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Derm Fundamentals Flashcards

1
Q

What does skin do

A

1) Barrier- keeps moisture, protein, and electrolytes in
2) Keeps microbes and allergens out
3) Largest organ in body
4) Innate and adaptive immunity

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2
Q

what is the vascular portion of the skin

A

the dermis

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3
Q

Why is dermatology really important

A

9 in cats - atopic dermatitis

Top 4 reasons (dogs)
1) Atopic dermatitis
2) Ear infections
3) Benign skin neoplasia
4) Pyoderma
10) Anal gland sacculitis/expression

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4
Q

You should never say that something smells

A

yeasty

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5
Q

What is important to distinguish when getting the history

A

1) Need chronological order
2) Which came first, lesions, or itch
3) Disease progression
4) Prior treatments, efficacy
5) Seasonality

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6
Q

What might be affecting younger patients

A

think things that would affect an immature immune system
-Infection- impetigo (superficial non-follicular bacterial infection)
-Ectoparasitism- Demodex, ear mites, fleas, scabies
-Congenital/genetic- ichyhyosis (goldens), dermatomyositis (collies)
-Food allergy

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7
Q

What breed commonly gets ichthyosis

A

goldens

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8
Q

What breeds commonly get dermatomyositis

A

collies

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9
Q

What dermatological issues do you think of with older patients

A

1) Endocrinopathy (Cushings)
2) Neoplasia (epitheliotropic lymhoma)
3) Organ failure (superficial necrolytic dermatitis)

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10
Q

What is it called when a puppy develops a superficial non-follicular pyoderma

A

Impetigo

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11
Q

What kind of dermatologic conditions should you consider for middle aged dogs

A

anything

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12
Q

condition where liver failure can lead to dermatological conditions

A

Superficial necrolytic dermatitis

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13
Q

What breeds are predisposed to sebaceous adenitis

A

Poodles and Akitas

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14
Q

How can sex influence your work up of dermatological diseases

A

intact male? possible sertoli cell tumor leading to sex hormone dermatoses

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15
Q

What behaviors indicate pruritus

A

scratching
licking
chewing
biting
rubbing

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16
Q

If the prurutus is primary on the caudal dorsum, what does this make you think

A

flea bite hypersensitivity

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17
Q

If the pruritus is primarily across the entire body and trunk you think

A

lice/cheyletiella

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18
Q

If the pruritus is on the ventrum, paws, mouth, and eyes you think

A

allergic dermatitis (environmental/food)

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19
Q

Types of primary dermatololgic lesion

A

Papula
Nodule
Pustule
Bulla
Vesicle
Comedone
Macules
Plaque
Nodule

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20
Q

Are primary or secondary lesions more diagnostic

A

primary- they come first

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21
Q

What are examples of secondary lesions

A

Alopecia
Crust
Collarette
Lichenification
Seborrhea
Excoriation
Erosion
Ulcer
Fissure
Hyperpigmentation
Leukotrichia

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22
Q

thinning of the hair

A

hypotrichosis

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23
Q

complete hair loss

A

alopecia

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24
Q

What are words to describe lesion configuration

A

1) Linear
2) Reticular (net-like)
3) Punctate
4) Patchy
5) Well-circumscribed
6) Diffuse

