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Sarah - Mulller and Kirk > Chapter 19 - eyelids, claws, anal sacs and ears > Flashcards

Chapter 19 - eyelids, claws, anal sacs and ears Flashcards

1
Q

Are glands of Zeis prominent sebaceous glands or modified sweat glands?

A

Prominent sebaceous glands

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2
Q

Are glands of Moll prominent sebaceous glands or modified sweat glands?

A

Modified sweat glands

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3
Q

What is another name for Meibomian glands?

A

Tarsal glands

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4
Q

Which deep mycoses is most likely to affect the eyelids in cats?

A

Histoplasma capsulatum

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5
Q

Which oral drug can be used to treat FHV-1 associated blepharitis?

A

Famciclovir

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6
Q

Which drugs can trigger drug-induced apoptosis in allergic blepharitis?

A

Potentiated sulphonamides
Penicllins
Cephalosporins

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7
Q

Bilateral ulcerative blepharitis affecting the medial canthi is seen in which breeds of dog?

A

GSDs
Longhaired Dachs
Toy/minature Poodles

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8
Q

Name two metabolic/nutritional causes of blepharitis?

A

Zinc-responsive dermatosis
Generic dog food dermatosis
Superficial necrolytic dermatitis

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9
Q

Which breeds of cat are affected by idiopathic blepharitis (‘dirty face’)?

A

Persians

Himalayans

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10
Q

Periocular vitiligo occurs most commonly in which breed of dog?

A

Rottweilers

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11
Q

Transient periocular leukotrichia, associated with pregnancy or systemic illness, is seen in which breeds of cat?

A

Siamese

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12
Q

What is the most common canine eyelid tumour?

A

Sebaceous adenoma (from Meibomian glands)

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13
Q

What is the most common feline eyelid tumour?

A

Squamous cell carcinoma

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14
Q

What is a chalazion?

A

A painless swelling of the Meibomian gland caused by a blockage of its duct and retention of secretions. It looks like a firm, white-yellow nodule.

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15
Q

Leukonychia, when seen in isolation, is suggestive of which disease?

A

Vitiligo

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16
Q

Which immune-mediated disease, other than SLO, can be localised to the nails?

A

Lupus erythematosus
Subepidermal bullous dermatoses
Pemphigus vulgaris

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17
Q

Which breeds are predisposed to SLO?

A

GSDs

Gordon Setters

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18
Q

Are intracellular bacteria a normal or abnormal finding in canine anal sacs?

A

Normal

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19
Q

What is the most common type of anal sac neoplasia?

A

Adenocarcinoma

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20
Q

What is the most common endocrine cause of otitis?

A

Hypothyroidism

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21
Q

Which disease causes tightly adhered hyperkeratotic crusts (gold coloured) on erythematous plaques on the pinnae in cats?

A

Feline proliferative and necrotising otitis externa

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22
Q

Calcification of connective tissue occurs inside or outside the auricular cartilage?

A

Outside

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23
Q

Potent surfactants and detergents are often found in what type of ear cleaner?

A

Ceruminolytic

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24
Q

Which ceruminolytic agent was shown not to cause proliferative middle ear disease?

A

Squalene

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25
Q

How does EDTA make antibiotics/antiseptics more effective?

A

Induces changes in cell membrane permeability

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26
Q

Name two ‘soft’ glucocorticoids

A

Hydrocortisone aceponate

Mometasone furoate

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27
Q

Cystadenomatosis is most common in what signalment of cat?

A

Males, older age

Abyssinian, Himalayan and Persian and DSH

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28
Q

Is cystadenomatosis associated with viral infection in cats?

A

No - does not appear to be associated with papillomavirus, feline infectious peritonitis, feline immunodeficiency virus/feline leukemia virus status or other identifiable illnesses.

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29
Q

Cystadenomatosis has been found to primarily affect the preauricular region, concave pinna, concha, tragus and antitragus, and the external ear canal of cats; which non-aural areas can be affected?

A

Periocular, perioral and perianal regions

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30
Q

Which glands are affected in cystadenomatosis and where are they found?

A

Modified sweat apocrine glands
- found in the skin surrounding the eyelid margins (Moll’s glands), lip margins and perianal regions, but are most prevalent in and around the ears

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31
Q

What is cerumen made of?

