ࡱ> q` lbjbjqPqP ::k7:::::::$^P^I(p$qhf:::$p::>P::b @UN <I?? b?:b`'dI^^0BC$Df$@^^BCf^^^::::::  Australian College of Veterinary Scientists Fellowship Examination June/July 2009 Veterinary Dermatology Paper 1 Structure and Function Perusal time: twenty (20) minutes Time allowed: four (4) hours after perusal Answer five (5) from the six questions only All questions are of equal value (20 marks per question) Subsections of questions are of equal value unless stated otherwise Paper 1: Veterinary dermatology Answer five (5) from the six questions only. 1. a) Draw and label the structure of the canine desmosome. 5 marks b) Briefly describe, in table format, the pathogenesis of both autoimmune and non-autoimmune diseases targeting the desmosome in humans, dogs, horses, pigs and cattle. 15 marks 2. a) Describe the process of epidermal differentiation and cornification. 17 marks b) Briefly discuss the evidence for barrier dysfunction in canine atopic dermatitis. 3 marks 3 a) List the resident and transient bacterial flora of the skin of the dog and cat 5 marks b) Describe the innate defence mechanisms of the skin of both humans and animals against bacterial overgrowth. 15 marks 4. Describe the hair follicle cycle. Include in your answer the intrinsic and extrinsic factors (including drugs) that can influence this cycle. 20 marks Continued over page 5. a) Describe the development of immunological self-tolerance. 10 marks b) Describe the mechanisms leading to a loss of self tolerance and subsequent auto-immunity. 10 marks 6. Question six is to be answered in the attached booklet.  Australian College of Veterinary Scientists Fellowship Examination June/July 2009 Veterinary Dermatology Paper 1 Question 6 25 Multiple choice questions Answer all of the following questions Circle only one (1) answer for each question. Circling more than one (1) answer in the same question will be marked incorrect. 0.8 of a mark is gained for a correct answer. There is no penalty for incorrect answers. Question 6. 25 Multiple choice questions Answer all the following questions Circle one (1) answer for each question only. Circling more than one (1) answer in the same question will be marked incorrect. 0.8 of a mark is gained for a correct answer. There is no penalty for incorrect answers. 1. Which cytokeratins have been identified in the normal canine epidermis? 1, 4, 5, 6, 10/11, 14 & 16 1, 2, 4, 5, 6, 10/11, 14 & 16 1, 2, 5, 9, 10, 11, 14 1, 4, 5, 6, 9, 10/11, 14 & 16 None of the above are completely correct. 2. Which of the following cytokines do activated keratinocytes not produce? Interleukin1 Interleukin2 Interleukin8 Interleukin10 Interleukin12. Continued over page 3. What facts regarding Merkels cells are true? Merkel's cells are epidermal clear cells confined to or near the basal cell layer. Merkel's cells occur only in tylotrich pads and in the bulge region of the hair follicle. Merkel's cells contain a large cytoplasmic vacuole that displaces the cell nucleus dorsally. Merkel's cells contain cytokeratin, neurofilaments and neuron-specific enolase, suggesting a dual epithelial and neural differentiation. All of the above. 4. Which of the following is not a potent mitogen for melanocytes? UV radiation Transforming growth factor- -fibroblast growth factor Stem cell factor None of the above. 5. 3-hydroxysteroid dehydrogenase is an important enzyme in steroid production. Which of the following reactions does it catalyse? Progesterone ( 17 hydroxyprogesterone Dihydroepiandrosterone ( androstenedione Pregnenolone (17 hydroxypregnenolone 11 deoxycortisol ( cortisol a and c above. Continued over page 6. Regarding the biosynthesis of collagen: Zinc is a cofactor for lysyl oxidase. Vitamin C and copper are cofactors for prolyl hydroxylase. Vitamin C and copper are cofactors for lysyl hydroxylase. Iron is a cofactor for collagen galactosyl transferase and collagen glucosyl transferase. None of the above are true. 7. Which one (1) of the following regarding elastin fibres is true? Tropoelastin is entirely hydrophilic. Crosslink structures include desmosine and isodesmosine. Similar to collagen, 4hydroxyproline is required for synthesis of elastin. Synthesis only occurs in fibroblasts. a and b above are both true. 8. Regarding matrix metalloproteases (MMPs) 2 and 9, which of the following is not correct: They are both members of gelatinase class of MMPs. They can both cleave collagen IV. They both play a role in chemokine regulation, and establishments of chemokine gradients. Both are implicated in tumour angiogenesis, with more evidence for MMP-9. Both are copper dependent proteinases. Continued over page 9. Which one (1) of the following regarding polymodal nociceptor units and C fibres is not correct? C fibres are myelinated and conduct at 10-20 m/s. They are the classic pain receptors, responding to intense mechanical and thermal stimuli. They are involved with hyperalgia and itch. They are indirectly responsible for the flare around skin injuries. They are particularly vulnerable to metabolic injury. 10. Which of the following are correct with respect to angiogenesis? Fibroblast growth factors (FGFs) are angiogenic activators. Thrombospondin 1 (TSP-1) is an angiogenic activator. Placental growth factor (PlGF) is an angiogenic activator. Transforming growth factor- (TGF-) is an angiogenic activator. a, c and d above. 