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dermatology Flashcards

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1
Q

primary skin lesions

A

-happen as direct result of disease

exp:
Macule or patch
– Papule or plaque
– Pustule
– Vesicle or bulla
– Wheal
– Nodule

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2
Q

secondary skin lesions

A

– Evolve from primary lesions
– Are artifacts induced by the patient or
external trauma or medications

ex: – Epidermal
collarette
– Scar
– Excoriation
– Erosion or ulcer
-lichenification

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3
Q

lesions that may be primary or secondary

A

– Alopecia
– Scale
– Crust
– Follicular casts
– Comedones

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4
Q

Primary Lesion: Pustule

A

could be: pyderma, impetigo, folliculitis ect

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5
Q

Primary Lesions: Macule vs
Patchs

A

■ Macule:
– Circumscribed flat area of color change
– < 1 cm diameter

■ Patch:
– Circumscribed flat area of color change
– > 1 cm diameter

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6
Q

Hyperpigmented Macule primary lesion

A
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7
Q

Hemorrhagic Patches

A

-hemmorrage under skin could have macules and patches

ddx
■ Hemorrhage
– Trauma
– Vasculitis
– Vasculopathy
– Coagulopathy

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8
Q

Primary Lesion: Papule

A
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9
Q

Primary Lesion: Nodule

A

■ Nodule:
– Circumscribed solid elevation > 1 cm in diameter
– Usually extends into deeper layers of skin

■ Infiltration of inflammatory or neoplastic cells
■ Examples:
– Neoplasia
– Granulomatous inflammation

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10
Q

Primary Lesion: Wheal (Hives)

A

-could be tuffling of the hair but look at skin

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11
Q

Primary Lesion: Plaque

A

■ Plaque: Flat elevation in skin > 1 cm in diameter

■ Coalition of papules forming plaques
– Indicates chronic inflammatory disease

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12
Q

Primary Lesion: Vesicle and
Bulla. RARE to see in dogs and cats

A

■ Vesicle
– Sharply circumscribed elevation of epidermis filled with clear fluid
– < 1 cm in diameter
– Indicates: Viral, immune mediated, irritants

■ Bulla
– > 1 cm in diameter

-both rare in SA due to rupture when grooming, if you see biopsy

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13
Q

Secondary Lesion: Epidermal
Collarette

A

■ occurs secondary to papule, pustule, vesicle, bulla

■ Examples
– Pyoderma (Most common)
– Immune mediated disease
– Dermatophytosis

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14
Q

Secondary Lesion:
Lichenification

A
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15
Q

Secondary Lesion: Ulcers /
Erosions

A

■ Erosion:
– Shallow epidermal defect that does not penetrate the basal laminar zone
– Ruptured epidermal lesion; self-trauma

■ Ulcer:
– Break in continuity of epidermis with exposure of underlying dermis

biopsy: we want to take the edge* to show how epidermis transforms into erosion or ulcer. only with these two take EDGE**

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16
Q

Secondary Lesions:
Excoriations

A
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17
Q

Secondary Lesion: Fissure

A
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18
Q

Primary or Secondary Lesion:
Scale

A

dandriff = scale, we call it scale

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19
Q

Primary or Secondary Lesion:
Crust

A

■ Primary: more adhered to skin
– Zinc Responsive dermatosis

most commonly secondary: can peel that up with excaudate underneath
– Pyoderma
– Pruritus

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20
Q

Primary or Secondary Lesion:
Comedones

A

Primary
■ Feline acne
■ Endocrine dermatoses
-hypothyroidism

Secondary
■ Demodicosis
■ Dermatophytosis

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21
Q

Primary or Secondary Lesion:
Follicular Casts

A

-clumping at base of hair, will pull out easily (epulate)
-rule out secondary first then look at primary

Primary
■ Vitamin A Responsive
Dermatoses
■ Sebaceous adenitis

Secondary
■ Dermatophytosis
■ Demodicosis

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22
Q

Primary or Secondary Lesion:
Alopecia

A

■ Partial to complete loss of hair
-do we think hair fell out from inflammatory causes or non inflammatory causes (hypothyroidism)

■ Primary Lesion:
– Endocrine disease
– Follicular dysplasia

■ Secondary lesion: inflammation in the hair follicle
– Pruritus
– Bacterial folliculitis
– Dermatophytosis

