SAM II Final Exam - Dermatology Flashcards
1
Q
T/F: Enrofloxacin (Baytril®) is a good first choice systemic antibiotic for treatment of deep pyoderma
A
False
Enrofloxacin is a good pyoderma drug, but really should only be used if no other antibiotic is a feasible option. Use of fluoroquinolones and 3rd generation cephalosporins increase risk for emergence of MRSA
2
Q
What is the best way to diagnose eosinophilic granuloma complex?
A
cytology
confirm the lesion as part of eosinophilic complex
3
Q
A dog presents with these lesions on its elbows and ears. What is your top differential?
A
sarcoptic mange
4
Q
What is the most common perpetuating factor associated with lick granulomas?
A
deep pyoderma
most common and important; treat empirically with anti-staph antibiotic (first tier) or base selection on C&S results
5
Q
T/F: Culture and sensitivity (C&S) test is indicated in all cases of bacterial pyodermas
A
False
-
Indications
- Cytology shows cocci and rods or just rods
- Cocci but no response to right AB administered at right time at right dose
- Deep pyoderma
- Chronic AB/GC therapy
- GSD pyoderma
6
Q
What systemic antibiotics are considered 1st tier for empiric therapy?
A
- 1st generation cephalosporins (Cephalexin)
- Amoxicillin/clavuanic acid (Clavamox)
- Clindamycin
7
Q
What secondary infections are commonly seen associated with allergic dermatitis (atopy)?
A
Staph pyoderma, Malassezia, Otitis externa, lick granulomas
8
Q
What is the most important diagnostic test to perform if you suspect acute otitis externa?
A
CYTOLOGY
9
Q
What is the drug of choice for systemic treatment of dermatophytosis?
A
Itraconazole
- Treatment of choice 5‐10 mg/kg sid, or pulsed therapy: 1 month solid; then 1 week on/off.
- Systemic treatment should continue until 2 neg cultures 1 month apart
- Onychomycosis may require 6 – 9 months treatment
10
Q
Flea allergy dermatitis (FAD) has a fairly characteristic clinical presentation, but what is a more definitive diagnostic test that can be performed?
A
flea antigen test
- Elevated serum flea allergen-specific IgE. A negative does not rule out FAD!
-
Intradermal flea allergy test - 3 injections:
- Negative control (saline)
- Positive control (histamine)
- Flea antigen
11
Q
Which of the following are primary skin lesions?
- Macule, papule and ulcer
- Papule, wheal and plaque
- Nodule, abscess and erosion
- Plaque, erosion and wheal
- Crust, erosion and ulcer
A
papule, wheal and plaque
12
Q
What are the two most commonly used topical antibiotic shampoos?
A
benzoyl peroxide and chlorhexidine
13
Q
How does sebaceous adenitis typically present in short-coated dogs?
A
moth-eaten appearance
annular areas of scaling/alopecia (moth-eaten appearance) that sometimes coalesce; intermittent edematous swelling of muzzle, lips, eyelids
14
Q
Psychogenic alopecia in cats most commonly affects these areas:
A
medial thighs, ventral abdomen, medial forelimbs
15
Q
T/F: The vertical canal is the ideal site for cytology samples for diagnosing otitis externa
A
False
The horizontal canal is the ideal site
16
Q
A 3 year old dog presents with pruritus. Which of the following tests is least indicated?
- Adrenal testing
- Skin scraping
- Cytology
- Flea comb
A
adrenal test
17
Q
Do we use a superficial or deep skin scraping to diagnose sarcoptic mange?
A
superficial skin scrape
18
Q
A DSH cat from a multi-animal household is presented to your practice with facial pruritus. On examination of superficial skin scraping, you see the following organism. What is your diagnosis?
A
Demodex gatoi
19
Q
Why do we use benzoyl peroxide to treat secondary pyoderma associated with localized demodex?
A
Benzoyl peroxide FLUSHES the follicles
20
Q
T/F: There is strong evidence of efficacy regarding use of corticosteroids for treatment of allergic dermatitis (AD), and dexamethasone is recommended over prednisolone because of dexamethasone’s long duration of action
A
False
- There is strong evidence of efficacy regarding use of corticosteroids for treatment of allergic dermatitis (AD), but dexamethasone is not recommended over prednisolone, specifically because of dexamethasone’s long duration of action*
- With prednisolone, you’re able to have more control over the dosing due to the shorter duration of action*
21
Q
Most cases of generalized demodicosis that occur at 2‐4 years of age are likely undiagnosed ___________
A
juvenile‐onset demodicosis
22
Q
T/F: Before performing a skin biopsy, it is important to prep and scrub the area to ensure you get a viable sample
A
FALSE
You will not prep or scrubs for skin biopsies! You don’t want to disturb the superficial layers of the skin
23
Q
What is that?
