1. one big reason for getting a skin cytology? 2. what 3 things should we be looking for?

1. most animals are PRURITIC and get SECONDARY BACTERIAL INFECTIONS, good to determine 2. look for INFLAMMATORY CELLS, ORGANISMS, or FREE-FLOATING KERATINOCYTES

Defense & Barriers 2: Skin Exam/Cytology Flashcards by Nellie O'Leary

important things to ask in history? (5)

presence of pruritus?
travel history?
diet history?
duration/progression?
prior therapies?

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what 5 regions should be examined upon dermatologic exam?

**WHAT ARE WE AIMING FOR?

ears
paw pads
claws
mucocutaneous junctions
oral cavity

**OVERALL, ENTIRE SKIN SURFACE

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in the dermatologic exam…
1. what type of diagnostic test do we almost ALWAYS do?
2. what diagnostic test should we do if pet is ITCHY?
3. what’s the diagnostic test for HAIR PLUCKING?

SKIN SCRAPING
ITCHY = FLEA COMBING
TRICHOGRAM

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4 ADVANCED dermatologic tests we can run IF INDICATED?

DERMATOPHYTE PCR
FUNGAL culture
BACTERIAL culture & sensitivity
skin BIOPSY

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IMPRESSION cytology steps?
Impression slides are good for WHAT TYPES OF LESIONS
ACETATE TAPE cytology steps?
how is ACETATE TAPE cytology stained?

IMPRESSION cytology
1. REMOVE crust with EDGE of SLIDE
2. PRESS SLIDE ONTO SKIN
**Good for EXUDATIVE/MOIST lesions

ACETATE tape cytology = use packing tape to press to lesion and remove
STAINED via DiffQuik stain, latter 2

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one big reason for getting a skin cytology?
what 3 things should we be looking for?

most animals are PRURITIC and get SECONDARY BACTERIAL INFECTIONS, good to determine
look for INFLAMMATORY CELLS, ORGANISMS, or FREE-FLOATING KERATINOCYTES

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3 things we need to do to PREP slides?

**heat-fixing acetate tape cytology?

AIR DRY or USE BLOW DRYER
if GREASY, then HEAT-FIX
DiffQuik STAIN

**DO NOT HEAT-FIX TAPE SLIDES

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what organism is present here?

**what’s a normal finding?

= MALASSEZIA YEAST, present in BIG PURPLE GLOBS

normal finding = BROWN MELANOCYTES

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describe this organism in LOCATION

what organism is usually this SHAPE?

EXTRAcellular BACTERIA, COCCI

COCCI = STAPH

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describe this organism is LOCATION

what shape?

INTRACELLULAR BACTERIA

RODS

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identify this organism (genus & species)

what “shape” does it resemble?

MALASSEZIA PACHYDERMATITIS

resembles PACKING PEANUTS

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what is this cell?

what does the protrusion mean?

cell = NUCLEATED KERATINOCYTE

protrusion is a BACTERIA FROM OROPHARYNGEAL REGION, so this is evidence that DOG HAS BEEN LICKING SKIN

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what are the 2 steps of microscopic evaluation for SKIN CYTOLOGY? **list 2 diseases per magnification

start with 10X magnification to identify TYPES of cells present…
–> NEOPLASTIC = HOMOGENOUS
–> INFLAMMATORY = HETEROGENOUS
go to OIL IMMERSION at 100X to identify ORGANISMS
–> BACTERIA = RODS, COCCI
–> YEAST = MALASSEZIA

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3 indications for TAPE cytology?