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23
Q

Hypotrichosis

A

■ A form of alopecia
■ Less than normal amount of hair
-animal has hair but less than should be there

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24
Q

How to Approach the Dermatology Patient

A
  • History
  • Dermatologic Examination
  • Otoscopic Examination
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25
dermatology history signalment
* What breed is the patient? * Some diseases occur more commonly in certain breeds * Yorkshire terrier: Dermatophytosis (ringworm) * Persian cats: Idiopathic Facial Dermatitis
26
Dermatology History: reason for the appointment questions
What are the signs of the skin issue? * Why was the pet brought in? * What are the signs of the skin disease? * Alopecia * Crusts * Pruritus * If pruritic with secondary infection * Did the infection or pruritus occur first? did you notice rash before or after itching
27
pruritis
-can present in different ways * Not just scratching! * Ask about * Licking * Chewing * Rubbing * Pruritus: Use “itch scale” * Important for monitoring * Useful gauge for treatment * Initial assessment
28
derm history age when problem started?
* Young animals: - Parasites - Allergies * Middle aged animals - Allergy - Parasite - Endocrinopathy - Autoimmune disease * Older animals * Neoplasia * Parasites * Endocrinopathy * Allergies – way down low on list!
29
derm history timeline and symptoms
* How long has the disease been present?* How has it progressed? * Is there a seasonal component to the skin disease? * Allergic dermatitis * Flea Allergy Dermatitis * Cyclic Flank Alopecia
30
derm history where on the body is affected?
* What parts of the body are affected? * Where did the condition start?
31
derm history previous treatment and management
* Previous treatments? * Have any been successful? * Did the pet improve? * Parasite control? * Include all pets in the household -last medication and last bath can both affect diagnostic tests
32
derm history diet
* What diets have been tried? * How long was it fed? * Any other foods, treats given? * Any medications at the time? * Include flea, heartworm * Toothpaste? if diet trial done was is successful? were all pets on trial, or could they have shared bowls, ect.
33
derm history other pets?
* Do other pets have clinical signs? * Do any people have clinical signs?
34
derm history lifestyle
* Lifestyle of pet * Indoor / outdoor? * Around other animals? * Do the people foster pets? * If cat, FeLV / FIV status
35
Dermatologic Examination
-do exam in same systemic pattern * Skin has limited reaction patterns * History and lesion distribution can help differentiate disease processes -look at whole dog, see lesions and localize and think what can cause lesions in that area * Look at the pet from afar * Is pruritus present? * Does the pet appear healthy? * General attitude? * Weight and BCS -do a complete physical exam then a thorough dermatologic exam - assess coat -is there an odor? could mean infection need to use cytology to diagnose
36
Periocular Distribution - Dogs ddx and clinical
Differential Diagnosis * Atopic dermatitis * Food Allergy * Demodicosis * Bacterial Infection * Malassezia dermatitis * Dermatophytosis * Etc. Clinical Signs * Alopecia * +/- Erythema * +/- Lichenification * +/- Hyperpigmentation * +/- Crusts
37
Perioral Distribution
Differential Diagnosis * Demodicosis * Atopic Dermatitis * Malassezia dermatitis * Mucocutaneous Pyoderma Clinical Signs * Alopecia * Erythema * +/- Fissures * +/- Erosions * +/- Ulcers
38
Dorsal Aspect of Paws - Dogs
Differential Diagnosis * Atopic dermatitis * Food allergy * Demodicosis * Sarcoptic mange Clinical Signs * Alopecia * Erythema * +/- Lichenification * +/- Hyperpigmentation * +/- Crusts / exudate
39
Ventral Interdigital Aspect of the Paws
Differential Diagnosis * Demodicosis * Sarcoptic mange * Atopic dermatitis * Food allergy Clinical Signs * Alopecia * Erythema * +/- Lichenification * +/- Keratosebaceous exudate
40
derm exam areas to assess
* Paws * Mouth * Mucous Membranes * Vulva / prepuce * Ventral abdomen * Trunk -are the lesions symmetrical, localized, generalized?
