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SAM 2 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

what is a primary lesion?

A

the initial lesion is a direct reflection of the underlying disease, often appear and disappear quickly

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2
Q

what are some examples of primary lesions?

A

macule, papule, nodule, vesicle/bulla, pustule, wheals

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3
Q

what is a macule?

A

a flat spot, < 1 cm on skin with change in skin color

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4
Q

what is a patch?

A

a macule > 1 cm

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5
Q

what type of lesion is caused by underlying disease?

A

primary lesions

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6
Q

what is a papule?

A

small, SOLID elevation in skin < 1 cm in diameter

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7
Q

what is a pustule?

A

small elevation of epidermis filled with pus

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8
Q

what is a vesicle?

A

elevation of epidermis filled with clear fluid

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9
Q

what is a bulla?

A

a vesicle > 1 cm in diameter

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10
Q

what is a wheal?

A

a sharply delineated lesion of edema

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11
Q

what is a nodule?

A

solid raised palpable lesion > 1 cm

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12
Q

what is a secondary lesion?

A

evolves from primary lesion or induced by patient or external factors, usually stay around for a longer period of time

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13
Q

what are examples of secondary lesions?

A

epidermal collarette, lichenification, scar, excoriation, ulcer, fissure, callus

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14
Q

which type of lesion lasts longer?

Primary vs. Secondary

A

Secondary

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15
Q

what is an epidermal collarette associated with?

A

a pustule, vesicle or bulla

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16
Q

what layer of skin does a scar effect?

A

the dermis or s/c tissue

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17
Q

what is lichenification?

A

thickening or hardening of the skin

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18
Q

what is an ulcer?

A

break in the epidermis with exposure of the dermis

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19
Q

which lesions can be primary or secondary?

A

alopecia, scale, crust, follicular casts and comedone

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20
Q

what is a follicular cast?

A

an accumulation of keratin and sebaceous material stuck to a hair shaft

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21
Q

what is a comedone?

A

a dilated hair follicle filled with debris

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22
Q

what are the derm screening tests?

A

scrapings, cytology and culture (dermatophyte and bacterial)

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23
Q

what types of scrapes are there?

A

deep and superficial

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24
Q

what do you look for on a superficial scrape?

A

surface mites like sarcoptes, notoedres, otodectes, cheyletiella demodex GATOI in cats

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25
Q

if scrape is negative, do you rule out mites?

A

no

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26
Q

what do we look for on a deep skin scrape?

A

follicular parasites like demodex spp.

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27
Q

what is the difference between deep and superficial skin scraping technique?

A

you squeeze the follicle and induce capillary hemorrhage with deep skin scrape

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28
Q

How do you perform a direct impression?

A

press slide onto lesion

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29
Q

what methods are used to perform a cytology and look for bacteria and yeast?

A

surface scrape, q-tip onto slide, tape test, impression, and a FNA

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30
Q

what is a trichogram for?

A

to look at hair

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31
Q

what can you see with a trichogram?

A

broken tips of hair, the root (anagen or telogen), ringworm, follicle dysplasia and surface parasites

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32
Q

what are some indications of bacterial culture and sensitivity?

A
  • cytology shows cocci and rods or just rods
  • deep pyoderma
  • cocci but no response to right AB administered at the right dose at the right time
  • chronic AB/GS therapy
  • GSD pyoderma
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33
Q

what does a Wood’s lamp detect?

A

ring worm - specifically M. canis strains since other ringworm strains won’t fluoresce

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34
Q

what can cause false positives with the Wood’s lamp?

A

keratin scale, soaps, dyes and medications can also flouresce

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35
Q

what are indications for fungal culture?

A
  • ALL cats with skin disease!

- dogs with inflammatory skin disease

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36
Q

what should you do if the hair shaft fluoresces?

A

pluck those hairs for the DTM inoculation to culture

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37
Q

how do you sample if nothing fluoresces?

A

use the sterile toothbrush technique by combing the pet with toothbrush to collect hair/scales to inoculate media

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38
Q

how often should you look at DTM culture?

A

EVERYDAY important for interpretation

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39
Q

what determines a positive DTM culture?

