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Dermatology > Derm Fundamentals > Flashcards

Derm Fundamentals Flashcards

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Dermatology Board Prep 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
Q

Words to describe color and texture of lesions

A

soft
purulent
fluctuant
exudative
erythematous
dry
moist

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26
Q

net-like lesion configuration

A

Reticular

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27
Q

reddening of the skin

A

erythematous

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28
Q

Macules are ________
Patches are ________

A

Macules <1cm
Patches >1cm

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29
Q

flat area of different color < 1cm >
-erythema
-hyperpigmentation
-purpura (dermal bleeding)
-petechiation (dermal bleeding, punctate macules)
-Ecchymoses (dermal bleeding, patch)

A

Macule/Patch

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30
Q

Erythema is most likely due to

A

vasodilation (inflammation) or hemorrhage

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31
Q

Hyperpigmentation is most likely due to

A

inflammation (post-inflammatory)

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32
Q

Why is it important to do diascopy

A

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?)

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33
Q

Dome-shaped
solid
raised area
often confused for hives/urticaria
<1cm

A

Papule

(hives are transient but papules stay forever)

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34
Q

What should you do for pustules

A

Cytology!
-often suggestive of follicular disease but not always -pyoderma (infection)

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35
Q

Pustules are often suggestive of

A

-often suggestive of follicular disease but not always -pyoderma (infection)

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36
Q

Papules are _______
Nodules are ______

A

both are raised solid dome shaped structures

Papules <1cm
Nodule >1cm

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37
Q

dome shaped
solid
raised area
often dermal/SQ
>1cm
ulceration and drainage occur in many causes

A

Nodule

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38
Q

a raised but flat on top nodule
solid

A

plaque

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39
Q

Vesicles are ________ while bulla is ______

A

Vesicles <1cm
Bulla >1cm

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40
Q

Vesicles and bulla are usually

A

immune mediated

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41
Q

epidermal collarette usually starts as a

A

papule/pustule and then extends outward

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42
Q

What typically causes epidermal collarettes

A

Infectious
-Bacteria
-Dematophyte
-Demodex

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43
Q

annular
crust
erythema
hyperpigmentation
well circumscribed
starts as a papule/pustule and extends outward

A

Epidermal collarette

44
Q

What is another term for hives / wheals

A

urticaria

45
Q

well circumscribed edema
raised area
type I hypersensitivity
confused for collarettes but no crust

A

Wheal / Urtucaria / Hive

46
Q

What causes wheal / urticaria

A

type I hypersensitivity

horses: exercise and stress

people: cold temps

47
Q

How do you distinguish wheals from collarettes

A

no crust with wheals

wheals go away quickly

48
Q

partial alopecia
can be traumatic (fractured hairs) or true absence of the hair shaft)

A

hypotrichosis

49
Q

Anytime we have hair loss, what should we ask

A

Is it falling out or being removed (pruritus) ?

Is it growing back (endocrine)?

50
Q

seborrhea sicca

A

dry form of scale “dandriff”
exfoliation problem
epidermis- stratum corneum

51
Q

seborrhea oleosa

A

greasy form of scale
exfoliation problem
epidermis- stratum corneum

52
Q

What often causes scales (seborrhea sicca and oleosa)

A

allergy
steroids
infection

53
Q

What is follicular casting

A

severe seborrhea sicca
“cast” = shape of follicle
typically associated with sebaceous adenitis (immune)

54
Q

What is follicular casting typically associated with

A

sebaceous adenitis (immune)

55
Q

thickened stratum corneum
scale that is not exfoliated

A

hyperkeratosis

56
Q

What are the two types of hyperkeratosis that is only distinguishable on histopathology

A

Thickened straum corneum
1) Orthokeratotic = non-nucleated
2) Parakeratotic = nucleated

57
Q

hyperkeratosis where the stratum corneum is non-nucleated

A

orthokeratotic

58
Q

hyperkeratosis where the stratum corneum is nucleated

A

parakeratotic

59
Q

follicles that become plugged up with sebum
“blackheads”

caused by demodex, acne, endocrinopathy

A

Comedones

60
Q

With comedones, the follicles become plugged up with

A

Sebum

61
Q

What causes Comedones

A

1) Demodex
2) Acne
3) Endocrinopathy (ie hyperadrenocorticism)

62
Q

a reaction pattern that is typically chronic inflammation and macroscopic
thickened, wrinkly, elephant skin,
often hyperpigmented

A

lichenification

63
Q

What causes lichenification

A

Chronic inflammation- reaction
-allergic dermatitis
-hypothyroidism
-Malassezia (yeast) dermatitis

64
Q

a dry exudate that is secondary to erosion / ulceration
-Hemorrhagic
-Purulent
-Serous
Not scabs

A

Crust

65
Q

How do scabs differ from crusts

A

Crusts are a dried exudate (blood, pus, serum) while scabs are fibrin deposit for body and solving a problem

