Companion Animal Pathology II Flashcards
1
Q
Senior pet - descriptors
A
- Fraility - dec functional reserve, decline in physiological + cog performance, vulnerable to disease, more susceptible to drug effects (+ polypharmacy)
- Immunosenescence - immune dysfunc, remodelling of lymphoid tissues, susceptible to infections, autoimmune disease + neoplasia
- Inflammaging - chronic inflam
2
Q
Senior pet diseases
A
- CVS
- Chronic renal disease
- Cognitive dysfunc
- Osteoarthritis
- Immune problems
- Neoplasia
- Thyroid problems
- Diabetes mellitus
- Cushing’s
- Vision + hearing changes
- Dental disease
- Multiple organ involvement
3
Q
Heart disease
A
- Inc vascular + myocardial stiffness -> difficult to maintain BP
- Myocardial fibrosis in muscle
- Valvular degen - small dogs
- Reduced adrenergic response
4
Q
Heart diseases - dog
A
- Myxomatous valve disease - small breeds
- Dilated cardiomyopathy - large breeds
- Pericardial disease
- Arrhythmia
- Systemic hypertension
5
Q
Heart diseases - cat
A
- Hypertrophic cardiomyopathy
- Systemic hypertension
6
Q
Heart disease Dx
A
- CS - lethargy, syncope, cough, exercise intolerance, inc resp rate
- PE - heart murmur, arrhythmia, pulse deficit, weak pulses, retinal bleeds (cats)
- Dx - Radio, ECG, echocardiogram, NT-proBNP, cardiac troponins, BP, holter monitor, resting resp rate
7
Q
Renal system (senior)
A
- Common in older cats
- Reduced GFR, glomerulosclerosis, interstitial fibrosis
- CS - lethargy, anorexia, weight loss, V+, PUPD, incontinence
- Dx - cachexia, oral ulcers, abdo kidney palp, low USG, proteinuria, anaemia, hypertension + retinal changes, uraemia + elevated SDMA, electrolyte imbalance, radio, US
8
Q
Neuro disease (senior)
A
- Canine + Feline cognitive dysfunc
- 14 - 25% dogs > 8 y/o
- Similar to Alzheimer’s disease beta amyloid plaques/senile plaques
- Chronic pain-related anxiety - pain management
- Early detection + Tx -> inc QoL
- Dx = DISHAA - disorientation, social interaction, sleep-wake cycle, housetraining, activity, anxiety
9
Q
MSK (senior)
A
- Easily Dx in dogs, but cats hide pain
- Cats rarely have crepitus on joint manipulation
- > 60% cats have evidence of arthritis in one or more joints
10
Q
Osteoarthritis
A
- CS - lameness, pain, inactivity, reluctance to jump, dec mentation, reduced grooming in cats, getting ‘slow’
- Dx - PE, radio, CT
11
Q
Immune disease - senior
A
- Immunosenescence - reduced immune response - need to maintain vacc
- Auto-immune disease - IMHA, IMTP
- Neoplasia
12
Q
Neoplasia (dog)
A
- Lymphoma (multicentric)
- MCT
- Haemangiosarcoma (spleen)
- Osteosarcoma
- Anal sac adenocarcinoma
- Melanoma
- Transitional cell carcinoma
- Soft tissue sarcoma
- Melanoma
13
Q
Neoplasia (cat)
A
- Lymphoma (GIT)
- SCC
- Soft tissue sarcoma
- Injection site sarcoma
14
Q
Neoplasia
A
- CS - weight loss, anorexia, V+, D+, dyspnoea, coughing, limping, PUPD, palpable + visible masses, pain, behaviour changes, haematuria
- Dx = PE, CBC, serum chem, urinalysis, radio, US, FNA, cyto, biopsy, special staining, tumour markers, CT, MRI
15
Q
Hyperthyroidism
A
- Cats more common
- CS - weight loss, hyperactive, aggressive, tachypnoea, tachycardia, poor coat, V+, D+, polyphagia, PUPD, lethargic
- Dx - screening - total T4 + free T4
16
Q
Hypothyroidism
A
- Dogs more common
- CS - weight gain, lethargy, ‘sad’ expression, mental dullness, alopecia + coat changes, bradycardia, inappetence, anaemia
- Dx - PE, CBC, biochem, TT4, TSH
17
Q
Diabetes mellitus
A
- CS - PUPD, polyphagia, weight loss, blindness, DKA (diabetic ketoacidosis), neuropathy
- Dx - blood glucose, fructosamine (long-term glucose), urinalysis + culture, US
18
Q
Hyperadrenocorticism
A
- Cushing’s disease - can start in middle age
- CS - PUPD, polyphagia, pot belly alopecia, panting, weakness, seizures, lose muscle mass on lower limbs