A
  • Fatty secretions from sebaceous and ceruminous glands - triglycerides, sterol esters, fatty acid esters and squalene
  • IgG> IgA, IgM
  • Squames
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32
Q

Which part of the ear canal contains more ceruminal than sebaceous glands?

A

Ceruminous glands are more prevalent in the horizontal meatus compared with the vertical meatus, where there are more sebaceous and apocrine glands

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33
Q

Why are the lesions of cystadenomatosis blue/grey in colour?

A
  1. Distension of skin
  2. Pigmentary contributions from hemosiderin and ceroid of the thick acellular or cell-poor fluid filling the cystic lumen
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34
Q

What % of isolates of Pseudomonas aeruginosa from canine OE are MDR?

A

Up to 92%

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35
Q

Which cytokine is overexpressed in dogs with atopic otitis and otodectic mange and correlates with the otitis severity in atopic dogs?

A

IL-8

Significant increases in the levels of IL-10 were also overexpressed in atopic otitis but at lower rates

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36
Q

What effect did cleaning with an ethoxydiglycol, capric glycerides, isopropyl alcohol,calendula, tromethamine, glycerin and lipacids cleaner (Sonotix®) have on erythemato-ceruminous OE in dogs with predominantly Malassezia overgrowth?

A
  • It reduced pruritus score, OTIS-3, cytology score and otic secretion score in 7 days and further reduced it in 14 days
  • IL-8 also reduced compared to baseline and there was a decrease in free lipids and an increase in bound lipids.
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37
Q

Based on PCR, which three bacteria were most abundant in healthy ears of dogs?

A

Cutibacterium acnes (previously known as Propionibacterium acnes),Staphylococcus pseudintermedius, and Streptococcus spp

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38
Q

In dogs with OE, 78.3% had microbial overgrowth on PCR testing; was bacterial or fungal overgrowth more common?

A
  • 62.78% bacterial overgrowth
  • 8.5% fungal overgrowth
  • 7.0% had both
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39
Q

What type of bacteria is Finegoldia magna?

A

Gram +ve anaerobic coccus

Found in healthy ears of dogs on PCR but much more abundant in OE

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40
Q

Oclacitinib has been shown to be effective at managing ear tip ulcerative dermatitis; which differential diagnoses should be ruled out before starting treatment?

A

Infectious cases - leishmaniosis, bartonellosis (Bartonella henselae), Rickettsia rickettsia

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41
Q

What % of myringotomy aspirates can be contaminated by material from the external ear canal and how can this be reduced?

A

68%

By performing a ventral approach (special table etc. needed)

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42
Q

What are the benefits of CO2 laser surgery of proliferative ear canal/pinnal lesions compared to traditional surgery?

A
  1. Ability to sculpt rather than just excise
  2. Sterilisation of the wound bed
  3. Ablates sensory nerve endings, helping to reduce postoperative pain
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43
Q

Which special stain has been shown to identify biofilm?

A

PAS - stains polysaccheride matrix

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44
Q

When staining otic discharge with PAS, which findings are suggestive of biofilm associated infection?

A
  1. Presence of three or more microbial aggregates
  2. Presence of high-density material
  3. Extracellular staining and the presence of discretely stained matrix
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45
Q

What are the gold standard techniques to identify biofilm?

A
  1. Confocal laser scanning microscopy (CLSM) or scanning electron microscopy (SEM)
  2. Fluorescence in-situ hybridisation (FISH)
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46
Q

What are the benefits of referral for cases of chronic OE?

A
  • Number of episodes of otitis was reduced
  • Median time between recurrence of otitis reduced
  • Proliferative pathological change was significantly reduced
  • Better outcome if referral occurred within 6 months
  • Have equipment to perform effective, deep cleaning of the external ear canal
  • Access to advanced imaging modalities
  • Colleagues in associated fields such as neurology and soft tissue surgery, for specialist input
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47
Q

What is the pattern of epithelial migration on the tympanic membrane?

A

Centrifugal

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48
Q

Which ear treatment has been shown to exhibit the fastest diffusion through the cerumen lipids?

A

Aurizon

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49
Q

How long are compounded solutions of dexamethasone (0.1 and 0.25 mg/ml) in ear cleaner stable for?