A
Indolent ulcer (rodent ulcer)
24
Q
What skin condition occurs secondary to hyperadrenocorticism and can be more quickly resolved with the use of topical DMSO?
A
Calcinosis cutis
25
T/F: **Chin acne** (chin pyoderma) in dogs is typically a *deep pyoderma*
**True**
*Usually Staphylococcus*
* *Signalment: young dogs (\<1 year)*
* *Clinical signs: alopecia, non-painful, non-pruritic comedone, papules, discharge*
* *Treatment:*
* *Mild cases: topical benzoyl peroxide*
* *Severe cases: topical benzoyl peroxide & systemic antibiotics*
26
\_\_\_\_\_\_\_\_\_\_ is the most common underlying disease in adult onset **generalized demodicosis**
**Cushing's (hyperadrenocorticism)**
27
What is the underlying cause of **Alopecia X**?
**Unknown** (hence why it's called Alopecia X)
28
**Recurrent flank alopecia**, also known as __________ results in marked uni- or bilateral hyperpigmentation and is primarily seen in Boxers, English Bulldogs, and Airdales
**Seasonal Follicular Alopecia**
29
T/F: Culture may be indicated for **surface pyoderma**
**False**
*Culture is never really indicated for surface pyoderma*
30
What are the three major screening tests for diagnosing dermatologic conditions?
**skin scrape, cytology, culture**
31
For what type of **pyoderma** do we always recommend a culture?
**deep pyoderma**
32
**Dermatophytosis** can be treated both topically and systemically. You should ideally continue therapy until:
**1 or more NEGATIVE FUNGAL CULTURES**
33
What is the best way to diagnose **sterile nasal eosinophilic folliculitis/furunculosis**?
**biopsy**
34
What is the typical age of onset and lesion distribution associated with **allergic dermatitis (atopy)**?
* Age of onset: **1-3 years** (same as FAD)
* Lesion distribution: **face, ears, ventrum, feet, antebrachium, perineum**
35
What dermatologic screening test would be indicated if you suspect **yeast**?
**cytology**
36
What is the most common bacteria associated with **superficial pyoderma**?
***Staphylococcus***
37
If you're performing an intradermal allergy test in your patient, there are a few things to keep in mind:
* Avoid antihistamines and essential fatty acids for _______ before
* Avoid oral and topical steroids for at least _______ before
* No bath for at least _______ before
* Avoid antihistamines and essential fatty acids for **_2 weeks_** before
* Avoid oral and topical steroids for at least **_1 month_** before
* No bath for at least **_5 days_** before
38
What are the two forms of **canine demodicosis**?
* **1. Localized**
* 1 body location
* 5 or less lesions at that location
* \< 50% of area affected at that location
* **2. Generalized**
* \> 1 body location
* \> 5 lesions if only 1 location
* \> 50% of area affected if only 1 location
39
T/F: With proper adulticide treatment and shampooing, dogs can be cured of **FAD**
**False**
*A dog with FAD will always have FAD. It's a hypersensitivity to flea bites, so it can be managed, but you can't get rid of it.*
40
If you suspect a food allergy in your patient and you want to perform a **food trial**, what should the minimum duration of the trial be?
**4 weeks**
* *4 weeks minimum to start*
* ***_No other food source_***
* *Expect: 50% reduction in pruritus*
* *\< 50%: unlikely CAFR but continue for another 4 weeks*
* *Any improvement: continue for 4‐8 more weeks*
* *Trial of 3‐6 months if complex case*
41
What is the most likely *primary cause* of **lick granuloma**?
**atopy, food allergy**
* *For treatment:*
* *Symptomatic treatment for atopy/food allergy = glucocorticoids*
* *Topical steroid may help with inflammation*
42
T/F: **Mupirocin** is used topically and is effective against Gram-positive bacteria, including MRSA
**True**
*Mupirocin is a mixture of several pseudomonic acids. It is bacteriostatic at low concentrations and bactericidal at high concentrations*
43
Name three possible treatments for **allergic dermatitis (atopy)**:
* **Allergen-specific immunotherapy (ASIT)**
* **Symptomatic relief**
* **Allergen avoidance**
44
\_\_\_\_\_\_\_\_ is the most common cause of **primary otitis**
**allergic dermatitis (atopy)**
*_allergic dermatitis (atopy)_ is the most common cause of primary otitis*
45
This topical medication is commonly used on burns and has activity against several bacteria including pseudomonas:
**silver sulfadiazine**
46
Pyodermas can be separated into types based on the layer of skin they affect. What type of pyoderma is shown below?
**deep pyoderma**
* The image shows a lick granuloma (acral lick dermatitis)*
* Folliculitis/furunculosis and lick granuloma are the two main examples of deep pyoderma*
47
A dog presents with alopecia on its caudal dorsum. What is your highest differential?
