Derm history, physical exam

Question 1

components of signalment

Answer 1

• breed
• age
• sex
• color

Question 2

why is breed important in taking history

Answer 2

certain diseases have a heritable basis while others occur more frequently in some breeds than in others

Question 3

why is age important in taking history

Answer 3

• some are more common in younger animals (allergies, demodicosis, dermatophytosis)
• some are more common in middle age/older animals (endocrine dz, autoimmune dz, neoplasia)
• age of presentation sometimes different from age of onset

Question 4

why is sex important in taking history

Answer 4

endocrinopathies related to reproductive hormones, predilections for a disease in one sex over the other

Question 5

why is color important in taking history

Answer 5

• blue dobermans: color dilution alopecia

- black hair follicle dysplasia

Question 6

history questions about environment

Answer 6

• indoor or outdoor?
• chance of ectoparasites/fleas?
• contact with cement, plastic, plants?

Question 7

contagion history questions

Answer 7

• other pets in the house?
• do they have same condition?
• are humans being affected?

Question 8

diet history

Answer 8

• current and past diet

- diet changes

Question 9

health status questions

Answer 9

• overall health
• appetite, water intake, exercise, BCS, mental attitude
• heartworm prevention?

Question 10

lifestyle history questions

Answer 10

• swimming?
• go to work with owner?
• country of origin/travel

Question 11

disease history questions (8)

Answer 11

• when did it begin
• what did it look like
• how did it progress
• sudden onset or gradual
• what parts of the body were first and later affected
• is the animal pruritic (and severity)
• how does pruritis correlate with lesions
• is the animal licking feet/legs

Question 12

why is response to previous treatment important

Answer 12

• shorten or define list of differential diagnoses
• only helpful if tx was done correctly
• glucocorticoids, antibiotics, drug rxns

Question 13

important part of derm exam

Answer 13

• examine skin
• clip hair if needed
• mucous membranes and lymph nodes
• groin and azillary area
• interdigital spaces, nails, footpads
• tail and perianal region
• ear canals
• ID primary lesions
• evidence of pruritis?

Question 14

key factors for diagnosis (3)

Answer 14

• degree of pruritis
• distribution of pruritis
• nature/distribution of lesion(s)

Question 15

primary lesions

Answer 15

• arrive de novo in the skin
• often are a reflection of the underlying etiology
• not always present, especially in chronic cases

Question 16

secondary lesions

Answer 16

• evolve from primary lesions

- may be created by the patient or external factors (trauma, medications)

Question 17

macule

Answer 17

• flat change in skin color
• may be depigmented, hyperpigmented, erythematous
• cannot be palpated

Question 18

patch

Answer 18

• macule greater than 1cm in diameter

- cannot be palpated

Question 19

papule

Answer 19

• small, solid elevation (can always be palpated)
• infiltration of inflammatory cells
• very common presentation of superficial pyoderma

Question 20

plaque

Answer 20

• large, flat topped elevation
• extension of coalition of papules
• eosinphiolic plaque, fungus, neoplasia, panniculitis, calcinosis cutis, pyogranulomas (NOT A HORMONAL PROBLEM)

Question 21

nodule

Answer 21

• circumscribed solid elevation
• infiltration of inflammatory cells or neoplastic cells
• bacteria, fungus, neoplasm, panniculitis, pyogranulomas
• often seen with plaques

Question 22

tumor

Answer 22

• large mass involving any structure of skin or subq tissue

- neoplasia

Question 23

pustule

Answer 23

• small, circumscribed elevation filled with pus
• contain neutrophils, eosinophils
• superficial pyoderma (can be from demodex, pemphigus)

Question 24

abscess

Answer 24

• demarcated, fluctuant lesion from accumulation of pus
• larger and deeper than pustules
• bacterial infections, fungal infections, panniculitis

Question 25

vesicle

Answer 25

- circumscribed elevation filled with clear fluid | - autoimmune disorders, virus, chemicals, drugs

Question 26

bulla

Answer 26

- vesicles larger than 1cm | - autoimmune disorders, virus, chemicals, drugs

Question 27

cysts

Answer 27

- epithelial lined cavity filled with fluid or solid material - lined by skin adnexa structures - follicular cysts, apocrine sweat gland cysts

Question 28

wheal

Answer 28

- circumscribed raised lesion with edema that appears and disappears in minutes to hours - horses and dogs - allergic or nonallergic urticaria

Question 29

angioedema

Answer 29

- edema extends into the subcutis - lesion is diffuse - allergic or non-allergic lumphedema

Question 30

erythema

Answer 30

- diffuse red discoloration of the skin - blanches when pressed - can be primary or secondary lesion - common sign of inflammation

Question 31

alopecia

Answer 31

- loss of hair (partial or complete) - primary or secondary lesion - no inflammation: endocrinopathies, follicular dysplasia - inflammation: allergies, parasites

Question 32

scale

Answer 32

- accumulation of loose fragments of the horny layer (cornified cells) - from keratinocytes multiplying too rapidly

Question 33

follicular cysts

Answer 33

- accumulation of keratin and follicular material that adheres to the hair shaft - sebaceous adenitis

Question 34

crust

Answer 34

- formed when dried exudate, serum, pus, blood, etc adhere to the skin surface - color indicates dz process

Question 35

hyperpigmentation

Answer 35

- increased epidermal and sometimes dermal melanin | - post-inflammatory, chronic inflammation, endocrine disorders (when no lichenification)

Question 36

hypopigmentation

Answer 36

- loss of epidermal melanin | - post-inflammatory, immune mediated (lupus), vitiligo

Question 37

comedo (comedones)

Answer 37

- dilated hair follicle filled with keratin and sebaceous debris - endocrine disorders, feline acne, schnauzer comedo syndrome, demodicosis

Question 38

scar

Answer 38

area of fibrous tissue that has replaced damage to the dermis or subcutaneous tissue

Question 39

erosion

Answer 39

- shallow break in continuity of the epidermis that does not penetrate basal cell layer - heals without scarring

Question 40

ulcer

Answer 40

deeper break in the continuity of the epidermis with exposure of the underlying dermis -scar commonly formed

Question 41

excoriation

Answer 41

self-inflicted, often associated with secondary bacterial infection

Question 42

epidermal collarette

Answer 42

- superficial lesion arranged as circular rim of loose keratin - often indicates superficial staphylococcal infection

Question 43

lichenification

Answer 43

- thickened, hardened skin with exaggerated superficial skin markings - often a result of friction - indicates chronic inflammation

Question 44

draining sinus tracts

Answer 44

- ulcerated tracts in skin originating in deep dermis or subq fat - deep pyoderma, mycotic infections, foreign body granulomas

Question 45

hyperkeratosis

Answer 45

increase in thickness of stratum corneum

Question 46

fissure

Answer 46

- linear cleavage into the epidermis (sometimes into dermis) - disease process or injury - ear margins, footpads, mucocutaneous junctions of mouth and anus, planum nasale