A

the media will turn red at the same time the dermatophyte colony appears

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40
Q

why do you have to observe the DTM culture everyday?

A

you need to know when the colony forms to check for color change because if left without watching non-pathogenic fungi can use the protein in the media and cause the same color change but that colony would be present for days before the color changes

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41
Q

should you prep and scrub for a skin biopsy?

A

no, can disturb lesion and become non-diagnostic

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42
Q

can you clip hair for a skin biopsy?

A

yes, you can gently clip the hair

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43
Q

what are some indications for skin biopsies?

A
  • nodules/tumors
  • ulcers/vesicles
  • mucosal/footpad lesions
  • lesions not responsive to normal therapy
  • severe acute generalized disease
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44
Q

what do you do after you take a skin biopsy?

A

put it in 10% formalin

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45
Q

what are the types of biopsy techniques and when would you use them?

A
  • wedge/excisional - for large or fragile lesions
  • punch - for a sample of the disease process
  • amputation - nail/toe
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46
Q

what is the gold standard for identifying environmental allergens ?

A

intradermal allergy testing

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47
Q

what does serological allergy testing rely on?

A

relies on antigen-specific antibody levels

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48
Q

what are some advantages/disadvantages of serological allergy testing?

A

advantages - quick, no sedation/clipping

disadvantages - no positive control, false positives/negatives, only detects circulating IgE, not reliable for food allergens

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49
Q

what will we see early on with pruritus?

A

alopecia, erythema, excoriations

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50
Q

what will we see with the chronic stage of pruritus?

A

lichenification, hyperpigmentation and seborrhea

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51
Q

what are the main categories of causes of pruritus in the dog?

A

allergies, ectoparasites and infections

52
Q

what are allergic causes of pruritus in the dog?

A
  • flea allergy
  • atopic dermatitis
  • cutaneous adverse food reaction
  • insect bite hypersensitivity/contact dermatitis
53
Q

what are ectoparasitic causes of pruritus in the dog?

A
  • sarcoptes
  • demodex
  • cheyletiella
  • lice
  • chiggers
54
Q

what types of infections cause pruritus in the dog?

A
  • staph pyoderma
  • yeast
  • dermatophytes
55
Q

how do you characterize pruritus?

A

the body sites, if there’s seasonality, how intense, if the itch or skin lesion came first, age of onset

56
Q

what could be a cause of pruritus on caudal dorsum?

A

flea allergy

57
Q

what could be a cause of pruritus on elbows and ears?

A

sarcoptic mange

58
Q

what could be a cause of feet licking and chewing?

A

atopy or food allergy

“rears and ears” = food allergy

59
Q

what causes of pruritus have seasonality to them?

A
  • flea allergy
  • atopy
  • insect allergy
60
Q

what causes the most severe pruritus (10 on the scale!)?

A
  • sarcoptic mange (scabies)
  • flea allergy
  • food allergy
61
Q

what should you consider if the pruritus came before the lesion?

A

allergies or scabies

62
Q

what should you consider if the lesion came before the pruritus ?

A

demodex or dermatophytes

63
Q

what should you look for during the PE for pruritus?

A
  • look for lesions that confirm historical information
  • look for pyoderma, lesion distribution, hair loss, etc.
  • signs of immunosuppression that may predispose to infections
  • CHECK EARS! often involved
64
Q

what derm diagnostics should you do?

A

skin scrapings, surface cytology, flea comb, ear exam if needed

65
Q

when should you recheck after starting a course of treatment for pruritus?

A

1-2 weeks, have a follow up plan if signs aren’t improving

66
Q

True or False.

Flea allergy dermatitis (FAD) is very common

A

true, most common allergic skin condition in dogs and cats

67
Q

what type of hypersensitivity is FAD?

A

type 1 hypersensitivity, antigen antibody reaction

68
Q

True or False.

An infestation is necessary for flea allergic dermatitis?

A

false, infestation is not necessary, you ca get an allergic response from only 1 bite

69
Q

what is the main thing causing a reaction in FAD?

A

flea saliva because of the antigens it contains

70
Q

what is the classical distribution of a lesion of FAD?

