Derm 2: Food allergies, ectoparasites, otitis, cats (E2) Flashcards

1
Q

What organisms cause dermatophytosis? What becomes infected and how is it transmitted?

A

Microsporum canis

  • M. gypseum*
  • Trichophyton metagraphytes*

Fungal infection of: Ketatinized tissues, claws, hair, stratum corneum

Transmission: Direct contact

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2
Q

T/F: Food allergic dermatitis is a cutaneous adverse food reaction whose pathogenesis is idential to atopy.

A

True

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3
Q

What 3 drugs do poloxamer otic gels contain?

A

Florfenicol

Terbinafine

Betamethasone acetate

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4
Q

Where do you often see symmetrical alopecia in cats with atopic dermatitis? Food allergic dermatitis? Scabies?

A

Atopic: Medial thighs, ventrum, forelimbs, flanks

Food: face, head

Scabies: pinna, face, neck, forelimbs, progressing to whole body

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5
Q

What etiology does coffee ground-looking ear discharge indicate? What if it is moist and brown? Creamy yellow? Oily yellow-tan?

How can you determine the cause definitively?

A

Coffe grounds: mites

Moist, brown: staph or yeast

Creamy yellow: Gram - bacteria

Oily yellow-tan: glandular disorder or HS

Cytology

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6
Q

What dermatologic presentations are associated with pruritus in cats? What are 2 common causes?

A

Bilateral symmetrical hair loss with normal (non-inflamed) skin

Miliary dermatitis

Eosinophilic granuloma complex

Causes: Fleas, Ringworm

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7
Q

Which 2 tests can you do to diagnose sarcoptes? Which one is better?

A

Fecal floatation (better)

Superficial skin scrape x 6 (extremely difficult to find mite)

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8
Q

What is the first line topical antibiotic choice for otitis externa? Why is it a problem when there is purulent exudate?

A

Neomycin-Polymixin (Surolan)

Polymixin doesn’t work in pus

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9
Q

What are the infectious causes of Feline Leprosy?

A

Nocardia

Actinomyces

Mycobacterium

Dermatomycoses

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10
Q

What specific diets is based on the theory that if particles are really small they cannot bind to the respective IgE particle on mast cells, preventing degranulation (i.e. allergic reaction)?

A

Hydrolyzed protein diets

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11
Q

How long do you treat superficial pyoderma? Deep pyoderma?

A

Superficial: 3-4 weeks minimum, 1 week post-resolution

Deep: 3-12 weeks, 2 weeks post-resolution

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12
Q

T/F: Ear cultures are indicated for all cases of acute otitis externa.

A

False, not usually if acute

Culture (and sensitivity) may be indicated in chronic recurrent or unresponsive cases

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13
Q

What are some common antibiotics used to treat deep pyoderma? Include any important side effects.

A

Amoxycillin-clavulanic acid (Bactericidal aminopenicillin with beta-lactamase inhibitor (clav) that expands its spectrum)

Cephalexin

Trimethoprim-sulphurs Side effects: Liver and renal damage (C/O’d if have issues with liver or kidneys), careful in Dobermans (immune disease), can crysallize urine, irreversible keratoconjunctivitis sicca, can cause hypothyroidsm in dogs (longterm use)

Enrofloxacin Side effects: GI distress; Cats- blindness

Erythromycin/Clindamycin/Lincomycin (Macrolides) Side effects: Careful in dogs w/MDR-1

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14
Q

Sort the following as either against generalized severe greasy seborrhea or dry-moderately greasy sebohhea.

KetoChlor (2% ketoconazole + 2% chlorhex)

Selenium sulfide (1%)

Miconazole (1-2%)

Head and Shoulders Instensive

Selsun Blue

Chlorhexidine (1-2%)

A

Greasy:

Head and Shoulders Instensive

Selsun Blue

1% Selenium sulfide

Dry:

KetoChlor (2% ketoconazole + 2% chlorhex)

Miconazole (1-2%)

Chlorhexidine (1-2%)

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15
Q

What are the 3 most common causes of folliculitis in dogs?

A

Bacterial

Dermatophytes

Demodex

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16
Q

What bacterium is involved in the pathogenesis of superficial pyoderma? Where does the bacteria colonize? What is the most common clinical sign?

