Disease Diagnosis WebQuest
INTRODUCTION
Have you ever had the secret urge to play House or help with a case on Mystery Diagnosis? Well this
is your lucky day! A lot of veterinary medicine is about helping animals that are sick or injured. The
main difference between human and veterinary medicine is the fact that animals cannot talk;
however, this does not mean that they cannot communicate what’s going on in other ways. As
discussed by Dr. Trout in his book Tell Me Where It Hurts, owner observations and clinical tests can
be pivotal in figuring out what’s wrong. For this project, your group will select at least three
different cases to handle and meet with at least one client to discuss and explain your decisions
regarding their pet. Don’t forget that you will need to balance between doing everything possible to
heal the animal and doing the bare minimum to keep client costs down. No one said this was easy!
Think you’ve got what it takes? Good luck!
TASKS
Students will:
 Identify common pet and livestock illnesses/conditions
 Infer clinical symptoms based on owner descriptions of animal behavior
 Utilize several different diagnostic tools to narrow down disease search using provided
symptoms and observations
 Improve team working, cooperation, and research skills
 Apply deductive reasoning to determine the likelihood of several different
illnesses/diagnoses
 Describe the challenges of disease diagnosis for veterinary professionals
 Summarize cause of disease/condition in non-veterinary terminology for clients
 Understand the role various factors play in determining a course of action for a particular pet
PROCESS
Part 1: CASE STUDIES
1. Sit with your assigned group and begin by selecting a case. Read through the case as a group.
Identify relevant information that may help you formulate a diagnosis.
2. Use the Cornell Consultant to enter your symptoms and search for possible diagnoses. (See
Cornell Consultant handout in packet for more details as to how to use this web tool.)
3. Narrow down your possible choices to about five to seven choices and have each member
research one using the provided links on Moodle to see if it fits your scenario.
4. Discuss as a group your findings. If certain diagnoses do not fit the case, eliminate them
from the list of possibilities.
5. Determine which your group feels is most likely causing the client to be ill. Answer the
provided questions with the case study. You may divide questions among group members to
speed up this process. Be sure to review your answers as a group so each member
understands the diagnosis and treatment plan.
6. Once you have finished, show your work to the instructor. She will help you select another
case study or have you complete your client interview. Each group needs to complete at least
3 case studies.
Part 2: PATIENT EXAM/OWNER MEETING
1. Review the details of the case and your responses to the questions. Be sure to consider:
 What is the pet’s/owner’s name?
 How are you going to introduce yourself?
 How will the owner most likely be feeling?
 What lead us to this diagnosis?
 What may have caused the pet/animal to get this disease?
 What is the prognosis for the pet/animal?
 Are there several treatment options? How much do they cost?
 Which treatment are we recommending? Why?
 If it were your pet, what would you do?
 What additional questions might they have?
2. Discuss how you want to present your findings to the client so that each of you has an equal
speaking role.
3. Meet with the owner and patient. Present your diagnosis and any other relevant information.
Be prepared to answer questions.
Part 3: REFLECTION
1. Evaluate your group members based on their contributions to this project.
2. Answer the provided reflection questions.
RESOURCES
Please use the following resources (also linked on Moodle) to help you diagnose your case studies.
General Search Engines (START HERE)
 Cornell Consultant:
http://www.vet.cornell.edu/consultant/Consult.asp
Useful in identifying possible diagnosis in a variety of animals using provided symptoms
 Animal Disease Diagnosis Information System:
http://www-addis.iaea.org/ADDIS/default.htm
Useful in confirming or cross-referencing diagnosis from Cornell Consultant.