A

lumbo-sacral distribution and tail base

“pants” distribution

71
Q

what signs will you see in a dog with FAD?

A

pruritus, papules, crust, excoriations, alopecia, hyperpigmentation and lichenification

may or may not see fleas or flea dirt

72
Q

around what age does the onset of signs of FAD start?

A

between 1-3 years mostly but can be any age

73
Q

what is a more definitive test for FAD?

A

intradermal flea allergy test - gold standard
- includes 3 injections - positive control, negative control
and flea antigen

there is also a serum test that measures flea allergen specific IgE

74
Q

True or False.

We consider all dermatoses flea related until proved otherwise

A

True. Even if a lesion is not classical - FAD is most likely involved

75
Q

how do you treat FAD?

A

flea eradication
- ectoparasitic drugs on animal
- treat the environment
treat any secondary problems

76
Q

true or false.

a dog with FAD will always have FAD

A

True

77
Q

are atopy and allergic dermatitis the same thing?

A

yes

78
Q

what is atopy?

A

hypersensitivity type 1 to aeroallergens

79
Q

what is the most common cause of primary otitis ?

A

atopy

secondary infections are common with atopy

80
Q

what other diseases can atopy occur concurrently with?

A

other allergic or pruritic diseases like FAD or food allergies

81
Q

when should testing for atopy be done?

A

if a clinical diagnosis of atopy has been made or if allergen-specific immunotherapy is being considered

82
Q

true or false.

secondary infections are common with atopy.

A

True

83
Q

what do the allergy tests detect ?

A

allergen specific IgE

84
Q

do you see itching with atopy?

A

yes

85
Q

what is the gold standard allergy test for atopy?

A

intradermal skin test

86
Q

what kinds of allergy tests are available for atopy?

A

intradermal skin test and serum tests

87
Q

prior to testing what should be done?

A
  • avoid oral and topical steroids for at least 1 month before
  • avoid antihistamines and essential fatty acids 2 weeks before
  • no baths for 5 days before
88
Q

what is the multimodal approach to treat atopy?

A
  1. diagnose and control all infections
  2. allergen avoidance
  3. break the itch-scratch-itch cycle
  4. allergen specific immunotherapy
89
Q

what treatments show weak evidence of symptomatic relief with atopy?

A
  • antihistamines
  • essential fatty acids
  • topicals
90
Q

what treatments show fair evidence of symptomatic relief with atopy?

A
  • skin lipid therapy
91
Q

what treatments show strong evidence of symptomatic relief with atopy?

A
  • glucocorticosteroids
  • cyclosporine A (Atopica)
  • oclacitinib (Apoquel)
  • lokivetmab (Cytopoint)
  • recombinant k9 interferon gamma (Interdog)
92
Q

why is it important to treat atopy with skin lipid therapy?

A

the epidermal barrier is compromised and it leads to penetration by more allergens, irritants, yeasts and bacteria

skin lipid complexes restore the barrier

93
Q

how do essential fatty acids help treat atopy?

A

they are an important part of the cell membrane phospholipid layer and form arachidonic acid which is less inflammatory

94
Q

what is the goal when using corticosteroids for pruritus with atopic dogs?

A

to get to the lowest, most infrequent dose that will control the pruritus

95
Q

how long should you minimally trial cyclosporine A for atopy?

A

4 weeks minimally

96
Q

what are some potential problems with using apoquel?

A
  • may increase susceptibility to infection and demodicosis
  • may exacerbate neoplastic conditions
  • avoid using in breeding dogs and pregnant or lactating ones
97
Q

what are the signs of food allergies similar to?

A

signs are the same as allergic dermatitis, flea bite allergic dermatitis and scabies

all have non seasonal PRURITUS

98
Q

if the onset of pruritus happens before 6 months of age what is likely the cause?

A

food allergies

99
Q

true or false.

food allergies are the second most common cause of hypersensitive skin disease

A

false, the third most common cause

order is: fleas, atopy then food allergies

100
Q

will you see concurrent GI signs with food allergies?

A

yes, you can see vomiting, diarrhea and colic

101
Q

how do you diagnose food allergies?