11. Which of the following is incorrect with respect to heat dissipation? Sweating is the primary mechanism of heat dissipation in cattle and horses. At high temperatures 75% of heat loss is attributable to radiation, conduction and convection. In dogs, as the environmental temperature rises above 27-29C, the rate of breathing increases but the tidal volume decreases. In cats, as the environmental temperature rises above 32C, the rate of breathing increases but the tidal volume decreases marginally. Pigs and humans both have extensive superficial arteriovenous shunts to help disseminate heat. Continued over page 12. Which of the following integrins is not upregulated in keratinocytes during wound healing? 64 31 v5 v6 21. 13. Which of the following have not been reported to directly mediate pruritus? Acetylcholine Interleukin 1 Calcitonin gene-related peptide Substance P Tryptase. 14. Which of the following hormone(s) are not released from the hypothalamus or pituitary? Thyroid stimulating hormone Growth hormone releasing factor Thyrotropin inhibiting factor  melanocyte stimulating hormone c and d above. Continued over page 15. Which of the following regarding IgA is incorrect? IgA is produced in larger amounts than any other antibody isotype. Serum IgA can bind to CD89 (FCRI) on neutrophils. IgA is secreted prior to transport across mucosal surfaces as a dimmer connected by a J chain. The entire poly-Ig receptor is cleaved at the mucosal surface allowing the IgA to be secreted. Following secretion IgA functions to coat microbes and prevent attachment to mucosal surfaces. 16. Which of the following regarding IgE is incorrect? Canine IgE is inactivated after heating to 56C for 4-6 hours. Interleukin4 and interleukin8 can stimulate B cell isotype switching to IgE production. FcRI is the high affinity IgE receptor and in dogs is constitutively expressed on mast cells, basophils and Langerhans cells. IgE can trigger eosinophil mediated antibody-dependent cell-mediated cytotoxicity via FcRI. Interferon  downregulates B cell isotype switching to IgE production. 17. Which of the following are considered as major dust mite allergens in dogs? Der f 1 Der f 10 Der f 15 Der f 18 c and d above. Continued over page 18. Which of the following is incorrect regarding staphylococcal enterotoxins? Staphylococcal enterotoxins A (SEA), SEB, SEC and SED have been isolated from various Staphylococcus intermedius strains. S. intermedius SEA and SEB have demonstrated potent blastogenic effects on canine blood mononuclear cells in vitro. Staphylococcal enterotoxins bind to the V region of the T cell receptor. Staphylococcal enterotoxins bind to class II major histocompatibility complex (MHC) molecules without intracellular processing and away from the peptide binding cleft. Staphyloccal enterotoxin molecules each possess two binding sites for class II MHC molecules. 19. Which of the following is incorrect regarding  T cell receptors (TCR)? Each  and  chain has one V domain and one C domain. There are three hypervariable regions in each chain essential for antigen-major histocompatibility complex (Ag-MHC) binding. Associated CD3 is important for further binding of MHC as the affinity of the TCR for Ag-MHC is low.  protein is important for transducing the signals leading to T cell activation following binding of Ag-MHC. All  TCR expressing cells are MHC restricted and express either CD4 or CD8 coreceptors. Continued over page 20. Which of the following sets of cytokines are typically associated with TH2 T helper cells? Interleukin 2 (IL 2), interferon  IL 4, IL 5, IL 7, IL 10, IL 12, IL 18 IL 4, IL 5, IL 9, IL 10, IL 13 IL 4, IL 5, IL 6, IL 9, IL 10, IL 13 IL 4, IL 5, IL 6, IL 9, IL 10, IL 12. 21. Which of the following regarding T cell activation is correct? Complete interleukin 2c receptors are only expressed in activated T cells. CTLA4 is a T cell accessory molecule that when bound to B71 or B72 on antigen presenting cells enhances many T cell responses to antigen. NFAT is a transcription factor activated in response to TCR signals but is not essential for subsequent synthesis of IL2. T cell activation is associated with a decrease in cytosolic calcium. None of the above. 22. Which of the following molecule sets is expressed on Langerhans cells? CD1a, CD1b, CD1c, MHC class II, CD11c, E-cadherin CD1a, CD1b, CD1c, MHC class II, CD11c, CD4, Thy1/CD90 CD 11d, CD18, MHC class II CD1a, CD1b, CD1c, MHC class II, CD 11c, Thy1/CD90, Ecadherin CD1a, CD1b, CD1c, MHC class II, CD 11c, Eselectin. Continued over page 23. Mast cells may be degranulated by numerous mechanisms. Which of the following has not been reported to induce mast cell degranulation? Compound 40/80 Substance P Cathepsin G Anti-FcRI antibodies Bee venom. 24. Which of the following is not an effect of interleukin 10? Decreased eosinophil function Decreased IgG4 production Increased IgA production Inhibition of interleukin 12 from activated macrophages Inhibition of class II MHC molecules on macrophages. 