**flea allergy**
48
T/F: **Intradermal testing** is essential for diagnosis of allergic dermatitis (atopy)
**FALSE**
## Footnote
*Clinical signs make the diagnosis for atopy. Intradermal testing is useful for determining what allergens the patient is allergic to*
49
A dog presents for feet licking, chewing. What are your top two differentials?
**atopy or food allergy**
50
What are the three important factors for **otitis externa** (Three P's of OE)?
**primary, predisposing, and perpetuating**
51
A 2 year old dog presents with a bilaterally symmetrical truncal alopecia and is not pruritic. Which of the following diagnoses is most likely?
* Alopecia X
* Pemphigus
* Demodex
**Alopecia X**
52
If you see this picture clinically, what two rule-outs should be on the top of your list?
**DLE (discoid lupus erythematosus)** and **pemphigus foliaceus**
53
You note a mild pustular rash in axillary and/or inguinal areas of a young dog. What is your top differential?
**Impetigo (puppy pyoderma)**
* *Often associated with dirty environment, parasitism, etc.*
* *Usually self‐limiting*
* *Mild cases usually respond to topical antibacterial shampoos*
* *Occasionally need systemic antibiotics*
54
T/F: **Topical antibiotics** can be used for surface, superficial, and deep pyodermas
**True**
55
Bacterial culture of pyodermas are never contraindicated. When are they mandatory?
* **If \< 50% improvement with 2 wks treatment**
* **New lesions after 2 wks of treatment**
* **Residual lesions at 6 wks**
* **Intracellular rods on cytology**
* **History of MRSA**
56
**Injection site alopecia** is associated with *what vaccines*?
**rabies and lepto vaccines**
* *Hair loss at injection site or in a distant location*
* *Diagnosis: biopsy (characteristic histopathology)*
* *Treatment: oral _pentoxyfylline_*
57
What part of the skin is affected by this lesion?
**surface of the skin**
* *The image shows a pyotraumatic dermatitis (hot spot)*
* *To treat this:*
* *Eliminate trigger (fleas, stress, etc.)*
* *Clip hair, clean with antibacterial shampoo*
* *Topical antibiotics/steroid creams/sprays*
* *_Short course corticosteroids to break 'itch cycle'_*
* *NOTE: this is not what we would typically treat pyodermas with*
58
What is the preferred diagnostic method for the feline **fur mite** (*Lynxacarus radovsky*)?
* **Diagnosis:** acetate tape
* **Treatment:** pyrethrin spray, lime sulfur dips, Ivermectin, Selamectin
59
What is the treatment of choice for **familial dermatomyositis**?
**pentoxyfylline**
* *Dermatomyositis is inflammation of the skin and underlying muscle tissue*
* *Ischemic dermatopathy in Collie and Sheltie breeds primarily*
* *Pentoxyfylline improves microcirculation*
60
When using Wood's lamp to investigate **ringworm**, what color are you looking for?
**apple green**
* 50% of M. canis strains produce tryptophan metabolites that cause hair shaft to fluoresce apple green with ultraviolet (UV) light*
* Other ringworms don’t fluoresce*
61
T/F: 90% of generalized **demodex** cases usually resolve on their own
**False**
*90% of _localized demodex_ cases usually resolve on their own/don't require treatment*
62
How do you diagnosis **demodicosis** in the dog?
**deep skin scrape**
*(Remember: in the cat, D. gatoi is a surface dweller. So in the cat, you would diagnose demodex with a superficial skin scrape)*
63
Pyodermas can be separated into types based on the layer of skin they affect. What type of pyoderma is shown below on this puppy?
**superficial pyoderma**
* The image shows impetigo (puppy pyoderma).*
* Impetigo and superficial bacterial folliculitis are the two main examples of superficial pyoderma*
64
What do serum and intradermal **allergy tests** detect?
**allergen-specific IgE**
* *Allergy testing should be done:*
* *If clinical diagnosis of AD is made*
* *If allergen‐specific immunotherapy (ASIT) is being considered*
* *If allergen avoidance measures are consideration*
65
How do you diagnose **sebaceous adenitis**?
**skin biopsy from dorsal surfaces**
66
What is the gold standard test for identifying environmental allergens?
**intradermal testing**
67
What are the three presentations of **eosinophilic granuloma complex** in the cat?
1. **Indolent ulcer (rodent ulcer)**
2. **Eosinophilic plaque**
3. **Collagenolytic granuloma**
68
Fungal infection of the nail is termed:
**onychomycosis**
## Footnote
*gross.*
69
What is the standard medical treatment for **eosinophilic granuloma complex** in cats?
**glucocorticoids (Pred: 2mg/kg BID)**
* Note: Symptomatic therapy is NOT ideal before strict parasite control!*
* Note that this pred dose is much higher than we use in the dog. Cats are more resistant to the effects of corticosteroids.*
70
What is the typical presentation of **endocrine alopecia**?