41
derm exam hair coat
* How does the hair coat feel? * Greasy? * Coarse? * Dry? * Haircoat changes can indicate different conditions * Sebaceous adenitis * Endocrinopathy
42
otoscopic examination questions
* Ask specific questions! * Is there a history of ear disease? * Have medications been used before? * Were there any issues with any medications? * Are there other dermatological issues?
43
Otoscopic Examination outer ear
* Examine the pinna first and record changes * Is there erythema? * Crusts? * Are lesions present on the distal margins? * If worried about sarcoptic mange, is there a pinnal-pedal reflex? scratch ear see if reflex * Palpate at the base of the ears * Is there pain present? * Are the ears firm? -assess for end stage disease, otitis media * Open the mouth to see if pain is present * Can indicate otitis media * Are there neurological signs present? * Anisocoria * Head tilt, facial nerve paralysis
44
Otoscopic Examination in the ear with otoscope
* Visualize: * Vertical canal * Horizontal canal * Tympanic membrane * The normal ear canal may have * Hair * Wax * Record any abnormalities appreciated * Stenosis * Exudate * Ulceration * Does the tympanic membrane look abnormal? * Are the ears firm on palpation?
45
how to diagnose folliculitis
* Dogs will present with papules, pustules, crusts, alopecia, scale, epidermal collarettes * Differential diagnoses: * Pyoderma * Dermatophytosis * Demodex canis * Pemphigus foliaceus can present in a similar fashion
46
impression smears good for?
-lesions are moist or greasy * Beneath crusts * Lanced: * Papules * Pustules * Vesicles
47
tape preperations
Dry lesions * Neck * Interdigital spaces * Dorsum, etc... * Use Diff Quik to stain * DO NOT USE FIXATIVE!!!
48
scapings
* Sample: * Beneath crusts * Vesicles/pustules * Scale * Gently wipe onto slide * NOTE DIFFERENCE BETWEEN SCRAPINGS FOR CYTOLOGY AND PARASITES
49
swab smears
* Draining tracts or sinuses * Ear canals * Claw folds * Break end * Tapered end can be used to scrape out exudate * Gently role out onto slide
50
skin scrapings
* Need: * #10 scalpel blade * Mineral oil * Slides * Coverslips
51
skin scraping for different types of mites
* Deep skin scrapings * Demodex sp. * Squeeze skin first * Scrape until capillary bleeding * Superficial skin scrapings * Other ectoparasites (sarcoptes, Cheyletiella) * Scrape broad areas, under crust, do not need to cause bleeding
52
skin scraping technique
* Dip blade in oil first or put mineral oil on skin prior to scraping * Wipe onto slide with mineral oil present * Place a cover slip * Scan on 4x or 10x edge to edge * Close iris diaphragm on condenser!!
53
culture rules
-culture when cytology supports infection 6 Rules: * Intracellular rods * Previous history of Methicillin resistant infection * Infection not responding to treatment * Deep pyoderma * Immunosuppression? * Recurrent infection despite appropriate therapy?
54
culture technique
* When should tissue cultures be performed? * Cytology first! * Nodular lesions** * Deep pyoderma
55
Dermatophytes screening test (ringworm)
* Wood’s Lamp: * Microsporum canis * Warm up for 5-10 minutes * Infected hairs should fluoresce Trichograms * Pluck hairs and suspend in mineral oil * Hairs appear swollen and frayed, irregular, fuzzy * “Rotten log” * No clear demarcation between cuticle, cortex and medulla * Arthroconidia surround the hair * Hyphae grow within the hair shaft
56
trchograms
* Examine distal ends for evidence of pruritus (fractured ends, etc.) * Examine hair shafts for developmental defects * Examine roots to determine growth phase (telogen vs anagen)
57
Diagnostic Tests for Dermatophytes
* PCR * Fungal Culture: * Dermatophyte Testing Medium (DTM)
58
how to fungal culture
Pluck Hairs * Can use Wood’s Lamp * Pluck Hairs from around lesions * MacKenzie Technique (Toothbrush technique) * Sterile toothbrush * Collect hairs * Red color change does not = positive!! * Identify colony morphology
59
skin biopsy
* Excellent tool for diagnosing skin disease, not allergic dermatitis -do basic diagnostics first -describe lesion fully, where did you take it and use clinical history when submitting