 Merck Veterinary Manual
http://www.merckvetmanual.com/mvm/index.jsp
Species Specific:
 Cattle Disease Diagnosis System:
http://vie.dis.strath.ac.uk/vie/CaDDiS/
 Poultry Diseases and Parasites
http://www.poultryhelp.com/link-disease.html
 Atlas of Avian Diseases
http://partnersah.vet.cornell.edu/avian-atlas/
 Horse Diseases
http://www.horserides.org/a-z_diseases.html
 Poisonous Plants for Livestock
https://moodle.easdpa.org/file.php/414/Disease/Noxious_Plants_for_ANIMALS_sm.pdf
 Pet Diagnostic Test Results Interpreted
http://www.airparkanimal.com/frorms/Understanding%20Your%20Pets%20Testing.pdf
 Petside Symptom Checker
http://www.petside.com/symptom-checker
 Dog Symptom Sorter
http://www.dog-names.org.uk/dog-symptoms-sorter.htm
 Dog Diagnosis
http://www.helpmyhound.com/dog_diagnosis.php
Searching for Disease Diagnosis Using Cornell Consultant
1. Go to the Cornell Consultant: http://www.vet.cornell.edu/consultant/Consult.asp
2. Click on Search by Signs
3. If you have a specific sign or symptom:
a. Search using the Sign Keyword field. (Example: fever, diarrhea)
NOTE: The terms clients and veterinary professionals identify signs is often very
different. For instance, the consultant uses “anorexic” to describe an animal that has
not been eating.
b. Narrow your search by selecting a specific species.
Avian—poultry, chicken, turkey, duck
Caprine –goat
Ovine—sheep
Porcine—pig
c. If your sign appears, check the box next to it and click Add to Signs. If sign does not
appear, try to rephrase the symptom and try again.
d. Continue searching for signs using steps a through c.
e. When all signs are present, click Search for Diagnoses. All possible diagnoses will be
listed.
f. Click on the specific diagnosis for a detailed description.
4. If you are having difficulty describing signs or symptoms:
a. Click on Sign List (to the right of Help).
b. Select a system where the symptom appears.
Acoustic—hearing, ears
Cardiovascular—heart
Ophthalmology—eyes
Respiratory—lungs/breathing
Urinary—bladder
c.
d.
e.
f.
Place a check next to any applicable symptoms.
Click Add to Signs.
Select appropriate species if known.
When all signs are present, click Search for Diagnoses. All possible diagnoses will be
listed.
g. Click on the specific diagnosis for a detailed description.
5. Once you are relatively confident about the diagnosis, visit
http://www.merckvetmanual.com/mvm/index.jsp and other related sites to search for
additional descriptions to confirm.
Note: The Consultant from Cornell can also be used to search for diseases in addition to
symptoms. Simply click on Search by Diagnosis from the home page.
CLASS PRACTICE DISEASE DIAGNOSIS
Scenario:
Bob takes his pet Jack Russel, Benji, for behavior classes at the local Pet Smart. About three weeks
into his training class, he notices Benji seems to have a deep hacking cough yet never coughs
anything up (mucus, foreign objects, etc). It almost sounds like he’s wheezing. Bob doesn’t think
anything of it until at least a week later Benji still hasn’t stopped; in fact, he seems to be getting
worse and now doesn’t seem to want to eat.
1. Underline pertinent information in the provided case.
2. Record the symptoms (official terms) entered into the Cornell Consultant.
3. Identify at least 5 possible diagnoses and whether they are extremely likely (+), moderately
likely (0), or not very likely (-).