A

Staphylococcus pseudintermedius

Superficial hair follicle

Alopecia (patchy, focal)

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17
Q

Which ectoparasite causes parasitic folliciculitis in dogs?

A

Demodex canis

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18
Q

What species of Malassezia causes dermatitis in dogs? Cats?

A

Dogs: M. pachydermatis

Cats: M. sympodialis, M. globosa

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19
Q

What is the best thing to culture in pyoderma?

A

Pustules

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20
Q

What combination of starch and protein appears to be the least allergenic?

A

Brown rice

Tofu

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21
Q

For which type of pyoderma is cytology often critical?

A

Deep

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22
Q

What gram positive filamentous aerobe causes subcutaneous absesses and draining tracts as well as pyothorax?

A

Nocardia

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23
Q

What is the source of infeciton if a dog develops opportunistic mycobacteriosis? What are the clinical signs?

A

Soil and water (saprophytic mycobacterium)

CS: Slowly developing SQ nodules, non-healing abscesses, cellulitis, ulcers, fistulas, serosanguinous/purulent exudate, regional LN enlargement

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24
Q

T/F: Prophylactic use of topical pyoderma therapy, such as shampoos, is indicated for recurrent pyodermas and they have little to no side effects.

A

True

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25
Q

What are 3 active ingredients of antibacterial shampoos used to treat superficial pyoderma?

A

Chlorhexidine

Ethyl lactate

Benzoyl peroxide

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26
Q

Which 3 antibiotics are 1st tier empiric therapy for pyoderma? Which are used as a last resort?

A

1st Tier:

Cephalexin (1st gen cephalosporins)

Amoxi-Clav

Clindamycin

Last Resort:

Fluoroquinolones (enrofloxacin, marbofloxacin, ciprofloxacin, orbifloxacin)

3rd gen cephalosporins (cefodoxime, cefovecin (SQ inj q1-2wks))

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27
Q

What is the most common cause of miliary dermatitis in cats? What are some viral causes?

A

Flea allergic dermatitis

Herpes, FIV, FeLV

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28
Q

T/F: Bacteria or yeast are usually the primary cause of acute otitis externa.

A

False

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29
Q

Pancreatic neoplasia in cats can cause symmetrical alopecia. What body parts are commonly affected and how does the skin look?

A

Ventrum and legs

“Shiny” skin, hair epilates easily

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30
Q

What is the term for “skin fold pyoderma”? Where do clinical signs manifest in various breeds?

A

Intertrigo

Spaniels: Lip folds

Bulldogs: Facial folds, tail root folds, vulva folds

Spar Pei: Body folds

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31
Q

How is dermatophytosis diagnosed?

A

Wood’s lamp

Microscopy of hair pluck

Fungal culture (DTM w/phenols that change color at higher pH)

Biopsy (for kerion type disease)

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32
Q

Seeing what on cytology warrants a bacterial culture of pyoderma?

A

Intracellular rods

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33
Q

T/F: M. canis, in addition to causing dermatophytosis in dogs and cats, is also the most common fungal infection in humans.

A

True (it’s zoonotic)

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34
Q

What is the most important pathogen in deep pyoderma?

A

S. pseudintermedius

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35
Q

What is indicated by the “A”, the arrow heads and the arrows? What is your diagnosis?

A

A: Soft tissue density in right typanic bulla

Arrowheads: Thickened wall of right bulla

Arrows: Mineralized external ear canals

Dx: Bilateral otits externa + Right sided otitis media and bulla osteoitis

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36
Q

Why may systemic antibiocs be ineffective for deep pyoderma? If antibiotics are warrented, what 4 rules should be follwed (include what organism you would treat first if multiple are cultured) ?

A

The pathogens tend to produce B-lactamase

Poor drug bioavailibility to skin

Infection walled off by fibrotic tissue and exudate

Rules:

  1. Use B-lactamase resistant penicillins
  2. If multiple organisms are cultured - treat S. pseudintermedius first
  3. Dosage must be high enough, may exceed recommended dose
  4. Treatment is long
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37
Q

You perform a cytology for a skin rash and it reveals degenerative neutrophils, phagocytosed cocci, and a proteinaeous background. What type of pyoderma does this suggest?

