Clin Med- Derm 2

untimely's version from 2015-05-15 05:33

Intro to derm continued

Question Answer
symmetrical/bilaterial 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) with a woods lamp, it will light up. BUT, not only is M. canis the only one 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 and 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, and it is broken off, it was most likely due to overgrooming and not something attacking at the root causing it to come out
what are two DDX for nodules?neoplasia or granuloma.
what are three diagnostic methods you can use to try to determine the etiology of lumps and 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 two things can you do to further charaterize the nodule? and what is one parasite which can cause 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 cause nodules
what are some ddx's you could think of for this presentation: moderate to severe alopeacia on ventrum, some on back of neck, and extremities. mild erythema. he's also puritic (slide 29)mites (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...first two are neg (saline) and pos (histamine) controls...wait about 15-20 min, and look for a visible reaction (usually a red spot, might be raised) and 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 increased production of allergen-specific IgE antibodies-- you can do serological testing to find these IgE Abs
SOAP--> which part does history fall under?S for subjective (history 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 objecive
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 Differentials +/-diagnosis 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 history??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, age, gender, color
what are some things you ask for in the H (health/health maintenance) of SHED-C?Endo-/ectoparasite control, Previous disease (individual or farm/household), Current Rx
which drugs can cause porphyria?tetracyclines
what are some things you ask for the E (environment) of SHED-C?hisbandry, bedding, indoor/outdoor, 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 milkbones?)
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 treatments & outcomes. (Which came first… the lesion or pruritus? If pruritic… itch score (scale of 0-10)? Is it seasonal?)
what are three things you can look at with a distant examination with a derm case?General body condition, Haircoat (unkept or groomed? shiny or dull? appropriate color?), lesion distribution
what are three things to consider about lesion distribution in a derm case?“predilection sites” (places where certain things like to be), Localized vs. generalized, Symmetric vs. assymetric
what is a predilection site for demodecosis?"raccoon eye" where there is alopecia and 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 and 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, lymphnodes, feet/hoofs/nails, OTOSCOPY (ears are an extension of the skin)
which acronym do you use for differentials?DAMNIT
what are the three 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 (first three are part of minimum database), therapeutic trial, allergy screen (intradermal, serology), culture and sensitivity, coat brushing, biopsy, wood's lamp, trichogram. (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, Rx, further dx, and determine a time for a recheck