4. What is Benji’s diagnosis? What makes this a good match?
5. What course of treatment should be recommended?
6. What is Benji’s prognosis?
Name: __________________________
Case 1: __________________
Partner:__________________________
Case 2: __________________
Partner:__________________________
Case 3: __________________
Disease Diagnosis WebQuest Grading Rubric
Excellent
Very Good
ORGANIZATION
a) Your rubric and reflection questions
b) Group’s case studies stapled together
c) All group member’s rubrics on top with case
studies below
d) Rubrics and case studies fastened with paper
clip (NOT STAPLED)
5
CASE STUDIES
Approp Difficulty Level of Cases Selected
5
Accurate Diagnosis
5
Thorough Responses
a) All questions answered
b) Accurate terminology
c) Detailed explanations provided (type of
medication, why certain treatments selected,
etc)
15
Satisfactory
Unsatisfactory
--
3
0
4
4
3
3
0
0-2
13
11
0-8
3
0-2
7
0-5
Group member evaluation
5
4
PATIENT EXAM/OWNER MEETING
Presentation of Diagnosis and Treatment
10
8-9
Options
Professionalism
a)
b)
c)
d)
Greeting
Good eye contact
Knowledgeable about condition
Clear/easy to understand
e) Truthful statements
Interpersonal Skills
a) Patient
b) Compassionate
c) Friendly
Reflection worksheet
5
4
3
0-2
5
4
3
0-2
8-9
7
Deductions
0-5
REFLECTION
10
FINAL SCORE
/65
Peer Work Group Evaluation Forms
Directions: In the space below, honestly evaluate the work of other students in your group by
answering yes or no and by using a scale from 1 to 3, 1 being poor, 2 being average, 3 being
above average.
Group Member 1:___________________________
Did this group member complete his/her assigned tasks for the
group?
How would you rate the quality of this person’s work?
How would you rate his/her productivity during class time?
Overall, how would you rank this group member’s performance in
the group? How essential were they to your success?
Would you want to work with this person again?
Explain why in the space below.
Yes
3
3
3
No
2
2
2
1
1
1
Yes
No
Yes
No
Group Member 2:___________________________
Did this group member complete his/her assigned tasks for the
group?
How would you rate the quality of this person’s work?
How would you rate his/her productivity during class time?
Overall, how would you rank this group member’s performance in
the group? How essential were they to your success?
Would you want to work with this person again?
Explain why in the space below.
3
3
3
Yes
2
2
2
1
1
1
No
DISEASE DIAGNOSIS REFLECTION QUESTIONS
1. What are three factors that can influence a pet’s course of treatment? (1)
2. Why is it important for vets to have good interpersonal communication skills? (2)
3. What was the most difficult part for you about the disease diagnosis process? Why? (2)
4. What was the most challenging part of the client interview? Why? (2)
5. How has this WebQuest changed how you view/your opinions of veterinary professionals?
(3)
SCENARIO A: Chester
You notice that your horse, Chester, is exhibiting some atypical behavior and you are afraid
he is ill. You call the vet and the vet visits your horse. Temperature, respiration, and heart
rate are normal and the vet finds no other signs of illness. There is really no explanation as
to what you observed. The vet notices a pile of junk tires stacked near the barn. Upon
further observation, she notices that recent rainfall has filled the tires with water.
What disease is affecting Chester?
What lead you to that diagnosis?
What behaviors may have been observed?
What preventative measures should be taken to prevent this illness from reoccurring?
DL: 1
SCENARIO B: Bessy
A farmer calls you to her farm in the middle of March after a snow storm. She is concerned
about one of her favorite middle aged cows. This particular cow had her 5th calf on
Valentine’s Day and although she should be progressing toward peak lactation, her milk
production appears to be decreasing. The woman who knows her cow well says, “it’s
almost as if she’s depressed. She’s not eating well, and quite frankly, her breath stinks!”
What disease does this cow have?
How do you know?
As the vet, what tests might you perform to confirm your diagnosis?
How do you plan to treat it?
DL: 1
SCENARIO C: Ginger
A local neighbor brings you in to look at her pony, Ginger. Both her temperature and heart
rate are abnormally high. She appears to be favoring her front hooves and they feel warm to
the touch. You try and move her but she is reluctant to walk and appears to be walking on
eggshells when she does move. As an experienced vet, you are quite familiar with this
disease but are still trying to pinpoint a cause. You notice that wood shavings are being
used as bedding. When asked about her supplier, the owner says, “oh I just started getting
them from a local furniture store.”
What disease is the pony suffering from?
How do you know?
What caused the onset?