A

Superficial

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38
Q

What are the 3 ways you can treat sarcoptes? Name one specific treatment for each category.

A

Topical dips: Anti-seborrheic shampoo followed by 2-3% lime sulfur, Amitraz

Topical spot-on treatment: Selamectin (Revolution), Moxidectin (Advantage multi), Fipronil

Systemic treatment: Milbemycin (Interceptor, Sentinel, Trifexis), Ivermectin

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39
Q

You want to examine a dog’s ears using an otoscope, however swelling makes it impossible to fully visalize anything. What do you do?

A

Send home anti-inflammatories q4-7 days then try again

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40
Q

T/F: Dermatophytosis must be treated wiht both topical and systemic therapy.

A

True

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41
Q

What are the differential diagnoses for dermatophytosis in dogs? What if the lesions are mostly/only on the face?

A

Bacterial folliculitis

Demodecosis

Facial: Pemphigus foliceous/erythematosus

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42
Q

What purpose does adjunctive therapy with Cimetidine and Levamizole have?

A

Immunomodulation

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43
Q

What is the most serious non-neoplasitc disease seen in small animal practice?

A

Generalised demodecosis

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44
Q

Where does malaseezia dermatitis commonly occur?

A

Ears and skin folds (lips, ventral neck, axila, interdigital, perianal)

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45
Q

Match the following to deep or superficial pyoderma:

Nasal folliculitits/furunculosis

Acute traumatic pyodermatitis (hot spot)

Puppy pyoderma (Impetigo)

Chin acne/pyoderma

Lick granuloma (acral lick dermatitis)

A

Superficial: Acute traumatic pyodermatitis (hot spot), Puppy pyoderma (Impetigo)

Deep: Chin acne/pyoderma, Lick granuloma (acral lick dermatitis)

Both/either: Nasal folliculitits/furunculosis

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46
Q

Which dog breeds are predisposed to malassezia dermatitis?

A

WHWT

Mini poodles

Bassset hounds

GSD

Cocker spaniels

English setters

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47
Q

What is Lynxacarus radovsky? Where is it prevalent? What is the classical appearance? How is it diagnosed?

A

Fur mites (CATS)

Found in: TX, FL, HA, Australia, Brazil

CS: Salt and pepper appearance of fur

Diagnosis: Acetate tape test

48
Q

Which breeds are predisposed to deep pyoderma? Where does it usually occur in these breeds?

A

GSD: rump and thoracic regions (also skin blackens and becomes thin)

Bull terriers: hocks, elbows, ventral abdomen, feet

49
Q

What is the most widely accepted treatment for generalised demodecosis?

A

Amitraz (q14 days)

50
Q

Where are lesions usually localized in cats with the atypical eosinophilic granuloma form of EGC? What do the lesions look like?

A

Skin over bridge of nose, ear pinna: Papular erosion, crusting and depigmentation

Paws: Hyperkeratosis or ulceration

51
Q

Sarcoptes have a predilication for ____ _____ areas of the body.

A

Sparsely haired

52
Q

Malassezia is frequently a secondary invader of skin and ears. What conditions is yeast commonly associated with (4 disorders)?

A

Allergic dermatitis (fleas, food, inhalant allergens)

Endocrinopathies

Keratinization disorders

Immunosuppression (chronic corticosteroids, neoplasia)

53
Q

How does dermatophytosis present in dogs? Cats?

Include desciption of alopecia, localization, and specific maladies. For cats include the breed susceptible to generalized infections

A

Both dogs and cats: Alopecia in face, ears and paws

Dogs- alopecia: peripherally expanding alopecia, crust, follicular papules and pustules

Whole body seborrhea, nodular kerion on nose and distal limbs (M. gypseum, T. mentagraphytes), onychomycosis (nail-bed infection)

Cats-alopecia: irregular or annular, +/- scale

Inflammation rare, can cause miliary dermatitis, eosinophilic plaque

Generalized infection- Persian cats

54
Q

What antiseptic can be used to treat otitis externa involving resistant pseudomonas (include concentration)

A

1% silversulfadiazine

(Mix 1.5mL cream with 13.5 ml distilled water, apply BID)

55
Q

What is the most commonly found bacterium found on a dog with superficial dermatitis?

