6-7/9 is overweight, and 8-9/9 is obese. Assess by palpating ribs (easily palpable with slight fat cover at 4-5/9), visual waist from above, and abdominal tuck from the side.
Muscle Condition Score (MCS) should also be assessed, as it is independent of BCS. Evaluate muscle mass over the temporal bones, scapular spine, lumbar spine, and pelvis. Muscle wasting can occur even in overweight animals (sarcopenic obesity) and suggests chronic disease, inadequate nutrition, or protein-losing conditions.
Eyes: Assess symmetry, discharge, scleral injection, pupil size and symmetry, menace response, and PLR. Note lens clarity (cataracts vs nuclear sclerosis) and any corneal abnormalities.
Ears: Examine pinnae for erythema, thickening, or aural hematoma. Otoscopic examination assesses the canal for cerumen, erythema, discharge, stenosis, and tympanic membrane integrity.
Oral cavity: Evaluate mucous membrane color, dental health (calculus, gingivitis, tooth mobility, oral masses), tongue, palate, tonsils, and sublingual area. Dental disease is present in approximately 80% of dogs over 3 years old.
Lymph nodes: Palpate mandibular and retropharyngeal lymph nodes. Normal lymph nodes are small, smooth, mobile, and non-painful. Lymphadenomegaly warrants fine-needle aspiration.
Cervical region: Palpate the trachea (tracheal sensitivity suggests tracheitis or collapsing trachea). In cats, palpate the ventral cervical region for thyroid nodules (thyroid slip test).
Cardiac auscultation: Auscultate all four valve areas on the left hemithorax (mitral, aortic, pulmonic) and right hemithorax (tricuspid). Assess rate, rhythm, and presence of murmurs (grade, PMI, timing). Identify gallop rhythms (S3 or S4), which are always pathologic in dogs and suggest myocardial failure in cats.
Pulmonary auscultation: Systematically auscultate all lung fields (cranioventral, caudodorsal, and intermediate zones bilaterally). Normal breath sounds are bronchovesicular. Adventitious sounds include crackles (fluid/exudate in airways), wheezes (bronchoconstriction), and decreased/absent sounds (pleural effusion, pneumothorax, consolidation).
Referred upper airway sounds are commonly mistaken for lower airway pathology. If adventitious sounds are loudest over the trachea and diminish peripherally, they likely originate from the upper airway. Temporarily occluding the nares can help differentiate nasal from lower airway sounds.
Abdominal palpation is performed systematically, evaluating cranial, mid, and caudal regions. Use gentle, systematic technique progressing from superficial to deep palpation.
Cranial abdomen: Liver (sharp hepatic margin should be just at or slightly beyond the costal arch; rounding suggests hepatomegaly), stomach (assess for distension or pain).
Mid-abdomen: Spleen (palpable as a tongue-shaped structure in the left cranioventral abdomen in dogs), intestinal loops (assess for thickening, masses, pain, bunching/plication suggesting linear foreign body), kidneys (both kidneys are palpable in cats; left kidney readily palpable in dogs, right kidney less accessible).
Caudal abdomen: Urinary bladder (size, pain, wall thickness, masses), colon (fecal consistency), uterus (not normally palpable; enlargement suggests pyometra or pregnancy), sublumbar lymph nodes (assess for enlargement).
Musculoskeletal: Observe gait for lameness (grade 1-5), ataxia, or proprioceptive deficits. Palpate all four limbs: joints (swelling, crepitus, decreased range of motion, pain on flexion/extension), long bones (pain, swelling), and muscles (symmetry, atrophy, pain).
Neurological screening exam: Mentation assessment (already performed), gait evaluation (ataxia type: proprioceptive, vestibular, cerebellar), postural reactions (proprioceptive placing, hopping), and spinal reflexes (patellar, withdrawal, panniculus). This screening identifies patients requiring a full neurological examination.
Integument: Examine the skin and coat systematically. Note distribution and character of any lesions (alopecia, papules, pustules, crusts, erythema), coat quality (dry, dull, excessive shedding), parasites (fleas, ticks), and nail condition.
- Begin with observation from a distance: mentation, posture, breathing, and gait before any handling.
- Record TPR at every visit; know species-specific normal ranges and breed variations.
- Open-mouth breathing in cats is ALWAYS abnormal; minimize stress and provide oxygen immediately.
- Score both body condition (BCS, 1-9 scale) and muscle condition (MCS) independently.
- Auscultate all four cardiac valve areas; gallop rhythms are always pathologic in dogs.
- Develop a consistent, repeatable head-to-tail system to avoid missing subtle findings.