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196 Cards in this Set
- Front
- Back
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What is the signal most important diagnostic procedure in deem cases?
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HISTORY
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What are 4 important things to ask during a thorough history?
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past medical history
environmental history dietary history history of the present problems |
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T/F: history of the present problem should be taken in chronological order beginning with the owner's initial observations about the disease
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true
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What constitutes a derm database?
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skin scraping
impression smears trichogram |
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What is absolutely key to a successful skin scraping?
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gently squeezing the skin
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Which of the following are true of skin scrapings?
a) should clip hair b) squeeze skin c) scrape till red d) only need one sample e) you only need enough space to scrape as the blade is big |
a) should clip hair
b) squeeze skin c) scrape till red (NO sometimes need to get deeper but they shouldn't be hemorrhaging) d) MUTIPLE SAMPLES e) 2x 2 scrapings are ideal! |
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T/F: adhesive microscope slides are stained/prepped the same as non adhesive slides for impression smears
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false: No heat fixation or fixation wash of the diff quik for adhesive slides
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T/F: only telogen hairs are necessary for a trichogram
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false: want hairs in different phases
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What types of samples do you want for a fungal culture
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Broken hairs/hairs that fluoresce under a wood's lamp are preferred
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T/F: if the fungal culture turns red you have a definitive positive
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false: other things can change the medium color, really need to ID fungus w/ microscopy
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Which of the following are not true?
a) demodex is not normal flora b) The entire life cycle happens w/i the hair follicle c) genetic predisposition d) demodex is contagious e) mites are acquired from bitch (queen) at birth by direct contact |
a) demodex is NORMALLY found on the skin (yes but in very low numbers)
d) demodex is NOT contagious |
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T/F: demodex mites produce factors that further suppress the immune system
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true
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Finish this sentence: many of the immunologic abnormalities associated with demodicosis are due to immunosuppressive effects of secondary ________!
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pyoderma!
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T/F: any dog can be affected by demodex
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yes, but more frequent in purebred, short hair coat dogs
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T/F: demodex is most common in dogs > 1 year old
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false! < 1 years old
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T/F: dogs may outgrow demodex infestations unless complicated by secondary infections
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true
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What are the 2 forms of demodicosis
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localized (squamous)
generalized (pustular) |
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T/F: secondary problems are common w/ localized demodicosis
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false
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Where does localized demodex usually target
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forelimbs
face periorbital (ONE body area) |
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What is the tx for localized demodicosis?
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90% will spontaneously recover
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Which of the following are NOT true of generalized demodex
a) severe pruritis b) generalized lymphadenopathy c) animals may appear systemically ill d) secondary infections uncommon |
a) ABSENT OF MILD pruritis (unless there is secondary infection)
d) secondary infections COMMON |
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What is often the sequela to generalized demodicosis?
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folliculitis and furunculosis
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Define adult onset demodicosis
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onset of generalized demodicosis after 1-2 years of age associated with other immunosuppressive disorders
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Which spp of demodex is found over the dorsal midline and can lead to pruritus
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demodex injai (dog= d. canis, cat= d. gatoi)
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What is the most common finding in cats with demodex?
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symmetrical alopecia caused by licking (pruritus)
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T/F: d. gatoi is contagious
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true! Check all cats in a household if one is positive
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How do you diagnose demodicosis?
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Clinical features
skin scraping trichogram |
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What is the most important aspect of treating a generalized demodicosis?
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treat the pyoderma!!!! (topical abx)
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What are 2 therapeutic things that help the pyoderma associated with demodicosis?
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shampoos (remove crusts, debris etc)
hydrotherapy (alleviate pain/discomfort) |
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Which of the following are ineffective for treatment of demodicosis ?
a) amitraz b) lime-sulfur 2% c) imidocloprid + moxidectin d) ivermectin |
b) lime-sulfur 2% (d. canis/cati)
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What is the only approved tx for canine demodicosis?
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amitraz applications every 2 wks
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How do we actually dose amitraz?
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rinses every 1 week for 8-12 wks
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How long should you continue treatment for demodicosis?
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until 2 consecutive scraping are negative
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What are the adverse effects of amitraz?