66
Q

Whats the difference of erosion to ulcer

A

Erosion- partial absence of epidermis

Ulcer- complete absence of epidermis

67
Q

partial absence of the epidermis
due to: trauma, deep pyoderma, immune-mediated disease

A

Erosion

68
Q

complete absence of epidermis
due to: trauma, deep pyoderma, immune-mediated disease

A

ulcer

69
Q

linear ulceration

A

fissure

70
Q

What might cause pigmentation issues of skin

A

reaction pattern (chronic)
-Immune Mediated disease (hypo)
-Allergic dermatitis
-Mucocutaneous pyoderma
-Vitiligo
-Hypothyroidism

71
Q

What should jump to your mind when you see complete loss of pigmentation

A

1) Immune mediated disease -Discoud lupus, vitiligo
2) Neoplasia - epithelial trochlear lymphoma

72
Q

If you have a patient that is really itchy, what should you consider

A

Sarcoptes scabei

73
Q

How do you search for fleas

A

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
Q

What other ectoparasite can you use a comb to detect

A

Cheyletiella - then look undermicroscope

75
Q

T/F: sarcoptes scabei is zoonotic

A

true

76
Q

what might increase your chance of finding mites

A

sample from locations where the animal cant groom very well
ie behind pinna

77
Q

mite that commonly affects the ears of camels and sheep

A

Psoroptes ovis

78
Q

What mites are detectable with superficial skin scapes

A

-Sarcoptes scabei
-Psoroptes ovis
-Cheyletiella

79
Q

when doing a superficial skin scrape, why should you not get blood

A

because mites living in stratum corneum and sometimes in the superficial epidermis

80
Q

What do you need for skin scrapings

A

-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
Q

What species of mite can you do tape prep on

A

Cheyletiella

82
Q

Where do demodex species like to live

A

deep in the hair follicle and sebaceous glands

83
Q

For Demodex spp you do deep skin scraping except ofr

A

Feline Demodex - lives on the superficial skin and causes pruritus in cats - do superficial skin scrapes

84
Q

How do you know when youve achieved a deep skin scrape

A

there is a little bit of capillary bleeding
indirection of hair growth

85
Q

What direction to do stroke when doing a deep skin scrape

A

in the direction of the hair growth

86
Q

What can you do in hard to scrape areas for Demodex

A

hair plug- paws or around eye

but keep in might it is not as sensitive as DSS

87
Q

Is hair pluck or deep skin scrape more sensitive for demodex

A

Deep skin scrape

88
Q

How do you analyze a deep skin scrape on the miscropscope

A

View at 5x or 10x objective - lower condenser

Demodex- record location scraped, # adults, eggs, juveniles

89
Q

you should heat fix when the lesion is

A

waxy

90
Q

acetate tape cytology is important for

A

rapid assessment malassezia, cocci, rods

feet, periocular areas

lots of debris but it is an acquired skill

91
Q

T/F: you cant stain acetate tape cytology

A

False

92
Q

What are microscope tips for cytology

A

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
Q

What are methods to diagnose dermatophytosis

A

1) Wood’s lamp: 40% of M. canis
2) Trichogram
3) Dermatophyte PCR

fungal culture* is gold standard

94
Q

With dermatophytosis, what would you see on a trichogram

A

a hair with no definition between cortex and medulla
spores adhered to hairshaft

95
Q

When doing a Wood’s lamp for dermatophytosis dx, what do you need to consider

A

the actual hair shaft is fluorescing

crusts, medications, debris will all fluoresce

96
Q

How do you collect a sample for dermatophytosis fungal culture

A

1) Wipe hair with alcohol to discourage saphrophytes
2) Pluck from periphery because that is where the active dermatophytes

97
Q

What does dermatophyte growth look like when culturing

A

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
Q

How do you identify dermatophyte down to species level

A

slide with lactophenate cotton blue
see dermatophyte macroconidia

99
Q

You will only see dermatophyte macroconidia when

A

you take a sample from the culture plate

It is not a phase that grows on the patient

100
Q

How do you prepare for skin biopsy

A

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
Q

What are typical biopsy punch sizes used

A

8mm or 6mm

small-4mm for planum nasale

102
Q

When doing punch biopsies why should you only twist in one direction

A

can create a shear artifact which can give separation of dermis from epidermis

103
Q

You should never biopsy

A

Ulcers- you need intact epidermis to diagnose disease processes

104
Q

How many punch biopsies should you take

A

At least 3 that are representative- may be many types
get as big and as many as you can

105
Q

Should you do junctional biopsies

A

avoid if possible - you want to take all abnormal site

exception: widestream ulcer, not much healthy tissue to sample

106
Q

How do you show the pathologies the direction of hair growth

A

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
Q
A

Dermatology (10 decks)

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