What recommendations do you have for the owner?
DL: 1
SCENARIO D: Layers
As a vet, you are called to visit a local poultry farm where the farmer is concerned about his
layers. When you walk in you swear it sounds like a sick ward full of coughing and
sneezing patients. Some of his birds are looking thin, and they have been down on egg
production the past few days (several have soft shells). He shows you a bird that appears to
have a crooked neck and three birds with crippled legs. He also takes you out back to the
compost pile and shows you the 42 birds he has already lost out of his flock of 500. When
asked, he confirms that no new layers have been introduced to house within the past two
months. Although he’s confused about what’s happening, before you leave he takes you
inside his house to show off his daughter’s orange winged Amazon parrot that he bought
her for her birthday in September.
What do you tell him is responsible for his loses? (What is causing his birds to die?)
How do you know?
How did his birds come to be infected?
What steps should he take to minimize losses?
DL: 2
SCENARIO E: Midnight
In May, your niece calls you expressing concern for her show horse, Midnight. He has a
fever, mild diarrhea, and appears to be experiencing slight foot pain. She brought him to a
horse show two weeks ago but worked with him a lot before and after the show and didn’t
notice anything abnormal. Frustrated she tells you, “I guess the only thing that’s different
since we got back is that he’s been grazing in the pasture the past few days. While we were
training for the show, I primarily kept him in the barn. I thought letting him graze would
be a nice relief.” You decide to check out the pasture and find that it borders a small creek,
and the grass surrounding the creek is still damp even with the afternoon sun.
What do you suspect is causing her horse’s symptoms?
What leads you to that diagnosis?
How should she treat this illness?
How should she prevent it from reoccurring?
DL: 3
SCENARIO F: Yellowstone
You are called to assist a beef farmer in the greater Yellowstone area. Recently several of
his cows have experienced late term abortions, and he’s extremely concerned. Upon
inspecting his pastureland, you notice a lot of hoof prints outside the fence which piques
your curiosity. After a brief discussion with the farmer, you learn that it has been a harsh
winter and the prints are from wild elk and bison from Yellowstone National Park that are
looking for food. On two separate occasions he has found them on his rangeland amongst
his cattle.
What disease is the farmer worried about?
What leads you to this conclusion?
Why is he so concerned with elk and bison interacting with his cows?
How might they have contracted this disease?
How should these cows be treated?
What are some practical solutions that could protect the farmer’s herd from further
infections?
DL: 2
SCENARIO G: Sheila
Sheila, the barn cat, has started to become listless and no longer actively hunts. She is 2
years old but she has almost no energy. In the past few days, she has stopped eating and
her owner said it appeared as though she was drunk. She was wandering around aimlessly
and walked right into a pole. She also lost bladder control on her ride to the vet. Her
temperature today is 103 F. Her fecal float does not show any signs of oocysts.
What pathogen do you suspect is affecting Sheila?
What leads you to this diagnosis?
What tests do you need to perform to confirm your diagnosis?
Why was the fecal float negative?
If this is indeed her diagnosis, what are 2 actions would you recommend the owner take
upon returning home? Why? What are your major concerns?
DL: 2
SCENARIO H: Rambo
In September, a young family brings in their black lab complaining that he just doesn’t seem right ever since their
vacation to the Poconos three months ago. Today he didn’t seem to want to get up to eat, drink, or relieve himself.
The father explains that Rambo was fine during the trip; he was running in the meadows chasing rabbits and had a
great time jumping off their dock into the lake. He is perplexed by this rapid shift in emotion. As he is in your exam
room, he seems to have no energy and is reluctant to move. Upon further inspection, his joints seem to be hot and
swollen but further examination does not show any broken or sprained bones or damaged joints. The mother notes
that some days he seems to favor is right front leg but today it seems it is his rear left leg that has the worst swelling.
You also do a thorough examination of his paws that reveals nothing abnormal. His temperature is 103 today.