**Bilaterally symmetrical truncal alopecia**
*Not pruritic unless secondary pyoderma, seborrhea, Malassezia*
71
What are the primary lesions associated with **flea allergy dermatitis (FAD)**?
**papules**
72
T/F: **Benzoyl peroxide** is indicated for pyoderma with dry seborrhea
**False**
*Benzoyl peroxide dries out the skin. Chlorhexidine would be a better choice for pyoderma with dry seborrhea*
73
What are the two main indications for performing a **fungal culture**?
1. **All cats with skin disease**
2. **Dogs with inflammatory skin lesions**
74
An **infection of the nail bed** is termed:
**paronychia**
*This is a common clinical sign associated with Malassezia*
75
Pyodermas can be separated into types based on the layer of skin they affect. What type of pyoderma is shown below?
**deep pyoderma**
* The image shows _furunculosis_*
* Folliculitis/furunculosis and lick granuloma are the two main examples of deep pyoderma*
76
Which **pyoderma** do we commonly treat with a steroid?
**pyotraumatic dermatitis (hot spot)**
*short course of corticosteroids to break the itch cycle*
77
What are the two available methods for **allergen-specific immunotherapy (ASIT)**?
**subcutaneous** and **sublingual**
* ***Subcutaneous**: increasing dose/quantity of allergen. SCIT. “Allergy shots”*
* ***Sublingual**: Give 2x day. SLIT. “Allergy drops”*
* *Either one:*
* *Low risk of side effects*
* *May be more cost effective than symptomatic therapy (steroids) over time*
* *Concentration is gradually increased*
78
T/F: Demodectic mange causes intense pruritus (10/10) and is contagious and zoonotic
**False**
*_Sarcoptic mange_ causes intense pruritus (10/10) and is contagious and zoonotic*
* ***_Intense PRURITUS_***
* *Not very responsive to g‐corticoids*
* *Rapid development*
* *Diagnosis*
* *Superficial skin scrapes: may not be rewarding*
* *Response to therapy often recommended*
79
This presentation is very characteristic for:
**flea allergy dermatitis (FAD)**
*Clinical signs of alopecia will typically have a "pants" distribution: dorsal lumbosacral, tailbase, caudomedial thighs, ventral abdomen, flanks*
80
What is **Atopica®** and what is it used for?
**Cyclosporine A**
* *Used for treatment of allergic dermatitis*
* *Anti‐allergic & immunosuppressive*
* *5 mg/kg q 24 hr PO*
* *Better absorbed on empty stomach. If vomits = give with food*
* *_4 week trial minimum_*
* *_GENERIC FORMS ARE NOT RECOMMENDED_* *(absorption problems)*
81
List the 2nd tier non-empirical (based on C&S results) antibiotics used for treatment of pyoderma:
**chloramphenicol, rifampin, amikacin**
82
What are the *secondary lesions* associated with **flea allergy dermatitis (FAD)**?
**crusts and excoriations**
83
What animal is the reservoir for ***Microsporum canis***?
**CATS**
84
What is the minimum recommended treatment length for ***Cheyletiella***?
**6 weeks**
85
What are the disadvantages to **long-term corticosteroids use**?
* **PU/PD**
* **PP & weight gain**
* **Iatrogenic Cushing’s**
* **Iatrogenic Addison’s if steroids are suddenly withdrawn**
* **Less effective over time = higher doses needed**
* **More susceptible to infections**
86
Describe the presentation of feline **miliary dermatitis**:
**Localized or generalized areas of crusted papules, secondary alopecia, erythema, excoriations**
87
How is ***Malassezia*** diagnosed?
**cytology**
*cytology is _essential_ for diagnosis of Malassezia (surface cytology - scraping, scotch tape, cottom swab for ear canal lesions, direct impression)*
88
T/F: Fleas/flea dirt may not be present when a dog presents with **flea allergy dermatitis (FAD)**
**True**
*Fleas or flea dirt may not be present! Allergy or hypersensitivity, not necessarily an infestation! TAKES ONLY ONE FLEA BITE TO SET OFF ALLERGIC RESPONSE*
89
What are the **three forms** of skin lesions that we see in cats?
1. **Bilaterally symmetrical hair loss with normal skin (non-inflammatory)**
2. **Miliary dermatitis**
3. **Eosinophilic granuloma complex**
## Footnote
*Anytime you have a cat with ANY of these lesions, ALWAYS have flea allergy dermatitis and ringworm on your rule-out list*
90
Pyodermas can be separated into types based on the layer of skin they affect. What type of pyoderma is shown below?
**surface pyoderma**
* The image shows _pyotraumatic dermatitis_ (hot spot).*
* Pyotraumatic dermatitis and intertrigo (fold rash) are the two main examples of surface pyoderma*
91
What species of ***Malassezia*** do we typically see in dogs?