DRY lesions
DIFFICULT sample sites like SKIN FOLDS or INTERDIGITAL spaces
MALASSEZIA

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ear cytology…
when should we perform it?
where do we get the sample from? (2)
how to prepare the slide after getting the sample? (2)
how do we evaluate under a microscope & what 3 things are we looking for? (2)

when should we perform it?
FOR EVERY CASE OF OTITIS

where do we get the sample from?
1. JUNCTION between HORIZONTAL & VERTICAL ear canal
2. FROM BOTH EARS regardless of clinical signs

how to prepare slide?
1. ROLL IT ONTO A SLIDE, usually towards the LEFT/FROSTED EDGE
2. HEAT-FIX & STAIN with DiffQuik

microscope evaluation?
1. start at LOW magnification 4-10X and look for “BUSY” region
2. once we get to busy region, move to OIL IMMERSION 100X and look for COCCI, RODS, YEAST

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for ALL SKIN cytologies, examine at HIGH ____ and HIG
H ___

MAGNIFICATION, ILLUMINATION

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skin scraping…
how often do we do it?
what clinical signs indicate it? (5)
what 2 organisms do we look for?
what 4 pieces of equipment do we need?

done for MAJORITY of skin cases

clinical signs?
1. alopecia
2. comedones
3. pustules
4. papules
5. folliculitis (DEMODEX MITES)

2 organisms?
1. DEMODEX mites (deep)
2. SARCOPTES mites (superficial, scabies)

4 pieces of equipment?
1. scalpel blade
2. mineral oil
3. cover slip
4. slides

DEEP (4) vs. SUPERFICIAL skin scraping procedure & what it looks for

DEEP skin scraping
1. PINCH skin
2. scrape until CAPILLARY BLEEDING
3. put material onto slide with MINERAL OIL & COVER SLIP
4. examine under 10X objective with DIM DIFFUSE ILLUMINATION
**LOOK FOR DEMODEX

SUPERFICIAL skin scraping
1. scrape skin with LIGHT, BROAD STROKES
2. take 3-4 sites that should be REPRESENTATIVE & any NEW LESIONS
3. put onto slide with mineral oil & COVER SLIP
4. examine under 10X objective in DIFFUSE DIM ILLUMINATION
**LOOK FOR SCABIES

identify this organism

DEMODEX MITE

identify this organism

SARCOPTES MITE (scabies)

identify this disease

SARCOPTES MITE INFESTATION (scabies)

which organism CANNOT be found in DEEP skin scrapings? what organism is it found in?

DEMODEX GATOI

found in CATS

does a NEGATIVE skin scraping mean that there’s no mites present?

NO, just means none were found, MAY NEED A TREATMENT TRIAL

identify this organism

what “shape” does it usually resemble?

EAR MITES

“coffee grounds”

ear mite preparation for DIRECT MICROSCOPY? (3)

1. collect CERUMEN with a COTTON-TIPPED APPLICATOR or CURETTE 2. mix with MINERAL OIL 3. coverslip & examine at low magnification & DIM illumination

5 indications for TRICHOGRAM? why do a trichogram for a pruritic cat? 3 steps including the 3 regions of hair we need to evaluate

indications? 1. pruritis 2. alopecia 3. parasites 4. dermatophytosis 5. hair follicle diseases for CATS, can EASILY HIDE PRURITUS, so if we see BROKEN HAIRS = NOT SCRATCHING 3 steps? 1. PLUCK hairs with FORCEPS PERIPHERAL to the lesion 2. place in MINERAL OIL on SLIDE 3. examine HAIR SHAFT, HAIR BULB & DISTAL END of hair

identify

DERMATOPHYTOSIS (fungus)

identify

MELANIN CLUMPING so PIGMENT NOT EVENLY DISTRIBUTED THROUGH HAIR SHAFT

identify

LOUSE EGGS

identify & what type of organism

CHEYLETIELLA egg, BIG MITE

identify

CHEYLETIELLA

flea combing... what 2 clinical signs indicate it? what are we looking for? if we find it, what should we do? if there are SCALES, what do we do & what are we looking for?

