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SAM 1. IM Oral Questions > 4,5,6,7,8. Skin > Flashcards

4,5,6,7,8. Skin Flashcards

1
Q

Integumentum includes …

A
  • hair coat
  • skin
  • external ear canal
  • plenum nasale, foot pads
  • cutaneous appendages (claws)
  • perianal, circumanal glands
  • paraproctal glands
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2
Q

Types of hairs. The cycle of the hair follicle

A

Guard hairs (primary) + sebaceous glans + sweat gland + musculoskeletal arector pill
Undercoat hairs (secondary) + sebaceous glands

  1. Anagen: active, growing period
  2. Catagen: transitional period, “self-killer keratinocytes”
  3. Telogen: “resting” period, hair retained in the follicle as a “dead hairshaft”
  4. Exogen: shedding phase
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3
Q

What is hair cycle controlled by?

A
  • photoperiod: telogen 50% in summer, 90% in winter.
  • ambient temperature
  • nutrition
  • hormones (thyroxin, STH <-> CS, oestrogen)
  • general health state
  • genetics
  • poorly understood intrinsic factors (growth factors, cytokines)
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4
Q

Disorders of hair follicles

A
  1. Follicular atrophy: caused by alteration in factors controlling follicle cycle
  2. Follicular dysplasia: caused by alterations in factors that control hair follicle structure
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5
Q

Types of sweat glands

A
  1. Apocrin (epitrichial)
  2. Eccrin (atrichial, merocrin)
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6
Q

Apocrine sweat glands

A
  • located where hairs are. More at the mucocutaneous junctions, interdigital area and on the dorsum
  • NO on the foot pads and the nasal plane
  • pheromones, IgA
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7
Q

Eccrin sweat glands

A
  • ONLY on the foot pads
  • deep in the dermis, subcutis, but their optimum is on the surface of the foot pad
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8
Q

Examination methods of the integumentum

A
  • inspection
  • palpation
  • smelling

Additional:
- skin scraping + hair shift examination
- otoscopic examination of the external ear canal
- cytology
- biopsy
- blood, urine tests
- special immunological tests

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9
Q

What do we check in hair coat examination

A
  1. Density
  2. Colour
  3. Gloss
  4. Closure (how the coat fits together/to the skin)
  5. Occurrence of loose hair-pull ability
  6. Stiffness
  7. Localisation of abnormalities
  8. External parasites
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10
Q

How can we describe density of hair coat during integumentum examination

A

Hypertrichosis: excessive hair (hormonal, developmental)
Alopecia: lack of hair (partial - complete)
- hypotrichosis: partial hair loss, form of alopecia
- primary: endocrinodermatopaties, follicular dysplasia
- secondary: trauma, inflammation

Localised/generalised; single/multiple; patchy/diffuse, multifocal/focal; hereditary/congenital; symmetrical/assymetrical

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11
Q

What do we check in examination of the skin?

A
  1. Condition of the epidermis
  2. Colour and presence of haemorrhages
  3. Odour
  4. Temperature
  5. Moisture
  6. Greasiness
  7. Thickness
  8. Elasticity
  9. Sensitivity
  10. Ectoparasites
  11. Skin lesions
  12. Skin swelllings
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12
Q

What is difference between primary and secondary skin lesions

A

Primary skin lesion: is the initial eruption that develops spontaneously as a direct reflection of underlying disease. They may appear quickly and then disappear rapidly

Secondary skin lesions: evolve from primary skin lesions or are artefacts induced by the patients or by external factors such as trauma or medications

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13
Q

List of exclusively primary skin lesions

A
  1. Macules - not elevated, differs in colour (patch: > 1cm)
  2. Papules - small, solid, elevation < 1 cm
  3. Plaques - extensive, relatively flat
  4. Nodules/tuber - solid mass > 1 cm
  5. Wheals - urticarial lesion, flat surface
  6. Vesicles, bulla - circumscribed elevation filled with fluid
  7. Pustules, abscesses
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14
Q

List of exclusively secondary skin lesions

A

Epidermal collarette, scar, excoriation, erosion, ulcer, fissure, lichenification, callus, necrosis

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15
Q

What lesions can be both primary and secondary?

A

Alopecia, scale, crust, follicular casts, comedo, pigmentary abnormalities

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16
Q

Macule — ?

A

Circumscribed, no palpable spot up to 1 cm in diameter and characterised by a change in the colour of the skin.

