Clin Med - Derm 2

drraythe's version from 2016-03-15 00:55

Intro to Derm Continued

Question Answer
Symmetrical/bilateral lesions usually indicate?Endocrine
How can you confirm from your trichogram that you indeed have a dematophyte?Add 10% KOH (Potassium hydroxide) which would allow you to visualize the fungal hyphae
What can you use a woods lamp for? whats important to know?You can sometimes detect Microsporum canis (ONLY DERMATOPHYTE WHICH WILL FLUORESCE) w/ a woods lamp, it will light up. BUT, not only is M. canis the only 1 it will work on, but also only about 50% of cases of M. canis will light up. so helpful. but not very sensitive test. (only dogs like to go in the woods, yo)
If you are looking at a large area of focal alopecia, what should you keep in mind? (example is of a cat belly)Look at the skin - is the skin fine? Esp if it's a cat, it might be overgrooming...if its the lower belly, it might be like Cystitis or something & the cat is licking due to discomfort
If there is hair loss, why might using a trichogram (when not relating to dermatophytes) be useful?If you look at the hair & it is broken off, it was most likely due to overgrooming & not something attacking at the root causing it to come out
What are 2 DDX for nodules?Neoplasia or Granuloma
What are 3 diagnostic methods you can use to try to determine the etiology of lumps & bumps (nodules)?(1) Fine needle aspirate (FNA)
(2) Excisional biopsy
(3) Punch biopsy
Once you've gotten your sample from FNA/excisional/punch biopsy, what 2 things can you do to further charaterize the nodule? What is 1 parasite which can cz nodules?You can do a culture or Histopathology to try to determine why the nodule has formed. Onchocerca, a roundworm, (responsible for Riverblindness) can also cz nodules
What are some Ddx's you could think of for this presentation: Moderate to severe alopecia on ventrum, some on back of neck & extremities. mild erythema. he's also pruriticMites (sarcoptes more likely bc they like a ventral distribution
Cant r/o demodex tho)
Maybe flea allergies
Food allergies
Environment allergy
Which mite likes being on the ventrum of the animal?Sarcoptes
If you suspect an allergy, what are thee things you can do to try to determine if that is the case?Intradermal skin test
Serology (ELISA)
Therapeutic trial
What is the BEST way to dx a food allergy?Food trial (therapeutic trial)
Explain how an intradermal skin test worksInject a bunch of potential allergens under the skin...1st 2 are neg (saline) & pos (histamine) controls...wait about 15-20 min & look for a visible rxn (usually a red spot, might be raised) & compare to the pos control to see if there might be an allergy
How can you use serology (ELISA) to try to determine if the problem is an allergy?Sensitization against allergens leads to ↑ production of allergen-specific IgE antibodies-you can do serological testing to find these IgE Abs
SOAP → which part does Hx fall under?S for subjective (Hx is the only part in S)
SOAP → which part does the distant examination fall under?O for objective
SOAP → which part does a THOROUGH physical exam fall under?O for objective
SOAP → which part does a Detailed dermatological exam fall under?O for objective
SOAP → which part does diagnostics fall under?O for objective
SOAP → which part does Ddxs +/-Dx fall under?A for assessment
SOAP → which part does the plan fall under?P for plan
What is the acronym you use for getting a complete Hx??SHED-C!
Which acronym would you use to approach every derm case?SOAP
SHED-C → what does S stand for?Signalment
SHED-C → what does H stand for?Health/health maintenance
SHED-C → what does E stand for?Environment
SHED-C → what does D stand for?Diet
SHED-C → what does C stand for?Complaint
What are some things you ask for the S (signalment) of SHED-C?Breed
What are some things you ask for in the H (health/health maintenance) of SHED-C?Endo/Ecto-parasite control
Previous dz (individual or farm/household)
Current rxn
Which drugs can cz porphyria?Tetracyclines
What are some things you ask for the E (environment) of SHED-C?Husbandry
Exposure to other animals
Potential for exposure to toxic or allergenic plants
Other animals or people affected?
What are some things you ask for the D (diet) of SHED-C?Ask about Diet (incl. treats & supplements)
Feed position
Food bowls
Access to other foods (is the cat getting into the milk bones?)
What are some things you ask for the C (complaint) of SHED-C?Age of onset
Original location of lesion(s) & appearance (could have been focal a year ago, but is now generalized)
Progression (or regression) of lesions
Previous Txs & outcomes
(Which came 1st… the lesion or pruritus? If pruritic… itch score (scale of 0-10)? Is it seasonal?)
What are 3 things you can look at w/ a distant examination w/ a derm case?General body condition
Haircoat (unkept or groomed? shiny or dull? appropriate color?)
Lesion distribution
What are 3 things to consider about lesion distribution in a derm case?“Predilection sites” (places where certain things like to be)
Localized vs. Generalized
Symmetric vs. Asymmetric
What is a predilection site for demodecosis?"Raccoon eye" where there is alopecia & lesions around the eyes
What is a predilection site for fleas?On the rump near the base of the tail - if you can put shorts on the dog & it covers the lesions, start to think fleas
What are 5 places you should be checking while doing your derm exam, aside from just the skin itself?Haircoat
Mucocutaneous junction
OTOSCOPY (ears are an extension of the skin)
Which acronym do you use for Ddxs?DAMNIT-V
What are the 3 tests you'd perform for a minimum derm database?Cytology
Skin scraping
Fungal assay (so basically tape, scrape, dtm)
List 10 common diagnostic proceduresCytology, skin scrape
Fungal assay (1st 3 are part of minimum database)
Therapeutic trial
Allergy screen (intradermal, serology)
Culture & sensitivity
Coat brushing
Wood's lamp
(you can do other diagnostics as indicated, esp if there may be systemic involvement, you can do bloodwork, or a ANA test (if autoimmune is suspected) )
What is an ANA test for?To check for autoimmune disorders
What are 4 things you do in the "plan" stage?Tx
Further Dx
Determine a time for a recheck