A

At least 90 days at room temperature

  • Except if using ULTRA+KETO Flush (0.15% ketoconazole, TrizEDTA)
50
Q

Kaimio et al. (2021); which factors were associated with ceruminal gland hyperplasia in American cocker spaniels?

A

Bacterial growth in microbiological culture of aural exudate

  • Previous history of OE, cutaneous findings or underlying allergies were not
51
Q

True or false; It is normal for the feline ear to have a moderate amount of dark brown ceruminous debris present in the canal

A

True

52
Q

What is considered normal on cytology of cat ears?

A
  1. 2 or fewer Malassezia PHPF

2. 4 or fewer bacteria PHPF

53
Q

Among cats presenting to general practice in a UK study, what % had OE?

A

2.8%

54
Q

What are the signs of sebaceous gland dysplasia?

A
  • Occurs congenitally in short-haired kittens (4–12 weeks old)
  • Hypotrichosis starts on the head but quickly generalizes
  • Bilateral crusting within the canal and along pinnal margins
  • Generalized alopecia and scale with a coarse haircoat
  • Otitis may occur secondary to obstruction of the canal
55
Q

Otodectes cynotis is associated with what % of feline OE cases?

A

53–69%

56
Q

What % of cats may have signs of Otodectes outside the ear canal?

A

Up to 23%

Has been associated with chin acne

57
Q

Apart from Malassezia, which other fungi can affect the ear canal of cats?

A

Dermatophytes
Cryptococcus neoformans
Aspergillus fumigatus
Sporothrix schneckii

58
Q

Idiopathic facial dermatitis of Persian and Himalayan cats can cause OE in ~50% of cases; which treatments are effective?

A

Ciclosporin, topical tacrolimus

59
Q

Describe the lesions of proliferative and necrotising OE in cats (PNOE)

A
  • affects the concave pinna and ear canal
  • can also affect eyelids or be generalised
  • proliferative plaques that develop thick, adherent, tan to dark brown layers of keratinaceous exudate
  • erosions or ulcers develop over time due to friable proliferative tissue
  • pain and pruritus
60
Q

What age of cat is typically affected with PNOE and what treatment is effective?

A
  • Young: kittens or young adults
  • Topical tacrolimus and topical and systemic glucocorticoids
  • Ciclosporin?
61
Q

OE has been reported in what % of cats with PF?

A

7-30%

62
Q

How often do inflammatory aural polyps recur after traction, per-endoscopic trans-tympanic traction and curettage and VBO?

A

Traction = up to 67% (reduced if given steroids)
Per-endoscopic trans-tympanic traction and curettage = 13.5%
VBO = 5%

63
Q

What are the most common aural neoplasias in the cat?

A

Ceruminal gland adenocarcinoma > SCC > carcinoma of unknown origin

64
Q

Name the two most common rod shaped bacteria from cats with OE

A

Pseudomonas aeruginosa

Pasteurella multocida

65
Q

Other than Staph. spp, Pseudomonas aeruginosa and Pasteurella multocida, which other bacteria are associated with OE in cats?

A

Streptococcus canis, Escherichia coli, Mycoplasma, Klebsiella and Corynebacterium

66
Q

O’Neill et al. (2021); what were the predisposing factors for OE in dogs in UK PCP?

A

Pendulous and v-shape ear carriage

Breed: Basset Hound, Chinese Shar Pei, Labradoodle, Beagle and Golden Retriever at highest risk

67
Q

O’Neill et al. (2021); which dog breeds were at lower odds of OE in UK PCP?

A

Chihuahua, Border Collie, Yorkshire Terrier and Jack Russell Terrier

68
Q

Do silver nano-particles (AgNPs) have an antibiofilm affect?

A

Yes - in vitro

S. pseudintermedius exposed to 20 μg/ml of AgNPs formed less bacterial slime compared to the controls on CRA plates. Scanning electron micrographs showed that the biofilm had few individually scattered cells along its surface when treated with AgNP concentrations of 20 and 10 μg/ml. Untreated surfaces showed an aggregated biofilm.

69
Q

Leonard et al. (2021); does topical mometasone affect ear microbiota and mycobiota in dogs with AD?