A

the only way to diagnose food allergy is a positive response to an elimination diet (food trial)

95% of dogs will improve within 3 weeks

102
Q

how can we perform a food trial? (2 ways)

A

have the client feed a novel diet, either home cooked or commercial with a protein or carb thats never been consumed before or a hydrolyzed protein diet (like purina HA)

103
Q

what type of hypersensitivity is contact hypersensitivity ?

A

type 4 hypersensitivity reaction - delayed/cell mediated reaction

104
Q

what are the early lesions you see with contact hypersensitivity?

A

macules and/or papules

105
Q

what can you see with chronic contact hypersensitivity?

A

lichenification, hyperkeratosis, hyperpigmentation, dryness, scaliness and fissuring

106
Q

what is an example of something that could cause contact hypersensitivity?

A

an allergy to the bowl they eat out of or the collar they wear

107
Q

how can we diagnose contact hypersensitivity?

A

we can try to do rule outs by:

  • taking the dog out of its normal environment and seeing if it improves
  • the patch test method, apply allergen directly to skin to see if there is a reaction
108
Q

what is the treatment for contact hypersensitivity ?

A
  • avoid allergen
  • treat any present secondary infection
  • topicals
  • glucocorticoids
109
Q

what is a very important clinical sign with sarcoptic mange?

A

INTENSE PRURITUS

110
Q

what is important to tell owners about sarcoptic mange?

A

its zoonotic and very contagious to other animals

111
Q

what are some clinical signs you see with sarcoptic mange?

A

intense pruritus, pinnal pedal reflex, papules, alopecia, erythema, crusts, excoriations, secondary weight loss, peripheral lymph node enlargement

112
Q

what are the predilection sites for sarcoptes?

A

ears, elbows and ventral abdomen

where there are sparse amounts of hair

113
Q

how can you diagnose sarcoptes?

A
  • response to treatment
  • positive pinnal-pedal reflex
  • fecal float - can find mites (not always) if pet chews to itch and swallows mite
  • skin scrape - however, extremely difficult to find the mite on scraping
114
Q

how long do we treat sarcoptic mange?

A

minimum of 6 weeks

115
Q

how do we treat sarcoptes?

A
  • topical dips (lime sulfur or mitoban)
  • topical spot on or systemic (selamectin, moxidectin, ivermectin, milbemycin or fipronil)
  • clean all bedding/kennels
  • treat secondary infections
116
Q

if we choose to treat sarcoptic mange with a topical dip, what do we need to do? how often do we do them?

A

clip the hair, use an antiseborrheic shampoo prior to the dip then select which dip to use.

dip is done q 7 days x 6 weeks

117
Q

why would you choose a lime sulfur dip over a amitraz (mitoban) dip?

A

lime sulfur dips are safe to use in young animals

118
Q

how do we use topical spot ons for treatment of sarcpotic mange?

A

give every 2 weeks for about 2-3 weeks - we aim to treat for 6 weeks minimally

119
Q

do we use glucocorticoids as an additional treatment for sarcoptes?

A

yes, you can use glucocorticoids in first few days of treatment to help with pruritus

120
Q

what are some clinical signs you might see with cheyletiellosis?

A

walking dandruff, scaling, pruritus, papular crusts

121
Q

how do we diagnose cheyletiellosis?

A
  • acetate tape test for microscopy
  • examine flea comb debris under microscope
  • see with the naked eye crawling on fur
122
Q

what is the treatment for cheyletiella?

A
  • treat all in-contact animals and environment

- topical shampoos and spot ons - can also use amitraz dips

123
Q

how long do we treat for cheyletiella?

A

minimally 6 weeks

124
Q

what are some clinical signs of chiggers?

A
  • can be found around the legs, head and abdomen
  • in cats, can be seen with naked eye, often found in ear
  • look like paprika - red mites
  • pruritis, papules, erythema
125
Q

how can we diagnosis chiggers?

A
  • skin scrapes

- red color and clinical signs

126
Q

how do we treat chiggers?

A
  • two pyrethrin dips spaced two weeks apart
  • topical anti-parasitic drugs
  • prednisolone for a few days to help with itching

SAM 2 (9 decks)

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