- Dx - screening tests + confirmatory tests - ACTH stim test, low dose dexamethasone test, US, MRI
19
Q
Vision + hearing changes (senior)
A
- Vision - not all, dec vision, hardening of lens - loss of focus
- Hearing - common in older, progressive loss
20
Q
Dental disease (senior)
A
- Inc risk - periodontal disese + oral neoplasia
- Loss bone density -> pathological bone Fx
- Effects on general systemic health - periodontitis -> chronic inflam disease process
- Bacteria enter bloodstream - can enter heart valves -> valvular endocarditis
- Radiograph recommended
- Care w/ anaesthesia - but less of a risk than heart disease
21
Q
QoL - objectives
A
- Pain management
- Management of clinical signs
- Hygiene - maintain urine + faeces sanitation, access to elimination sites
- Nutrition - diet + BCS
- Mobility
- Safety - avoid self-trauma, from others, dec hazards
- Environmental needs - bedding, temp, ventilation, space, peace
- Family engagement, isolation avoidance, other pet interaction
- Mental stimulation
- Preservation of dignity - soiling, manage incontinence, hygiene, grooming
- Stress reduction
- Preserve pet’s household role
- Maintain will to live - monitor behaviour
22
Q
Maladaptive chronic pain
A
- Persists beyond expected course of acute disease, not associated w/ healing, no clear endpoint
- Associated w/ recurrent/long-standing disease conditions, can exist w/o a cause -> serves little to no biological purpose
- Osteoarthritis
- Cancer
- Periodontal disease
- Persistent Sx pain
- Episodes of acute pain
- AKA pathological pain
- Peripheral + central sensitisation -> permanent changes in CNS structure + func
23
Q
Chronic pain behaviours general
A
- Lameness/altered gait
- Reduced mobility
- Reduced activity - seem lazy, tired, lethargic
- Hesitant on stairs, slippery floors/uneven surfaces
- Reduced sociability - people + animals
- Inc anxiety
- Aggression
- Grumpiness
24
Q
Chronic pain behaviour evaluation (cat)
A
- General mobility - ease of movement, fluidity of movement
- Ability to perform activities of daily living - playing, hunting, jumping, using litter box
- Eating, drinking
- Grooming e.g. scratching
- Resting, observing, relaxing - how well activities enjoyed by cat
- Social activities - people + other pets
- Temperament
25
Chronic pain behaviour evaluation (dog)
- Vitality + mobility
- Mood + demeanour
- Levels of distress - vocalisation + response to other dogs + humans
- Indicators of pain - comfort levels, stiffness, lameness, orthopaedic exam
- Imprint of pain on somatic structures - myofascial exam, muscle strain patterns
26
Pain recognition
- Pain score scale
- Behaviour
- Pain recognition tool/device
- Questionnaire
27
Unresolved/chronic pain in cancer patients
- Direct cancer pain
- Neuroimmune interactions
- Dx procedures
- Metastatic disease
- Concurrent painful conditions e.g. OA
- Poorer response to chemo/radiotherapy
- Earlier death
28
Osteoarthritis
- Inflammation
29
Cancer pain
- Inflammation - caused by tumour invasion
- Tissue distortion - caused directly by tumour invasion
- Nerve injury -> neuropathic pain
- Visceral obstruction
- Ischaemia
30
Examples of severe to excruciating pain
- CNS infarction/tumours
- Meningitis
- Bone cancer
- Aortic saddle thrombosis
- Limb amputation
- Ear canal ablation
31
Examples of moderate to severe pain
- Immune-mediated arthritis
- Glaucoma
- Uveitis
- Pleuritis
- Mastitis
- Oral cancer
32
Examples of moderate pain
- ST injuries
- Urethral obstruction
- OVH
- Cystitis
- Dx arthroscopy + laparoscopy
- Oseoarthritis
33
Examples of mild to moderate pain
- Dental disease
- Otitis
- Superficial lacerations
- Mild cystitis
- Chest drains
- Abscess lancing
- Castration
34
Hyperalgesia
- Exaggerated or prolonged response to noxious stimulus
35
Allodynia
- Pain response to normally innocuous stimulus
