Author Bio xv Preface xvii Acknowledgments xix Part One Introducing the Problem?Oriented Approach 1 1 The Problem?Oriented Approach to Clinical Medicine 3 2 The Role of the Comprehensive Patient History in the Problem?Oriented Approach 11 Part Two The Integumentary System 19 3 Claw and Claw Bed Pathology 21 4 Wounds 41 5 Hypotrichosis and Alopecia 61 6 Infestation 95 7 Skin Fragility 125 8 Changes in Coat Color 135 9 Changes in Pigmentation 149 10 Nasal and Footpad Hyperkeratosis 169 11 Erythematous Wheals and Angioedema 181 12 Papules and Pustules 197 13 Scale and Crusts 209 14 Skin Nodules and Tumors 221 Part Three Eyes and Ears 239 15 Acute Blindness 241 16 Hyphema 257 17 Hypopyon 265 18 Anisocoria 271 19 Abnormalities Associated with the Upper and Lower Palpebrae 283 20 Abnormal Presentations Involving the Nictitans 293 21 Changes in Globe Position within the Orbit 299 22 Changes in Globe Size 311 23 Abnormal Alignment of One or Both Eyes 321 24 Nystagmus 331 25 Reflex Blepharospasm 337 26 Abnormal Tear Production and Other Ocular Discharge 345 27 Abnormal Appearances of the Conjunctiva 355 28 Abnormal Appearances of the Sclera 367 29 Abnormal Appearances of the Cornea 383 30 Abnormal Appearances of the Iris 393 31 Abnormal Appearances of the Lens 401 32 Abnormal Appearances of the External Ear 411 Part Four The Respiratory System 429 33 Nasal Discharge 431 34 Stertor and Stridor 449 35 Sneezing and Coughing 463 36 Changes in Respiratory Rates and Patterns 481 37 Abnormal Lung Sounds 505 Part Five The Cardiovascular System 517 38 Abnormal Mucous Membranes and Capillary Refill Time (CRT) 519 39 Palpably Cool or Cyanotic Extremities 535 40 Collapse 543 41 Jugular Vein Distension and Jugular Pulses 555 42 Muffled Heart Sounds 561 43 Abnormal Heart Sounds: Murmurs 569 44 Gallop Rhythms 583 45 Bradycardia 589 46 Tachycardia 595 Part Six The Digestive System 603 47 Abnormal Gut Sounds 605 48 Abnormal Ingestive Behaviors 611 49 Abnormal Numbers of Teeth and Enamel Defects 617 50 Acute Abdomen 627 51 Changes in Fecal Appearance 647 52 Dysphagia and Regurgitation 671 53 Halitosis 683 54 Emesis 695 Part Seven The Urogenital System 717 55 Abnormalities Associated with Testicular Palpation 719 56 Bilateral Pre?Scrotal Swellings in the Canine Patient 729 57 Spines Along the Feline Penis 733 58 Abnormal Presentations Involving the Prepuce and the Penis 737 59 Preputial Discharge 747 60 Ambiguous External Genitalia 753 61 Vulvovaginal Discharge 757 62 Abnormal Presentations of the Mammary Glands 769 63 Abnormal Palpation of One or Both Kidneys 783 64 Polyuria and Polydipsia 799 65 Acute Presentations of Diminished Urine Output: Urinary Tract Obstruction (UTO) 811 66 Grossly Abnormal Urine 821 Part Eight The Musculoskeletal and Nervous Systems 831 67 Cervical Ventroflexion 833 68 Forelimb Lameness 843 69 Pelvic Limb Lameness 861 70 Shifting Leg Lameness 883 71 Abnormal Mentation 891 72 Head Tilt, Circling, and Other Manifestations of Vestibular Disease 907 73 Abnormal Somatic or Spinal Reflexes 921 74 Upper and Lower Motor Neuron Signs and Anatomic Localization of Disease 927 75 Diffuse Flaccidity in the Dog: Unusual Presentations Involving Diffuse Lower Motor Neuron Dysfunction 941 76 Unusual Presentations of Spastic Rigidity in the Dog 947 77 Involuntary Movements or Dyskinesias 955 78 Seizures 963 Index 983.