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Y3 MOD Dermatology > Nodular skin disease > Flashcards

Nodular skin disease Flashcards

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Dermatology Board Prep flashcards
1
Q

Define what a nodule is

A

A circumscribed solid elevation greater than 1 cm in diameter that usually extends into deeper layers of skin

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2
Q

Nodules usually result from infiltration of?

A
  • Inflammatory cells
  • Neoplastic cells
  • Deposition of fibrin or crystals (e.g. calcinosis cutis)
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3
Q

What factors need to be considered when a nodule is clinically presented?

A
  • Location on the body
  • Number (single vs multiple)
  • Size
  • Behaviour (acute vs gradual onset)
  • Aspect/clinical features
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4
Q

Give some examples of nodule clinical features

A
  • Warm and/or painful
  • Hard, soft, elastic, fluctuant, movable, fixed
  • Alopecic, smooth/rough surface
  • Ulcerated: possible presence of draining tracts
  • Hyper/hypopigmented
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5
Q

Describe cytology of a nodule

A
  • Fine needle aspirate
  • Apposition (if ulcerated/discharging)
  • Can be diagnostic or direct you to further testing (culture, special stains, immunocytochemistry)
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6
Q

Describe histology of a nodule

A
  • Excision of the whole nodule
  • Punch/wedge biopsy
  • Depends on clinical presentation (number, size, location)
  • Often diagnostic (especially when single nodules are excised and when dealing with neoplastic conditions)
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7
Q

What further diagnostic tests can be taken when dealing with nodules?

A
  • Immunohistochemistry, clonality
  • Special stains (Gram, PAS, ZN, GMS)
  • PCR
  • Biochemistry, urinalysis (e.g. calcinosis cutis)
  • Serology (e.g. Leishmania, Toxoplasma, Neospora, Cryptococcus)
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8
Q

Give some examples of things that may cause a nodule due to a foreign body reaction

A
  • Plant material
  • Grass
  • Embedded insect mouth parts
  • Suture material
  • Endogenous material e.g. hair, sebum, keratin
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9
Q

What are 3 causes of abscesses?

A
  • Penetrating wounds
  • Bites
  • Foreign bodies
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10
Q

What clinical signs are caused by filamentous bacteria?

A
  • Nodules and abscesses, with ulcers, draining tracts and cellulitis -> anywhere the bacteria are inoculated (mainly extremities, head and neck, and inguinal area) from bite wounds or penetrating foreign bodies
  • Serosanguineous exudate
  • Possible systemic signs – pyrexia, depression
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11
Q

How are filamentous bacteria diagnosed?

A
  • Cytology +/- special stains (Gram, ZN)
  • Histology +/- special stains - nodular to diffuse pyogranulomatous dermatitis and panniculitis, with or without tissue grains “sulfur granules”
  • Culture
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12
Q

How are filamentous bacteria treated?

A

Surgical drainage and antimicrobial therapy

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13
Q

Mycobacteria (saprophytic) cause which two conditions? Which animals does each affect?

A

Canine leproid granuloma (CLG) – short coated breed (boxers ++)
Feline leprosy syndromes (FLS) - ++ male cats with outdoor access

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14
Q

What are the clinical signs of a patient infected with mycobacteria (saprophytic)?

A
  • Single or multiple, firm, well‐circumscribed nodules in the skin or subcutis
  • Peripheral lymphadenomegaly
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15
Q

How is mycobacteria (saprophytic) diagnosed?

A
  • Cytology + special stains
  • Histology + special stains
  • Culture: specialist mycobacterial culture and subsequent genotyping at a national reference laboratory (APHA) for official confirmation
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16
Q

Atypical/non-tuberculous mycobacteria can affect which SA species?

A

Cats

17
Q

What are the signs of Atypical/non-tuberculous mycobacteria?

A

Granulomatous panniculitis - Single/multiple nodules, plaques, macules and diffuse swelling – multiple punctate ulcers and draining tracts (++ inguinal fat pad, tail base, flank)

18
Q

What are the clinical signs of mycobacterium tuberculosis in small animals?

A
  • ++ Male outdoor cats – face, extremities, tail base, perineum
  • Firm nodules, ulcerations, non-healing wounds with draining tracts -> thick yellow to green fluid + systemic signs
  • +/- local or generalized lymphadenopathy
19
Q

How is mycobacterium tuberculosis in small animals treated?

A

Notifiable disease – owner might need to be screened at TB-clinic
Euthanasia/empirical multidrug regimens/culture and susceptibility

20
Q

Dermatophytic pseudomycetoma causes what clinical signs?

A
  • Commonly Persian or domestic long hair cats
  • Painless, single or multifocal ulcerated dermal nodules - yellow granular discharge
  • NO history of skin trauma
  • Neck, dorsum, tail, flanks or limbs
21
Q

How is Dermatophytic pseudomycetoma treated?

A

Systemic antifungals (itraconazole, ketoconazole, terbinafine) +/- surgery

22
Q

Describe the clinical signs of nodular dermatophytosis (dogs)

A
  • Single ++ or multiple erythematous, alopecic, exudative nodules
  • Head, neck, limbs
23
Q

Name some examples of subcutaneous fungal infection

A
  • Mycetomas
  • Chronomycosis
  • Hyalohyphomycosis
  • Cryptomycosis
24
Q

Name 3 examples of protozoa that can cause nodular skin lesions (this is rare)

A
  • Toxoplasma gondii
  • Neospora caninum
  • Leishmania spp
25
Q

Name 3 examples of immune mediated conditions that can cause nodular skin lesions

A
  • (Juvenile) Sterile granulomatous dermatitis
  • Eosinophilic granuloma
  • Sterile Pyogranulomatous Dermatitis
26
Q

Name some neoplastic histiocytic proliferative disorders

A
  • Histiocytomas
  • Canine cutaneous Langerhans cell histiocytosis
  • Histiocytic sarcoma
  • Feline progressive histiocytosis
27
Q

Cutaneous histiocytosis is an example of what kind of disorder?

A

Reactive histiocytic proliferative disorders

28
Q

Describe the main features of Cutaneous histiocytosis

A
  • Inflammatory lymphohistiocytic proliferative disorder that primarily involves skin and subcutis
  • Multiple cutaneous and subcutaneous nodules up to 4 cm diameter – non-painful, non-pruritic
  • Skin ulceration common
29
Q

How are histiocytic proliferative disorders treated?

A

Glucocorticoids

Ciclosporin

Y3 MOD Dermatology (12 decks)

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