Framework for derm

Question 1

What are the aims of a dermatology consult?

Answer 1

• Address owner’s concerns
• Identify patient’s problems and treat them specifically
• Provide relief for unacceptable discomfort
• Progress towards a diagnosis
• Increase owner’s understanding of pet’s problem and the proposed route to diagnosis

Question 2

What are the key questions for a dermatological history?

Answer 2

• **True age of onset **
  
  • Check no prior history of skin disease, unrecognised by owner e.g foot licking, otitis
  • NB important to detail the manifestations of pruritus for owner
• Evidence of contagion or zoonosis
• Ectoparasiticidal regime – detail – include in-contacts
• Distribution of lesions/pruritus
• **Did pruritus start before or after onset of lesions? **

Other questions, e.g.
* Progression – change/spread of lesions, seasonality
* Lifestyle – kenneled/indoors, contact with others
* Diet
* Travel abroad

Question 3

What are the general history considerations when dealing with derm disease?

Answer 3

• Underlying systemic disease - E.g. PUPD in hyperadrenocorticism
• Systemic disease that may affect diagnostic or treatment plan - E.g. concurrent cardiac failure
• Drug history - cutaneous drug reaction/ intolerance, iatrogenic effects

Question 4

Using the DAMNITV appraoch what are the most common general causes of skin disease?

Answer 4

• metabolic (incld endocrine)
• neoplastic
• inflammatory, Immune-mediated, infectious
• traumatic

Question 5

Describe this lesion

Answer 5

1 - alopecia, excoriated
2 - Crust, erusion, ulceration (pemphigus foliaceus)
3 - nodules and papules, ulcerated (excoriated)

Question 6

What lesions are primary and which are secondary?

Answer 6

• Primary - e.g. papules, pustules, follicular casts
  Look for these - important diagnostically as d/ds often limited
  Often transient
• Secondary - e.g. crusts
  Result from primary lesion or external factor
  May be useful diagnostically

Question 7

What are the common differentials for Dogs?

Answer 7

• Ectoparasites
• Infections
  
  • Staphylococci
  • Malassezia
  • *Dermatophytes
  • *Viral/protozoal
• Allergic
• Neoplastic
• Endocrine

*= uncommom

Question 8

What are the common differentials for cats?

Answer 8

• Ectoparasites (Fleas!!)
• Infections
  
  • Dermatophytes
  • Viral
  • Staphylococci
  • Malassezia
• Allergic (food and enviromental)
• Neoplastic

Question 9

What tests can you do to look for surface parasites?

Answer 9

coat comb, acetate tape strip unstained, superfical skin scraping

Sarcoptes (scabies) might require superfical skin scraping

Question 10

How do you test for demodex?

Answer 10

Deep skin scraping

Question 11

What are you sample are you going to take for cytology of the following areas:
Wet/greasy , accessible with slide?
Wet/greasy , inaccessible with slide?
Dry?

Answer 11

• Wet/greasy , accessible with slide - direct impression smear
• Wet/greasy , inaccessible with slide - indirect smear (cotton bud)
• Dry - Stained acetate tape strip