36
Rabbit diet + digestion
- Require hay/grass-based diet, diet correction mandatory - bacterial flora normalises slowly - probiotics not as effective
- Will take starchy food if offered
- 40% of energy from VFAs absorbed across caecal epithelium
- Caecotrophs - (formed after fermentation in caecum) - provide microbial protein, approx 10% energy requirement, all B + K vits + VFAs
- Caecotrophs eaten (large no. if diet low protein or high fibre)
- Won't get cold as quickly, don't starve for anaesthesia - VFAs in caecum, dripping small amounts of energy in bloodstream. Anaesthetics starts 4 - 6 w prior to ensure gut bacteria prepared
37
Effect of starch consumption (rabbit)
- Some starch digested in SI
- Excess starch dumped in caecum
- Rabbits have fast GIT transit time -> fast fermentation, dysbiosis, pathogenic bacteria overgrowth
- If give starch based food - digestion becomes similar to monogastric
- Clostridial growth - building up pockets of nasty bacteria - when rabbit has problem later - gut flora wiped out, clostridia resistant, no competition -> production of toxins -> sudden death
38
Ileus - gut stasis (rabbit)
- 2y to: pain, fear, diet change, other disease (dental, MSK)
- Large amount of fluid into abdo/intestine -> dehydration
- Only will see caecotrophs when animal unwell + smear on backside = small, firm indigestible droppings
39
Diarrhoea (rabbit)
- True D+ = medical emergency, vast majority will die
- Normally young rabbit
- Most D+ cases = caked caecotrophs
- Cause: flystrike, skin ulceration - DIET, teeth - cannot physically pick up droppings + swallow/pain - slower fusus coli (digestion pace maker), heart disease - too weak to turn around + clean self, older rabbits - spinal pain + hip arthritis, lazy male rabbit
40
Bonding (rabbit)
- Pairs/threes - protection needed for prey species, keep in groups for clinical procedures, improves recovery
41
Neutering (rabbit)
- Female = 6 - 9 m/o
- Male = > 10 - 16 w
- Reduce aggression, spraying, some fighting
- Eliminate uterine adenocarcinoma risk
- Inc success of bonding
- Anaesthesia + surgical risks
42
Encephalitozoon cuniculi
- V common, but not common cause of disease, bad breeding background
- Concurrent disease - had for long time then see as renal disease presentation
- Zoonosis - dangerous to O, end up w/ spores on hands, wear gloves
- Obligate intracellular protozoal parasite
- Uterine spread - 4 w survival of spores
- Granulomatous inflam in liver, *kidneys*, CNS - infection on nerve, lungs, heart
- CS - depends where the microsporidia end up
- Dx - serology - +ive/-ive of IgM/IgG - only tells you about exposure
43
Rabbit anaesthesia considerations
- Stress free for prey species
- Ensure preoperative nutrition is good as possible - gut bacteria
- Provide good analgesia - use NSAIDs early to see effect + monitor + manage BP
- Prokinetics if needed
- Good induction to Sx plane of anaesthesia - lidocaine + pre-oxygenate - ensure no reaction to stimulus
- Manage airway w/ face mask, supraglottic airway device or ET tube/V-gel (pharyngeal ariway)
- Monitor temp
- Tend to under-ventilate - provide IPPV (intermittent positive pressure ventilation) or w/ ventilator + monitor CO2 to prevent hypercapnia (capnograph)
- Blood pressure
- Pulse ox - anything under SpO2 94% issue
- Stress free recovery w/ adequate analgesia
- Back w/ partner rabbit ASAP
44
Hypercapnia (rabbit)
- Smaller thorax : abdo vol ratio, + obligate nasal breathers, + common occurrence of pre-existing URT disease - compromising airway patency
- Poor husbandry - dusty/mouldy conditions -> U/LRT
- Diaphragm arches caudodorsally so liver, stomach and/or caecum can collapse or put pressure on caudal lung lobes when rabbit is positioned for Sx (dorsal recum)