What are Rambo’s symptoms?
What clues tell you that Rambo does not have arthritis?
What ailment do you suspect is affecting Rambo?
What leads you to this diagnosis?
What tests do you want to perform on Rambo?
How do you propose that the illness be treated?
What recommendations do you have for this family if they have other dogs at home? Why?
DL: 1
SCENARIO I: Hazel
Hazel is a stray cat that Angelica just found in the alleyway by her house. She’s a little
rough around the edges; it looks like she may have been in a few cat fights lately, but that’s
not Angelica’s primary concern. Hazel has a litter of 5 small kittens at home to take care of,
and she doesn’t seem to be doing well. Today she is running a fever, her lymph nodes are
enlarged, she hasn’t eaten in about two days, and she barely seems to want to get up at all.
Angelica wants to know what to do with these cats. She is a single working woman who
loves animals but also doesn’t have a lot of extra time or money to spend on medical
expenses.
What do you suspect is wrong with Hazel?
What leads you to this diagnosis?
What test(s) should you perform to determine if your suspicion is correct?
How do you recommend she should manage the cat? The kittens? Why?
DL: 3
SCENARIO J: Stray
Annie, a client who lives in inner city Lancaster adopted a stray a Doberman puppy. She
explains that her particular neighborhood has a lot of strays, and she just couldn’t bear to
let this one live his life on the streets. You are able to estimate he is about 4 months old.
She reports he’s been having bloody diarrhea and has also been vomiting all the food and
liquids she’s been trying to give him. As expected, he has become dehydrated from losing
all of this fluid.
What do you believe is causing the stray to be so sick?
What leads you to this diagnosis?
What additional tests should be performed to confirm your diagnosis?
What treatment should be administered?
Do you recommend that she keep the sick puppy? Why not or under what conditions?
DL: 2
SCENARIO K: Molly
Molly, a 6 year old schnauzer comes into your office hunched over in pain. When talking with her
owner, Samantha, she says she caught Mollie inhaling about 5 to 10 burgers and hot dogs that had
just come off of the grill for their 4th of July BBQ. “When I caught her, I pulled her away, but there
really wasn’t anything I could do. She wasn’t choking on a bone or anything, so I just locked her in
the basement so she wouldn’t do it again.” The next day Molly had diarrhea and explosive
vomiting. “I thought maybe it would work itself out of her system, but even this morning
everything she ate still came right back out. When things continued worse, I knew that it was a
bigger problem and we needed to come in and see you.” From her description, Molly now refuses
to eat and appears depressed. Samantha would like to know what is wrong with Molly and wonders
if it has anything to do with her BBQ bash.
What is Molly’s diagnosis? What helped you decide?
What tests would you want to perform to verify this diagnosis?
What would you tell Samantha to explain this condition/disease? What is Molly’s
prognosis? Will she survive? Will there be long term effects?
What treatment plan would you recommend? Why?
How should Samantha respond to prevent this problem from reoccurring in the future?
DL: 3
SCENARIO L: Chi Chi
9 year old male Golden Retriever
Observations: tachypnea, lethargic, anorexic
Below are the blood test results for this patient*. Calculate the normal test ranges using the
standard deviation values. (For instance, if the average pH is 5 and the standard deviation is .2, then
the normal low would be 4.8 and the normal high would be 5.2.) Place a check mark in the
abnormal column for any of the values outside of your calculated ranges.
Abnormal
Test
Actual
Normal Low
Normal High
Temperature
39.0 C
34.0 C
40.0 C
Hemoglobin
15.0 g/dL
12.1 g/dL
20.3 g/dL
pH
7.457
PaCO2
19.5 mmHg
PaO2
56.7 mmHg
HCO313.3 mmol/L
BE
-9.3 mmol/L
Saturation of Oxygen
92%
Alveolar - arterial gradient
0
20
*Blood sample obtained on room air with spontaneous ventilation
Is the sample arterial or venous? ________________
What is the patient’s ventilation status? ____________________
What is his acid/base state? How do you know?
