By now you have probably figured out that veterinary medicine is a combination of medical science and detective work! With experience, your ability to diagnose based on clinical signs, presenting complaints, and owner information alone will improve.
But don't be fooled, Vet Student! Below are two examples of medical conditions that can be misdiagnosed if diagnostic work-ups are skipped and the "likely choices" are assumed!
Scenario One
Female spayed young adult dog presents with owner complaint of bloody urine of three days duration. Per owner, the dog is acting fine, and is eating and drinking well. On exam you find no weight loss and no fever.
Diagnostic test chosen: Urinalysis
Results: TNTC erythrocytes, 1+ WBC, bacteria present
Presumptive diagnosis: UTI
Treatment: antibiotics
Don't Be Fooled: Despite owner's report of the dog otherwise acting fine, you notice it seems a bit lethargic but because the dog was otherwise happy and interactive, you ignored it. You didn't do an oral exam, after all this is a urinary case, so you didn't notice the bleeding gums. You didn't catch the petechial hemorrhages on the pinnas. And, you didn't ask enough questions to learn the dog regularly eats mice that it catches, which are in great supply due to the restaurant across the street.
What you missed: Anticoagulant Rodenticide Toxicity
Scenario Two
Female spayed middle-aged, overweight Chihuahua presents with owner complaint of urinating in the house and drinking lots of water for three to four days duration. Communication with client is a bit challenging due to language barrier but you are able to determine that table food is regular part of the dog's diet and the dog has been gaining weight. Upon exam the dog is bright and alert, well hydrated, not showing any pain on abdominal palpation (though palpation is difficult due to the dog's size), and has a very slight fever, which you think insignificant given the hyper nature of the dog.
Diagnostic tests chosen: Urinalysis and CBC/Chem are chosen because you are concerned about potential pancreatitis or diabetes in addition to a probable UTI
Results: Urine is isosthenuric with heavy WBCs and bacteria. BUN and Creatinine are slightly elevated. Total WBC is slightly elevated due to neutrophilia.
Presumptive diagnosis: Kidney Infection
Treatment: Antibiotics, subcutaneous fluids, recheck scheduled
Don't be Fooled: Weight gain and difficult abdominal palpation were probably worth investigating further. But, because you were confident in your diagnosis, you elect not to recommend abdominal radiographs deeming them unneccessary and assuming they would be normal. What you didn't realize was the extent to which the language barrier impacted the accuracy of the information you received from the owners.
What you missed: PyometraDon't be Fooled! Clinical experience does not replace the value of diagnostic testing! As a veterinarian, it is always best to recommend thorough diagnostics, and not assume owners will decline, or results will be normal.
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