- Ventilation : pefusion mismatch - shallow breathing - prey species when stressed, not getting air into alveoli for gas exchange - CO2 will be raised before giving drugs
- Stress/fear can reduce resp rate or depth under v light anaesthetic depth
45
Airway management - adv of face mask
- Quick/easy to use
- Clinicians experienced w/ use
46
Airway management - disadv of face mask
- Volatile agent leakage, contamination of environment, health + safety risk
- Does not protect airway
- Suboptimal anaesthesia - due to gas leaks
- Difficult/cannot use w/ capnograph
- Cannot use for dental procedures
47
Airway management - adv of v-gel (rabbit)
- Easy/fast placement
- Wide airway - coming over top of larynx, not narrowing the airway
- Doesn't touch arytenoids
- Blind placement makes insertion easier
- Prevents issues related to upper airway obstruction
48
Airway management - disadv of v-gel (rabbit)
- Larger device than ET tube - can inc dead space = make dental access difficult
- Pharyngeal access impossible - have IV cannula place, sedatives pre-med IV, medetomidine, actively going to sleep, face mask on + ventilate, then try v-gel - if pharynx working against, give break + breath of O2 + try again
- Can dislodge + needed ongoing monitoring
- Doesn't prevent laryngeal spasm
49
Airway management - adv of ET tube
- Prevents aiway obstruction from laryngeal spasm
- Prevents upper airway obstruction
- Slim structure makes dental access, oral access + pharyngeal access easier
- Slim structure reduces dead space
50
Airway management - disadv of ET tube
- Narrow diameter inc airway resistance to breathing
- Can cause laryngeal, tracheal trauma - damage to ciliated epithelia, get ripped off, takes 10 - 14 d to heal -> inc risk of LRT infections
- Difficult to place - small rabbits
- Tubes can kink of block
- Does not prevent prevent bronchospasm
51
Clinical signs of dental disease - pain (rabbit)
- Reduced appetite
- Weight loss
- Behaviour change or food choice change
- Dribbling/hypersalivation
- Polydipsia - inc drinking to reduce pain by cold water
- Epiphora
52
Clinical signs of dental disease - loss of function (rabbit)
- Poor grooming ability
- Reduced activity due to muscle weakness
- Inc caecotrophs
- Urine scale (unable to keep fur in good condition)
- Epiphora (tear overflow) - reserve crown changes in maxilla - affects nasolacrimal duct
- Sneezing/URT disease - reserve crown changes in maxilla
53
Congenital dental disease (rabbit)
- Genetic - Netherland dwarfs - imbalanced growth of mandible + maxilla
- Short maxilla
- Severe incisor malocclusion
- Young rabbits
54
Acquired dental disease (rabbit)
- Root (reserve crown) disease
- Eruption of teeth ventrally/dorsally - once new bone formed, always going to be there
- Inadequate dietary fibre = ad lib pellets/muesli + minimal hay/grass consumption
- Metabolic bone disease = dietary calcium deficiency +/- vit D deficiency due to insufficient year round exposure to natural light
- Genetic predisposition - dwarf + lop over-represented - imbalance in jaw growth
- Incisor malocclusion - manifestation of a whole mouth problem - eruption of teeth ventrally/dorsally - cause trauam to cheek/tongue
55
Dental disease pain (rabbit)
- Overgrowth of reserve crowns -> pain
- Pain prevents proper grinding movements of crown surfaces + retrograde root growth into surrounding bone
56
Polydipsia DDx (rabbit)
- Kidney disease
- Psychogenic e.g. chronic pain
- Liver disease
- Hypokalaemia
- Sepsis
- Neoplasia
- Cystitis/Urolith
- Diabetes mellitus
57
Hind limb paresis DDx (rabbit)
- E. cuniculi
- Spondylosis
- Degenerative disc disease
- Arthritis
- Trauma/spinal Fx
- Neoplasia
- Toxoplasmosis
- Splay leg
- Cerebrovascular accident (stroke)
- Toxin ingestion (e.g. lead)
58
Mid-abdo pain DDx (rabbit)
- Gut stasis (ileus)
- Neoplasia
- GIT infection
- Mild bloat
59