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25
Words to describe color and texture of lesions
soft purulent fluctuant exudative erythematous dry moist
26
net-like lesion configuration
Reticular
27
reddening of the skin
erythematous
28
Macules are ________ Patches are ________
Macules <1cm Patches >1cm
29
flat area of different color < 1cm > -erythema -hyperpigmentation -purpura (dermal bleeding) -petechiation (dermal bleeding, punctate macules) -Ecchymoses (dermal bleeding, patch)
Macule/Patch
30
Erythema is most likely due to
vasodilation (inflammation) or hemorrhage
31
Hyperpigmentation is most likely due to
inflammation (post-inflammatory)
32
Why is it important to do diascopy
press on the lesion with a slide to see if it blances Vasodilation if it blanches bc youre squishing vessels Hemorrhage if it stays (vasculitis?)
33
Dome-shaped solid raised area often confused for hives/urticaria <1cm
Papule (hives are transient but papules stay forever)
34
What should you do for pustules
Cytology! -often suggestive of follicular disease but not always -pyoderma (infection)
35
Pustules are often suggestive of
-often suggestive of follicular disease but not always -pyoderma (infection)
36
Papules are _______ Nodules are ______
both are raised solid dome shaped structures Papules <1cm Nodule >1cm
37
dome shaped solid raised area often dermal/SQ >1cm ulceration and drainage occur in many causes
Nodule
38
a raised but flat on top nodule solid
plaque
39
Vesicles are ________ while bulla is ______
Vesicles <1cm Bulla >1cm
40
Vesicles and bulla are usually
immune mediated
41
epidermal collarette usually starts as a
papule/pustule and then extends outward
42
What typically causes epidermal collarettes
Infectious -Bacteria -Dematophyte -Demodex
43
annular crust erythema hyperpigmentation well circumscribed starts as a papule/pustule and extends outward
Epidermal collarette
44
What is another term for hives / wheals
urticaria
45
well circumscribed edema raised area type I hypersensitivity confused for collarettes but no crust
Wheal / Urtucaria / Hive
46
What causes wheal / urticaria
type I hypersensitivity horses: exercise and stress people: cold temps
47
How do you distinguish wheals from collarettes
no crust with wheals wheals go away quickly
48
partial alopecia can be traumatic (fractured hairs) or true absence of the hair shaft)
hypotrichosis
49
Anytime we have hair loss, what should we ask
Is it falling out or being removed (pruritus) ? Is it growing back (endocrine)?
50
seborrhea sicca
dry form of scale "dandriff" exfoliation problem epidermis- stratum corneum
51
seborrhea oleosa
greasy form of scale exfoliation problem epidermis- stratum corneum
52
What often causes scales (seborrhea sicca and oleosa)
allergy steroids infection
53
What is follicular casting
severe seborrhea sicca "cast" = shape of follicle typically associated with sebaceous adenitis (immune)
54
What is follicular casting typically associated with
sebaceous adenitis (immune)
55
thickened stratum corneum scale that is not exfoliated
hyperkeratosis
56
What are the two types of hyperkeratosis that is only distinguishable on histopathology
Thickened straum corneum 1) Orthokeratotic = non-nucleated 2) Parakeratotic = nucleated
57
hyperkeratosis where the stratum corneum is non-nucleated
orthokeratotic
58
hyperkeratosis where the stratum corneum is nucleated
parakeratotic
59
follicles that become plugged up with sebum "blackheads" caused by demodex, acne, endocrinopathy
Comedones
60
With comedones, the follicles become plugged up with
Sebum
61
What causes Comedones
1) Demodex 2) Acne 3) Endocrinopathy (ie hyperadrenocorticism)
62
a reaction pattern that is typically chronic inflammation and macroscopic thickened, wrinkly, elephant skin, often hyperpigmented
lichenification
63
What causes lichenification
Chronic inflammation- reaction -allergic dermatitis -hypothyroidism -Malassezia (yeast) dermatitis
64
a dry exudate that is secondary to erosion / ulceration -Hemorrhagic -Purulent -Serous *Not scabs*
Crust
65
How do scabs differ from crusts
Crusts are a dried exudate (blood, pus, serum) while scabs are fibrin deposit for body and solving a problem
66
Whats the difference of erosion to ulcer
Erosion- partial absence of epidermis Ulcer- complete absence of epidermis
67
partial absence of the epidermis due to: trauma, deep pyoderma, immune-mediated disease
Erosion
68
complete absence of epidermis due to: trauma, deep pyoderma, immune-mediated disease
ulcer
69
linear ulceration
fissure
70
What might cause pigmentation issues of skin
reaction pattern (chronic) -Immune Mediated disease (hypo) -Allergic dermatitis -Mucocutaneous pyoderma -Vitiligo -Hypothyroidism
71
What should jump to your mind when you see complete loss of pigmentation
