Cats and Dogs Flashcards

Question

When does a dog typically get vaginitis? Clinical signs? Tx?

Answer 1

Puppy- prior to first oestrus Adult- after first oestrus and in spayed females \* CS: discharge, may attract male dogs \* TX: puppy vaginitis spontaneously resolves often, check for brucellosis, phenylpropanolamine for adults

Answer 2

\* Physiological and behavioural signs of proestrous occur without progress to oestrus (common in young bitches) \* after 4 weeks "normal oestrous cycle" with ovulation occurs

Answer 3

German Shepherds-- TX: delay oestrous with androgens (mibolerone; Cheque Drops)

Answer 4

\* piece of ovarian tissue left behind at time of spaying \* bitches present with signs of prooestrous (+/- bleeding) \* can do hcG/GnRH stimulation test \* laparoscopy during oestrus or luteal phase

Answer 5

\* look for midline incision \* measure LH and FSH--\> would be high due to lack of negative feedback

Answer 6

\* Sample of prostatic fluid--\> collect ejaculate

Answer 7

\> 90% \* TX: Castration

Answer 8

Benign Prostatic Hypertrophy/plasia (BPH) \* prostatitis- acute or chronic \* Prostatic abscesses- often secondary to prostatitis \* prostatic cysts \* Neoplasia: castration is not a cure!-- grave prognosis by the time diagnosed it has almost always metastasized... almost always malignant adenocarcinoma

Answer 9

\* haematuria, haemospermia, tenesmus (flat faeces), dysuria, poor semen quality/ infertility, acute prostatitis: fever, anorexia, lethargy

Answer 10

\* Rectal palpation: size, symmetry, surface, pane \* RX \* Cytology and culture of prostatic fluid \* Urinalysis \* Retrograde cysturethrography

Answer 11

Finasteride (5 alpha reductase inhibitor) or progesterone until breeding career is over... consider freezing semen

Answer 12

mate multiple times to ovulate

Answer 13

\* Ovariohysterectomy \* If not okay, then first confirm she is pregnant (if it too early, do not give anything): - PGF2alpha (dogs are not as sensitive as other species- over a course of 5 days) - dopamine agonists (prolactin, maintenance of pregnancy, antagonist) - aglepristone (block progesterone receptors) - corticosteroids or a combination of the above

Answer 14

\* it is an emergency \*two procedures should always be done: 1. vaginal exam (to feel or see stressed pup, check for contractions (hypocalcaemia if no contractions; obstructive if contractions) 2. ultrasonography (if they are alive and how stressed they are)

Answer 15

\* karotyping

Answer 16

\* limited organ reserve \* exaggerated or prolonged effects of anaesthesia \* CV: low myocardial contractile mass, low ventricular compliance, SV and cardiac reserve are limited, CO is rate dependent, persistence of fetal circulation in foal up to 3 days (right to left shunt) \* Symp NS not full developed: minimal increase in HR and myocardial contractility--\> further impairing ability to increase CO, poor vasomotor control and inadequate response to blood loss \*Resp: pulmonary reserve is minimal, more compliant chest--\> greater work of breathing, higher minute volume \* Thermoregulation: immature thermoregulatory system, high body surface to mass ratio, prone to hypothermia

Answer 17

1. Hypoalbuminemia--\> more free drug 2. Increased permeability of BBB 3. Increased percentage of body water content--\> greater apparent volume of distribution 4. Fixed circulating fluid volume--\> more susceptible to hypovolaemia 5. Low body fat percentage-- less drug redistribution in adipose tissue 6. Immature hepatic metabolism- increased duration of action 7. Immature GFR- increase duration of action 8. higher metabolic rate-- increase oxygen consumption and CO production

Answer 18

Sedative, muscle relaxant, analgesia, hypnotic

Answer 19

\* IM medetomidine & methadone- cats and dogs (or Ace & hydromorphone- dogs, or ketamine & midazolam & methadone- cats)

Answer 20

\* Propofol +/- diazepam (or Alfaxalone +/- diazepam, or diazepam & ketamine)

Answer 21

Isoflurane in oxygen, balanced crystalloid solution (5 ml/kg/h)

Answer 22

\* Line block with bupivacain or ropivacaine \* intra-testicular block with lignocaine (dogs)

Answer 23

\* NSAID (carprofen or meloxicam), +/- opioid

Answer 24

IM anaesthetic--\> acepromazine (low dose) & methadone- dogs and cats (or hydromorphone (dogs), or ketamine (low dose) & midazolam & methadone-cats)

Answer 25

\* Propofol +/- diazepam \* Alfaxalone +/- diazepam

Answer 26

\* isoflurane in oxygen, balanced crystalloid solution, +/- dextrose solution at 2 to 5 mL/kg/hr

Answer 27

Caution to total volume administered \* line block with bupivacaine or ropivacaine \* intra-testicular block with lignocaine (dogs)

Answer 28

NSAID (carprofen or meloxicam) +/- opioid

Answer 29

\* estrogens decrease vascular resistance, combined with CO-- BP unchanged, increased HR and SV \* Blood volume increased by 40%-- plasma \> RBCs = decreased PVC = decreased [Hb] \* Labor: - Increased HR, CO, BP, and central venous pressure (CVP), increase oxytocin levels - in dorsal recumbency, gravid uterus will compress caudal vena cava= decrease venous return which will decreased blood for to uterus

Answer 30

\* Progesterone increases CNS sensitivity to CO2-- normal PaCO2 decreased to 30 mmHg, increased minute ventilation \* increased tissue oxygen demands (VO2) \* Decreased functional residual capacity (FRC)- gravid uterus pushes up on diaphragm= less space for lungs, more sensitive to hypoxemia and hypercapnia \* decreased FRC + increased minute ventilation = faster induction with inhalants

Answer 31

\* Gravid uterus pushing on stomach \* Decreased gastric motility \* decreases oesophageal sphincter tone \* risk of regurgitation increased

Answer 32

\* Increased hepatic and renal blood flow-- GFR increased by up to 60%, BUN and creatinine decreased

Answer 33

\* Uterine blood flow changes during pregnancy and labour \* Uterine contraction and oxytocin decrease uterine blood flow--\> decreased foetal viability, effect worsen by anaesthesia

Answer 34

Drug: \* Poor ionization in the dam- non-ionized can pass but becomes ionized and cannot pass back out \* Low molecular weight \* low protein binding \* high lipid solubility (qualities of a good anaesthetic drug but bad for the foetus) Placenta: \* thickness and surface area of placenta determine how much drug will transfer \* concentration gradient (dam to fetus) another determination Patient: \* pH \*pK

Answer 35

\* Be prepared and quick \* Use smallest doses possible \* consider local anaesthetics \* Avoid long acting drugs \* Choose reversible drugs if possible \* Minimize inhalant concentration (reduced MAC in pregnancy) \* Dam is at increased risk for vomiting and regurgitation \* have warming devices, oxygen, intubation kits, dry gauze to wipe secretions from mouth and nose ready \* Emergency drugs ready: reversal agents (for dam and puppies), epinephrine, atropine, dextrose

Answer 36

\* Opioids- minimal resp effects vs. analgesia--\> methadone \* Avoid Acepromazine or alpha 2 agonists (NO XYLAZINE) \* May skip pre-med \* pre oxygenate the patient!!!

Answer 37

\* Propofol, Alfaxalone \* Can consider Fentanyl + Midazolam if dam is exhausted after prolonged dystocia

Answer 38

\* propofol/isoflurane or sevoflurane \* will require IPPV due to dorsal recumbency \* Consider additional analgesics after removal or puppies \* don't forget local analgesia \* Ephedrine maintains uterine blood flow while treating hypotension

Answer 39

\* Oxygen is the single most important thing you can provide \* Rub vigorously to stimulate breathing \* Doxapram under tongue if nothing \* provide warmth and oxygen rich environment \* reversal of the drugs given to the dam that could have transferred to the puppies through the placenta

Answer 40

NSAIDs +/- Tramadol for dam for post-op pain

Answer 41

6 months of age (in a shelter 8-12 weeks of age-- claimed decreased stress and operative time, assurance de-sexed when rehomed)

Answer 42

The aorta \* The ovarian a. supplies the ovary and the cranial aspect of the uterus

Answer 43

\* Right ovarian vein drains into the caudal vena cava \* Left ovarian vein drains into the left renal vein

Answer 44

Broad ligament: mesovarium, mesosalpinx, mesometrium

Answer 45

Proper ligament (continused caudally as the round ligament that courses within the broad ligament, passing through the inguinal canal)

Answer 46

Internal pudendal artery

Answer 47

\* hypogastric and lumbar LNs \* Hypogastric plexus (symp), pelvic nerves (PS)

Answer 48

\* Better access to peritoneal cavity if problems occur \* Can check haemostasis \* Access to right ovary can be difficult through flank approach \* Anecdotally increased incidence of seroma with flank procedures (3 x muscle layers)

Answer 49

Canine: 1-2 cm caudal to the umbilicus extending 5 cm Feline: 3-4 cm incision centred over the midpoint between the cranial rim of the pelvis and the umbilicus \* express the bladder

Answer 50

\* abdominal palpation, radiographs, ultrasound (most sensitive-- demonstrates presence of fluid and thickness of uterine wall)

Answer 51

Vaginal oedema-- during oestrogenic phase, vaginal mucosa becomes swollen allowing a transverse fold to prolapse through vulva (esp Brachycephalic breeds)... regresses spontaneously, OVH permanent relief

Answer 52

Less tensile strength and its loss of tensile strength relies on phagocytosis not hydrolysis and its rate is unpredictable

Answer 53

Episoplasty is most commonly used in the treatment of chronic perivulvar dermatitis secondary to skin folds and or infantile external genitalia. Cresenteric resection of redundant skin folds improves the micro environment, prevents vaginal hooding and allows improved air circulation and drying of perivulvar skin. Medical therapy with appropriate antimicrobial agents should be instituted prior to surgery

Answer 54

\* Haemorrhage, most common (76% of all complications) \* Wound healing complications e.g. suture reaction (esp cats), seroma, fistulous tracts \* Stump pyometra- progesterone produced by remnants of ovarian tissue or exogenous \* Ureteral ligation \* Ovarian remnant syndrome (mammary development, bleeding) \* Urinary incontinence (11-20%) \* Weight gain (26-38% gain reported)

Answer 55

2-3 cm cranial to and 5-6 cm caudal to the umbilicus

Answer 56

\* Also histo via excisional biopsy \* for high breeding value animals- testicular sampling (FNA and biopsy)

Answer 57

Safer, swinging has been implicated in causing brain damage

Answer 58

\* Cushing or Lembert pattern with synthetic absorbable monofilament suture

Answer 59

\* Cervix closed and progesterone increases secretions of uterine glands, inhibits myometrial contraction and closes the cervix, results in cystic endometrial hyperplasia, inhibits the leukocyte response facilitating bacterial colonisation

Answer 60

\* PGF2alpha luteolysis (lowering progesterone) + Broad spectrum antibiotics (Clavulox or enrofloxacin) \* Surgical : OVH, care not to rupture distended uterus, lavage

Answer 61

Circumferential prolapse of the vagina

Answer 62

Mast Cell Tumour with FNA

Answer 63

6-9 months as optimal age (no demonstrated negative effects in dogs and cats

Answer 64

\* Scrotal bruising/haematoma \* Haemorrhage \* Dermatitis \* Infection/abscess \* Persistent Priapism in cats

Answer 65

\* Bilaterally affected animals- sterile; unilaterally affected animals- sub-fertile