A

No

70
Q

What are the most common causes of vestibular disease in dogs?

A
  1. Idiopathic
  2. Otitis media/interna
  3. Meningoencephalitis of unknown origin (MUO)
  4. Brain neoplasia
  5. Ischaemic infarct
  6. Hypothyroidism
71
Q

What age of dog is more likely to have OM/OI as a cause of vestibular disease than idiopathic / MUO / infarct?

A

Young dogs are more likely to have OM/OI

Older dogs are more likely to have idiopathic / MUO / infarct

72
Q

What autologous product can be used to manage canine aural haematomas?

A

Leukocyte- and platelet-rich plasma (L-PRP)

  • can accelerate the healing process by providing increased concentrations of platelet-derived growth factors
  • resolved haematomas in 12/15 dogs after 0.5-1ml instilled following drainage
73
Q

Which diluent has the most stable concentration of ceftazidime when refrigerated for 28 days?

A

Sodium chloride

Triz EDTA and Douxo Micellar Solution were less stable compounded solutions

74
Q

O’Neill et al. (2021); which risk factors were identified for aural haematoma in dogs?

A
  • V-shape or semi-erect pinnae
  • OE was present in 54.6%
  • Breed:
    Bull Terrier
    SBT
    Saint Bernard
    French Bulldog
    Golden retriever
75
Q

What were the clinical signs associated with patulous Eustachian tube in the dog?

A

OE characterized by frothy liquid and food fragments in the ear canal in addition to sneezing after drinking water

76
Q

Continuous vacuum drainage for surgical treatment of aural haematoma in dogs is performed on which side of the pinna?

A

Convex side of the pinna

77
Q

Where does the cleft occur in aural haematoma?

A

Within the cartilage

78
Q

How is the microbiota and mycobiota affected in dogs with OE?

A
  • Staphylococcus was the most abundant taxa across all groups.
  • Ears cytologically positive for cocci had decreased diversity
  • All types of OE were associated with decreased fungal diversity compared to controls
79
Q

LED-illuminated gel consists of two components: a light source comprised of blue light emitting diodes (LEDs; peak wavelength between 440 and 460 nm) and a topical substrate containing chromophores. Was once or twice weekly application more effective at treating OE in dogs?

A

Twice weekly

80
Q

Which clinical signs can be associated with middle ear effusion in dogs?

A

Head and neck pain, impaired hearing, facial paralysis, vestibular signs, head tilt, and otic pruritus.

81
Q

Middle ear effusion is most common in which breeds?

A

CKCS

Brachycephalic breeds e.g. Boxer, bulldogs

82
Q

Milne et al. (2020); what were the findings from middle ear effusion in dogs?

A
  • Neutrophils and macrophages predominate
  • 79% showed no bacterial growth on culture
  • 38% had neuro deficits
  • 56% had AD and OE
  • Staph. pseud was the most common bacterial isolated 67%
  • Bulla mucosa was thickened (dilated glands were present in unaffected dogs as well)
83
Q

Tyler et al. (2020); what % of cats had Malassezia on ear cytology and which factor was it associated with?

A

37.8%

Associated with increasing age

84
Q

Which phyla of bacteria are most abundant in the cerumen of healthy dogs?

A 
Proteobacteria
Actinobacteria
Firmicutes (includes Staph) 
Bacteroidetes
Fusobacteria
85
Q

What are microRNAs?

A

MicroRNAs (miRNAs) are short (∼22 nucleotides), single-stranded non-coding RNAs that modulate gene expression by binding to complementary target mRNA

86
Q

Micro(mi)RNAs involved in monocyte/macrophage polarization were detected in cerumen of dogs with OE, what does this suggest?

A

That during inflammatory responses, monocytes are attracted to cerumen, and become activated on site and modulated by miRNAs

87
Q

Can miRNAs discriminate otitis-affected from healthy dogs?

A

Yes - miR-125b and miR-320a

- with high sensitivity (>86%) and specificity (>97%), may be suitable biomarkers

88
Q

Can chlorhexidine-Tris-ethylenediaminetetraacetic acid (EDTA) and medical grade honey solutions be used to treat OE with Malassezia overgrowth in dogs?