***Malassezia pachydermatis***
*Commonly in ear (otitis externa), lip folds, ventral neck, axilla, interdigital, perianal. May generalize - CHECK FOLDS! CHECK EARS!*
92
T/F: One of the downsides to performing **serology** for allergy testing is that it only detects circulating IgM
**False**
*It only detects circulating _IgE_*
93
What is the treatment for ***Notoedres*** **(feline scabies)** in cats?
**Lime sulfur dips or ivermectin injections or Selemectin or Imidacloprid/Moxidectin**
94
In moderate to severe cases of **FAD**, prednisolone can be used to reduce pruritus once pyoderma is eliminated/resolved. You want to get to the lowest dose possible that will control signs. Why?
**iatrogenic Cushing's**
*Iatrogenic Cushing's is caused when there is excessive administration of an oral or injectable steroid*
95
*Malassezia pachydermatis* is frequently a secondary invader of skin and ears. Most commonly, it is associated with \_\_\_\_\_\_\_\_\_\_
**allergic dermatitis**
*fleas, food, inhalant allergens*
96
What is **Apoquel®**?
**oclacitinib**
*I know, it doesn't even look like a real word... Apoquel® is the first _Janus kinase (JAK) inhibitor_ approved for veterinary use; _targets the itch and inflammation pathway. Decreases inflammatory mediators and cytokines that cause pruritus_.*
97
What are the predilection sites for *Sarcoptes scabei*?
**ear pinna, elbows, hocks**
*(may become generalized)*
98
Pyodermas can be separated into types based on the layer of skin they affect. What type of pyoderma is shown below?
**surface pyoderma**
* The image shows _intertrigo_ (skin fold dermatitis).*
* Pyotraumatic dermatitis and intertrigo (fold rash) are the two main examples of surface pyoderma*
99
How do we treat cases of ***Malassezia***?
**topical treatment**
* *Topical:*
* *Anti-yeast shampoos: ketoconazole, miconazole, selenium sulfide*
* *Anti-yeast rinse: enilconazole*
* *Creams/lotions: good for focal lesions*
* *If it is systemic: ketoconazole, itraconazole, or fluconazole orally*
100
Which of the following is _NOT_ a common location for **atopy**?
* Ears
* Feet
* Ventrum
* Dorsum
**dorsum**
*Lesion distribution for atopy: face, ears, ventrum, feet, antebrachium, perineum*
101
What treatment is most commonly used for **generalized demodex**?
**daily oral Ivermectin or weekly Mitaban® dips**
102
Pyodermas can be separated into types based on the layer of skin they affect. What type of pyoderma is shown below?
**superficial pyoderma**
* The image shows _superficial bacterial pyoderma_*
* Impetigo and superficial bacterial folliculitis are the two main examples of superficial pyoderma*
103
What three diseases do we associate with the most severe pruritus (10/10)?
**scabies, flea allergy, food allergy**
104
What dermatologic screening test would be indicated if you suspect ***Demodex***?
**deep skin scrape**
* *Indicated for most Demodex spp.*
* *For Demodex gatoi in cats, you would do a superficial skin scrape*
105
Oh shit. You slept through SAM lecture and forgot that you should give the *lowest possible dose* of prednisolone to control pruritus associated with **FAD**. Your patient is now showing signs of iatrogenic Cushings.
Your nightmares have come true: your client is upset and Dr. Reich is laughing at you from 1000 miles away. _You know that you need to stop the prednisolone_, but you also know that if you stop it too quickly, you can cause:
**iatrogenic Addison's**
*well damn.*
106
What diagnostic modality is necessary for definitive diagnosis of **color dilution alopecia**?
**biopsy**
*abnormal hairshafts and distorded hair follicles full of keratin and melanin*
107
T/F: Corticosteroids may be indicated as part of the treatment protocol for **Sarcoptic mange**
**True**
*Initial worsening of pruritus during the first days of Sarcoptes treatment may occur and can be treated with glucocorticoids daily for 3 to 4 days at 1 mg/kg body weight*
108
T/F: Nasal folliculitis & furunculosis are usually examples of *deep pyodermas*
**True**
*This is involving the _dermal layer_*
109
What are the 5 main lesions discussed in class that can be primary _or_ secondary?
* ****_F_**ollicular casts**
* ****_A_**lopecia**
* ****_C_**rust**
* ****_C_**omedo**
* ****_S_**cale**
110
Rupture of deeply infected hair follicles within the dermis is known as:
**furunculosis**
*this is associated with a _deep_ pyoderma*
111
What is the main cause of **otitis externa** in cats?
***Otodectes***
112
What is the most notable *chronic change* associated with **flea allergy dermatitis (FAD)**?
**lichenification**
113
How long do you treat **superficial pyoderma** with systemic antibiotics?