Cause pigment or vascular (erythema = redness)

Primary skin lesion.

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17
Q

Patch — ?

A

Macule larger than 1 cm

Primary skin lesion

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18
Q

Papula — ?

A

Small solid elevation of the skin up to 1 cm in diameter that can always be palpated as solid mass.

Many papules are pink or red swelling produced by tissue infiltration or inflammatory cells in the dermis, by intraepidermal and subepidermal edema or by epidermal hypertrophy.

May or not involve hair follicles

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19
Q

Examples of papules

A

Erythematous papules: scabies, FAD, superficial bacterial folliculitis, allergic contact dermatitis

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20
Q

Plaque — ?

A

Larger flat-topped elevation formed by the extension or coalition of papules

E.g.: cat: eosinophil granulosa complex: eosinophil plaque

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21
Q

Nodule — ?

A

Circumscribed solid elevation > 1 cm that usually extends into deeper layers of skin

Usually result from massive infiltration of inflammatory or neoplastic cells into the dermis or subcutis. Deposition of fibrin or crystalline material also produces nodules

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22
Q

Tuber — ?

A

Inflammatory elevation of papillary zone of skin or mucus membrane with different shape and size

Tumour: large mass that may involve any structure of the skin or subcutaneous tissue. Most tumors are neoplastic or granulomatous in origin (fibroma, mastocystoma, melanoma, lipoma)

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23
Q

Wheal — ?

A

Sharply circumscribed raised lesion consisting of edema that usually appears and disappears within minutes or hours.

Usually produce no changes in the appearance of the overlying skin and haircoat.

White to pink elevated ridges or round edematous swellings that only rarely have pseudopods at their periphery.

24
Q

Examples of wheals

A

Urticaria, insect bites, positive reactions to IDST (intrdermal skin test)

25
Q

Angioedema — ?

A

Huge hive of a distension region such as lops or eyelids

Type 1 hypersensitivity reaction

26
Q

Vesicle — ?

A

Sharply circumscribed elevation of the epidermis filled with clear fluid

Can be intraepidermal or subepidermal. Vesicles are rarely seen in dogs and cats because they are fragile and transient. They iccur in viral and autoimmune dermatoses or in dermatitis caused by irritants.

Up to 1 cm in diameter

27
Q

Bullae — ?

A

Vesicles with diameter more than 1 cm

E.g. bullous pemphigoid

28
Q

Cyst — ?

A

Epithelium-lined cavity containing fluid or solid material. Smooth, well-circumscribed, fluctuant to solid mass

Usually are filled with cornified cellular debris or cebaceous or epitrichial secretions

29
Q

Pustule — ?

A

Small, circumscribed elevation of the epidermis that is filled with pus.

Most commonly, pustules contain neutrophils and are infectious in origin, however, eosinophils may predominate (especially in parasitic or allergic disorders) and may be sterile.

30
Q

Abscess — ?

A

Demarcated fluctuant lesion resulting from a dermal or subcutaneous accumulation of pus. Pus is not visible on the surface of the skin until it drains to the surface. Abscesses are larger and deeper than pustules

31
Q

Alopecia — ?

A

Loss of hair and may vary from partial to complete
Can be both primary and secondary

32
Q

Possible causes of primary alopecia

A

Endocrine disorders, follicular dysplasia

33
Q

Possible causes of secondary alopecia

A

Trauma or inflammation

34
Q

Scale — ?

A

Accumulation of loose fragments of the horny layer of the skin (cornified cells). ‘The corneocyte is the final product of epidermal keratinisation. Normal loss occurs as individual cells or small clusters not visible to naked eye.

Abnormal scaling is the loss of in larger flakes. Flakes vary greatly in consistency and colour.

35
Q

Possible causes of primary scaling

A

Colour dilution alopecia, primary idiopathic seborrhoea, follicular dysplasia

36
Q

Possible cause of secondary scaling

A

Chronic inflammation

37
Q

Crust — ?

A

Formed when dried exudate/serum/pus/blood/cells/scales/ medications adhere to the surface.

  • tan, lightly adhering crusts are found in impetigo
  • honey-coloured crusts are more commonly infectious in nature
  • thicker dry yellow crusts: typical of scabies ans zinc-responsive dermatosis
  • tightly adherent crusts are typical in zinc-responsive dermatosis and necrolytic migratory erythema, seborrhoea
38
Q

Possible causes of primary crusts

A

Primary idiopathic seborrhoea, Zn-positive dermatosis

39
Q

Possible causes of secondary crusts

A

Pyoderma, fly strike, pruritis (Scabies: dry, yellow, papulocrusta)

40
Q

Comedo — ?