A

Yes - both reduced clinical signs and cytological counts of MP

89
Q

Which novel topical treatments have shown in vitro efficacy against Gram -ve bacteria associated with OE in dogs?

A
  1. Narasin (ionophore) with Tris-EDTA or disodium EDTA

2. Manuka oil with Tris-EDTA

90
Q

What are the risk factors for facial nerve paralysis in dogs?

A
  • Male
  • Middle age
  • CKCS
91
Q

What were the most common diagnoses for dogs with facial nerve paralysis in Chan et al. (2020)?

A
  1. Idiopathic (37% of naturally occurring FNP)
  2. Surgical trauma
  3. Neuromuscular disease
  4. Intracranial disease
  5. OM/OI (14.3% of naturally occurring FNP)
  6. Hypothyroidism (3-4% of cases)
  7. Non-surgical trauma
92
Q

Which is the most sensitive method for diagnosing otoacariasis?

A

Otoscopy alone sens = 67%
Curette sampling sens = 93%
Swabbing sens = 57%

Otoscopy and curettage = 100%
Otoscopy and swabbing = 86%

93
Q

What % of dogs with chronic OE (> 2m) have OM with no overt clinical signs?

A

21%

94
Q

Is the MIC for silver sulfadiazine lower than the concentration of the commercial product for Pseudomonas aeruginosa?

A

Yes - 1% product

MIC 1-64 ug/ml

95
Q

Cole et al. (2019); are bacteria commonly cultured from middle ears of CKCS with OME?

A

No - 10% of external canals, 25% of middle ears and 8% from both
- Coagulase-negative staphylococci and Staphylococcus pseudintermedius most common

96
Q

Is MRI or CT more sensitive at diagnosing early tympanokeratoma?

A

MRI

97
Q

Which adjuvants are effective in vitro against common bacteria and Malassezia associated with OE in dogs?

A

N-acetylcysteine
Tris-EDTA
Disodium EDTA

98
Q

Which medium and time-frame are preferable for assessing biofilm production of Pseudomonas aeruginosa isolates?

A

Mueller–Hinton Broth and 24 hr incubation

99
Q

What % of clinical isolates of Pseudomonas aeruginosa from OE in dogs can produce biofilm?

A

> 90%

100
Q

May et al. (2019); was NAC synergistic, indifferent or antagonistic when used with enrofloxacin and gentamicin in vitro against Staphylococcus pseudintermedius, Pseudomonas aeruginosa and Corynebacterium?

A

Indifferent to antagonistic

101
Q

Name the anatomy

A
102
Q

What is the diameter of the auditory tube and which cells line it?

A

≤ 1.5 mm

Pseudostratified ciliated columnar epithelium and goblet cells

103
Q

Belmudes et al. (2018); what % of dogs with and without OE had bulla abnormalities on CT?

A
  • 40.7% of dogs with OE >6 months
  • OM associated with purulent or proliferative OE (particularly severe OM in French bulldogs)
  • 14.2% of dogs with peripheral vestibular signs but no OE
  • 9/9 CKCS with deafness showed fluid filled bullae
104
Q

Imai et al. (2018); what % of dogs with tympanokeratoma had bulla expansion?

A

53.8%

105
Q

What are the three theories of tympanokeratoma formation in dogs?

A
  1. Migration of cells through damaged tympanic membrane
  2. Invagination of tympanic membrane into middle ear
    - Auditory tube dysfunction
  3. Metaplastic change of ciliated epithelium within middle ear
    - Chronic inflammation
106
Q

Which method and outcomes were reported with non-surgical management of tympanokeratoma in dogs?

A
  1. Endoscopic removal of material via ear canal
    - Manually and with diode laser
  2. Ongoing post-operative lavage and at home cleaning – labour intensive
  3. Recurrence of clinical signs in 4/13 ears (30.8%)
  4. Procedure repeated once in one dog and twice in another
  5. Facial nerve paralysis developed in 1/11 dogs post-operatively
107
Q

Swales et al. (2018); medical management of OM in cats is successful in what % of cases?

A

72.7%

108
Q

What are the complication rates for VBO for polyps in cats?