Answer 66

Interstitial Cell Tumours (aka Leydig) Sertoli Cell Tumours Seminomas

Answer 67

Underneath the bladder

Answer 68

\* Neoplastic change in cells responsible for spermatogenesis

Answer 69

\* Abdominal or inguinal \* Palpation (fat, LNs) \* Ultrasound

Answer 70

\* Dyschezia/ constipation \* Urethral bleeding/ discharge \* Pyrexia \* Hindlimb stiffness- weakness

Answer 71

\* Radiography (mineralisation associated with neoplasia in castrated dogs, displacement of adjacent tissues- colon, bladder, osteolysis of vertebral bodies, positive contrast studies) \* U/S-- enhances accuracy of FNA or biopsy \* Fluid samples for cytology and culture can be obtained by: sampling ejaculate, prostatic wash , U/S guided FNA

Answer 72

\* Biopsy, prostatic abscess, cystic disease, prostatic neoplasia \* avoid the dorsolateral aspects- neurovascular pedicle \*Omentum: vascular supply, lymphatic drainage, immuno-competent cells

Answer 73

\* Partial prostatectomy: potential for significant blood loss, temporary arterial occlusion, pre-place catheter to ID the urethra, \* Complete: Malignant neoplasia sole indication (uncommon due to late dx, early metastatic dx, lack of impact on distant disease, likely incontinence)

Answer 74

\* Inability to extrude penise because preputial orifice is too small (congenital) or acquired due to trauma, infection, scarring, neoplasia.... from urine pooling and balanoposthitis, erectile pain \*\* Surgery- enlargement of a narrowed preputial os using a v-shaped incision on the dorsal surface and apposition of mucosa to skin

Answer 75

\* INability to retract within the prepuce-- congenital or acquired (trauma, infection, internal rolling and entanglement with hair)

Answer 76

Increases serum calcium level through increased tissue responsiveness to PTH

Answer 77

Muscle contractions

Answer 78

Likely Congenital-- crossing with other breeds now Changed food similar to what you'd do in dairy cows-- which lowered the stillbirth rate

Answer 79

\*\* Ionized Ca

Answer 80

\* Degranulation of MCT - oedema - ulceration - swelling

Answer 81

Can be bad: rapid growht, local swelling, paraneoplastic signs, palpably enlarged spleen or draining LNs, anatomic location (mucocutaneous junctions and inguinal region)

Answer 82

\* Grade 1- benign \* Grade 2- hasn't decided \* Grade 3- aggressive with early metastases

Answer 83

A. FNA lump BECAUSE your best chance to cure is your first cut

Answer 84

FNA cytology confirms MCT

Answer 85

\*\* a C- kit - if the tumour has a c- kit mutation known to be sensitive to tyrosine kinase inhibitor. Not quite Chemotherapy but similar idea. Wouldn't choose C because it makes the dogs really sick and we aren't even sure it will work-- and we are not in Brisbane. It is not in an area that would have few side effects (e.g. a limb) \*\* B. probably

Answer 86

Rapid develop, so it is aggressive, so FNA lump and pre scapular lymph node (B)

Answer 87

C. Revision Surgery (+ B is the optimal)

Answer 88

C or D gold standard

Answer 89

C. Staging is still necessary for each MCT

Answer 90

\* Skin and S/C most common locations but can be anywhere \* Slow growing \* Locally invasive \* Low metastatic rate (grade dependent)

Answer 91

\* Pseudocapsule- tumour cells at capsule invade surrounding tissue \* Make STS appear easy to shell out-- DO NOT shell out tumour \* Margin status predictive of local recurrence \* Local recurrence common after incomplete surgical resection

Answer 92

A. Incisional biopsy

Answer 93

C. Marginal excision and radiation (Can do amputation, no indication for metronomic chemotherapy)

Answer 94

A. amputate leg is the most curative but depends on owner.... otherwise B and C \*\* STS' are not that responsive to chemotherapy

Answer 95

Imidacloprid + permethrin (fleas, ticks, and mossies)

Answer 96

\* Cytology usually diagnostic & prognostic \* Can consider incisional biopsy-- more $, great risk wound breakdown \* thorough planning is best

Answer 97

\* Dogs with a normal HPA axis- the use of GC with antibiotics may be counter productive \* But short term use of combinations of corticosteroids and antibiotics with comparable pharmacokinectics on the skin like aminoglycoside antibiotics can be of clinical benefit

Answer 98

\* Protease pathway is not blocked

Answer 99

Alopecia \* Excess loss or failure to grow \* DDX: - excess loss: self trauma or folliculitis - failure to grow: endocrinopathy

Answer 100

Pyo traumatic dermatitis (aka hot spot) \* considered surface infection in most cases (usually staph) \* Treat with topical drugs

Answer 101

Treat topically

Answer 102

\* oral antibiotics for 2-3 weeks Short acting Dex (36 hours)-- not steroids on going!! \* Topical antibiotic with steroid-- e.g. He always uses fusiderm or neocort-- (but does not penetrate, has lignocaine in it which is toxic to the skin so longer than a week causes a chemical burn-- so never in thin skins-- nowhere near scrotum in male dogs)

Answer 103

1. Trauma 2. Dermatophytosis (ringworm) 3. Parasites 4. Anagen: Telogen ratio

Answer 104

Does not need oral antibiotics

Answer 105

Does not need oral antibiotics-- topical will be faster, quicker, easier

Answer 106

Malassezia but could be bacteria so cytology

Answer 107

Eosinophil- does not mean allergy, just means skin infection

Answer 108

Degenerative neutrophil- toxic effects because of bacterial-- just means bacterial infection

Answer 109

Treat for at least 7 days after clinical resolution, minimum of 3 weeks

Answer 110

\* Staging more important \* Splenectomy more helpful \* No histological grading scheme but nasty appearance normally poor prognosis \* Surgery curative if possible \* Radiation poor results \* Chemotherapy if metastatic disease \* Tyrosine kinase inhibitors maybe

Answer 111

\* Blood meal --\> lay eggs (50/day) \* Eggs hatch faster when warmer \* Adults are less than 5% of population \* Flea dirt- digested blood and excrement from adult fleas \* Treat all animals in household with adulticide and IGR \* Environment? Flea bombs \* Wash bedding- hot water \* Vacuum, empty out vacuum bags

Answer 112

Two ways: \* Drugs absorbed transdermally into the plasma e.g. fentanyl patch \* Long acting-- topical administered and act locally e.g. fipronil

Answer 113

\* Convenience, compliance, safety, maximize local drug concentrations CHALLENGES: \* Penetration of stratum corneum- intercellular, transcellular, sweat glands/ hair follicles \* Absorption- lipids solubility, penetration enhancers (e.g. propylene glycol) \* skin is an organ, not just a barrier- some metabolism does occur in the skin \* Human safety (petting after application)- young children \* Metabolism phase I and phase II metabolic processes \* Species variation (wool on sheep vs. pigs)

Answer 114

Rapid resolution but increase in fucidin resistant S. aureus

Answer 115

\* Removal of allergens, decrease antimicrobial load (chlorhex and miconazole), reduce itch (colloidal oatmeals) \* Surfactants are irritants-- shampoo with 44 ingredients

Answer 116

Skin has limited ways it can react

Answer 117

Cephalexin \*\* Could be fungal, could be MRSP

Answer 118

\*Dog comes in with infection with a history of visits from multiple vet clinics, most common place to pick up is vet waiting rooms \* Dogs who have been hospitalized \* Dogs with a history of antibiotics AND drugs that affect the immune system (GCs, cyclosporin, etc.) \*\* immune system does not discriminate between staph and resistant staph \* High density living- contact with other dogs- grooming salons \* dogs who have had lots of ear infection-- enough systemic absorption of antibiotics to change and skew staph bacteria towards resistance

Answer 119

\*Anatomical reasons-- face folds like bull dogs \*Microclimate changes-- left wet \*Decreased exfoliation/follicular obstruction \*Decreased immunity \*Self trauma (scratching) \*Atopic dermatitis

Answer 120

\* Almost always surface infection, but bacteria can be surface, superficial or deep

Answer 121

Pseudomonas

Answer 122

Treat for it and see if it goes away

Answer 123

Surface treatment

Answer 124

\* Folliculitis: demodicosis, dermatophytosis \* Pustules: pemphigus foliaceous, contact allergy

Answer 125

Infection, immune mediated, allergy

Answer 126

Dry papules for bacteria or cell types, acantholytic cells

Answer 127

Nodules, tumours, cysts

Answer 128

\* Focal light-- intense, bright light source with fibre optics \* Handheld magnification \* equipment to look at the fundus (interior surface of the eye retina, optic disc, macula, fovea, and posterior pole)-- direct opthalmoscope or 20 D hand held lens \* Schirmer tear test strips \* topical local anaesthesia \* local anaesthetic for regional nerve blocks \* sterile spatula, MC and S swabs, glass microscope slides \* Tonometer \* Fluorescein stain \* Mydriatic NOT atropine \* Saline for irrigation

Answer 129

Sherman Tear Test- evaluates tear production-- at the beginning of the examination Microbial Culture and Sensitivity

Answer 130

\* Aniscoria- direct opthalmoscope set to zero-- look at both eyes simultaneous-- get the dogs or cats attention-- retro illuminate the eyes-- highlights the pupil size. \* Outside of eye - looking at eyelids, third eyelid, conjunctiva, and sclera (surface occular structures) \* anterior segment- cornea, AC, iris \* Dilate pupil (tropicamide): lens, vitreous, fundus exam \* Measure intraocular pressure (IOP)-- concerned with inner structures of the eye

Answer 131

\* Assess vision in light room \* Menace (care with cats as creating air currents can move whiskers) \* Moving object, visual placing \* Dazzle reflex \* Obstacle course exam \* Assess symmetry, size & position of the orbit, globes and eyelids \* Check for any discharge, redness or swelling around the eyes \* Palpate bony orbit, retropel globe

Answer 132

Retroillumination-- ulcer, cyst, lens opacities determining if there is cataract or advanced aging change, if they do have cataract how much of the lens is affected-- immature or mature where the whole lens is affected

Answer 133

Mydriacyl (Alcon) tropicamide opthalmic solution This anticholinergic preparation blocks the responses of the sphincter muscle of the iris and the ciliary muscle to cholinergic stimulation, dilating the pupil (mydriasis). The stronger preparation (1%) also paralyzes accommodation. This preparation acts in 15-30 minutes, and the duration of activity is approximately 3-8 hours. Complete recovery from mydriasis in some individuals may require 24 hours. The weaker strength may be useful in producing mydriasis with only slight cycloplegia. Heavily pigmented irides may require more doses than lightly pigmented irides.