1) Immune mediated disease -Discoud lupus, vitiligo 2) Neoplasia - epithelial trochlear lymphoma
72
If you have a patient that is really itchy, what should you consider
Sarcoptes scabei
73
How do you search for fleas
Flea comb - to look for fleas or flea dirt use a wet q-tip to moisten the dirt with water or alcohol to show the owner that it is blood and debris harder on cats because they groom regularly
74
What other ectoparasite can you use a comb to detect
Cheyletiella - then look undermicroscope
75
T/F: sarcoptes scabei is zoonotic
true
76
what might increase your chance of finding mites
sample from locations where the animal cant groom very well ie behind pinna
77
mite that commonly affects the ears of camels and sheep
Psoroptes ovis
78
What mites are detectable with superficial skin scapes
-Sarcoptes scabei -Psoroptes ovis -Cheyletiella
79
when doing a superficial skin scrape, why should you not get blood
because mites living in stratum corneum and sometimes in the superficial epidermis
80
What do you need for skin scrapings
-Blade or spatula -Mineral oil -Slide and coverslip 1) Trim long hair w scissors - keep crusts 2) Mineral oil on blade to help collect debris 3) sweep the blade- superficially like butter bread 4) Smear on the slide
81
What species of mite can you do tape prep on
Cheyletiella
82
Where do demodex species like to live
deep in the hair follicle and sebaceous glands
83
For Demodex spp you do deep skin scraping except ofr
Feline Demodex - lives on the superficial skin and causes pruritus in cats - do superficial skin scrapes
84
How do you know when youve achieved a deep skin scrape
there is a little bit of capillary bleeding indirection of hair growth
85
What direction to do stroke when doing a deep skin scrape
in the direction of the hair growth
86
What can you do in hard to scrape areas for Demodex
hair plug- paws or around eye but keep in might it is not as sensitive as DSS
87
Is hair pluck or deep skin scrape more sensitive for demodex
Deep skin scrape
88
How do you analyze a deep skin scrape on the miscropscope
View at 5x or 10x objective - lower condenser Demodex- record location scraped, # adults, eggs, juveniles
89
you should heat fix when the lesion is
waxy
90
acetate tape cytology is important for
rapid assessment malassezia, cocci, rods feet, periocular areas lots of debris but it is an acquired skill
91
T/F: you cant stain acetate tape cytology
False
92
What are microscope tips for cytology
1) raise condenser 2) Start out on 5x then 10x 3) Look for clumps of blue and purple 4) then use immersion oil and 100x for identification and quant
93
What are methods to diagnose dermatophytosis
1) Wood's lamp: 40% of M. canis 2) Trichogram 3) Dermatophyte PCR fungal culture* is gold standard
94
With dermatophytosis, what would you see on a trichogram
a hair with no definition between cortex and medulla spores adhered to hairshaft
95
When doing a Wood's lamp for dermatophytosis dx, what do you need to consider
the actual hair shaft is fluorescing crusts, medications, debris will all fluoresce
96
How do you collect a sample for dermatophytosis fungal culture
1) Wipe hair with alcohol to discourage saphrophytes 2) Pluck from periphery because that is where the active dermatophytes
97
What does dermatophyte growth look like when culturing
colonies should be white and fluffy (M. canis) media turns red when dermatophyte growth go further to find he species - color change with beige/white growth
98
How do you identify dermatophyte down to species level
slide with lactophenate cotton blue see dermatophyte macroconidia
99
You will only see dermatophyte macroconidia when
you take a sample from the culture plate It is not a phase that grows on the patient
100
How do you prepare for skin biopsy
1) Local anesthesia: lidocaine/ bupivacaine SQ application (0.5-1ml/site) +/- deep sedation or anesthesia for feet and face Do NOT surgically prep/scrub the area
101
What are typical biopsy punch sizes used
8mm or 6mm small-4mm for planum nasale
102
When doing punch biopsies why should you only twist in one direction
can create a shear artifact which can give separation of dermis from epidermis
103
You should never biopsy
Ulcers- you need intact epidermis to diagnose disease processes
104
How many punch biopsies should you take
At least 3 that are representative- may be many types get as big and as many as you can
105
Should you do junctional biopsies
avoid if possible - you want to take all abnormal site exception: widestream ulcer, not much healthy tissue to sample
106
How do you show the pathologies the direction of hair growth
grow a line in the direction of the hairgrowth this allows pathologist to know how to cut the tissue so they do not get cross sections
107

Dermatology (10 decks)

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