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lethargy
bradycardia depression vomiting (maybe reversed w/ yohimbine) |
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What are the systemic therapies available for demodicosis?
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ivermectin
milbemycin oxime doramectin moxidectin |
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What doesn't Noxon like doramectin?
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can kill dogs he wouldn't use
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Who should you caution using ivermectin in?
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collie/ related breeds the MDR-1 mutation
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When dosing ivermectin is it best to just pick a dose and stay there or start a low dose and increase over a few days?
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start low and increase
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What is the treatment of choice for demodex gatoi infestation?
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2-3% lime sulfur applied weekly for 3-6 rinses
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The use of what drugs is totally contraindicated in patients w/ demodicosis?
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corticosteroids
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Should dogs with demodex be used in breeding programs?
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probably not since there is a hereditary component! ( specifics are unclear however)
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What are 4 ddx for intense pruritus?
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sarcoptic mange
flea allergy malassezia (most common) Combo of problems |
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Scabies is highly ______ and is considered ______ risk
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contagious
zoonotic risk |
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T/F: the male and female mite burrow through the epidermis
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false: only the females burrow
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What layer of the epidermis are scabies commonly found in?
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stratum cornium
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What is the hallmark of scabies? What "relax" might they exhibit
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intense pruritis
pinna-femoral reflex because they are so itchy |
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What is the classic distribution of scabies?
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PEEL!
Periorbital margins of Ears Elbows Lateral aspects of extremeties |
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T/F: systemic signs are not commonly seen with scabies
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false: may see weight loss and generalized peripheral lymphadenopathy
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Dx for scabies?
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superficial skin scraping
KOH/sugar centrifugation of scrapings fecal float ELISA (not in US) Histopathology (rare to find) |
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T/F: it is easy to find mites in scabies
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false: may do up to 80 scrapings in a dog
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T/F: scabies tx should start even if you haven't positively identified the mite
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true
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In addition to a total body clip and keratolytic baths to remove crusts what are 2 effective topical (dips) therapies for scabies?
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2-3 % lime sulfur 3-6 treatments
Amitraz 2-3 rinses |
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What other topical treatments are used for scabies? What is your choice for collie breeds?
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Good for collies- selamectin (3 doses @ 2-3 wk intervals)
moxidectin ( 3 doses @ 2wk intervals) fipronil SPRAY |
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What is the systemic therapy for scabies?
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ivermectin
milbemycin |
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What are the adverse effects of ivermectin? Which Cx is seen first usually?
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Neuro signs
Usually see ataxia first muscle tremors dilated pupils etc |
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T/F: environmental decontamination is also important for scabies
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true
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Which of the following are NOT true
a) the most commonly identified flea of the dog and cat is ctenocephalides felis b) fleas are host specific c) larvae comprise less than 1% of all forms in the environment d) temperature and humidity are important environmental factors |
b) fleas are NOT host specific
c) ADULTS comprise less than 1% of all forms in the environment |
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Flea larvae are negatively ______ and positively ______
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Flea larvae are negatively PHOTOTACTIC and positively GEOTACTIC
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Which are correct regarding fleas
a) can cause anemia in debilitated animals b) a heavy burden can lead to flea allergies c) can carry other parasites or pathogens |
a) can cause anemia in debilitated animals
b) JUST A FEW FLEAS CAN LEAD TO ALLERGIES c) can carry other parasites or pathogens |
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T/F: integrated flea control (i.e. environmental, killing different life stages) is important
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duh
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What insecticides are available for flea control (12)
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inert insecticides
botanicals organochlorines (not used much anymore) organophosphates (not used much anymore) carbamates (not used much anymore) imidocloprid Nitenpyram Fipronil Avermectins/Macrocyclic lactones metaflumazone/amitraz (not available in US) Dinotefuran Spinosad |
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What are 2 inert insecticides that good for environmental control of fleas?
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diatanacious earth (dangerous to humans)
borates |
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What are 4 botanicals used to control fleas? Which can't be used in cats?
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pyrethrins
synthetic pyrethrins (permethrin toxic to cats) rotenone citrus derivatives |
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Imidocloprid cannot be combined with which other insecticide?