Answer 134

Checking for uveitis-- characterising the degree of inflammation \* Frequently occurs with anterior segment disease in horses \* focal light essential to detect aqueous flare \*\* look for reflected light-- opposite side \*left its reflecting off the iris, the right it is reflecting off the lens-- we are looking in between looking at the aqeous humour hoping it is nice and black-- if it is foggy there is flare such as RBCs or fibrin

Answer 135

\* e.g. blunt end of scalpel scrape at the edge of the ulcer \*\* looking for bacteria, fungus, type of white cells

Answer 136

Does the dog have uveitis or glaucoma? \* pressure reading does not matter, looking at the difference

Answer 137

\* Touch to bulbar conjunctiva-- not too much stain- DO NOT touch the cornea with the Fluorsecein strip as it causes false positives \*\* fluorescein binds to mucous threads, granulation tissue, rough epithelium and it will sit in shallow facets (healed corneal ulcers with a shallow stromal deficit) -- flush excess stain from the eye to avoid false positives \* Fluorescein can also determine patency of nasolacrimal ducts-- apply dilute fluorescein liberally to the eye and fluorescein should be present in the nose within 5-10 minutes... this should be performed in all cases of conjunctivitis

Answer 138

Auriculopalpebral nerve provides motor supply to orbicularis occuli muscle (branch of CN VII) • Frontal nerve provides sensation to the upper eyelid and dorsal periocular skin (branch of CN V) • Blocking both nerves provides total akinesia and analgesia to upper eyelid

Answer 139

Highly magnified upright image of the fundus. Peripheral regions of the fundus are hard to examine. \* Turn the magnification setting to zero (real image allows for a better image of the fundus), brightest setting of light, resting against the examiner's brow \* once a fundus reflection is viewed by retroillumination, slowly move forwards towards the eye-- the fundus comes into focus when the direct ophthalmoscope is about 1-2 cm from the eye

Answer 140

\* Better "scanning" view of the fundus but technically more difficult to perform \* different regions of the fundus can be simultaneously compared for disease \* 20 D lens is most common \* Inverted view of the fundus

Answer 141

Fluorescein staining-- performed last so it does not interfere with other tests like the Sherman Tear Test (STT)

Answer 142

Exam for entropion, distichiasis, trichiasis, ectropic cilia, punctal atresia, under the eyelid for any foreign objects

Answer 143

\* any animal with inflamed eyelids or conjunctivitis \* Detecting infection, discerning between acute and chronic disease and will help determine antibiotic selection

Answer 144

\* Determining whether the NLD is working NLD= nasolacrimal duct

Answer 145

Fluorescein

Answer 146

tap water, sterile saline, or artificial tears

Answer 147

Describe what you see: \* Epiphora (watery ocular discharge), overflow onto periocular skin, cornea clear, senile nuclear sclerosis \* Unpigmented eyelids DDX: \* Block NLD, punctal atresia (absence of puncta)? \* Conjunctivitis- allergic, bacterial, viral, UV radiation (solar?)-- common in unpigmented eyelids of dogs-- eyelids also get sunburnt/ reddened \* Surface irritation- ectopic cilium, distichiasis, trichiasis \* FB? \*\* Further testing: STT, Conjunctival cytology, Fluorescein passage to nose, NLD flush or explore under GA

Answer 148

Describe what you see: \* upper and lower eyelid erythema, oedema and alopecia. Mild watery discharge. DDX: \* Bacterial, funal, viral, parasitic, immune- mediated blephartitis \* Neoplasia- MCT, Lymphosarcoma (LSA), sebaceous adenoma, lipoma \* Inflammatory conditions- nodular fasciitis, histiocytosis TESTS: \* Skin scraping, sticky tape cytology, incisional biopsy, deep tissue microbial culture and sensitivity TREATMENT: \* Bactericidal antibiotics which are effective against staph and strep \* Oral steroidal anti-inflammatory medications \* Review in 2 weeks... prolonged treatment may be required

Answer 149

Describe what you see: \* Narrow palpebral fissure, water discharge along lower eyelid margin, trichiasis, entropion \* Hair in contact with the tear duct (trichiasis- long hair gets in there OR eyelid conformation abnormal) \* Can't see the lower eyelid margin either-- eyelid is rolled in \* (Some cases also have concurrent ulceration) DDX: \* Entropion- primary or secondary? \* Trauma \* Conjunctival FB \* Corneal ulceration \* Feline Herpes Virus infection \* (Distichiasis, ectopic cilium) TESTS: apply topical anaestheisa- entropion may resolve indicating spastic entropion is present; fluorescein stain- is there concurrent ulceration? \* Diagosis: Entropion-- Certain breeds predisposed: Rottweiler, Shar Pei, Great Dane, Weimaraner, Mastiff - entropion is common in young and older dogs and cats TREATMENT: \* young cats-- secondary to FHV conjunctivitis & corneal ulceration \* older dogs and cats it occurs secondary to orbital fat atrophy and enophthalmos \* Treat primary cause if present e.g. FHV, trauma, FB \* Tackingi n young animals \* Surgical correction of eyelid position

Answer 150

Describe what you see: \* moderate to marked stick, mucopurulent ocular discharge, left eye \* Dull cornea, corneal vascularisation (keratitis)- well advanced TEST: STT, cytology (secondary bacterial conjunctivitis), fluorescein stain, MC& S unlikely to be necessary Diagnosis: Keratoconjunctivitis (KCS) or dry eye-- common in dogs-- certain breeds predisposed: Cavaliers, West Highlands, Bulldogs, Pugs, Cocker Spaniels, Schnauzers - dogs with Degenerative Myelopathy (DM) and older dogs predisposed - cats with FHV TREAMTENT: - clean eyes - optimmune, cyclosporin or Tacrolimus eye drops/ ointments - topical preservative free lubricants- applied regularly - topical antibiotics - canthoplasty or PDT (photodynamic therapy) surgery in refractory cases

Answer 151

Describe what you see: \* Epiphora, upper eyelid distichiasis \* Dull cornea with faint axial oedema and ulceration DDX: \* Distichiasis (abnormal growth of lashes), ectopic cilium, trichiasis \* (Trauma) \* (Alkaline burn) \* (Chronic corneal epithelial defect) TESTS \* Fluorescein staining to confirm ulceration DIAGNOSIS \* Careful examination revealed distichiasis (bilateral) and secondary corneal ulceration \* Distichiasis common cause of epiphora (overflow of tears) in dogs \* Symptoms of disease more frequent in short- coated (bristly-haired) dog breeds e.g. Staffordshire Bull Terrier, Bull Dogs, Labrador, Boxers \* Less of an issue in Cavaliers and Poodles TREATMENT: \*Transconjunctival excision in thick-eyelid breeds \* Cryosurgery in thin-eyelid breeds

Answer 152

Transconjunctival exicision

Answer 153

Describe what you see: \* swollen hyperaemic eyelids & periorbital region \* Conjunctival hyperaemia \* Third Eyelid (TE) protrusion \* Mild mucopurulent ocular discharge \* Mild exophthalmos (abnormal protrusion of eyeball) DDX: \* Orbital trauma, orbital FB, Orbital infection: cellulitis & abscess, Orbital cyst, neoplasia, haemorrhage, severe uveitis, chronic glaucoma TESTS: \* Physical palpation- open mouth! Check for abscesses- roof of the mouth \* Retropulsion \* Examination of the mouth \* Orbital ultrasound, CT, MRI \* Exploratory surgery DIAGNOSIS: \* Ultrasound examination confirmed orbital abscess and probable FB TREATMENT: \* Dental abscesses are a common cause for orbital cellulitis or abscess, so make sure you examine the mouth \* Neoplasia accounts for approx 50% of orbital diseases \* Many neoplasia is often primary and malignant

Answer 154

Place at the edge of table \* Looking down towards the ground, less likely to have their third eyelids prolapse (thinking they might jump off the table) \* Measure BP in all cats \> 8 years of age because they are prone to primary or secondary hypertension which is a blinding condition-- try to pick it up before they detatch their retinas

Answer 155

Using a light source to illuminate the deeper structures of the eye and looking at it from another direction

Answer 156

1. Increased ocular discharge 2. Impaired drainage 3. Both increased production and impaired drainage (rare) \*\* Always STT!! at the start of the exam (recall GA and sedation cause temporary reduction in STT in all species)

Answer 157

Cornea and sclera

Answer 158

Tapetum (lucidum)

Answer 159

Rods and cones

Answer 160

The cornea

Answer 161

About one third

Answer 162

Senile nuclear sclerosis

Answer 163

The vitreous

Answer 164

The outer fatty layer (contributes to the lacrimal fluid) \*\* Aka Tarsal glands

Answer 165

It produces part of the tear film

Answer 166

Lipid, aqueous, mucous layer

Answer 167

The goblet cells of the conjunctiva and the corneal epithelium

Answer 168

CN V- trigeminal

Answer 169

Conducted at the same time Focal is just the surface Retroillumination is where you use the same light source but use the back wall of the eye to reflect light back towards us

Answer 170

No retroillumination-- it is not glowing

Answer 171

White cell infiltration into the aqueous humour -- particulate matter in the air

Answer 172

\*cats and horses rarely develop cataracts that is vision threatening, however different for dogs

Answer 173

Cataracts-- insipiant (immature), moderate, mature (whole lens + causing vision loss)... hyper mature-- lens shrinks like a raisin

Answer 174

Lens removal using an instrument like a pen to aspirate it out and then lens replacement

Answer 175

Cats and horses more variable- becomes noticeable when they are very old (cats 15-16; horses just becomes more yellow 20-25) \*\* See the pearl in the lens-- middle eye have cataracts too-- top, look like spoke wheels from a car

Answer 176

semi set jelly and with age it becomes more liquified Cholesterol like inclusions

Answer 177

Tonometry \* Pressure build up in the eye causes endothelial disfunction = oedema

Answer 178

Indirect ophthalmoscopy

Answer 179

\* iris when it gets inflamed, it is sticky-- so can predispose to glaucoma and other things \* antibiotics to avoid vision and eye loss, serious consequences to infection NSAIDs- pain relief and tx of underlying inflammation

Answer 180

Bandage Contact Lens for protection

Answer 181

Describe: watery discharge, brown, rectangular shaped corneal lesion, mild focal corneal oedema, fluorescein positive, miosis DDX: Corneal FB, corneal fungal plaque, iris prolapse Diagnosis: careful examination with magnification revealed corneal FB TX: do not use forceps, 10 ml syringe with broken-off 25G needle. Removal with hydropulsion, alternative 2 x 25G needles to flick off... topical BS AB eye drop or ointment, oral NSAIDs, atropine? doxy? BCL? or TEF?

Answer 182

Treatment for uncomplicated ulceration

Answer 183

\* painful left eye \* moderate to severe conjunctival hyperaemia and chemosis \* Large, dorsal paraxial corneal epithelial erosion \* Fluorescein positive DDX: * Trauma * Chronic epithelial erosion/indolent ulceration * Alkaline ‘burn’ of the cornea * Distichasis, trichiasis, ectopic cilia * Other ... Diagnosis: •Slit lamp examination revealed upper central eyelid ectopic cilium Treatment: **Transconjunctival excision of hair**

Answer 184

Describe ## Footnote * Mild conjunctival hyperaemia * Watery discharge * Corneal ulceration with loose epithelial margins * Mild focal corneal oedema DDX Trauma Indolent ulceration Alkaline ‘burn’ of the cornea Distichasis, trichiasis, ectopic cilia Other ... Treatment: Sterile Debridement & grid keratotomy, heavy sedation, topical anaesthesia (+GA), BCL/TEF/TT?, oral or injectable NSAIDs, topical AB eye drops, doxy

Answer 185

\* Is it stuck down? = healthy, easy to peel off in a sheet then we know we are dealing with chronic epithelial erosion or indolent ulceration, etc.