Weight loss DDx (rabbit)
- Kidney disease
- Chronic pain (reduced appetite)
- Neoplasia
- GIT worms
- Liver disease
- Diabetes mellitus
- Infection
- Stress e.g. bullying
60
Sludgy bladder (rabbit)
- Excess of mineral buildup in urine -> CaCO3 (calcite) + calcium oxalate uroliths
- CS - Straining to urinate, blood in urine, depressed, painful (hunched), bladder enlarged + turgid, urinating small amounts more freq or dribbling
- Hx - diet/mineral supplementation (high ca + oxalate), reduced water intake, obesity, urine retention (stress/arthritic pain)
- Dx - radiographs, blood in urine on dipstick
61
Rabbit haemorrhagic disease (RHD)
- High mortality
- RHD 1 = sudden death
- RHD 2 = fatal within 1 - 2 w
62
Rebreathing in rabbits (canography)
- Rebreathing in rabbits - if not enough 'puff', small lung space in rabbits
- Sucking air back in that just breathed out
- When breathe out not able to clear out all gas breathed in
- CO2 inc
- Line not returning to 0
- Normal finding
- Use ventilator - face mask to actively ventilate lungs
63
Head tilt (rabbit)
- Middle ear disease - flush ear w/ sterile saline - see improvement
- E.g. Ear wax build up in ear -> pressure on nerves -> vestibular signs
- Dx - MRI / CT
64
Hyperthyroid cat
- Hx - older, inc appetite + weight loss, poor coat condition, inc aggression
- CE - weight loss, poor coat condition, palpable goitre, tachycardia, heart murmur
- Hypertension
- Inc ALT + ALP
- Inc Total T4
65
Chronic renal failure (cat)
- Hx - older, PUPD, dec appetite, less activity
- CE - bradycardia, weight loss
- Inc protein on dipstick
- Dec USG
- Inc BUN, inc serum creatinine, inc TP
- Dec lymphocytes, inc monocytes
- Radiographs, US, urine protein : creatinine, urine culture
66
Diabetes mellitus (cat)
- Hx - older, PUPD, inc appetite, pot weight loss, less inclined to groom
- CE - QAR, overweight (but loss of muscle mass), lacklustre coat
- Elevated glucose
67
Exocrine pancreatic insufficiency (EPI) (dog)
- Hx - older, chronic weight loss, loose stools, inc appetite (polyphagia)
- CE - tacky mm, mild skin tent (mild dehydration), poor coat quality, low BCS - weight loss inc nutrient loss, loose faecal material
- Dec cholesterol
- cTLI (Serum Trypsin-Like Immunoreactivity) dec, <2. 5 μg/L)
68
Small intestine bacterial infection
- Dec cobalamin
- Inc folate = upper SI
- Dec folate = lower SI
68
Hyperadrenocorticism (Cushing's) (dog)
- Hx - PUPD, polyphagia, weight gain - pot-bellied, distended abdo, dec activity
- CE - tense abdo on palp, no mass, weight gain
- Inc protein
- Dec USG
- Inc ALT, inc ALP, inc GGT
- Inc glucose
- Dec T4
- Stress leucogram (inc lymphocytes, inc monocytes, in neutrophils)
- US - accum of fat in abdomen - liver enlargement
- Inc cortisol pre (> 25 - 125 nmol/L) + post ACTH (125 - 520 nmol/L)
69
Hypoadrenocorticism (Addison's) (dog)
- Low or below normal basal cortisol levels w/ little or no inc post-stimulation
70
Flea anaemia (cat)
- Hx - neonate, weak, cold, dehydrated
- CE - tachycardia, systolic heart murmur, pale mm, CRT > 2s, weak peripheral pulses + thready, hypothermic, skin tent (dehydration), visible flea infestation + flea dirt - signs of regn anaemia
- Inc ALP
- Dec RBCs, dec PCV, dec Hb, dec Hct, inc MCV
- Blood smear - polychromasia, nucleated RBC, reticulocytes, no parasites - regen process
71
Feline hepatic lipidosis
- Hx - overweight -> lost weight, inappetent, V+, lethargy
- CE - QAR, poor coat quality, icteric mm, pendulous abdo, enlarged liver, muscle wasting along dorsum
- Inc bilirubin, inc ALT, inc ALT
- US - diffuse hyperechoic parenchyma of liver
- Definitive Dx from FNA/histopathology of liver
72
Ruptured splenic neoplasia (dog)
- Hx - acute onset collapse, unable to stand