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nitenpyram (they are related drugs)
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Spinosad (confortis) should not be combined w/ what other drug(s)?
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ivermectin
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How do juvenile hormone analogs work?
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interfere w/ development of larval stages by mimicking natural growth hormones (inc growth--> metabolism can't keep up-->death)
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What are 2 juvenile hormone analogs?
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methoprene
pyriproxyfen |
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T/F: Methoprene is stable in UV light
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false: no stable in UV light
pyriproxyfen is stable in UV light |
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Which drug is a chitin synthesis inhibitor?
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lufeneron
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What are the most common "ringworm" isolates?
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microsporum canis
M. gypseum Trichophyton mentapgrophytes |
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T/F: all dermatophytosis are zoonotic
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false: most except m. gypseum
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Which are not true regarding dermatophytosis?
a) invade and grow in viable keratinized tissue b) grow in any phase of hair growth c) Type IV hypersensitivity |
a) invade and grow in NONviable keratinized tissue
b) grows ONLY in no- living portion of ANAGEN Hairs |
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What are 3 ddx for folliculitis?
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dermatophytosis
demodex bacterial infection |
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Which fungus species frequently presents as pustular eruptions and will confuse you?
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trichophyton
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What are 2 easy screening tests for ringworm?
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wood's light
trichogram |
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T/F: If a patient is negative with a wood's lamp they are good to go
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false!
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T/F: your fungal culture turned red....great job doctor you have ringworm
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false!! other things can make it turn red
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What is the definitive dx for ringworm?
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fungal culture + MICROSCOPIC identification of pathogen
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T/F: skin biopsy is rapid and as accurate as a fungal culture
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false: rapid but not as accurate as a culture
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What are some topical disinfectants for ringworm?
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* miconazole-chlorohexidine shampoo
2% lime sulfur ketoconazole/chlorohex etc |
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What are the systemic drug options for dermatophytosis?
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griseofulvin
Azoles (ketoconazole, itraconazole, fluconazole) terbinafine |
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What is a major side effect of griseofulvin in cats?
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leukopenia more likely in FIV positive cats
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Which azole has good CSF, eye, and claw penetration is typically has fewer side effects?
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fluconazole
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T/F: the azoles can be used in pregnant animals
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false
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Which systemic dermatophytosis drug is fungicidal and will likely become the drug of choice in the future?
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terbinafine
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T/F: bleach is an appropriate environmental disinfectant for dermatophytosis
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true
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How can you monitor your ringworm therapy>
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hair growth/Cx
trichogram fungal culture |
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When can ringworm treatments be stopped?
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4 weeks beyond clinical cure
(min systemic course is 6 week) |
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Which of the following are true regarding malassezia pachydermatis
a) non obligatory b) lipophilic c) normal flora d) stain gram positive |
all of em!
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Which of the following are true regarding malassezia pachydermatis
a) activates alternate complement pathway b) non pruritic c) Type 1 hypersensitivity |
a) activates alternate complement pathway
c) Type 1 hypersensitive INTENSE PRURITIS |
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M. pachydermatis is synergistic with what other bacteria?
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staph pseudintermedius
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The skin and hair coat of an animal with malassezia are generally ______ and ______
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greasy and malodorous
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T/F: malassezia doesn't cause systemic cx
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false: peripheral lymph node enlargement
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What is often the cause of a malassezia infection?
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atopic dermatits
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Dx of malassezia?
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ID the primary factor!!!!!
Confirm yeast: impression smears |
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Where are some good locations to check for malassezia?
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Between the toes
ventral neck skin folds Lip folds Where claw meets skin |
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Tx for malassezia?
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Shampoos (selenium sulfide in selsun blue OTC)
Wipes (miconazole/chlorohex, malseb wipes) Rinses: acetic acid Systemic antifungals (ketoconazole or another azole) |
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What is important when administering ketoconazole?
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give with food!
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T/F: systemic treatments alone work well for malassezia
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false
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T/F: Shampoo treatments alone may be sufficient if malassezia infections are mild and owner compliance is good
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true
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What is really the main thing with malassezia infections?
