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SAM 4 MT 2 > Additional Examination Methods In Dermatology > Flashcards

Additional Examination Methods In Dermatology Flashcards

1
Q

What are the basic diagnostic way of dermatology

A

History –> clinical examination -> additional examinations –> diagnosis

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2
Q

What are the most important additional diagnostic methods in dermatology

A

Skin scraping, biopsy and cytology most imp

- knowing the indication, method, evaluation of result

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3
Q

What can we examine in dermatology

A

 parasites, bacteria, fungi
 hair, skin
 Other organs
(immune-, hormonal system)

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4
Q

What methods can we use to examine the skin for the physical exam

A

inspection / palpation / smelling / percussion

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5
Q

Name the additional examinations we can do

A
  • flea comb / Wood-lamp / Otoscopy
  • skin scraping + pluged hairshuft sending to laboratory
    (Microscopy, microbiology, sterike swabs, cytology)
  • cytology (impression/swab, ear/cytobrush smear, FNA, scraping, biopsy, scotch tape)
  • biopsy sampling
  • allergy tests
  • blood tests
  • immunological tests
    –> (histopathology: immunfluorescency, immunhistochemistry)
    (Urine)
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6
Q

What additional method would you do in suspicion of fleas

A 
Flea comb and flotation!
Comb, on paper
Flea dirt: digested blood
If few - hard to find, they are fast!
Cat: self cleaning away feces, may not find. If suscpision - treat!
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7
Q

What is a woodlamp used for

A

Nanometer light: ringworm flourescence (not specific, sensitive) but may help to guide you in direction of ringworms!

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8
Q

Why are gloves important to use in derma investigations!

A

Gloves - zoonotic skin diseasaes! Scabies, cayletiella, fungi, ringworm; microspora trichomonas …
Bacteria: staphylococci, pseudomonas - Multiresistant strains! MRSA

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9
Q

Why is a camera used during examinations?

A

Take pictures!
Compairing first with second (control) examination - change, what hasnt changed
Asking help from collegues - owner see everyday - hard to see changes

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10
Q

How do we approach sampling and sending samples to a lab?

A

 Ask: what type of sample is needed for the given examination to not have to do it again if use wrong tube.
 Ordering/ buying of the sampling instruments of the given laboratory (sterile swabs/ tubes with test medium/ solutions for biopsy sampling etc.)
 Accompanying documents and sample labeling to avoid mixing!

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11
Q

How do we approach sampling for own examinations

A 
 If we’ got microscope 
– Skin scraping (Paraffin oil on skin surface to get more str corneaum, parasites etc. If send to lab to culture, microbio etc dont do this!!)
– trichogram (eval of hair roots)
– Cytology
 Instruments and materials 
– Scalpel blade, glass slide
– Paraffinoil
– Diff-Quick for staining
– Immersion oil
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12
Q

What do we have to remember before performing a sample and evaluating it?

A

 Appropiate method
– For example: if only superficial skin
scrape was taken - Cannot find demodex - live deep in follicle
- For example: if we are looking for
Sarcoptes mites - Not in lesion - run far away - scrape sample may not find any in scraping
 Correct evaluation of the results
– the possibility of finding Demodex mites is less, we will have only 10-50% possibility of finding them even if we took the sample really from huge region
- Compairing the finding to lesion - eg staph aureus (normal skin flora) but no pyoderma - can negl this result

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13
Q

What is the method for skin scraping (for microscopic evaluation and culturing)

A

We should do all if have no idea of whats going on.
– Superficial (str. Corneum) / deep (Untll first amount of blood is seen - small erosion is made)
pushing out of hair follicle / pulling out hair shufts (trichogram) (If see anything filling the follicles
Also pull out hair shaft on border of healthy and skin lesion part - most fresh, most infected part)
– Huge surface / many region / border of the lesion and healthy skin (Sarcopes - fast)
– Crusts are not needed but sampling from the str. corneum (feline demodex(other demodex live in hair follicles), Ringworm - dermatophytosis
Can live on str. Corneum or they can live on hair shaft
–> need sample from both! Take sample beneath crust formation in str corneum!!!!

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14
Q

How do we evaluate the skin scraping (for microscopic evaluation and culturing)

A

– Sensitive method for ectoparasites, except Sarcoptes mites
– Bacterial culture: the antibiotic resistance is important
– Fungal culture: the only sure method for proving Dermatophytosis (Scrape + culture is the basis of diagnosis of ringworm! (PCR yes, suscpicion woodlamp no diagnosis)

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15
Q

What are the basic materials for own and lab sampling

A

Lab - swab etc. sample in sterile syringe

Own exam: slide, paraffin oil

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16
Q

For what infectious causes do we need multiple supf scrapings?

A
  • (mange)Sarcoptes scabiei (var. canis, ear pinnae cat)
  • (mange)=Notoedres cati (ususally found on cats ear pinnae first)
  • (mites)Otodectes cynotis (ear mite, cat)
    These we def find if correct sampling:
  • Linognathus setosus; Cheyletiella yasguri; Neotrombicula
  • sucking louse (pediculosis);cheyletiellosis; trombiculosi
  • ringworm/dermatophycosis: Gold standard scrape + micr culturing. Hair shaft cuticle no longer intact!!
17
Q

As we should take skin scraping for sarcoptes from a huge area - what areas are the most important to do?

A
  • Multiple supf scrapings - Predlection sites: thin skin (ear pinnae, hock, elbow, Ventral
  • Overgrowth - will probably find
    May only find eggs - also good for diagnosis
18
Q

What is typical for dermatophycosis signs?