A

Staphylococcus

56
Q

At least how many differrent antihistamines should be tried before you can claim a failure of response? Name a few.

A

2

Chlorphenamine

Diphenhydramine hydrochloride

Clemastine

Hydroxizine

Terfendine

57
Q

What causes walking dandruff? Is it zoonotic?

A

Cheyletiella mites

Yes

58
Q

Where are lesions for FAD usually located in dogs? Cats?

A

Dogs: Muzzle, ears, distal limbs, paws (interdigital), axillae, groin region

Cats: Head, face, pinnae, neck

59
Q

T/F: If a puppy is <6 months old, food allergies are more common that atopy.

A

True

60
Q

What is the main cause of otitis externa in dogs? Cats?

A

Dogs: allergies

Cats: otodectes

61
Q

What causes Chiggers? Where do they like to hang out? What do they look like?

A

Trombicula mites

Legs, head, abdomen (in cats inside ears)

Look like paprika (red mites)

62
Q

What houses the typmpanic cavity?

A

Tympanic bulla (bony)

63
Q

Clinical cure of generalized demodecosis precedes parasitological cure. How long must treatment be continued?

A

Until you a negative skin scrape result for 3 consecutive weeks

64
Q

How is actinomyces best diagnosed? What are the treatment options (include drugs)?

A

Dx: Anaerobic culture

Tx:

Best= Surgical debulking

Long-term antibiotics- Clindamycin, pen G, erythromucin, minocyline, amoxycillin

65
Q

What are the 2 most common causes of eosinophilic granuloma complex in cats? What are the 3 common and 1 uncommon presentations and which are pruritic?

A

Hypereosinophilic syndrome, Parasites

  1. Indolent ulcers
  2. Eosinophilic plaques: intensly pruritic
  3. Collagenolytic granuloma

Uncommon: Atypical eosinophilic granuloma

66
Q

What is the pathogenesis of feline acne and what are the clinical signs?

A

Idiopathic disorder of follicular keratinization

CS: Comodones on chin and lower lip, papules, pustules, furunculosis and scaring

67
Q

This is a hair sample from a dog with dermatophyosis. What has the fungus caused?

A

Cuticle degeneration

68
Q

What is the only way to diagnose food allergic dermatitis? What is the biggest limitation?

A

Positive response to an elimination diet

Limitation: Owner compliance

69
Q

Chronic inflammation caused by chronic otitis externa leads to ________ and _________. This causes increased _________ production which prediposes to secondary infections..

A

Hyperplasia

Hyperkeratosis

Cerumen

70
Q

What organism is responsible for sarcoptic mange?

A

Sarcoptes scabei var canis

71
Q

What can you use to clean a dog’s ears who has a lot of cerumin clogging the ear? What if there is pus?

What can be used after cleaning to dry the area? What if the tympanic membrane is ruptured?

A

Ceruminolytic: Docusate sodium (emulsift wax and lipids), Propylene glycol

Pus: Warm saline or water; flush with bulb syringe or 3-way stock cock system or automatic system; use curette-loop (less traumatic than swab)

Dry: isopropyl alcohol + acetic acid or salicylic acid or benzoic acid

Alcohol + 2-5% acetic acid if ruptured

72
Q

What site do you swab and how many swabs should you take to assess otitis externa? What type of sample do you take if you suspect otitis externa caused by mites? What if you’re looking at yeast, inflammatory cells or bacteria?

A

Site: Horizontal canal

2-3 swabs

Mites: swab to slide with mineral oil, low mag exam

Yeast, inflammatory cells, bacteria: roll sample from swab onto slide, heat fix, Wright’s stain

For keratinocytes and inflammatory cells: Scan at 100x

For bacteria and yeast: Scan at 1000x

73
Q

What does the topical therapy to treat dermatophytosis entail? (include length of treatment)

A

Clip around the lesion
Apply topical therapy (Niz shampoo- ketoconazole, creams with sustained/residual activity, spot treatments, rinses (enilconazole)
Continue until you get 2-3 negative (consecutive) weekly cultures

74
Q

A pruritic dog presents to you with black wax rancid-smelling coming from the ears as well as a red0brown discoloration of the hair around the ears. You also suspect this dog has hypothyroidism. What is probably causing the pruritus?

