Table 1

Clinical vignettes, possible probabilities and response options

Suspected conditionClinical scenarioRange of probabilitiesDecision options
PanosteitisAn eight-month-old male neutered German shepherd dog presents to your clinic for evaluation of acute forelimb lameness over the past several days. Based on the dog’s history and physical exam, you believe there is an X per cent  probability that he has panosteitis. Radiographs of the long bones are approximately US$100 per limb. The owner has moderate financial restrictions. You decide to…X=(2, 5, 10, 15, 18, 20, 22, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90)
  1. Recommend radiographs of affected long bone to evaluate for injury vs panosteitis.

  2. Recommend a non-steroidal anti-inflammatory to help with the discomfort and explain that panosteitis should resolve over time.

HypothyroidismA nine-year-old female spayed Golden retriever presents to your clinic for weight gain and mild lethargy over the past several months. Based on the history and physical exam, you believe there is an X per cent  probability that this dog has hypothyroidism. The owner has moderate financial limitations and further blood work is approximately US$140. You decide to…X=(2, 5, 10, 15, 18, 20, 25, 30, 35, 40, 45, 48, 50, 55, 58, 60, 65, 68, 70, 72, 75)
  1. Recommend a prescription for a metabolic (weight maintenance) diet to aid in weight loss and have the dog follow up in 6 months.

  2. Recommend a systemic workup including complete blood count (CBC), chemistry and total T4.

Urinary tract infection (UTI)A seven-year-old female spayed Schaunzer presents to your clinic for a first time episode of stranguria, polyuria and hematuria. Based on the history, physical exam and in-house lab work (CBC, chemistry and urinalysis), you feel there is an X per cent  probability that this dog has a lower UTI. The owner has moderate financial restrictions. Urine culture is approximately US$50. You decide to…X=(2, 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 98)
  1. Recommend pursuing other diagnostics.

  2. Recommend a cystocentesis and culture submission.

  3. Recommend a two to three weeks course of prophylactic antibiotics and recheck at that time.

Mechanical gastrointestinal obstructionA five-year-old male neutered labrador mix presents to your clinic for vomiting and diarrhoea over 12–24 hours duration. After completing the history and physical exam, the owner agrees to two-view abdominal radiographs. Based on your history, physical exam and images, you feel there is an X per cent  probability that this dog has a mechanical obstruction. A barium study or abdominal ultrasound is approximately US$250 each. Abdominal exploratory surgery will be an estimated US$2500. The owner has moderate financial limitations. You decide to…X=(2, 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 98)
  1. Send the dog home with a prokinetic and antibiotic. Have the owner monitor at home and advise to return for a recheck if vomiting and diarrhoea continue.

  2. Recommend further diagnostics, such as a barium study or abdominal ultrasound.

  3. Recommend emergency abdominal exploratory surgery.

Idiopathic epilepsyA two-year-old female spayed Beagle presents to your clinic for evaluation of an initial episode of a generalised seizure. Based on the history, physical and neurological exam and normal findings on blood work, you are X per cent certain that the dog has idiopathic epilepsy. MRI is US$1800 (assume you are working at a facility with an MRI). The owner has moderate financial restrictions. You decide to…X=(2, 5, 8, 10, 12, 15, 18, 20, 25, 28, 30, 35, 38, 40, 45, 48, 50, 55, 58, 60, 65)
  1. Treat this as an isolated incident or potential syncope and discharge the patient.

  2. Recommend an MRI.

  3. Recommend an antiseizure medication.

Chronic kidney disease (CKD)An eight-year-old male neutered domestic short hair cat presents to your clinic for an annual wellness exam. Based on the history, physical exam and PCV (packed cell volume)/TS (total solids), you feel that there is an X per cent  chance that this cat has early stage CKD. The owner has moderate financial restrictions and further lab work is approximately US$100. You decide to…X=(10, 12, 15, 18, 20, 22, 25, 28, 30, 35, 38, 40, 45, 48, 50, 55, 58, 60, 65, 70, 75)
  1. Tell the owner that CKD is unlikely, and recommend returning in 1 year unless signs of CKD develop such as increased thirst or inappropriate elimination.

  2. Recommend a blood chemistry and urinalysis to further evaluate kidney function.

  3. Recommend a prescription for a renal diet and have him return in 6 months for follow-up exam.