**3-4 weeks minimum (_1 week beyond resolution_)**
*Ideally you'll want to recheck this patient 2 weeks after starting treatment*
114
Which of the following is a **deep pyoderma**?
* Pyotraumatic dermatitis
* Impetigo
* Furunculosis
**Furunculosis**
115
List the 2nd tier empirical antibiotics used for treatment of pyoderma?
**sulfas, erythromycin, lincomycin, doxycycline**
116
T/F: Bilaterally symmetrical pruritic truncal alopecia is the typical presentation for **endocrine alopecia**
**False**
Bilaterally symmetrical truncal alopecia is the typical presentation for **endocrine alopecia**
*_Not pruritic unless secondary pyoderma, seborrhea, Malassezia_*
117
What age is associated with onset of clinical signs of flea allergy dermatitis (FAD)?
**1-3 years**
*61% start between 1-3 years of age*
118
Between **chlorhexidine** and **benzoyl peroxide**, which one has _follicular flushing activity_?
**benzoyl peroxide**
*this is useful for oily, crusty pyodermas as well as for Demodex (because Demodex lives in the follicle)*
119
How long do you treat **deep pyoderma** with systemic antibiotics?
**3-12 weeks (_2 weeks beyond resolution_)**
*Ideally you'll want to examine these patients weekly. You may be able to taper rechecks to every 2 weeks.*
120
A German Shepherd came in for a spay and the hair hasn't grown back since you clipped it for surgery. What is the most likely diagnosis?
**Post-clipping alopecia**
* *Prolonged period of alopecia following clipping. +/‐ mild scaling at clip site. Rest of hair coat is normal*
* *Alopecia may persist: 12‐24 months, depending upon the follicular cycle of the individual.*
* *Dx: history, signs, biopsy (diffuse catagen arrest)*
121
What types of hairs are more severely affected in the case of **follicular dysplasia**?
**primary hairs**
122
What dermatologic screening test would be indicated if you suspect **sarcoptic mites**?
**superficial skin scraping**
* *Surface mites*
* *Sarcoptes, Notoedres, Otodectes, Cheyletiella, Demodex gatoi in cats*
* *Moisten blader with liquid paraffin or KOH or mineral oil*
* *Scrape a larger area because mites are fewer in number*
* *If negative, you _can not rule out_ superficial mites*
123
What primary factor most likely started this lesion?
* Ruptured hair follicles
* Allergies
* Behavioral problems
* Deep pyoderma
**Allergies**
124
How would you manage the lesion?
* Stop/reduce the licking with corticosteroids
* Eliminate secondary deep pyoderma
* Look for and treat any compulsive behavioral issues
* Prevent dog from reaching the lesion
* All of the above
**All of the above**
125
What type of pyoderma is this?
* Deep
* Superficial
* Surface
* Combination of deep and superficial
**Surface**
126
How would you manage this?
* a. Stop/reduce the licking with corticosteroids
* b. Eliminate secondary deep pyoderma
* c. Use topical antibiotic
* d. Prevent dog from reaching lesion
* e. All of the above except for B
**All of the above except for B**
127
Which of the following clinical signs is most suggestive of chronic Malassezia?
* Ulcerations
* Scales
* Hyperpigmentation
* Furunculosis
**Hyperpigmentation**
128
Which of the following is LEAST LIKELY to suggest pyoderma?
* Epidermal collarette
* Pustule
* Papule
* Macule
**Macule**
129
Which of the following could represent a deep pyoderma?
* Hot spot
* Nasal furunculosis
* Impetigo
* Chin acne in dog
* B and D
**B and D**
130
How is Malassezia best diagnosed?
* Intradermal testing
* Culture
* Cytology
* Serum antibody level
* Culture and sensitivity
**Cytology**
131
Bilaterally symmetrical alopecia in a cat can be associated with:
* Psychogenic issues
* Pruritus
* Endocrine diseases
* All of the above
**All of the above**
132
What is this?
* Deep pyoderma
* Surface pyoderma
* Superficial pyoderma
* Demodex
* Contact hypersensitivity
**Superficial pyoderma**
133
Which of the following diseases can produce signs similar to those of Malassezia?
* Sarcoptic mange
* Superficial pyoderma
* Atopy
* Hyperadrenocorticism
* Surface pyoderma
**Atopy**
134
Which of the following skin disorders have furunculosis?
* Puppy pyoderma
* Impetigo
* Lick granuloma
* Hot spot
**Lick granuloma**
135
Which of the following is UNLIKELY to cause a moth-eaten appearance to a dog’s coat?
* Demodex
* Alopecia X
* Ringworm
* Sebaceous adenitis
**Alopecia X**
136
Recurrent flank alopecia is a form of:
* Post-clipping alopecia
* Alopecia X
* Hypothyroidism
* Follicular dysplasia
* Sebaceous adenitis
**Follicular dysplasia**
137
What is the treatment for juvenile cellulitis?