Answer 186

Describe: A complicated ulcer-- stromal defect ## Footnote * Blepharospasm * Epiphora * Conjunctival hyperaemia, chemosis * Corneal ulceration, oedema, keratomalcia * Aqueous flare DDX: * Bacterial ulcerative keratitis (commonly Pseudomonas) * Corneal bullae * Trauma, Alkaline injury Tests: Cytology and MC&S Treatment: topical fluoroquinalone antibiotics (saw rod shaped bacteria)... Ocuflox, topical atropine (sometimes in cats) we want to dilate the pupil so no complications from iris adhesions, oral doxy (vibravet), oral NSAIDs \*\* No bandage and no TEF because the eye is infected

Answer 187

Describe: ## Footnote * 6 week old female kitten * Sudden onset painful, closed & watery left eye * Depression * Sneezing & snuffly * Mucopurulent discharge * Blepharospasm * Conjunctival hyperamemia, chemosis * Corneal ulceration, keratomalacia DDX: * FHV, Calicivirus, Chlamydophila * Bacterial, fungal keratitis * Trauma, alkaline burn * Eyelid abnormalities ...entropion, trichiasis, distichiasis TESTS: * PCR for infections disease * Corneal cytology? * STT? Precorneal tear film deficiency? * NONE?? Diagnosis: •Tentative diagnosis of acute lytic FHV keratoconjunctivitis was made Treatment: * Oral antivirals ... Famvir * Oral doycycline ... Vibravet * Oral Lysine * Oral NSAIDs ... Metacam * Topical Antiviral ... Idoxuridine, Cidofovir * Topical lubricants

Answer 188

Describe: ## Footnote * Diffuse, severe corneal oedema of endothelial origin (endothelium thin sheet on the cornea responsible for water balance) * Moderate perilimbal hyperaemia * Fluorescein negative * Mild buphthalmos? DDX * Glaucoma (high intraocular pressure) * Lens luxation * Severe uveitis (low intraocular pressure) * Corneal endothelial degeneration * Keratitis TESTS: * Schirmer test test ... 20 mm, both eyes * Tonometry ... IOP L 65 mmHg; R 12 mmHg-- test for glaucoma and uveitis * Gonioscopy, ocular ultrasound Diagnosis: Primary glaucoma often associated with breeds/ inherited because the angle was normal (secondary glaucoma with an identifiable cause--e.g. trauma and full of blood or retinal detachment and now has glaucoma.... is treated differently) Treatment: * Trusopt, Azopt or Cosopt (Carbonic Anhydrase Inhibitor)reduce aqueous production * Xalatan, Travatan (Prostaglandin analogues)- reduce outflow of aqueous out of the eye * Topical corticosteroids anti inflammatory-- all have some degree of inflammation (uveitis)-- high pressure = inflammation * Oral pain relief * Laser glaucoma surgery?? * PROPHYLAXIS FOR FELLOW EYE!! CAI indefinitely once or twice a day to help delay onset of glaucoma \*\* Guarded prognosis longterm-- unrecognized for days or weeks and already blind

Answer 189

Describe: ## Footnote * Mild pain (third eyelid prolapse) * Dilated pupil * Anterior lens luxation * Mild cloudiness DDX * Primary lens luxation * Glaucoma & lens luxation * Uveitis and secondary lens luxation * Other lens abnormalities e.g. lens coloboma, microphakia TESTS * CONSENSUAL PLR, menace response * Tonometry ... IOP 24 mmHg * Fluorescein stain ... negative Anterior Lens Luxation treatment * Anterior lens lux = emergency * Early lens removal surgery may help preserve vision * Due to complications e.g. retinal detachment & glaucoma, complications higher than cataract surgery * Medical management whilst awaiting surgery: * Topical corticosteroids e.g. Prednefrin Forte or Maxidex * Oral corticosteroids or NSAIDs * Topical Atropine BID * Topical Cosopt/Azopt/Trusopt * Do not apply XALATAN * Trap lens in posterior segment with Xalatan * Long term prognosis if managed well is similar to surgery of anterior lens lux * Enucleation or intraocular prosthesis best for chronic lens luxation & blindness

Answer 190

Congenital Developmental issue (cataracts, lens luxation, etc.) Sudden (with a clear eye or cloudy eye) or progressive

Answer 191

Basic neurological exams... light response, dazzle, obstacle course \* Ancilliary vision test- like doing an ECG on the heart, it is a sequence of light flashes used to stimulate the retina and teh electrical response is recorded by a contact electrode on the cornea \* used predominantly to diagnose retinal disease e.g. SARDs and PRA, if normal in a blind animal it indicates central disease is present

Answer 192

Coloboma -- if large vision loss as well Tortuous vessels

Answer 193

Do not have in AUS

Answer 194

Syndrome-- infectious disease viral and fungal especially cats-- cryptococcus, aspergillosis \* German shepherds- aspergillosis \* Vislas or other long nose dogs- granulomas \*\* or immune mediated-- small white fluffy dogs-- Granulomatous Meningoencephalitis (GME)

Answer 195

Risk with corticosteroids especially for cats because they can end up with disseminated crypto

Answer 196

Thought to be immune mediated (may be associated with Immune Mediated Retinitis) Sudden loss of vision in dogs (more common in females) which affects the retina-- NOT CATS \* IN some dogs vision loss is over a period of weeks, some over night \* Any breed can be affected but small breeds may be predisposed \* DIAGNOSIS: Flat Electroretinogram (ERG)-- no retinal function (absence of photoreceptor activity) even though they have a normal eye DDX: causes of central (neurological) blindness and optic neuritis, both of which have a normal ERG

Answer 197

\* most common in vet med are exudates or haemorrhage accumulation beneath the retina DDX: hypertension, bullous retinal detachments (clear fluid under the retina), hypoproteinaemia, hyperviscosity, polycythemia, uveodermatologic syndrome and idiopathic \*\* Traction detachments: occur with organization and contraction of fibrous membranes (usually after inflammation and haemorrhage) which pull off the retina \* Rhegmatogenous retinal detachments: occur with tearing of the retina, which allows liquefied vitreous to enter the subretinal space, rare in animals

Answer 198

By the time they lose vision due to neurological disease they often have other issues -- e.g. seizures, ataxic, facial nerve paralysis

Answer 199

\* generally on farms with dogs that have access to large animal anthelmintic preparations Acute onset blindness (DDX SARD, optic neuritis, central lesion) \* negative menace response, dazzle response and PLR-- blindness may be central without ocular lesions-- but often see characteristic retinal oedema and folds with papilloedema

Answer 200

Cataracts Diabetes- can develop rapidly (weeks)

Answer 201

Bilateral: think systemic disease \* unilateral- young dog-- think trauma .... in old dog-- think neoplasia \*\* older cat-- think hypertension (any cat)

Answer 202

• ALWAYS Bilateral and symmetrical • Inherited in some breeds • Degenerative condition of photoreceptors – Rods then later cones • Night vision loss first • Fundic changes – Blood vessel thinning – Tapetal hyper-reflectivity – ONH becomes grey • May see secondary cataracts late in disease

Answer 203

Diagnosis: \*\*optic nerve hypoplasia (OR optic nerve atrophy)

Answer 204

\*\* problem if it was a breeding dog but not otherwise

Answer 205

Retinal haemorrhage secondary to hypertension

Answer 206

Tests: PLR, vision test, fundus exam, CBC/Biochemistry, urinalysis, MRI +/- CSF tap, thoracic radiographs \*\* Findings: PLR absent, mydriasis, menace absent, bumping into obstacles, optic nerve head looks unusual

Answer 207

Medial lower eyelid entropion, large eyelid opening STT:4 mm/ min right eye 6mm/min left eye \* Diffuse corneal melanosis- chronic corneal irritation Diagnosis: Keratoconjunctivitis sicca (dry eye), oversized eyelid openings, medial lower eyelid entropion

Answer 208

\* Required to moisten and nourish cornea and flush away foreign objects, a waste product-- stimulated by conjunctival, corneal, or nasal irritation \* Three layers: lipid layer ( spreads tear film evenly and reduces evaporation); aqueous layer (lacrimal gland and gland of the TE); inner mucous layer (from goblet cells in conjunctiva and corneal epithelium- binds tears to the cornea) \*\* Drains via lacrimal puncta and canaliculi to nasolacrimal ducts

Answer 209

\* External ophthalmic artery- principal supply to the eye branches from the Maxillary artery \* Internal ophthalmic artery supplies CNII and spreads over retina from optic disc

Answer 210

1. Examine from distance: symmetry and eye position 2. Examine more closely: menace response and globe retropulsion and digital orbital examination 3. Focal light examination: pupillary light reflexes (direct and consensual), dazzle response, anterior chamber exam (depth, abnormal contents?), initial lens examination (pupillary dilation required for complete exam) 4. Examination under magnification: eyelids, conjunctiva, sclera, corneal surface, anterior chamber, iris (colour and topography) 5. Schirmer Tear Test (Normal dog 15 mm/60 sec; Normal cat 10 mm/ 60 sec) 6. Collect diagnostic samples 7. Perform tonometry and check beneath the third eyelid 8. Fluorescein stain: check for corneal ulceration, passage to nares when nasolacrimal duct is patent (usually within 5-10 minutes) 9. Mydriacyl (Alcon) application to dilate pupil: examin lens with focal light and magnification; examine the fundus

Answer 211

6 to 12 hours No evidence of straining in stage 1

Answer 212

15 minutes to 2 hours

Answer 213

Bitch- yes ; ewe- no

Answer 214

Cat- 65 days; Rabbit- 30 days

Answer 215

Their skin is without pigment or hair at birth. Rabbit.

Answer 216

Part of the chorion

Answer 217

\* Stretching of the vagina, stretching of the cervix, suckling of the puppies already born.

Answer 218

\* Hypotension with an associated reflex tachycardia

Answer 219

\* A rapid and irregular heart rate associated with premature contractions (VPC's) identified on an ECG trace

Answer 220

Depressed post natal respiratory drive

Answer 221

Hypocalcaemic

Answer 222

\* Parathyroid hormone \* Cholecalciferol

Answer 223

\* Correction of hypocalcaemia with IV calcium gluconate prior to surgery \*Aggressive fluid therapy piror to surgery for correction of fluid balance and any acid/ base anomalies was indicated \* if pre medication is required (though commonly not required) then a low dose or partial mixed opioid would be more appropriate (butorphanol or bprenorphine). Acepromazine provides excellent sedation but is profoundly hypotensive. Morphine provides excellent analgesia but causes marked cardiovascular depression \* clip prior to anathesia so she doesn't have to be under as long \* pre-oxygenating the bitch is a good idea since all induction agents, and inhaled gaseous anaesthetics are cardio-respiratory depressive \* Isoflurane inhalation should be kept to a minimum to reduce cardio respiratory depression and resulting hypotension \* prior preparation is important- a warm dry area should already be prepared for the puppies

Answer 224

\* Dogs 15-25 mm/ 60 sec (less than 10 diagnostic for dry eye) \* Cats 10 mm (less than 5mm is diagnostic for dry eye) \* Horses 20-30 mm (less than 10 mm is diagnostic for dry eye)

Answer 225

\* Dog 12-25 mmHg \* Cats 12-25 mmHg \* Horses 15-30 mmHg

Answer 226

Absence of one or more puncta in eyelids-- function to collect lacrimal fluid

Answer 227

\* Inflammation of the nasolacrimal sac/duct

Answer 228

Turned in upper or lower eyelid

Answer 229

Hair or cilia growing through meibomian (tarsal) glands

Answer 230

Hair or cilia growthing through conjunctiva

Answer 231

\* Hair from the skin/ face touching the eyes

Answer 232

Defect of the corneal epithelium with or without loss of the stroma (supportive tissue of the epithelium)

Answer 233

Blepharitis- inflammation of the eyelids Conjunctivitis- inflammation of the conjunctiva (the mucous membrane that covers the front of the eye and lines the inside of the eyelids)

Answer 234

Inflammation of the uvea-- iris, ciliary body and/or choroid

Answer 235

Inflammation of the cornea and conjunctiva in dry eyes

Answer 236

Increased water content in the cornea giving it a blue/white appearance

Answer 237

severe form of corneal ulceration associated stromal degeneration and loss

Answer 238

Unusual bilateral and symmetrical opacity of the cornea, not associated with inflammation

Answer 239

Inflammation of the cornea

Answer 240

aka Superficial Stromal Keratitis is an immune mediated disease of dog conjunctiva and cornea, exacerbated by UV radiation

Answer 241

\* Degenerative process of the cat cornea where by it becomes amber/black colour

Answer 242

Cells and protein observed in the anterior chamber when the eye is inflamed (uveitis)