- CE - Recumbent, but responsive, tachycardia, pale pink mm, CRT > 2 s, weak + thready peripheral pulse, generalised pain + discomfort of abdo on palp, mild distension - pos fluid thrill on ballottement, unable to stand w/ no pain on limb palp + normal spinal reflexes + normal limb tone
- Inc ALP, inc urea
- Dec Hct, dec Hb, dec MPV (mean platelet vol), dec RBC
- US - free abdo fluid, few hyperechoic cavitated lesions in liver, masses on spleen - haemangiosarcoma, bleeding into peritoneal cavity
- BMBT - normal
73
Dilated cardiomyopathy (dog)
- Hx - large breed, dec activity
- CE - systolic heart murmur
- Inc NT-ProBNP biomarker
- Echocardiogram - dilation of L ventricle in systole + diastole + evidence of systolic dysfunc, normal mitral valve leaflet morphology, inc end systolic vol, dec ejection fraction + dec fractional shortening L partial dilation + mild mitral regurgitation
- ECG - pos arrhythmia
74
IMHA (dog)
- Hx - exercise intolerance, weakness, lethargy
- CE - QAR, pale + yellow mm - icteric, tachycardia, tachypnoea
- Blood smear - polychromasia (reticulocytosis) (anaemia), spherocytosis (immune-mediated disease), immature nucleated RBCs
- Dec PCV
- Inc liver enzymes (ALT, ALP, AST)
- Hyperbilirubinarmia
- Slide agglutination positive - Coomb's positive
- Exclude Leishmania/Ehrlichia/Babesua by serology/PCR
75
Atrial fibrillation (dog)
- Hx - excessive panting, prolonged cough - dry + non-productive + not associated w/ exercise, lethargy, perivulvar erythema/clear serous discharge from vulva
- CE - pale pink mm, tachycardia, arrhythmia, systolic murmur, pulse quality diminished, variable pulse deficits, incessant panting, harsh bilateral bronchovesicular lung sounds
- Radio - enlarged cardiac silhouette, inc VHS, bulge at LA, angling upwards of caudal VC, prominent pul vasculature, pul congestion, interstitial pattern - pul oedema, peribronchial pattern on lung fields
- Echocardiogram - dilation of LA, globoid appearance of heart, mitral valve leaflets distorted
- ECG - flutter of p-wave/irregular - atria cannot contract -> poor ventricular filling
- Inc cardiac troponin
76
Cranial cruciate ligament rupture (dog)
- Hx - large breed, hind leg lameness + stiffness, exacerbated w/ exercise
- CE - inc BCS/overweight, partial weight bearing, muscle wasting, difficulty rising, pain to hind limb
- Radio - OA, loss of radiolucent triangular fat pad caudal to patellar ligament, periarticular osteophytes
- +ive cranial draw test
77
Peripheral idiopathic vestibular syndrome (dog)
- Hx - onset ataxia, wobbly, head tilt -> circling
- CE - QAR, ataxia, circling, positional strabismus, rotatory nystagmus, proprioceptive + spinal reflexes intact
- Otoscopy - NAD
- Pos CT of inner ear - NAD
78
Intervertberal disc disease
- Hx - acute onset neck pain, progressive R-sided neurological deficits
- CE - QAR, low head posture carriage w/ myoclonus (twitching) of neck muscles, tetraparetic, R > L no CN deficits, hopping deficits, conscious proprioception diminished, +ive myotaticreflexes in all limbs, deep pain in all limbs, panniculus reflex present
- CSF analysis for exclusion
- CT - disc extrusion
- MRI
79
Sarcoptes scabiei infection (dog)
- Hx - intense progressive pruritus, alopecia, erythematous papular, crusting rash, dorsal aspect of head - pinna, feet, axillae, groin + ventrum, pot kennelling
- CE - Erythematous, papular, crusting rash with alopecia and evidence of self-
excoriation
- Skin scrap - mites
- Skin cyto - pos 2y bacterial infection, inc neutrophils, inc eosinophils, intracellular coci
- Sarcoptes Ab ELISA
80
Atopy (dog)
- Hx - progressive pruritus, flea + worming Tx
- CE - erythema and papules noted in the axilla, groin and interdigital areas, no evidence of ectoparasites, bilateral otitis external
- Dermatological exam negative - skin scrapes, hair pluck, tape cyto, coat brushings
- Allergy testing - intradermal test, serology, diet trial