* Systemic corticosteroids
* First tier antibiotics
* Pentoxifylline
* Drainage
**Systemic corticosteroids**
138
When referring a dog for intradermal skin testing, what should you tell the owner?
* Antihistamine use is okay on day of test
* No corticosteroids for at least a month prior to the test
* No bathing for at least a month prior to test
* Fatty acid use is okay up to a day before the test
**No corticosteroids for at least a month prior to the test**
139
Acute otitis externa case with a creamy yellow discharge bilaterally. What test is MOST INDICATED?
* Culture from horizontal ear canal
* Culture from vertical ear canal
* Culture from middle ear
* Cytology of discharge
**Cytology of discharge**
140
Which of the following is INCORRECT information to tell owner about a food trial?
* Dog can’t sit under owner’s dining table and eat dropped food
* Dog can’t have access to cat litter box
* Chewable heartworm preventatives are replaced with non-flavored ones
* During the first 2 weeks of the trial, the old food is mixed in with the hypoallergenic food and a 50% reduction in pruritus is expected
**During the first 2 weeks of the trial, the old food is mixed in with the hypoallergenic food and a 50% reduction in pruritus is expected**
141
Which of the following would _not be a good choice_ to treat superficial pyoderma on first examination?
* Amoxicillin/clavulanic acid
* Marbofloxacin
* Topical benzoyl peroxide
* Cephalexin
* Chlorhexidine
**Marbofloxacin**
142
Which of the following is an indication for a C/S?
* Deep pyoderma
* Chronic otitis externa
* Intertrigo
* All of the above
* Only A and B
**Only A and B**
143
6 month old dog. Sudden pruritus leading to excoriations. Which of the following is MORE LIKELY based on that minimal information?
* Scabies
* Demodex
* Ringworm
* Seborrhea
**Scabies**
144
4 year old cat with pruritus around face and ears. Which of the following is LEAST LIKELY?
* Food allergy
* Flea allergy
* Notoedres
* Psychogenic alopecia
**Psychogenic alopecia**
145
What 2 diseases can cause just about any kind of skin lesions in cats?
* Food allergy and Staphylococcal pyoderma
* Ringworm and flea allergy dermatitis
* Atopy and eosinophilic granuloma complex
* A and B
**Ringworm and flea allergy dermatitis**
146
You have a Cocker Spaniel with primary idiopathic seborrhea. What is the MOST LIKELY cause?
* Zinc deficiency
* Resistant staphylococcus
* Increased epidermal turnover
* Dysplastic hair follicles
**Increased epidermal turnover**
147
Which of the following clinical signs is UNLIKELY to occur with JUST middle ear disease?
* Inability to close eyelid
* Miotic pupil on affected side
* Nystagmus
* Ptosis on affected side
**Nystagmus**
148
For which diseases is a combination of tetracycline (or doxycycline) and niacinamide used?
* DLE and PF
* Pattern baldness and color dilution alopecia
* Follicular dysplasia and Alopecia X
* None of the above
**DLE and PF**
*Discoid lupus erythematosus (DLE) and Pemphigus foliaceus (PF)*
149
Are ear cultures typically needed for acute cases of otitis externa?
**Nah.**
*Indications: Chronic recurrent cases or unresponsive cases*
150
When determining what to use to clean the ear canals, you note that you can NOT see an intact pars tensa. What should you use to clean the ear canals?
**normal saline**
*If you can't see the pars tensa and you put other cleaners (ceruminolytics, cleaning solutions, drying agents) in the ear, you may cause ototoxicity!*
151
T/F: Bacteria/yeast are usually the primary cause of acute otitis externa
**False**
*Bacteria/yeast are usually NOT the primary cause of acute otitis externa*
152
If a patient has otitis externa, what additional clinical signs would suggest **otitis media**?
**Horner's Syndrome and/or facial paralysis**
153
What might you expect the tympanic membrane to look like in a case of **otitis media**?
**ruptured or bulging**
* *Eardrum may be difficult to see - or bulging or rupture*
* *Myringotomy indication:*
* *Bulging eardrum with C&S of fluid in middle ear*
154
This guy comes into your clinic for an ear examination and you note a bulging pars flaccida. What is your diagnosis?
**Primary secretory otitis media (PSOM)**
* *A bulging pars flaccida in a Cavalier King Charles Spaniel = PSOM (but it is not always bulging)*
* *Cause is unknown; possibly dysfunction of Eustachian tube*
* *Clinical signs: head tilt, neck pain, 'air' scratching, facial paralysis, vestibular signs*
* *Myringotomy may show mucus in middle ear, but not always*
* *Treatment: myringotomy and middle ear flush. Signs may return as mucus reaccumulates*
155
What is the specific treatment for **primary idiopathic seborrhea**?