Answer 243

Opacity of the lens or lens capsule

Answer 244

Disinsertion of the lens so that it luxates into the anterior or posterior chambers

Answer 245

Increased intraocular pressure resulting in damage to the optic nerve

Answer 246

Degeneration of the vitreous. Usually associated with liquefaction

Answer 247

Optic nerve hypoplasia- Congenitally small optic disc usually due to decreased numbers of retinal ganglion cells-- fundoscopically the nerve appears small, round and grey-- Toy and miniature poodles probably autosomal recessive (and other breeds) \* Optic nerve atrophy- acquired degernation of optic nerve

Answer 248

Congenital disorder of the retina, occasionally associated with retinal detachment or optic nerve head colobomas occur in some severe affected dogs which can also result in retinal detachment and therefore blindness (Shetland Sheepdogs, Australian shepherds, Border Collies, and some other breeds) \* main lesion is choroid hypoplasia (pale area lateral to the optic disc with bizarre choroidal vessels)

Answer 249

Congenital disorder of the retina, occasionally associated with retinal detachment

Answer 250

An inherited disorder leading to vision loss

Answer 251

\* Inflammation of the optic nerve-- bilateral or unilateral-- if the inflammation extends into the globe, the optic disc will appear swollen, elevated and hyperaemic. The margins of the optic nerve also become indistinct \* Can be caused by Distemper or other viral diseases, fungal disease (especially Cryptococcus in cats), neoplasia, granulomatous meningoencephalitis, or be idiopathic \* Diagnostics: CBC, chemistry panel, urinalysis, chest radiographs, and titers as indicated, MRI or CT scan possibly indicated, CSF taps have the highest diagnostic yield \*\* Treatment directed at the primary cause-- vision can be preserved if treated early

Answer 252

Nyctalopia- loss of night vision Hemeralopia- loss of day vision

Answer 253

Inflammation of the fibrous coat of the eye

Answer 254

HPA axis: neural responses, endocrine responses, immune responses \* Autonomic system- sympathetic stimulation-- adrenal medulla releases adrenalin: increase HR and BP, hydrolysis of glycogen to glucose, focussed attention and responses

Answer 255

\* Stereotypies: repeated motor patterns \* Compulsions: fixation on a goal \* Repetitive, exaggerated, sustained \* Out of context behaviours \* Interferes with normal functioning

Answer 256

Unable to express stress, frustration, conflict (psychological causes of compulsive disorders) results in displacement or redirected behaviours

Answer 257

\* Lack of control and predictability (e.g. inconsistent owner interactions, lack of training and inconsistent commands) \* Stressors are additive (threshold theory, one stressor may initiate compulsive response but other stressors maintain the behaviour) LOOK for multiple causes

Answer 258

\* Acute management of self harming- bandages, muzzle \* Reducing stress-- Request-Response-Reward interactions (instead of punishment); Consistent routine; Daily walks- aerobic exercise, stimulation, social interaction; opportunity to control aspects of the environment e.g. meals from food dispensing toys \*\* Pharmacotherapy: SSRIs (fluoxetine, sertraline); TCAs (clomipramine, amitriptylline, doxepin), Do not use if NOT anxiety based skin condition, most effective in early stage!! So treat early!! Wean off after two months of complete clinical resolution-- 75% for 2 weeks, then 50% for 2 weeks, then 25% for 2 weeks-- recommence at lowest effective dose if reappears

Answer 259

\* CNS lesions-- circling (brain stem and forebrain, vestibular, lumbosacral stenosis, hydrocephalus, neuromas) \* Seizures \* Sensory neuropathies (reduced pain in distal extremities, trigeminal dysfunction (cats) \* Musculo-skeletal (response to pain may mimic or trigger CD) \* Dermatological (anything that causes licking) \* Conditioned behaviour (attention seeking) \* Acute conflict behaviour (occurs in response to a trigger)

Answer 260

Poor owner compliance, long problem duration, did not attempt treatment

Answer 261

\* More common in large breeds \* Male 2X \> females \* Differentials: Dermatological, neurological or displacement behaviour Treatment: behavioural and dermatological

Answer 262

Removal of stressors, response substitution (no punishment), acute management of self harming, medication

Answer 263

\*Dobermans \* Damp ruffled skin to raw open sores \* If no physical damage with normal functioning then may be acceptable coping mechanism \* IN some cases constant sucking when not sleeping or engaged in other activity

Answer 264

\* DDX: conflict, frustration, reinforced, epileptic, episodic behaviour, neuropathological, psychotic/hallucinary, dermatitis Treatment: other possibilities: Neuropathic pain: Gabapentin, Carbamazepine

Answer 265

\* Anal glands, otitis, dental disease \* Skin problems--association with pruritis or malodours skin disorders that received vet treatment and biting family members

Answer 266

\* History: environmental or social change may be trigger, more common in indoor cats (confinement stress? social stress? social isolation?), excessive grooming, chewing, pulling out hair (away from owner is previously punished) \* Hair loss: focal, partial, bilateral, common in groin, ventrum, medial and caudal thighs, skin normal to erythematous and/or abraded \* Cats: licking can be conflict behaviour, becomes generalized, stress may affect the immune system, large percentage of cases have underlying medical problems: allergy, endocrine, infections: parasitic, fungal, bacterial, trichogram important to determine cause is grooming (but still multiple aetiologies) \*\* DIAGNOSIS OF EXCLUSION

Answer 267

A genetically predisposed inflammatory and pruritic allergic skin disease with characteristic clinical features most commonly associated with IgE antibodies to environmental allergens

Answer 268

If we look closely at the EM of a normal dog SC we can see normal lamellar appearance to the intercellular spaces However if we look at the skin from an AD dog this lamellar structure is gone. There is significant evidence for both innate and acquired barrier defects in atopic humans and dogs. - It is thought that in humans (and likely in dogs) that inherited innate barrier function defects are a (if not the) major primary risk factor for atopic dermatitis. - Decreased ceramides in lesional and nonlesional skin - Decreased expression of filaggrin in atopic Beagles and humans - In huamn patients with a genetic predisposition toward AD, upregulation of the stratum corneum chymotryptic enzyme results in premature breakdown of the corneodesmosomes and thinning of the stratum corneum (and higher pH from dec FLG also encourages this).

Answer 269

\* Complex genotype that varies between breeds and gene pools. Breeding programs to eliminate AD are therefore unlikely to succeed but this complexity could explain variations in clinical phenotype and response to treatment.

Answer 270

\* Urban life \* High human population density \* increased average annual rainfall \* Adoption at the age of 8 to 12 weeks \* Regular bathing of young healthy dogs

Answer 271

1. Is it scabies/ flea/ demodex--- give Bravecto/Nexgard to rule out \*\* Also resolve infection

Answer 272

Contact avoidance trial-- booties, coat, avoid grass in the park, etc. Classical atopic areas-- food elimination trial

Answer 273

\* Eliminate suspected allergy, symptoms disappear then reappear when you feed it again, then disappear when you take it away, and reappear when you give it one more time (REPEATABLE) \*\* MINIMUM 6 to 8 weeks, total compliance needed \* Reassess before rechallenge... if 14 days and no flare... sequential rechallenge

Answer 274

\* Avoid antigens found in their original diet... e.g. fed beef prior, change to venison though may have to home cook as many dog foods have undeclared types of protein, etc. \* but not clinically proven therefore-- best is Home cooked NOVEL protein and NOVEL carbohydrate Purified maize to remove all proteins, ;line cleaning , ELISA testing The aim of this diet is to ensure all hydrolysed peptides are of very low molecular weight (\< 1 kDa) in order to ensure they are non-immunogenic. This diet is essentially purified corn starch (protein removed) and hydrolysed chicken, turkey, duck feathers. To minimise risks of diet contamination there is complete cleaning of manufacturing lines before production, single diet production and post production quality control (PCR to check for poultry and beef proteins) and chromatography to ensure anallergenic molecular weight of the hydrolysis. Independent studies showing usefulness of these diets for elimination diets are still lacking. There are two company sponsored trials involving a total of 34 dogs using a non-validated pruritus score and a validated CADESI 03 lesional score, that showed significant improvement in dog’s global score when this diet was fed to dogs with suspected cutaneous food reactions (many of which had previously failed on hypoallergenic diets). Palatability was reported to be high. These were low evidence studies based on design but warrants further evaluation.

Answer 275

Enzymatically modified to reduce the molecular weight of proteins to reduce the risk of immunogenic reaction. The aim is to overcome the difficulty in identifying a novel protein source. \*\* but not clinically proven therefore-- best is Home cooked NOVEL protein and NOVEL carbohydrate Purified maize to remove all proteins, ;line cleaning , ELISA testing The aim of this diet is to ensure all hydrolysed peptides are of very low molecular weight (\< 1 kDa) in order to ensure they are non-immunogenic. This diet is essentially purified corn starch (protein removed) and hydrolysed chicken, turkey, duck feathers. To minimise risks of diet contamination there is complete cleaning of manufacturing lines before production, single diet production and post production quality control (PCR to check for poultry and beef proteins) and chromatography to ensure anallergenic molecular weight of the hydrolysis. Independent studies showing usefulness of these diets for elimination diets are still lacking. There are two company sponsored trials involving a total of 34 dogs using a non-validated pruritus score and a validated CADESI 03 lesional score, that showed significant improvement in dog’s global score when this diet was fed to dogs with suspected cutaneous food reactions (many of which had previously failed on hypoallergenic diets). Palatability was reported to be high. These were low evidence studies based on design but warrants further evaluation.

Answer 276

* Croc and tapioca * RC Anallergenic \* * Home cooked

Answer 277

\* Environmental irritants, shampoos, exogenous environmental proteases-- they can all activate kerationcytes to participate in and modulate the immunological response

Answer 278

Increased water loss--\> dry skin--\> itch Increased allergen dose--\> allergy flare--\> itch Irritants--\> irratable skin--\> itch

Answer 279

\* Life long disease-- cannot cure a Westie of being a Westie \* Not an allergy- failure to address all aspects of the disease, the barrier dysfunction, the allergic components and infections will lead to failure \* Continual maintenance required-- not stopping and starting treatment \* Treatment needs to consider client's life style, compliance, etc.-- consider quality of life for the animal

Answer 280

* Infection control * Flea control * Mild shampoos * Topical glucocorticoids * Oral and injectable glucocorticoids * Oclacitinib (Apoquel) NO EVIDENCE FOR: Antihistamines, Fatty acids, Cyclosporine

Answer 281

Shampoo therapy is often useful in AD because (see above). Some formulations have sustained-released microcapsules which break open once the coat dries to release contents Ingredients in shampoos that may help moisturise are fatty acids, lipids, urea, glycerin, colloidal oatmeal and chitosanide e.g. Epi-soothe Spherulites® (Virbac) oatmeal and chitosanide; Allergroom S® (Virbac) contain glycerin, lactic acid, urea and chitosanide. HOWEVER: not all dogs are improved by shampoo therapy. Can increase barrier dysfunction by drying due to their detergent action (stripping lipids), can increase pH which leads to increasing chymotryptic activity leading to premature breakdown of corneodesmosomes that hold the stratum corneum together to create the barrier. And can irritate dysfunctional skin. Shampoos should not be relied upon as the sole moisturising treatment except in very mild cases. It should also be remembered that even “non-irritant” shampoos may irritate skin with a dysfunctional epidermal barrier. Not all dogs are improved by shampooing!