2 clinical signs? 1. ALOPECIA 2. PRURITUS what are we looking for? FLEA DIRT/FECES, looks like dark pepper if we find it, what do we do? PLACE MATERIAL ON WET PAPER TOWEL & IF IT TURNS RED, THEN IT'S FLEA FECES if there are SCALES... 1. scrape up scale and PLACE ONTO SLIDE WITH MINERAL OIL 2. look for CHEYLETIELLA

identify condition

FLEA INFESTATION

wood's lamp examination... 2 indications? for what organism? procedure? (2) what SPECIFICALLY is being illuminated?

FOR DERMATOPHYTOSIS 2 indications? 1. alopecia 2. suspect dermatophytosis procedure? 1. hold wood's lamp 2-4 cm away from skin surface in DARK ROOM 2. look for APPLE-GREEN FLUORESCENCE under UV LIGHT TRYPTOPHAN METABOLITE of DERMATOPHYTE WILL FLUORESCE in UV LIGHT

fungal culture... what does it aim to do? indications? (2, one particularly in cats) procedure? (5, including how we collect sample)

aims to CONFIRM FUNGAL INFECTION indications? 1. alopecia 2. FOLLICULITIS (cats) procedure? 1. collect HAIR/SCALE from LESION or HAIR THAT FLUORESCES under Wood’s Lamp --> can collect via MACKENZIE TOOTHBRUSH METHOD 2. then, EMBED TOOTHBRUSH GENTLY IN CULTURE MEDIUM 3. incubate for 3-4 weeks IN DARK, HUMID ROOM at ROOM TEMP 4. CHECK DAILY for WHITE, FLUFFY SPORES 5. use ACETATE TAPE to PLACE ON SLIDE & EXAMINE

identify organism & technique

FUNGAL CULTURE MICROSPORUM CANIS

identify organism

MICROSPORUM CANIS (fungus)

label & WHAT DISEASE ARE THESE LESIONS FROM

BACTERIAL FOLLICULITIS

indications for BACTERIAL CULTURE & SENSITIVITY? (5)

MANY!!! 1. history of DRUG-RESISTANT infections 2. DEEP pyoderma 3. RECURRENT or RELAPSING pyoderma 4. empiric antibiotic FAILURE 5. suspected UNCOMMON or ATYPICAL bacterial infection

biopsy & histopathology 3 indications? **which of the 2 is done more commonly?

**SKIN BIOPSIES DONE COMMONLY 1. Suspected NEOPLASIA, AUTOIMMUNE or METABOLIC Dz --> Want to ensure that we’re not missing a disease that mimics allergies 2. Condition that requires EXPENSIVE, EXTENSIVE, OR HAZARDOUS TREATMENT 3. Failure to respond to appropriate therapy

skin biopsy... 4 goals? 3 methods of restraint? 2 steps of SITE PREPARATION (& what NOT to do)? how many lesions to sample?

4 goals? 1. establish DEFINITIVE diagnosis 2. rule out OTHER DISEASES 3. determine PROGNOSIS 4. PRIORITIZE DDxs restraint? 1. LOCAL anesthesia like LIDOCAINE and MINOR PHYSICAL restraint, can use EPINEPHRINE/LIDOCAINE for HEMOSTASIS 2. SEDATION if necessary 3. GENERAL ANESTHESIA for DIFFICULT SITES --> nasal planum, footpads, claws, periocular skin, pinnae site PREPARATION? 1. CLIP HAIR CAREFULLY but DO NOT SCRUB (not a sterile procedure) 2. make sure to MARK SITES prior to LIDOCAINE ADMINISTRATION bc it'll make lesions VANISH sample 3-4 lesions

punch biopsy 3 steps

1. Rotate gently in ONE DIRECTION and APPLY GENTLE PRESSURE until BLADE ENTERS SQ TISSUE 2. Then, GENTLY GRASP PEDICLE OF UNDERLYING SQ fat and GENTLY CUT WITH IRIS SCISSORS (DO NOT CRUSH) 3. finally, FIX SAMPLE IN FORMALIN