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find the underlying cause!!!!!!!
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The majority of pyodermas involve what bacteria?
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straphylococcus pseudintermedius
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what is the most common underlying cause of pyoderma? second most common?
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1) atopic dermatitis!
2) endocrinopathies (hypothyroidism, hyperadrenocorticism) Others: ectoparasites, scaling disorders, immunodeficiencies |
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What are 2 classical finding for furunculosis?
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draining (fistulous tract)
patchy alopecia |
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What are 3 ddx for folliculitis?
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pyoderma (staph infections**)
dermatophytosis demodex |
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How do you dx pyoderma?
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derm database: scraping, trichogram, impression smears
cytology C&S Biopsy (CBC, T4, etc) |
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What is a key diagnostic test whenever pustules, papules, or draining tracts are present?
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cytology
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What are 4 indications for C&S testing?
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recurring infections
failure of the patient to respond to traditional tx only bacT on cytology are rod shaped organisms (rare) deep pyoderma cases |
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T/F: Diagnostic samples are best from ruptured pustules
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false: try to get intact pustule when possible
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T/F: you should sterile prep a pustule prior to FNA
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false: you might break it
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List some topical abx used to manage pyoderma
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Benzyl peroxide (gel, cream, etc)
OTC (bacitracin, triple ointment) Mupriocin ointment Povidone iodine Chlorhexidine Shampoo tx ( BPO, chlorhexidine, triclosan, ethyl lactate) Wipes (Nisin) |
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T/F: mupriocin ointment works really well against staph and gram - bacteria and is a first choice topical drug for pyoderma
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false: work great but he considers it a heavy hitter and saves for serious cases
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What is the contact time and water temp for good shampoo tx?
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10 min contact time
Neutral temp to slightly cool(not hot!!!) |
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What is a powerful degreaser and should be used w/ conditioner if used regularly for maintenance of pyoderma?
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BPO
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T/F: wipes alone are sufficient to tx pyoderma
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false: won't fix it but may help with maintenance
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What abx group is considered standard of care for pyoderma?
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cephalosporins
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Which of the following are poor choices for cutaneous tx?
a) penicillins b) fluoroquinolones c) lincomycin d) sulfonamides e) clavamox f) tetracycline |
a) POOR penicillins
b) HIGHLY EFFECTIVE fluoroquinolones c) INTERMEDIATE lincomycin d) POOR sulfonamides e) HIGHLY EFFECTIVE clavamox f) POOR tetracycline |
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which abx is associated with the most drug adverse effects?
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sulfas
(KCS, anaphylaxis, erythema multiforme, polyarthritis, sick euthyroid) |
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Ideal abx for pyoderma are bacteriastatic or bacteriacidal?
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bacteriacidal
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T/F: ciprofloxacin is an appropriate go to abx for pyoderma
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false: variable bioavailability in dog. Use enrofloxacin or marbofloxacin
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In addition to drugs what are 2 other therapies that might benefit patients with pyoderma?
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hydrotherapy
ultrasonic bathing |
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Pyoderma are usually classified based on the ___ of infection
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depth
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What are the 4 depth classifications of pyoderma?
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surface pyoderma
superficial pyoderma deep pyoderma cellulitis |
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Which of the following are true regarding acute moist dermatitis?
a) risk factors include thin hair coat, high environmental temp/humidity b) primary factors incldue allergic skin dz, ectoparasites, trauma c) generalized d) intense pruritis/painful |
a) risk factors include THICK, DENSE hair coat, high environmental temp/humidity
b) primary factors incldue allergic skin dz, ectoparasites, trauma c) VERY FOCAL LESIONS d) intense pruritis/painful |
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T/F: hot spots develop very quickly
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true
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How do you tx hot spots?
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clip region/expose to air
gently clean area Astringents to DRY lesion systemic abx glucocorticoids |
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How long should you use abx for hot spots
|
notes say 7-21 in class he said 10-14 days + topical tx
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You are presented with a 8 month old puppy w/ pyoderma. What might you be suspicious of?
|
DEMODEX or canine acne
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T/F: canine acne is more common in immature animals and shorthaired breeds
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true! usually < 1 year
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Where is a common place to spot canine acne?