Answer 282

\* Fuciderm-- topical ointments \* Settle inflammation with daily use at first then drop back to twice weekly and add in moisturizer. \* Wet wrap therapy- apply cream over affected area, wet T-shirt, write out and put on damp to improve penetration, repeat BID in severe cases 20 minutes BID. Lower limbs can use glad wrap occlusion and vet wrap \* Oclacitinib (Apoquel)- JAKs inactivate the intracellular proteins called STATs to induce gene transcription-- induce JAK/STAT pathways-- short term use but side effects of pyoderma, skin nodules, otitis externa, demodicosis

Answer 283

* Identification and avoidance of flare factors (infections, shampoos, botanical contacts, fleas, foods, emotional stress) * Allergen specific immunotherapy- suppression of DCs that support generation of effector T cells (Th1, Th2, Th17 cells), Ag specific IgE, mast cells, basophils, eosinophils, effector T cell migration into tissue and induction of IgG4. IL-10 from Treg cells has multiple effects on reduction of allergic inflammation. * Cyclosporine- problm causes broad spectrum suppression of T cell functions (PE every 6 months- urine culture after 12 weeks on therapy and every year) * Topical glucocortiocoids- problem longterm side effects * Oral glucocorticoids- minimal effective dose if you have to e.g. topical steroids with low dose twice weekly GCs topical on the day prior to oral dosing * Topical immunomodulators * Recombinant interferon * Antihistamines * Fatty acids * Barrier treatments- fixing the skin barrier- Omegaderm supplementation improved epidermal lipid levels in atopic dogs

Answer 284

Sebaceous adenitis: Immune destruction of sebaceous glands \* Breed related: Akita, Samoyed, Vizsla, Maltese, Gold Ret, Std Poodle, GSD, Cats, Rabbits \* Diagnosis: Histopathology (end stage or active inflammation) \* Treatment: Ciclosporin if active End stage Oil soaks Cover baby oil/coconut oil 30 mins Wash off and descale with Palmolive detergent Phytosphingosine shampoo/mousse/conditioner Repeat as needed eg monthly soaks to normalise skin and weekly phytosphingosine

Answer 285

Pemphigus foliaceous (PF) \* Auto-antibodies, desmosomal proteins, loss of cellular cohesion \* Clinical forms: breed related (Jack Russels, Akita, Alaskan Malamute, Keeshonds; cats: DSH, Siamese derivations), drug induced/ triggered, secondary to chronic skin disease \* Clinical signs: pustular disease: Papules, pustules, crusts, follicular pustules cause alopecia \* Diagnosis: Cytology-- acantholytic cells (keratinocytes that have lost their adhesions-- cell becomes a sphere-- form rafts, a row stuck together-- round, blue and bigger than a neutrophil) \* Therapeutic trials: Antimicrobials: Enrofloxacin, Clindamycin Treatment: Cats sometimes responsive to low dose pred, not so much dogs. Dogs require steroid sparing immunosuppression azathioprine-- bone marrow suppression, hepatopathy, pancreatitis (require close monitoring)

Answer 286

Pemphigus foliaceous

Answer 287

Deep recuts at 500 micron intervals

Answer 288

Discoid lupus erythematosus Pathogenesis: UV induced, basal cell cytotoxicity, Ab and Cell mediated injury \* Breeds: Scotch Collies, Border Collies, Shetland Sheep Dogs, Maremma, Weimeraner, Kelpie, any \* Clinical signs: depigmentation, loss of architecture, erosion/ ulceration/ crusting, nasal planum (BEWARE mucocutaneous pyoderma and nasal hyperkeratosis) \* Diagnosis: antibacterial trial, histopathology \* Treatment: sun avoidance, pimecrolimus 1% (ELIDEL); oral corticosteroids short duration, doxy and nicotinic acid

Answer 289

Lupoid onychodystrophy Diagnosis: failure to respond to antibiotics or biopsy (dew claw amputation, referral for digit sparing biopsy of the germinal epithelium) Treatment: Aggressive early Tx, CyA (Cyclosporin) + Glucocorticoids, Fatty acids

Answer 290

Cutaneous histiocytosis- dendritic cell proliferation Diagnosis: FNA, histopath (culture, special stain) \* Treatment: Prednisolone, Doxy and B3, CyA (Ciclosporin)

Answer 291

Cutaneous vasculitis \* Pathophysiology: AbAg excess, endothelial injury, ischaemia \* Clinical signs: Purpura, erosions, ulcers, crusts, alopecia, extremities +/- multifocal \* Diagnostic approach: Drug history, systemic disease, histopath, imaging, blood culture, urine culture \* Treatment: Improve perfusion: pentoxifyline, immunomodulation: referral, prednisolone, dapsone, azathioprine

Answer 292

Erythema multiforme Pathophysiology: Cytotoxic T cell attack on keratinocytes, drug, viral, neoplasia Clinical signs: variable lesions, serpiginous, arciform, target lesions, multifocal ulceration \* Diagnostic approach: histopathology (ALONG THE EDGES), selection is critical to diagnosis, drug history, thoracic radiograph, PCR (feline herpes) \* Treatment: Cyclosporin

Answer 293

Packed with eosinophils.. bitten on lateral aspect

Answer 294

\* Correct medication interval, correct application technique (may have to watch them), correct timing with shampoos/ swimming (avoid within 2 days before or after Frontline, avoid 2 hours after revolution, avoid 12 hours after advantage), correct dose for each pet, all pets in the house treated \*\* Efficacy drops at the end of the month \* Speed of kill is not instantaneous \* Environmental fleas can persist \> 140 days \* Closed environment = easier to control

Answer 295

AD, food allergy, scabies, bacterial pyoderma, Malassezia dermatitis

Answer 296

\* Poor compliance, access to flea "nests", untreated animals, resistance

Answer 297

\* Determine if inside or outside the home \* Inside--\> prolonged emergence \* Outside--\> indefinite emergence--\> requires ongoing adulticides \*\* can also use flea shampoos once weekly-- & avoid daily swimming

Answer 298

\* Historical clues: spring/ summer exacerbation, inadequate flea control, fleas not always seen, \* Primary lesion: crusted papules \* Treatment/ Diagnosis (response to tx, trial): Nitenpyram or spinosad, nexgard, bravecto, activyl \*\* can give short term Pred/Apoquel if required... environmental flea treatment \* Long term: other pets in house. Dogs: IGR +/- adulticide; Cats: Selemectin/ Comfortis/ Activyl

Answer 299

Scabies- Sarcoptes scabei var canis (obligate parasite, foxes, cats, humans) \* Burrow through stratum corneum \* Can survive up to 3 weeks off host (longer at lower temps) \* Disease: Hypersensitivity to mite antigens, pruritis is low until seroconversion Lesions: PRIMARY: papules and hyperkeratosis; Secondary- from pruritis Distribution: sparsely haired regions Zoonosis Diagnosis: superficial skin scrapes: papules, elbows, pinnae \*\* only find mites 10% of the time Therapeutic trials: Revolution, Nexgard, or Bravecto Treatment: Antibiotics if secondary infection, Pred only if not infected, warn clients of possible worsening first week

Answer 300

Demodex canis (obligate parasite, transmitted at birth, present in all dogs, disease results from genetic/ immunological factors, concurrent disease, immunosuppressive drugs) Predisposing factors: mean age onset 4.2-5.9 years, terriers juvenile \< 18-36 months-- breed, body condition, oestrus, fair-good prognosis... adult: hyperA, hypoTh, leishmaniasis, neoplasia, immunosuppressive drugs, 50% idiopathic... localized disease or generalised disease \*\* Aetiology: identified in follicles and sebaceous glands \* History: chronic disease (especially AD), prior decrease in immune drug use, young onset with no underlying causes) Diagnosis: deep skin scrape, trichnograms- periocular, paws, exudative/pustular samples, tape preps (also:biopsy, otic swabs, LN aspirate)... look for concurrent bacterial infection (cytology, culture and sensitivty) OR look for underlying disease if adult onset-- biochem and haematology, thyroid assessment, ACTH stim, radiographs and ultrasound \*\* Treatment: "benign neglect" desexing recommended, treat underlying condition.. do not treat with miticidal therapy because you want to see if it becomes generalized or can resolve on its own... spontaneous recovery rare. Concurrent infections common (S. pseudintermedius, Pseudomonas spp)-- so Cephalexin, Clindamycin, Enrofloxacin \*\* If you have to treat: MLs

Answer 301

\* Blepharospasm (closing the eye) \* Weeping eye \* Rubbing the eye \* Sleeping more than usual \* Protects the eye

Answer 302

\* Conjunctival cytology, skin scraping, FNA, biopsy \* With allergic conjunctivitis usually associated with other conditions- skin, ears, feet \* Tx: anti-inflammatory drugs- topical, systemic \* Antibiotics- Cephalexin 22 mg/kg BID, Clindamycin

Answer 303

Topical steroids

Answer 304

TX: Lysine powder

Answer 305

\* DDX: infection, degeneration, ulceration Tests: corneal cytology, MC&S, fluorescein stain Diagnosis: Ulcerative Keratitis with stromal loss (deep corneal ulceration) \*\*Treatment: - debride and conjunctival graft (referral) - temporary tarsorrhaphy (stitch the TE up) - topical antibiotics- drops preferred- Ofloxacin, Chloramphenicol, fortified Cephalexins (750 mg in 15 ml artificial tears) - topical atropine (if the iris is spasming, because it is painful) - supportive therapy- pain relief, anti-inflammatory medication

Answer 306

Inflammation, degeneration, ulceration (does not always have fluoroscein uptake, also any area that is degenerate allowing the stain through the intracellular junctions, it will take up the stain... difference ulceration takes up the stain rapidly, degenerative cells takes up the stain slowly/ incompletely... check the other eye in the mean time.... use wood's lamp) \* Fluoroscein stain, corneal cytology, MC & S \*\* Diagnosis: ulcerative keratitis- chronic corneal erosion (indolent ulcer, recurrent ulcer, Boxer ulcer) \*\* Treatment: surgery * Debride with cotton bud/high speed ophthalmic burr (cut grooves in the cornea in the form of a ring, referral) * Bandage contact lens * Third eyelid flap/temporary tarsorrhaphy not usually necessary * Topical antibiotic +/- topical atropine * Supportive therapy - pain relief, anti-inflammatory medication

Answer 307

Fungal Keratitis (rare in a dog, more common in horses) \* Fluorescein stain, corneal cytology, MC&S \* Topical antifungal medication- voriconazole (Rolls Royce of antifungals), itraconazole \* anti-inflammatory medication \* Possible surgery

Answer 308

Diagnosis: Eosinophilic Keratitis Treatment: - topical anti-inflamm/ immunomodulating medication - Dexamethasone (Maxidex) drops - Cyclosporin (Optimmune) or compounded Tacrolimus

Answer 309

\* DDX: FB, ulceration, neoplasia, perforation and iris prolapse Tests: Fluorescein, MC&S, Corneal cytology, excisional biopsy \* Diagnosis: Feline Keratitis Nigrans-- corneal sequestration, secondary to Feline Herpes Virus keratitis, lower eyelid entropion, exposure (especially Persians) Treatment: - treat primary cause, artificial tears (for comfort), medical therapy unrewarding, surgery- keratectomy with "button" graft, pedicle graft or corneoconjunctival transposition

Answer 310

DDX: inflammation, immune- mediated disease, lipid aqueous, neoplasia Tests: transillumination, examine using magnification, haematology, serum analysis, aqueocentesis Diagnosis: anterior uveitis-- Cat- neoplasia (lymphoma), FIP virus, Toxoplasmosis, FeLV, Cryptococcus, possibly FHV -- Dogs- neoplasia (lymphoma), uveodermatological syndrome

Answer 311

Lymphoma in cat

Answer 312

•Treat primary cause eg. Toxoplasmosis, Cryptococcosis • •Anti-inflammatory/immunomodulating medication - topical, systemic • •Secondary glaucoma or phthisis bulbi not uncommon • •Surgery - enucleation

Answer 313

Inflammation, ulceration, glaucoma- increased intraocular pressure, neoplasia Tests: PLR, menace, tonometry, ultrasound, gonioscopy on fellow eye \* Diagnosis: primary IOP \> 40 mmHg; secondary- lens induced uveitis \* Treatment: treat primary cause e.g. uveitis and anti-inflammatory medication; reduce production of aqueous (CA inhibitors)-- diode laser ablation, increased outflow (PG analogues), pain relief, surgery- enucleation

Answer 314

\* Environmental protection \* Maintenance of skin microclimate \* psychosocial functions

Answer 315

Actinic keratosis

Answer 316

Hypotrichosis- reduction in the number of hairs in a normally haired region Alopecia- lack of hair in a normally haired region

Answer 317

\* Exogen \* Anagen (poodles have a longer growth phase which is why they need a haircut) \* Telogen \* Catagen Follicular cycling is complex and not fully understood. Essentially the cycle can be broken up into anagen (growing phase), catagen (involution phase), telogen (resting phase) and exogen (shedding phases). Very few dogs need a hair-cut. Hairs grow, for a genetically predetermined period to reach the desired hair length and then remain in the resting phase, telogen. This conserves energy, protein and lipid. The telogen hair is NOT easily epilated. It is tightly anchored within the follicular shaft until the exogen phase. Control of cycling is largely by intrinsic factors such as growth factors, genetic factors, adhesion molecules and receptor expression within the follicle itself (epithelial-mesenchymal interactions) but can be modified by extrinsic factors like the environment (light, temperature and nutrition) and endocrine factors.