A
  1. Lower risk of recurrence reported cf. traction (0-8%)
  2. Immediate post-op Horner’s (57-83%)
  3. Otitis interna/vestibular signs (26-42%)
  4. Facial nerve paralysis (12-13.5%)
    Post-operative complications usually reversible
109
Q

Describe the per-endocscopic approach to polyp removal in cats and the rate of complications

A
  • Traction to debulk followed by endoscopic removal of any residual portion of polyp using curettage
  • Septum bullae removed to improve access if necessary

Resolution of clinical signs in 35/37 cats (94%) over 19-month follow up

  • 8% developed Horner’s syndrome
  • 13.5% had polyp recurrence
110
Q

One method of collecting ear cytological specimens utilizes a cotton-tipped swab inserted into the vertical ear canal. A proposed alternative method is to aspirate exudate from the deep horizontal canal using a rubber tube. Is there a difference in cytological assessment with these methods?

A

More neutrophils are obtained with the tube method otherwise no significant difference

111
Q

What are the most common causes of Pseudomonas OE in dogs?

A

Allergy&raquo_space;> masses and endocrine disease > autoimmune disease

112
Q

How were brainstem auditory evoked responses affected in dogs treated with aqueous solutions of marbofloxacin, gentamicin, tobramycin and ticarcillin?

A

Brainstem auditory evoked responses in dogs treated with aqueous solutions of marbofloxacin or gentamicin remained unchanged or improved after therapy of otitis media but were impaired in dogs treated with ticarcillin or tobramycin

113
Q

How is tympanic bulla anatomy affected in brachycephalic dogs?

A
  • CKCS had significantly flatter tympanic bullae (greater width:height ratios) versus Pugs, English bulldogs, Labrador retrievers, and JRTs.
  • French Bulldogs and Pugs had significantly more overlap between tympanic bullae and temporomandibular joints
  • All brachycephalic breeds had significantly lower tympanic bulla volume:weight ratios
  • Soft tissue attenuating material (middle ear effusion) was present in the middle ear of 48/100 (48%) of brachycephalic breeds
114
Q 
In a 2017 study, which antiseptics/cleaners were most effective in vitro against M. pachydermatis?
Otoclean
EpiOtic
MalAcetic
1.5% hydrogen peroxide
A

Hydrogen peroxide 1.5% > Epiotic® and MalAcetic® > Otoclean®

115
Q

What are the risk factors/primary causes of Aspergillus OE in dogs and cats?

A
  • Typically seen as unilateral otitis externa in cats and larger breed dogs
  • Possible risk factors include immunosuppression and otic foreign bodies
  • Previous antibiotic usage was common
116
Q

Rim enhancement of polyps on post-contrast CT is present in what % of cases and associated with what pathology?

A

73%

Positively correlated with the histologic grade of inflammation in the superficial stroma

117
Q

How often are ear cleaners contaminated and which bacteria are involved?

A
  • 10% of the bottle tips and in 2% of the solutions.
  • Isolated bacteria included Staphylococcus pseudintermedius, Bacillus spp., coagulase-negative Staphylococcus spp., Micrococcus spp. and Burkholderia cepacia
  • The contamination rate was significantly higher when Tris–EDTA was an ingredient.
118
Q

Are Corynebacterium considered pathogenic when isolated from canine OE?

A
  • May be pathogenic
  • However, almost invariably present with other microbes and usually disappear from the ear with resolution of other infections
  • Gentamicin and enrofloxacin would be rational choices for the empirical, topical therapy
119
Q

Krainer et al. (2021); what % of French bulldogs with no history of otitis had middle ear effusions on CT and did this correlate with nasopharyngeal dimensions?

A

54%

Not related to nasopharyngeal dimensions

120
Q

Has fluorescence light energy (FLE) been used to treat canine perianal fistulae?

A

Yes - small number of dogs - significant reduction in vocalization, straining and licking after 2 weeks and lesional areas had significantly decreased after 5 weeks

121
Q

How effective is pip/taz at treating bacterial OE in dogs?

A
  • 84.6%) of dogs had clinical and microscopic resolution after28 days of treatment - rest partial response
  • 38.5% developed acute or progressive Malassezia otomycosis during or following treatment.
122
Q

Has Tris-NAC been shown to have anti-biofilm affects?

A

Yes - for Pseudomonas and Staph. pseud (not for Malassezia!)

Sarah - Mulller and Kirk (14 decks)

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