How well is the dog oxygenating? Show your work! (The Barometric pressure is 635
mmHg)
What treatment would you recommend? Why?
DL: 3
Interpreting Blood Gas Results
Test
pH
pCO2
pO2
HCO3
B.E.
Saturation
of Oxygen
Average
7.386
31.57 mm Hg
79.68 mm Hg
18.22 mmol/L
-4.55 mmol/L
92.74%
Standard Deviation
0.030
3.60
6.44
2.16
2.14
1.43
1. Oxygen saturation is a measure of the percentage of Hemoglobin in an arterial blood
sample that is occupied by oxygen molecules. Each molecule of hemoglobin can bind four
molecules of oxygen. This binding process occurs rapidly and reversibly to facilitate the
loading of oxygen in the lungs and the release of oxygen to the tissues. Generally, levels
below 88% indicate that the sample was taken from a vein because the blood is returning to
the heart to be re-oxygenated. Low percentages can also be caused by pulmonary disease.
Levels above 88% indicate arterial samples.
2. Determine the acid base status of the animal.
a. The pH of the blood helps determine whether the animal acidotic, alkaloid, or normal. Animals that
have a pH below the specified range are considered acidotic and have a condition called acidosis.
Animals that have a pH above the specified range have a condition called alkalosis.
b. Use the chart below to determine the specific type of acidosis or alkalosis, if applicable. Basically,
you are determining the cause for the low/high pH level by looking at the concentrations of PCO2
and HCO3 in the blood. If the pH increase/decrease was caused by a breathing problem, it is
considered respiratory, while if the increase/decrease was caused by other conditions, it is
considered metabolic. If both CO2 and HCO3 levels are outside of their normal ranges, use the one
that is furthest outside of its normal range to determine whether it is respiratory or metabolic.
Condition
Most Abnormal
Blood Level
Metabolic Acidosis
Decreased HCO3
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Increased HCO3
Increased PaCO2
Decreased PaCO2
c. Determine if the animal’s body is trying to compensate for these increased or decreased levels by
considering abnormal PCO2 or HCO3 levels. If the body is trying to make up for the difference, the
animal is experiencing metabolic compensation while if the lungs are trying to make up for the
difference, the animal is experiencing respiratory compensation. (see chart)
Existing Condition
Metabolic acidosis
Signs of Compensation
pCO2 decreases by 0.7-0.9 mmHg
for each 1 mEq/L decrease in
HCO3
Type
Respiratory Compensation
Metabolic alkalosis
pCO2 increases by 0.7 mmHg for
each 1 mEq/L increase in HCO3
Respiratory Compensation
Respiratory acidosis
Acute: HCO3 increases by 1-1.5
mEq/L for each 10 mmHg increase
in pCO2
Chronic:HCO3 increases by 3-4
mEq/L for each 10 mmHg increase
in pCO2
Metabolic Compensation
Respiratory alkalosis
Acute: HCO3 decreases by 2-2.5
mEq/L for each 10 mmHg decrease
in pCO2
Chronic:HCO3 decreases by 5.5
mEq/L for each 10 mmHg decrease
in pCO2
Metabolic Compensation
3. Ventilation is assessed by measurement of PaCO2. Ventilation is the total amount of gas
moved in and out of the lung per minute, and is a measure of the volume and the respiratory
rate. Hypoventilation (slow breathing) leads to increased PaCO2 while hyperventilation (fast
breathing) leads to decreased PaCO2.
4. Oxygenation can be determined by calculating the Alveolar-arterial (A-a) gradient. Basically
it tells us how successful an animal is while breathing either on its own or with assistance.
Use the following equation to calculate this value. Values above 21 indicate acute respiratory
distress.
A =(Barometric pressure - 47) X 0. 21 – (PaCO2/0.8)
Alveolar-arterial gradient =A - a
and
a=PaO2