A

Malassezia

75
Q

Which topical cream is effective against gram positive bacteria? Which is effective against Pseudomonas?

A

Mupirocin

Silver sulfadiazine

76
Q

You are treating a dog with gram negative, gentamycin resistant otitis externa. What drugs can you use topically? To increase efficacy, what can you do?

A

Tiracillin

Amikacin

Enrofloxacin

To increase efficacy presoak with TRIS EDTA

77
Q

What is the most common predisposing cause for deep pyoderma? What secondary immunodeficiencies can predipose to this type of skin infection?

A

Allergies

Ehrlichia, Distemper (dogs), Retrovirus (cats)

78
Q

What do Horner’s sydnrome and facial paralysis in a patient with otitis externa indicate?

A

Concurrent otitis media

79
Q

You are cleaning the ears of a dog with otitis externa, however you cannot visualize the pars tensa. What should you avoid using? What can you use instead?

A

Avoid ceruminolytics, cleaning solutions and drying agents

Use normal saline

80
Q

Definciency of what interleukin is linked to generalized demodecosis?

A

IL-2

81
Q

Which 2 things normally prevent food allergens from passing through the intestinal wall?

A

Innate immune system

IgA antibodies lining the mucous layer

82
Q

TF: Feline pyoderma is rare.

A

True

83
Q

What type of hypersensitivity reaction occurs in contact dermatitis?

A

type 4

84
Q

T/F: Contact dermatitis and sarcopitc mange are usually poorly steroid responsive.

A

True

85
Q

What drugs are used in the systemic treatment of dermatophytosis? How long is the treatment course?

A

Griseofluvin
Ketoconazole
Intraconazole
Can be as long as 6-12 months.

86
Q

How is norcardia diagnosed (3 options)? What are the treatment options (include drugs)

A

Dx: FNA/cytology, Histopathology, Culture

Tx:

Best= Surgical debulking and drainage

Long-term antibiotics (TMS, ampicillin, erythromucin, minocyline)

87
Q

A cat comes to you because the owner has noted hair loss on the medial thighs, ventral abdomen and forelimbs. The cat is on a monthy parasiticide and the owner just had a baby. What is the most likely cause of the alopecia?

A

Psychogenic (Anxiety, self-induced)

88
Q

Otitis externa is rarely caused by one factor. What can contribute to this infection?

A

Predisposing factors: stenosis, hair in canals, pendulous pinnae, swimmers ear, overactive glands, polyps, neoplasms

Primary causes: parasites, microbes, atopy, food HS, drug rxns, contact HS, keratinization disorders, glandular disorders, autoimmune dz’s, solar dermatitis

Perpetuating causes: bacteria, yest, topical rxns, foreign bodies, epidermal hyperplasia, hyperkeratosis, dermal edema/fibrosis, lumen stenosis, cartilage mineralization, typanic membrane changes, middle ear disease

89
Q

What is the MOA for amitraz? If you use too much, what do you do?

A

A-adrenergic agonist, MAO inhibitor, and prostaglandin synthesis inhibitor

Give atipamazole or yohimbine to reverse

90
Q

You notice a well-circumscribed, proliferative inflammatory lesion with a dish-shaped central ulcer on the upper lip of a cat. It is not painful nor itchy. What are 2 possible causes?

A

EGC

Calicivirus

91
Q

Does every food antigen result in an acquired immune response? Why or why not?

A

No

T-cells need co-stimulatory factors for activation which do not get activated unless the allergen is a “threat”

92
Q

What bacterium causes Impetigo?

A

Staphylococcus

93
Q

What are the 3 forms of the Collagenolytic granuloma presentation of EGC in cats?

A

Linear

Pharyngeal

Chin

94
Q

What gram postivie anerobic bacterium causes infection following trauma/penetrating wounds which can create draining tracts that can take years to form? What are the clinical clinical signs?

A

Actinomyces

SQ abscesses, draining tracts, exudates (thick, yellow-gray, hemorrhagic, foul-smelling, +/- sulfur granules)

95
Q

T/F: Cats tend to have adverse food reactions against beef, dairy, wheat, chicken eggs, lamb and soy. Dogs tend to have adverse ractions to beef, dairy and fish.