Answer 318

Telogen (resting)

Answer 319

1. Hair being lost prematurely (excessive loss) A. Mechanical- pruritus, psychogenic, abnormal behaviours B. Folliculitis- bacterial, fungal, parasitic 2. Hair failing to be replaced (failure to grow) A. disruption of follicular cycling without structural change to follicle- HyperA, HypoTh, Alopecia X...etc. B. Distruption of follicular cycling WITH structural change to follicle- pattern baldness, colour associated follicular dysplasia, non- colour associated follicular dysplasia, follicular lipidosis C. Folliculopathy- ischamic alopecia, traction alopecia, topical flea spot treatment alopecia, thermal injury 3. Absence of follicles A. Congenital alopecia- anhidrotic ectodermal dysplasia, hairless breeds B. Cicatricial alopecia

Answer 320

\* Age * 0-4 weeks (congenital alopecias) * 0-9 months (black haired follicular dysplasia, pattern baldness, follicular lipidosis) * 6 months to 3 years (colour dilute follicular dysplasia) * 2 to 4 years (non-colour linked follicular dysplasia) * 3 to aged (endocrinopathy, alopecia X) \* Breed: e.g. Alopecia X (Pomeranians, Miniature Poodles, Alaskan Malamute); Follicular Lipidosis (Rottweiler) \* Sex/ entire or neutered: - female (hypo or hyper oestrogenism, ventral pattern baldness) - male (testicular neoplasia, hypogonadism, pinnal pattern baldness) \* History: systemic with cutaneous manifestations? Or just skin disease? \* Physical exam: e.g. temporal muscle wastage HyperA, neuromuscular disease +/- tragic facial expression (hypoTh) \*\* Dermatological exam: hair colour, dull hair? faded hair (colour change seen where follicular development is altered)\> Changes in hair texture (mechanical hair loss and diseases with structural change to the follicle)? Area affected? Skin atrophy (hyperA or just senile change)? Increased skin thickness (hypoTh)? Comedones (follicular hyperkeratosis, rule out demodicosis and sebaceous adenitis)? The optical appearance of the hair coat is determined by the uniformity of reflected light from the hair. A healthy coat with an even layer of sebum coating the outer cuticle of the hair shaft reflects light evenly and therefore looks shiny. When hairs stop growing for any reason (cycling disruption, folliculopathy) the “tiles” of the outer cuticle tend to open. This leads to uneven surface and altered light reflection creating an optically dull coat. A dull coat then usually represents prolongation in telogen and ALL the follicular cycling abnormality should be considered. \*\* Diagnostic tests

Answer 321

lpolydipsia, polyuria 80-90% lpolyphagia 80-90% lmuscle weakness and lethargy 50-80% lincreased panting 30% lrecurrent skin infections lurolithiasis lanterior cruciate repair

Answer 322

lweight gain lheat seeking behaviour lmuscle weakness and lethargy lrecurrent skin infections ldecreased fertility (females) lbehavioural changes

Answer 323

drug induced alopecia- flea spot on treatment

Answer 324

Canine Recurrent Flank Alopecia (CRFA)- indoor dogs that do not receive appropriate light affecting their pineal gland, etc.

Answer 325

Phlebectasia- HyperA

Answer 326

\*pheomelanin resistant to oxidation--bronzing = sign something is wrong with the hair coat-- it is not growing properly \*\* could mean the dog has a lot of sun exposure as well, but less likely

Answer 327

Cushingoid-- skin problems due to lack of exfoliation

Answer 328

\* looks normal- no pendulous abdomen \* Mechanical trauma- doesn't have to be from scratching

Answer 329

Folliculitis-- trichogram shows Demodex

Answer 330

Follicular dysplasia in a Doberman

Answer 331

Colour dilute follicular dysplasia

Answer 332

Follicular casting * Vertically orientated scale (follicular casting) is where the scale extends into the follicle and aligned parallel to the longitudinal axis of the hair shaft (demodicosis, follicular cycling defects).

Answer 333

1. Allergic dermatitis (41/100) 2. Foreign body (12/100) 3. Ear mites (7/100) 4. Uknown (32/100)

Answer 334

Microclimate change = inflammation and maceration therefore opportunistic infection Allergies-- atopic dermatitis or food allergy \*\* Microclimate changes: anything that causes inflammation of the ear canals-- parasites, FBs, allergies, irritants, other diseases involving EAC such as PF, juvenile cellulitis.....anything that increases the moisture of the ear canals-- swimming, over use of ear cleaners, high environmental humidity, breed factors, stenosis of proximal canal, etc.... anything that interferes with self cleaning-- damage to the tympanic membrane, polyps, neoplasia or large FBs, hyperplasia of the canal lining secondary to otitis, congenital or acquired stenosis, etc.

Answer 335

* Medication cannot penetrate to the bottom of the ear canal due to exudate, stenosis, polyps etc. * The wrong dose of medication is applied * The wrong choice of medication (must be active against target organisms, stable, safe e.g. if tympanic membrane is not intact) * Poor owner compliance * Failure to control inflammation * Maceration. Your treatment also alters the microclimate of the ear. Long duration (longer than 2 to 3 weeks) or combination (aqueous cleaners with commercial ear drops with oily vehicles) leads to MACERATION of the ear canal. A macerated epithelium cannot form an effective epithelial barrier. The vehicles in the ear drops, plasticized gels, propylene glycol, mineral oil etc then become toxic to the epithelium and can promote ongoing inflammation. \* Otitis externa means inflammation of external auditory canal (not necessarily infection)-- infectious otitis externa means otitis complicated by bacterial or fungal infection

Answer 336

1. Resolve the current infection-- remove all exudate, collect samples from all levels of the ear canal, ID the integrity of the tympanic membrane, assess the ear canal for glandular and epidermal hyperplasia, stenosis due to oedema or stenosis due to fibrosis, check for polyps and FBs and tumours... treat microbial overgrowth and address microclimate change by resolving inflammation (topical or systemic GCs), re-examine and repeat cytology is essential... treat for 7 days beyond cytological cure 2. Control trigger disease-- microclimate change-- visualization for FBs (video otoscopy), systemic disease treatment 3. Control secondary predisposing factors-- sequelae that occure due to chronic inflammation of the EAC that will guaruntee relapse of the otitis externa irrespective of whether the trigger factor has been controlled-- e.g. epidermal and or glandular hyperplasia, inflammatory polyps, fibrosis, stenosis, calcification of the EAC, cerumenoliths, otitis media, cholesteotomas and complete occlusion of the EAC

Answer 337

Keratosis obturans- ball of wax-- automatic ear cleaning is disrupted for some reason-- need to remove surgically

Answer 338

epithelial hyperplasia-- reversible... have to get it back to normal in order to avoid recurrent otitis externa... these ears needs oral pred!

Answer 339

* **Glandular hyperplasia**. This is less amenable to treatment and glandular hyperplasia may persist post treatment and is often associated with rapid cerumen accumulation and recurrent otitis. Cerumenolytics and or drying agents are needed in such cases as long-term maintenance. These dogs are problematic. Currently I use **AQUA EAR** **â for the** drying agent and will commonly add dexamethasone 10mg/ 10mls to make a 0.1% concentration if irritancy is a problem. Where a cerumenolytic is required I will use **PAWs EAR CLEANER** **â** followed 5 minutes later by **EPIOTIC**. PAWs has a detergent like action that emulsifies the lipids in cerumen but if not flushed out can cause irritation..

Answer 340

1. Inadequate dose of aural medications. Making sure they know how much medication to put in and how to do it properly 2. Failing to adequately clean the ear 3. Failing to control inflammation 4. Poor owner compliance 5. Wrong choice of medication e.g. gentamicin not effective in the presence of pus, polymixin is a poor choice for Pseudomonas in AUS 6. Failure to address trigger factors-- e.g. atopic dermatitis 7. Failure to re-assess patient, confirm cytological resolution and continue treatment for 7 days past clinical and cytological resolution 8. Failure to address secondary changes e.g. epidermal or glandular hyperplasia 9. Bacterial or fungal resistance 10. Maceration due to diluted shampoos and overzealous use of ear cleaning agents

Answer 341

Squalene is middle ear safe... would have to rely on e.g. systemic antibiotics if bacterial though generally they are not as effective

Answer 342

\* Different bugs in different parts of the ear canal

Answer 343

\*\* problem with gentamicin-- won't work with pus in the ear

Answer 344

Heavy growth means nothing-- not a quantitative culture \*\* qualitative \* In vitro \* same sampling limitations \* Sensitivity/ resistance can be misleading-- e.g. Pseudomonas spp. 9 different strains, so they may all grow but may all have different sensitivity (different antibiograms) \* there will also be passenger bacteria e.g. Corynebacteria, Enterococcus that you can ignore

Answer 345

When you treat ears for extended period, you get a lot of build up that causes the ear to remain wet and therefore makes it difficult to clean up the infection (toxic environment for the epithelium).... so you have to get rid of the buildup. \* Squalene is as close as you can get to normal ear wax in terms of lipid concentration \* So ears with chronic treatment-- get ears clean and then use Pred and Squalene to get ears clean

Answer 346

Primary Secretory Otitis Media-- must be treated early or permanent hearing loss... neurological signs, head, cervical pain.... end up with facial nerve paralysis but can be reversed if you recognize it early \*\* won't allow mucous to drain through the eustachian tube

Answer 347

uVisualise everything uA clean ear is half way there uCytology, cytology, cytology, revisits uCulture RESISTANT infections uYou can not fix ears without ear drops uDemonstrate administration uDon’t neglect underlying disease/trigger uDon’t neglect secondary changes

Answer 348

NOT a diagnosis-- reaction pattern of the skin Eosinophil recruitment-- simply by cytokines... Allergies \*\* often is an allergy-- flea allergy, atopic dermatitis, etc. Viral infection Fungal infection Furunculosis Tissue necrosis Neoplasia