60
Best Method to Biopsy
Multiple samples * Most labs will allow for 5-6 biopsy samples * Biopsy things that “look different” * Pustules, papules, crusts * Do not throw away crusts!!!!! -use biggest punch you can, do not scrub or clip hair, take the entire lesion
61
layers of the skin
-epidermis -dermis -subcutis
62
epidermis layers
 Stratum corneum  Stratum granulosum  Stratum spinosum  Stratum basale  Outer layer of the skin  Dogs and cats  2-3 cell layers thick  Footpads  Nasal planum
63
epidermis main cells
 Keratinocytes  Langerhans cells: antigen presenting cells  Melanocytes: barrier from radiation, inflammation
64
Stratum Basale
 Mitotically active  Attach to basement membrane  Attach to other keratinocytes  Desmosomes
65
Stratum Corneum
 Stacked layers of anucleate, flattened cornified cells-> Undergo desquamation  “Bricks and mortar”  Corneocytes and lipids  Function  Mechanical protection  Barrier to water loss  Barrier to permeation of soluble substances in environment
66
Pemphigus foliaceus
 Autoimmune disease  Affects desmosomes  Causes pustules  Crusting -disease affecting the EPIDERMIS
67
ichythyosis
 Congenital skin disorders  Causes abnormalities in differentiation of keratinocytes  Golden Retrievers  Excessive scaling*** -DISEASE AFFECTING THE EPIDERMIS
68
Diseases of Langerhans Cells
Canine cutaneous histiocytomas  Typically benign masses  Young dogs  Usually spontaneously regress
69
Diseases of Melanocytes
Colour Dilution Alopecia  Some dogs with dilute hair coat  Blue, fawn, silver -leads to recurrent skin infections
70
Basement Membrane Zone
 The interface between the epidermis and dermis  Many roles:  Anchors epidermis to dermis  Maintains a functional and proliferative epidermis  Maintains tissue architecture  Wound healing  Functions as a barrier
71
Diseases of the Basement Membrane Zone
Epidermolysis Bullosa  A group of hereditary disorders  Targets the anchoring complexes of the epidermis  Causes ulceration of “stressed” skin  Bony prominences, pressure points
72
dermis
 Part of the connective tissue system  Contains  Blood and lymph vessels  Nerves  Epidermal appendages  Modulates:  Wound healing  Structure and function of epidermis
73
dermis stregnth
 Dermal insoluble fibers  Collagenous fibers  Provides tensile strength Accounts for 90% of dermal fibers  Elastins  Provides elasticity
74
Diseases of the Dermis
Ehlers Danlos Syndrome  Inherited disorder affecting connective tissue  Fragility and hyperextensibility of the skin
75
Hair Follicles functions of hair
 Physical barrier against trauma  Protection from UV radiation  Thermoregulation / insulation  Repelling water  Source of cells for re-epithelialization during wound healing
76
tactile hairs
 Sinus hairs Whiskers  Face, eyebrows  Palmar aspect of carpus on cats  Slow adapting mechanoreceptors  Tylotrich hairs  Scattered amongst normal hairs  Rapid acting mechanoreceptors
77
sebaceous glands
 Distributed through haired skin  Open into hair follicle lumen  Most prevalent:  Mucocutaneous junctions  Interdigital spaces  Dorsal neck / rump  Chin  Dorsal tail  Not present  Footpads  Nasal planum
78
alopecia X
 Abnormalities in sex hormone receptor function  Level of the hair follicles -disease of the hair follicle
79
Diseases of Sebaceous Glands
Sebaceous adenitis  Sebaceous glands are destroyed by inflammation Loss of sebum:  Severe scaling  Follicular plugging
80
diseases of subcutis
 Post-rabies vaccination panniculitis  Poodles, Chihuahuas, Bichon Frises, Maltese  Site of vaccination  Hair loss  Pigmentation  Inflammation
81
Cerumen
 Normal emulsion that coats the ear canal  Comprised of:  Desquamated keratinized squamous epithelial cells  Secretions from cerumen and sebaceous glands  Immunoglobulins  Forms a protective barrier
82
Tympanic Membrane
 Separates the External Canal from the Middle Canal  Separated into two sections:  Pars flaccida  Upper part – contains small blood vessels  Pars tensa  Lower part - the manubrium of the malleus attaches
83

veterinary diagnostic medicine (11 decks)

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