**Oral Vitamin A**
*Primary idiopathic seborrhea is also called Vitamin A responsive Dermatosis*
156
This is an Inherited dysplasia of the hair follicle resulting in the formation of comedones (blackheads) on the back of Schnauzers:
**Schnauzer Comedo Syndrome (Schnauzer bumps)**
* *Sharp, crusted papular eruptions: neck to tail base spreading laterally*
* *Secondary folliculitis and furunculosis*
157
\_\_\_\_\_\_\_\_ is the most common immune-mediated dermatosis in dogs and cats
**pemphigus foliaceus**
158
What is the treatment for localized **pemphigus foliaceus**?
**tetracycline + niacinamide**
*Along with topical corticosteroids, fatty acids, Vitamin E, avoid UV exposure*
159
What disorder causes hyperkeratosis of the footpad and a unique honeycomb pattern in liver or mass in pancreas?
**Superficial necrolytic dermatitis**
* "Saturday Night Dead"*
* This is also called HEPATOCUTANEOUS SYNDROME*
160
What are the top 3 benign neoplasms that should be on your rule-out list for skin nodules?
**lipoma, papilloma, histiocytoma**
161
A 5 week old, intact male Beagle dog presents to your clinic with facial and submandibular swelling. Cytology of the area reveals neutrophils and macrophages but no bacteria. What would you like to prescribe this patient?
* Antibiotics for secondary infection
* Glucocorticoids for immunosuppression
* Opioids for pain
* Appetite stimulants
**Glucocorticoids for immunosuppression**
*Remember that this is an immune thing (Puppy strangles/ Juvenile cellulitis), so if you prescribe antibiotics, you’re not doing anything for this patient and they will get worse!*
162
Inflammation of the subcutaneous fat is termed:
**panniculitis**
163
\_\_\_\_\_\_\_\_\_\_ is really the only reliable method for diagnosing food allergy
**food elimination trial**
*Usually clinical signs resolve in 8-12 weeks. You can confirm by recurrence of signs with provocation.*
164
What is the most common flea associated with **flea allergy dermatitis (FAD)** in dogs and cats?
***Ctenocephalides felis*** **(cat flea)**
165
Female fleas can consume ___ times their body weight in blood per day
**15x**
166
The cat flea can complete its entire life cycle in ___ days
**12-14 days**
*In typical household conditions, usually 3-8 weeks*
167
The oily or greasy form of seborrhea is termed:
**seborrhea oleosa**
168
The dry form of seborrhea is termed:
**seborrhea sicca**
169
Name some side effects associated with Amitraz administration:
* **Sedation**
* **Dry skin**
* **Pruritus**
* **Bradycardia, seizures, hypothermis, diarrhea, vomiting**
170
What are some underlying causes/conditions associated with **hepatocutaneous syndrome**?
**hypoaminoacidemia, diabetes mellitus, chronic liver disease, phenobarbital toxicity, pancreatic glucagonoma (rare)**
171
What sort of prognosis is associated with **hepatocutaneous syndrome**?
**Guarded to poor**
Hepatocutaneous syndrome is also known as superficial necrolytic dermatitis (SND) or "Saturday Night Dead"
172
What is the active ingredient for fleas in Advantage II?
**Imidacloprid + Pyriproxyfen**
173
What is/are the active ingredient(s) for fleas in Frontline®?
**Fipronil + Methoprene**
174
What is the active ingredient for fleas in Revolution®?
**Selamectin**
*Selamectin kills parasites by blocking nerve signal transmissions. Revolution enters the bloodstream through the skin. It then stays in the bloodstream protecting against heartworm disease, passes into the gastrointestinal tract where it can kill certain intestinal parasites, and passes into the sebaceous glands and then onto the hair and skin providing protection against fleas and certain mites and ticks.*
175
What is the active ingredient for fleas in Vectra®?
**Dinotefuran**
*Dinotefuran interferes with the nerve conduction system of insects, and is effective upon contact. The insect does not need to ingest the insecticide for it to affect the insect.*
176
What is the active ingredient for fleas in Comfortis® and Trifexis®?
**Spinosad**
*Spinosad causes excitement of the insect's nervous system, which leads to muscle spasms, tremors, paralysis, and death of the insect.*
177
What is/are the active ingredient(s) for fleas in K9 Advantix II?
**Imidacloprid, Permethrin, Pyriproxyfen**
178
What is/are the active ingredient(s) for fleas in Sentinel®?
**Lufenuron**
179
The **anti-inflammatory dose** for glucocorticoid administration is:
**0.5-1 mg/kg/day**
180
What is **steroid tachyphylaxis**?
Decrease in the response to a certain steroid drug after repeated doses
181
What is the mechanism of action of Apoquel®?
**JAK1 Inhibitor**
## Footnote
*Inhibits IL-31 (pruritogenic cytokine) and stops pruritus*
182