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chin and muzzle
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Tx for canine acne?
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mild- topical abx
systemic abx |
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Skin fold pyoderma aka ______
|
intertriginous pyoderma
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Where are some common locations for skin fold pyoderma and in what breeds?
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lip folds (spaniels)
facial folds (brachycephalic) vulvar folds (obese, spayed females) corckscrew tails (brachycephalic) |
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Superficial pustular pyoderma aka ______
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impetigo
"puppy pyoderma" |
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T/F: Superficial pustular pyoderma is usually seen in animals < 9 months and lesions are usually found on the dorsum
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False: Superficial pustular pyoderma is usually seen in animals < 9 months and lesions are usually found on the VENTRUM
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What is most commonly isolated from Superficial pustular pyoderma?
|
staphlycoccus (streptococcus)
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Tx for Superficial pustular pyoderma?
|
Id and correct underlying cause
topical abx (BPO) Systemic Abx 7-14 days or PRN |
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T/F: nasal pyoderma exists
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true
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Superficial Folliculitis lesions progress from a _____ -->______--> _____
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Folliculitis lesions progress from a PAPULE -->PUSTULES--> EPIDERMAL COLLARETTES
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T/F: deep folliculitis are individual lesions centered around individual hairs
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true! Lumpy bumbies
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An animal with was clinical presentation is a dead give away for folliculitis?
|
moth eaten, patchy alopecic hair coat
|
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What is the minimum systemic and course for folliculitis?
|
30 day min + topicals
find underlying cause |
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The following key lesions indicate?
nodules--> crusted ulcers--> small draining tracts |
furunculosis!
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What type of alopecia is observed with furunculosis?
|
cicatricial alopecia
|
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T/F: pressure point pyoderma and german shepherd pyoderma exist
|
true (he didn't talk much about the specifics)
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Tx of deep pyoderma (furunculosis)?
|
Abx 1-6 months
hydrotherapy sx debridement/lancing |
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T/F: topical abx are a good choice for furunculosis
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false! may work if focal not the best (if you do this go with mupirocin)
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T/F: interdigital pyoderma may involve one or all feet
|
true
|
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what is the main cause of a lick granuloma?
|
atopic dermatitis
|
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____ is inflammation of the claw (nail) fold
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paronychia
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T/F: atopic dermatitis has a familial predisposition
|
true
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Atopic dogs have a shift in the ______ population from ___ to ___
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Atopic dogs have a shift in the lymphocyte population from Th1 to Th2
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What is the major mechanism thought to contribute to atopy? what is the major pathogenic factor leading to allergies/
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Mechanism: Type I hypersensitivity (IgE mediated)
Pathogenic factor: disruption/damage to epidermal barrier |
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T/F: antigen sensitization is not associated with atopic dermatits
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false: animal needs initial exposure to to antigen to SENSITIZE it
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What IL plays a large role in pruritus in dogs?
|
IL 31
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Atopic patients have been shown to have a cellular defect that allows increased adherence of bacteria to ______
|
keratinocytes
|
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What is the number one allergen for ppl and dogs?
|
house dust mites
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T/F: atopy is often seasonal
|
true may become year round as time passes
|
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What is the hallmark of atopy?
|
PRURITIS (licking, rubbing, chewing, scratching)
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What locations are commonly affected with atopic dogs?
|
thin haired areas
feet/btwn toes around eyes axilla/inguinal area Vulva/perianal |
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What is a common and sometimes the only manifestation of atopy?
|
otits externa
|
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What do atopic cats look like?
|
miliary dermatitis or reaction patterns
|
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T/F: atopy Cx are often noted in the morning
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false: at the end of the day
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Dx of atopy?