A

Dilated hair follicle filled with cornified cells and sebaceous material. Initial lesion of feline acne and may predispose the skin to bacterial folliculitis

41
Q

Possible causes of primary comedo

A

Infection with Demodex and sermatophytosis
Vitamin A responsive dermatosis
Schnauzer comedo syndrome
Cushing’s disease
Sex hormone dermatosis
Idiopathic seborrhoea disorders

42
Q

Possible cause of secondary comedo

A

Seborrheic skin disease
Occlusion with greasy medications or administration of systemic or topical corticosteroids

43
Q

Follicular cast — ?

A

Accumulation of keratin and follicular material that adheres to the hair haft extending above the surface of the follicular ostia

Primary: vit A responsive dermatosis, primary idiopathic seborrhoea, sebaceous adenitis

Secondary: demodectic mange and dermatophytosis

44
Q

Abnormal pigmentation

A
  • black: melanin present throughout the epidermis (lentigo)
  • blue: maelanin within melanocytes and melanophages in the middle and deep dermis (dermal melanocytoma)
  • gray: diffuse dermal melanomas or superficial dermal melanosis from pigment incontinence
  • brown: hemochromatosis is due to primarily to melanin nit hemosiderin
  • yellow-green: accumulation of bile pigments
45
Q

Hypopigmentation (hypomelanosis)

A

Primary: vitiligo-like disease
Secondary: post inflammatory change

Leukoderma: general term for white skin, whereas vitiligo refers to a specific disease

Leukotrichia, achromotrichia: lack of pigment in hair

46
Q

Hyperpigmentation (hypermelanosis, melanoderma)

A

Primary: endocrine - diffuse
Secondary: post inflammatory, chronic, traumatic - latticework appearance

47
Q

Epidermal collarette

A

Special type of scale arranged in a circular rim of loose keratin flakes or peeling keratin

Represents remnants of the roof of a vesicle/bulla/pustule/papule or hyperkeratosis caused by. Point source of inflammation as seen with papules and pustules

48
Q

Excoriation

A

Caused by scratching, biting or rubbing. Usually result from pruritis. Often partly recognised by linear pattern

49
Q

Erosion

A

Shallow epidermal defect that does not penetrate the basal laminar zone and consequently heals without scarring. Generally results from epidermal diseases

50
Q

Ulcer — ?

A

Break in the continuity of the epidermis with exposure of the underlying dermis. Deep pathology process is required for an ulcer to form.

51
Q

Scar (cicatrix) — ?

A

Area of fibrous tissue that has replaced the damaged dermis or subcutaneous tissue

Remnant of trauma or dermatological lesion.
Most scars in dogs and cats are alopecic, atrophied and depigmented

52
Q

Fissure — ?

A

Linear cleavage into the epidermis or through the epidermis into the dermis caused by disease or injury

Have sharply defined margins and may be dry or moist. Occur when skin is thick and in elastic and then subjected to sudden swelling from inflammation or trauma, especially in the region of frequent movement.

53
Q

Lichenification — ?

A

Thickening and hardening of the epidermis characterised by an exaggeration of the superficial skin markings. Lichenification areas often result from friction. They may be normally coloured but often are hyperpigmented.

54
Q

Callus — ?

A

Thickened, rough, hyperkeratotic, alopecic, often lichenification plaque that develops on the skin.

Most commonly calluses occur over bony prominences and result from pressure and chronic low-grade friction

55
Q

Swellings

A
  1. Oedema
  2. Emphysema (emphysema subcutaneum)
  3. Haematoma (haematoma cutis)
  4. Tumour (tumour cutis)

Localisation, number, size, temperature, pain, consistency, percussion, content

56
Q

Cutaneous appendages

A

Claws, nails.

Shape, length, colour, temperature, pain, consistency, tenderness

Onychomadesis (complete loss)
Onychorrhexis (crumbling)

57
Q

External ear canal

A
  • head position
  • position of the external canal
  • shape of the ear
  • skin of the ear pinnae and external ear canal
  • pain, sensitivity of the basis of the ear
  • otoscopy: skin inside, earwax (cerumen), ear drum
  • test: microscopical and microbiological examination

SAM 1. IM Oral Questions (12 decks)

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