Answer 349

Miliary dermatitis \* DDX: lFolliculitis (dermatophytosis, bacterial) lAllergy (flea, atopy, food, mosquito) lEctoparasites (Otodectes, Cheyletiella) lImmune mediate (Pemphigus) lNutritional (EFAs, biotin def) \*\* Historical clues lNutritional (diet) lFleas, Cheyletiella, Otodectes (current flea control) lFood allergy (if seasonal) lAtopy/Fleas (seasonal) lPersians (dermatophytosis) lCattery (dermatophytes, Cheyletiella) \*\* Clinical clues lHead (atopy, food allergy, Otodectes) lNeck (fleas, atopy, food allergy) lPre-auricular (atopy, food) lLimbs/paws (atopy, food) lTail base, caudal thighs (fleas)

Answer 350

Always ring worm until proven otherwise

Answer 351

Feline Herpes Virus

Answer 352

\* Wood’s lamp (M. canis glows 80% of the time) \* Fungassay (hairs on the fungal assay, check everyday-- colonies starting to grow and red change at the same time) \* Cytology/antimicrobial trial lBiopsy ( if nasal planum/pads) lInsect elimination trial lFood trial lIntradermal skin testing/Allercept serum testing

Answer 353

Acantholytic cells-- PF

Answer 354

Cut into the crust for biopsy (nasal planum/pads)

Answer 355

\*\* Food trial and flea trial at the same time ## Footnote lNovel protein (6-8weeks) (add EPO and B1) lControl concurrent infection lDo concurrently with flea elimination diet lIndoor housing \*\*So you don't have to keep the cat on steroids long term.... Intradermal skin testing/ Allercept serum testing is another option

Answer 356

Indolent ulcer- 98% of the time they are infected DDX: SCC, feline sarcoid (papilloma virus) \* Causes: flea allergy, atopy, food allergy, over-grooming, idiopathic \* Diagnosis: cytology/antimicrobial trial, biopsy, insect elimination trial, food trial, intradermal skin testing \*\* Convenia! Because of anaerobic activity or clindamycin (not Cephalexin as no activity against anaerobes)

Answer 357

Eosinophilic plaque (really itchy!= e-collar)- pockets of degenerative neutrophils, full of bacteria \* Clinical clues: lick accessible areas ONLY (can help differentiate), erythematous/yellow foci, moist surface, extremely pruritic \* DDX: infectious granulomas, neoplasia, xanthoma (in diabetic cats-- but are not itchy so you can tell them apart) \* Causes: flea bite hypersensitivity, atopy, food allergy, Idiopathic, reaction to their own saliva?? \* Diagnostic recipe: Cytology (surface and FNA), AM trial (oral and topical), biopsy (if poorly responsive), insect elimination trial, food trial, intradermal skin testing/ Allercept serum testing

Answer 358

Oral granuloma/ ulcer (clinical clues: yellow foci) \*\* in the mouth-- rare to have infections therefore won't respond to AMs \* Causes: flea bite hypersensitivity, atopy, food allergy, idiopathic \* DDX: neoplasia, infectious granulomas \*\* TX: Ciclosporin \*\* Can be anaemic without owner noticing because swallowing blood

Answer 359

Diabetes \*\* Dex dose/ 7 = pred equivalent \*\* Steroid sparing strategies -- minimal effective dose

Answer 360

\* Feline herpetic dermatitis ## Footnote Eosinophilic inflammation Intra-nuclear inclusion bodies IHC Re-activation of latent infection

Answer 361

Mosquito allergy ## Footnote lNose, pinnae and LATERAL pads lOutside exposure lSeasonal \*\* Tx: avoidance, vitamin B1 in humans

Answer 362

Mastocytosis

Answer 363

Trichogram with broken hairs-- know it is mechanical-- but don't know if psychogenic or otherwise ## Footnote Self trauma in lick areas means eosinophilic dermatitis on DDx Work up lFlea trial lFood trial (less likely if no involvement of the head) lIntradermal skin testing?, biopsy?, behavioural consult?

Answer 364

Arterial supply that spreads out over a large area of the skin-- allows us to rotate and transpose large areas of the skin to different parts of the body helps us with \*\* tension issues or large dead spaces

Answer 365

Recognize there are different stages and adapt treatment accordingly

Answer 366

\* area of high movement e.g. axilla \* bite wound- drain before definitive closure

Answer 367

\* drains AROUND the drain-- not through the lumen-- so if you are expecting a lot of exudate produced, then use a larger drain= larger surface area \*\* ascending infection can be a problem... \*\* need for sterile gauze bandage for infection but also so exudate doesn't get everywhere

Answer 368

\*\* fenestration internal

Answer 369

\* Subcutaneous, intradermal, and skin sutures

Answer 370

\* Deep superficial, superficial deep Then simple interupted \*\* in limbs assess ligament and tendon damage

Answer 371

\*\* if you drain it will likely just reform, but also potential for bacterial infection because of the protein enriched serum as an excellent medium to grow bacteria

Answer 372

Skin closure - Abscess • Causes: – Penetration (e.g. FB like grass awns or plant material or bite wound) – Infection (e.g. anal gland abscess) • Clip liberally and sterile surgery • Sample (centesis or swab) for C&S • Lance and drain abscess • Lavage with 0.9% NaCl • Passive or active drain • Start empirical antimicrobial

Answer 373

Cat bites- cellulitis \* All will be contaminated, mixed bacterial population, aerobic, anaerobic

Answer 374

\* Assess the whole patient and stabilize, external may be tip of the iceberg \* IV fluids, oxygen, imaging \* minimize further contamination-- sterile gauze sponges, sterile gel, liberally clip hair around puncture wound, cleanse skin around the wound with warm saline and surgical preparation solution \*\* Explore wound-- be prepared for bigger surgery (thoracotomy or laparotomy) \* IV antibiotics (cephalosporins) \*\* Explore, debride, lavage (0.9% NaCl), collect samples C&S-- close dead space, primary closure of skin if possible but nothing wrong with leaving wound open if contamination present (follow with delayed primary or secondary closure) and use drains...

Answer 375

\*\* through the phases of healing and repair-- granulation tissue (resistant to infection due to excellent blood supply) \*\* Lavage-- pulsatile lavage, gravity flow, or manual (8 psi) delivery via 35-60 ml syringe with 18-29 gauge needle \* Debridement-- surgical, mechanical... daily or twice daily dressing changes

Answer 376

\* Undermining \* Walking sutures \* tension releasing incisions \* tension suture patterns \* plasty techniques

Answer 377

\* does predispose to more dead space formation-- so only use in a small area (2 cm laterally)

Answer 378

on the leg for example as limited amount of tissue

Answer 379

\* horizontal mattress can compromise blood supply if you're cranking up on it tight-- so vertical preferred \* stents- IV tubing cut into small lengths, spreads tension out

Answer 380

\*\* flank

Answer 381

\* remove blood clot, reduce the dead space, prevention of further trauma (immobilizing the ear and treating the primary disease) \* Linear or S-shaped or punch biopsy on inner surface of the ear to drain the haematoma (stent tubing for drainage)... close the dead space-- full thickness sutures through the pinna. PARALLEL incisions to the LONG axis ofthe pinna00 to prevent damage to the vascular supply of the pinna \*\* SUTURES PLACED WITH A STRAIGHT NEEDLE

Answer 382

SCC (chronic non-healing wounds) \* White cats have 13.4 x greater risk than coloured \* pinnectomy +/- vertical canal resection

Answer 383

Indications: – Facilitate management of otitis externa that is controlled with medication – Removal of benign neoplasia of external canal – NOT indicated if stenosis of canal is present or Cocker Spaniels – Success rate 35- 50%

Answer 384

Indicated for end stage otitis externa/ media \* Hyperplastic, stenotic vert and horizontal canals \* removal of entire ear canal and lateral bulla osteotomy to drain bulla

Answer 385

(4 o'clock and 8 o'clock)

Answer 386

\* open- open up anal sac-- non-neoplastic-- advantage-- you can see you have removed everything (internal is grey and glistening surface, easy to ID)....disadvantage- have to cut across the external anal sphincter therefore more trauma and more potential for infections \* closed approach- parianal approach- dissect down until the stalk... indicated for neoplasia. Do not need to transect. Can leave tissue behind

Answer 387

Perianal Adenoma (most common perianal tumor in intact male dogs: hepatoid gland tumors, cicumanal gland tumors... androgen dependent-- often have a concurrent testicular tumor as well (interstitial cell tumor) \*\* slow growing, non-painful, freely moveable, may occur on tail head, prepuce or scrotum, +/- ulcerated, diffuse form TX: Resection and castration, castration alone if diffuse form, castration + cryosurgery for small lesions \*\* Always submit for histopathology! \*\* Good prognosis \> 90% cured with castration and mass removal... recurrences may be adenocarcinoma

Answer 388

Perineal Adenocarcinoma Next step: biopsy! \* Adenoma are androgen dependent... castrated male dog-- think adenocarcinoma \*\*work up: caudal radiographs or ultrasound, rectal exam, chest radiographs for metastasis, +/0 adanced imaging to assess degree of invasiveness \*\* Treatment: aggressive surgical removal with margins if possible-- radiation if margins are incomplete... does not respond to castration

Answer 389

Anal Sac Adenocarcinoma \* Large, invasive subcutaneous mass \* Hypercalcaemia- paraneoplastic syndrome (Lymphoma is most common, Anal Sac Adenocarcinoma is the next most common) \* Female \* Tx: surgery on primary mass +/- lymph nodes depending on if they are involved \*\* Correct hypercalcaemia prior to anaesthesia or surgery

Answer 390

Dogs are non-seasonal breeders and ovulate spontaneously. The onset of puberty in the bitch corresponds with the first oestrus and will occur anytime between 3.5 and 24 months (average: 10-12 months). In general, small breeds experience their first oestrus earlier and large breeds later. For some breeds it can be physiologic to not show heat up to the age of 24 or even 30 months of age, e.g. Afghan hound, Greyhound, Whippet, Saluki.

Answer 391

Plasma progesterone levels begin to increase slowly in late prooestrus but suddenly double (between 1.5 – 2.5 ng/ml) at the time of the LH surge, making measuring progesterone plasma levels a valuable tool to indirectly determine the LH surge. Ovulation occurs approximately 2 days after the LH peak and is not dependent upon breeding. Canine oocytes are ovulated as primary oocytes and need to go through a phase of maturation before they can be fertilized. It takes 48 to 72 hours for them to undergo meiotic division to become secondary oocytes. \*\* 5 ng/ml at OVULATION

Answer 392

Less sensitive to progesterone... no intrinsic mechanism of luteolysis

Answer 393

\* fresh semen- vagina- natural or AI with catheter \* Frozen- uterus- AI with transcervical insemination (TCI) or surgically (because of limited lifespan)

Answer 394

\* At the first sign of prooestrus (vulvar swelling/ bleeding), take the first vaginal smear for cytology and a serum sample for progesterone determination. Keep doing this every other day until the serum progesterone indicates it is the time of the LH surge (doubling of serum progesterone level, most commonly ~ 1.5 – 2.5 ng/ml). Stop cytology at the first day of dioestrus (D1). \*\* Breeding reflexes-- flagging, lordosis, standing for the male, reduced vaginal discharge (light coloured serosanguineous in the beginning, darker in the end) \*\* exfoliative cytology-- keratinized and cornified cells in prooestrus and oestrous... becoming less in Dioestrous where leukoctyes can then come through and you will also get the intermediate cells and parabasal cells since the keratinized and cornified layer has now sloughed \* Vaginoscopy-- vaginal folds swollen, moist, hyperaemic, gradually starting to shrink-- folds becoming increasingly shrunken/angular (crenulated), pale in color, dry

Answer 395

Because the neutrophils can't get through the keratinized/ cornified layer

Answer 396

\* ear infection cytology

Cats and Dogs Flashcards

(619 cards)