A

False, opposite

Dogs: Beef, dairy, wheat, chicken eggs, lamb, soy

Cats: Beef, dairy, fish

96
Q

T?F: Generalized demodecosis is hereditary.

A

True (don’t breed)

97
Q

What type of surface pyoderma commonly affects the commisures of the lips?

A

Mucocutaneous pyoderma

98
Q

How do you diagnose hookworm dermatitis?

A

Fecal floatation

99
Q

Match a term under A with something from B:

A:

Food allergy/Hypersensititivity

Dietary Intolerance

Food anaphylaxis

B:

Systemic involvement

No immune respose

Immune response

A

Food allergy/HS: immune resposne

Dietary Intolerance: no immune response

Food anaphylaxis: systemic involvement

100
Q

What is “glue ear” and which breed is predisposed to it? How is it treated?

A

Primary secretory otitis media (PSOM)

CKCS (King Charles)

Tx: Myringotomy and middle ear flush

101
Q

Which presentation of EGC in cats is associated with allergies?

A

Eosinophilic plaque

102
Q

Malassezia can cause paronychia. What is this?

A

Soft tissue infection around the claw/nail (claw fold)

103
Q

How is feline acne treated? What about refractory cases?

A

Treat secondary infection (systemically or topically)

Clip and clean area with human acne preparation (Benzoyl peroxide)

Refractory: Vit A

104
Q

What is the best way to diagnose deep pyoderma?

A

Bacterial culture and antibiogram

(C&S)

105
Q

What are the 2 parts of the tympanic membrane? Bulging of which part indicated material in the tympanic bulla?

A

Pars flaccida

Pars tensa (if bulging=material in bulla)

106
Q

What are the 2 antigen types that most commonly cause food allergies? What is the most common specific antigen?

A

Proteins

Glycoproteins

Specifically: Beef protein

107
Q

What ectoparasites, aside from fleas, cause pruritus in cats?

A

Notoedris

Demodex gatoi

Fur mites

Cheyletiella

Ectopic ear mites

108
Q

The middle ear starts at the _____ _____ and consists of the _____ cavity, ____, auditory ______, and ______ tube.

A

Tympanic membrane

Tympanic

Bulla

Ossicles

Eustachian

The middle ear starts at the tympanic membrane, and consists of the tympanic cavity, bulla, auditory ossicles**, and **eustachian tube.

109
Q

T/F: A deep skin scape is used for demodex while a superficial skin scape is used for sarcoptes.

A

True

110
Q

T/F: If mites are detemrined to be the cause of otitis externa in a dog, all dogs and cats in the household need to be treated.

A

True

111
Q

Cell immunity is mediated through ___ lymphocyte activation.

Humoral immunity is mediated through ___ lymphocyte activation as well as _____ and _____.

A

Cell: T

Humoral: B, plasma cells, immunoglobulins

112
Q

What are the topical and systemic treatment options for malassezia? When would you use one over the other?

A

Topical:

Anti-yeast shampoo (ketoconazole, miconazole, selenium sulfide)

q2-3 weeks

Anti-yeast rise (enilconazole)

Systemic:

Keto or Intraconazole until clinical cure

Always use TOPICAL FIRST if possible, systemic if infecion is extensive and topical isn’t working.

There are side-effects that limit the use of -azole group drugs, these include anorexia, vomiting, diarrhea, and HEPATOTOXICITY.

113
Q

What is the pinnal pedal reflex and which cause of pruritis does a positive reflex suggest?

A

Touch ear = Shake leg

Sarcoptic mange

114
Q

Why is there usually an underlying disorder if a dog or cat comes down with deep pyoderma?

A

Healthy skin is resillient to infection

(Physical defense- compact stratum corneum, lipid emulsion and intracellular cement; Immune system, and microbial defense)

115
Q

How can you diagnose malassezia (include values)?

A

Cytology: skin scrape, scotch tape, cotton swab, direct impression

Must have >2 per HPF (1000x)

116
Q

Which topical product is used for pyoderma with dry seborrhea? Which would be used for pyoderma with oily seborrhea or comodones?

Include the strength/concentration

A

Chlorhexidine <0.5%

Benzoyl peroxide 1-5%