A

Patchy alopecia, caryion/inflammation,

19
Q

Multiple deep scrapings - when, how

A

Demodicosis!
Until first capillary bleeding - demodex -> onto slide
Sharpei - thick skin - may not be able to do this sample! Biopsy may be needed
Microscopy - found on/around hair shaft/root/follicle!
(Face, back, btw toes, neck ventral/dorsal)

20
Q

When do we use swabs

A

In case of pus

21
Q

Trichocram - how do we sample for it, what are we looking for?

A

Hair sampling - looks like just cut some hairs off, tape on skin, (demod. Probably with root imp too)
 Demodicosis: on shaft (follicle)
 Dermatophytosis/ringworm: we see the hair shaft is no longer intact
 Cheyletiella: eggs are found on the hair shaft.

22
Q

Trichogram - how can we differentiate alopecia?

A
  • primary vs secundary(licking etc) alopecia - easily pullable shaft indicates primary. Symmetric alopecia abdomen cat, no skin lesion indicates no licking.
  • Distal end trauma indicates pruritis. (Distal end - should be sharp, if self trauma - pruritis. CAT!! Owner may not be able to see if incr self groowning, done at nigh.)
  • Radix: thick radix of shaft - anagen/growth phase. 2´Alopecia due to pruritis - it grows back!
  • Telogen phase: thin, primary alopecia (hormonal, aquired foll. Dysplasia) Spontanious loss. (Sligtly widened end, resting phase of hair growth - fall out)
23
Q

Method of cytology

A
  • impression-smear (glass-slide; scotch tape) Sensitive: malessia, staph, bact pyoderma (staph)
  • aspiration (FNA) Nodule: inflamm vs neopl or both
  • swab smear (from extarnal ear canal) Any pus, fluidy.. do a smear!!
  • ”cytobrush” (PCR: papilloma/herpes etc.)
    (- from skin scraping or biopsy sample)
24
Q

Evaluation of dermatological cytology

A

– Sensitive method: bacterial and Malassezia owergrowth (easy to spot if present)
– (FNA?) Differentiation of inflammatory (septic / non septic) and neoplastic skin lesions:
– Fast, but not always giving exact final diagnosis

25
Q

Describe the different smear methods

A

 Direct smear (placing sample direcly on slide with eg a pipette; blood, or placing feces on slide and adding saline)
 Impression smear (placing slide directly on surface to be sampled)
 Swab smear (rolling swab with sample on slide)

26
Q

Cytology - FNA

A

Aka fine needle biopsy

  • Make vacuum inside nodule – needle in center, until we see something aspirating
  • When pulling out the needle no NOT have vacuum! Contamination with skin cells..
  • Big needle used
  • Take off needle, aspirate a bit, put needle back on, and blow it on slide. If too thick – smear
27
Q

How can you stain a scotch tape slide sample?

A

Same as with normal slide! (Diff quick)

28
Q

Diagnostic value of HP - which skin diseases need HP for their diagnosis?

A

(Biopsy)

  • skin tumors
  • inherited/congenital diseases
  • autoimmune dermatopathies
  • aquired alopecia
  • follicular dysplasia
  • keratoseborrhoeatic skin diseases
  • any case where we dont know whats going on - do biopsy!
29
Q

Diagnostic value of HP - which skin diseases DOESNT need HP for their diagnosis?

A
  • Ectoparasitosis
  • pyoderma
  • supf. Mycosis
  • allergodermatitis (typically food allergy!)
  • endocrinodermatopathies (eg. Thyroxine suppr/stim)
30
Q

Cytology - how can you differentiate deep from sterile pyoderma

A
  • Bacteria present in deep pyoderma - p. Aeruginosa, or staph spp. Which is most common, intermedius!)
  • in sterile pyoderma you wont see any infectious casue, and rather a bunch of NG..
31
Q

How can you recognize Malassezia pachydermatis in cytology

A

A yeast, they make “foot step” lesions in microscope.
Greasy skin surface typical, Rancid
Impression smear is made.

32
Q

Cytobrush

A

Collection of cells used for cytology and PCR

Spoolie

33
Q

Biopsy

A
  • local anasthesia at site
  • Scalpel – at border of healthy-disease area (we cut)
  • Biopsy punch – do only at disease area!! Cant be sure the horisontal incision is taken only
    from healthy if 50:50 like with scalpel
  • Min. 3 biopsy from each lesion + 1 from healthy region
  • Cut (twist) punch in one direction only
  • after:
    o May get stuck in punch – pull out with needle -> put in formalin o Cut end with scissors
    o Suture with 1-2 suture (dep on the diameter tho)
    o Disinfect with betadine, aluminium spray
    o Can also push the biopsy onto slide then stain – not so informative
34
Q

Intradermal skin test, metadodic allergy test

A
  • ONLY after excluding all other diseases, esp sarcoptes.
  • A lot of false positives.. wrongly give steroids – may cause huge problem!!
  • we inject different allergens in skin to check for allergic reactions (inflamm, red, hevelse..)
35
Q

Blood sampling in dermatology - what can it detect?

A
  • allergies - serology
  • Sarcoptes: IgG-serology
  • Blood count, biochemistry, hormones (endocrinobathies..)
36
Q

Demodex mite occurance

A
  • demodectic mange - all mammals have them! Transmission from mother at birth.
  • Immunosuppr -> clinical lesion (overgrowth)
  • Indicator disease (indicates immunosuppr.)
  • Pyoderma – always look for them (=heavy immunosuppression!)
  • common in dog, less common in cat
37
Q

Diagnosis of pyoderma

A

Must check microscopy aswell to confirm – NG, babcteria. (Lines are seen, strands on slide – dna pushed out from NG! Pushed too hard during sampling)

SAM 4 MT 2 (12 decks)

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