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signalment, hx, cx
Allergy tests |
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What are 2 indications for allergy tests?
|
confirm dx
provide additional info for tx (i.e. hyposensitization) |
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T/F: intradermal skin tests are looking for Type 1 hypersensitivity reactions and should be read immediately (like w/i 15 min)
|
true
|
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T/F: Patients need to be off antihistamines, glucocorticoids and fatty acid supplements prior to intradermal allergy testing
|
trufth (can be on cyclosporine however)
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Serologic allergen tests are also available. What are they measuring?
|
IgE level in serum
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What is really important to do 1st when treating atopic patients?
|
control secondary problems i.e. malassezia, pyoderma
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What are 2 methods of atopy tx?
|
symptomatic
immunotherapy |
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What are some symptomatic tx available for atopy?
|
colloidal oatmeal alone or better w/ addition of pramoxine, hydrocortisone
antihistamines (not really that effective: hydroxyzine, chlorpheniramine, diphenahydramine) Fatty acid supplements Glucocorticoids Cyclosporine Oclacitinib |
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Fatty acid supplements promote production of non inflammatory prostaglandins in lieu of those inducing inflammation by modulating what pathway?
|
arachidonic pathway--> leads to production of prostaglandins and leukotrienes that competitively inhibit receptors
|
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T/F: Fatty acid supplements alone are great for atopy patients
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false: most effective when in COMBO w/ antihistamine or glucocorticoids
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T/F: glucocorticoids are acceptable for short term tx of atopy but should not be used long term
|
true
|
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What is a great glucocorticoid combo drug that has been shown to reduce itch?
|
temaril P (prednisolone + trimeprazine)
|
|
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What are the side effects of glucocorticoids?
|
weight gain
PU/PD polyphagia panting |
|
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If glucocorticoids are given and the patient responds what is you top ddx? partial response ddx? no response ddx?
|
Respond: Atopy
Partial: scabies, malassezia Non Responsive: food allergy, behavioral, secondary infection |
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According to Noxon the best way to control atopic dogs is to control _____ using what combo of drugs?
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control ITCH
antihistamine/fatty acids/steroids |
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T/F: cyclosporine is best given on an empty stomach
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true
|
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Oclacitinib moa?
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IL 31 inhibitor (JAK STAT)
|
|
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What are 4 indications for immunotherapy?
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1)symptomatic therapy alone is not effective
2) patient has unacceptable side effects due to symptomatic therapy 3) client chooses to tx cause rather than symptoms 4)Appears more effective at keeping secondary infections under control |
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T/F: Allergen specific immunotheapy (ASIT) shifts T cell back to Th1 predominantly and will result in a higher IFN gamma: IL- 4 ratio
|
true
|
|
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How long until ASIT will work?
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may take 4-6 months (induction over 1-6 months)
|
|
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What is the first sign of anaphylaxis in dogs? cats?
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dogs: vomiting
cats: respiratory distress |
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what is the number 1 reason for atopy "relapses"?
|
malassezia dermatitis
|
|
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Summary: what are 4 basic tx option for atopy?
|
glucocorticoids
cyclosporine oclacitinib immunotherapy |
|
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Most common food allergens are _____
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protein 10,000-60,000 daltons
|
|
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Which types of hypersensitive reactions are involved w/ food allergies?
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Type 1 and IV (maybe III)
|
|
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What are the 5 most common allergens dogs?
|
1. beef
2 dairy 3 wheat 4 poultry 5 corn |
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What are the 4 most common allergens in cats?
|
beef
dairy fish poultry |
|
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T/F: food allergies usually only arrive after a recent food change
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false: often happens after years on the same food
|
|
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Which of the following are NOT true regarding food allergies?
a) seasonal b) pruritis at any age c) recrruing pyoderma d) GI signs e) glucocorticoid responsive |
a) NON seasonal
b) pruritis at any age c) recrruing pyoderma d) GI signs e) NOT glucocorticoid responsive |
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Elimination diets involve novel proteins and must be tried for what time period?
|
3 months!
|
|
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For the following categories answer for atopy.
age? Seasonal? Secondary infection? Steroid responsive? |
age: 1-3 yr
Seasonal: maybe Secondary infection: yes! Steroid responsive: yes! |
|
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For the following categories answer for food allergy.
age? Seasonal? Secondary infection? Steroid responsive? |
age: any age
Seasonal: no Secondary infection: yes! Steroid responsive: no (well maybe a bit) |
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T/F: allergy testing (intradermal or serologic) is a great way to dx food allergies
|
false: unrealiable and not recommended at this time
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