25. Which of the following regarding complement is incorrect? Complement activation may also be triggered by binding of microbial polysacharrides to circulating lectins. Formation of the membrane attack complex is inhibited by CD59 on normal host cells. C5a can induce degranulation of mast cells and increase vascular permeability. C1 can bind to Fc regions of soluble and antigen bound IgG and antigen bound IgM to initiate the classical pathway of complement activation . Properdin can stabilise the C3bBb complex on microbial cells. End of paper  Australian College of Veterinary Scientists Fellowship Examination June/July 2009 Veterinary Dermatology Paper 2 Perusal time: twenty (20) minutes Time allowed: four (4) hours after perusal Answer five (5) from the six questions only All questions are of equal value (20 marks per question) Subsections of questions are of equal value unless stated otherwise Paper 2: Veterinary dermatology Answer five (5) from the six questions only. 1. Describe each of the following: The mechanisms of injury and effects to the skin caused by ultraviolet radiation. 10 marks The location and type of clinical lesions associated with both acute and chronic ultraviolet exposure in the dog. 5 marks The characteristic histological changes observed with acute and chronic ultraviolet light exposure in the dog. 5 marks 2 . Write short notes on four (4) of the following. Each question of equal marks (total 20 marks) Describe the mechanism of action of selamectin. Contrast the pharmacokinetics of selamectin in the dog and the cat. List the clinical indications for the use of selamectin in the dog and cat. Briefly contrast the physical and chemical properties of ointments and creams and list where these may be used in the management of skin disease of the dog. Describe the pharmacokinetics, mechanism of action and list the clinical indications for the use of terbinafine in the management of skin diseases of the cat. Describe the mechanism of action and pharmacokinetics of enrofloxacin and list the clinical indications for the use of this antibiotic in the management of skin diseases in the dog. Describe the mechanism of action of CCNU (Lomustine) and list the clinical indications and potential adverse events of this drug in dogs. Continued over page 3. A 9-year-old thoroughbred horse presents with multifocal areas of alopecia and scaling associated with moderate levels of pruritic behaviour. The lesions involve the face, neck, thorax and proximal limbs and have been slowly progressing over the last four weeks. List your differential diagnoses. 5 marks Describe your diagnostic approach. 13 marks Describe the treatment options and prognosis for your most likely diagnosis. 2 marks 4. Write short notes on four (4) of the following. Each question of equal marks (total 20 marks) Facial eczema in sheep Heritable equine regional dermal asthenia Feline cutaneous herpes Symmetrical androgenic alopecia in ferrets Facial tumours of Tasmanian Devils. 5. A 10-year- old DSH cat presents with multifocal, papulonodular dermatitis affecting the dorsal muzzle, pinnae and trunk. The lesions are variably alopecic with an intact epithelial surface. What is your differential list? Include diseases exotic to Australia. 5 marks Describe your diagnostic approach. 10 marks If your diagnosis in this cat was feline leprosy, describe your treatment options and prognosis. 5 marks 6. Question six is to be answered in the attached booklet.  Australian College of Veterinary Scientists Fellowship Examination June/July 2009 Veterinary Dermatology Paper 2 Question 6 25 Multiple choice questions Answer all of the following questions Circle only one (1) answer for each question. Circling more than one (1) answer in the same question will be marked incorrect. 0.8 of a mark is gained for a correct answer. There is no penalty for incorrect answers. Question 6. 25 Multiple choice questions Answer all the following questions Circle one (1) answer for each question only. Circling more than one (1) answer in the same question will be marked incorrect. 0.8 of a mark is gained for a correct answer. There is no penalty for incorrect answers. 1. Pseudomonas aeruginosa resistance mechanisms have been studied in isolates from dogs. Which of the following is incorrect? Mutation in the gyrA gene that encodes for the A subunit of DNA gyrase is a mechanism for resistance to fluoroquinolones. Mutation in the parC gene that encodes for the subunit A of topoisomerase IV is a mechanism for resistance to fluoroquinolones. Mutation in the parD gene that encodes for the subunit B of topoisomerase IV is a mechanism for resistance to fluoroquinolones. Overexpression of drug efflux pumps is a mechanism for resistance to fluoroquinolones. The impact of drug efflux pumps on different fluoroquinolones was correlated with lipophilicity of the fluoroquinolone. 2. Based on a recent study, acral lick granulomas are commonly infected. Which of the following is incorrect? Deep bacterial culture was positive in 94% of clinical cases. A single case was reported with Microsporum gypseum isolated on superficial culture. Complete agreement between deep tissue and superficial cultures occurred in 36% of cases. Morphology of bacteria identified on surface cytology matched with superficial culture results in 64% of cases. Demodex canis were found on biopsy in 12% of cases. Continued over page 3. Which of the following clinical signs has not been reported with canine leishmaniosis? muscle wastage endocarditis generalised lymphadenopathy nasal depigmentation systemic vasculitis. 4. With regard to dermatophytes, which of the following is incorrect? Terbinafine has been used with success in the medical treatment of dermatophytic mycetoma. Keratinolytic protease subtilisin 3 is likely involved in adherence of Microsporum canis (M. canis) arthroconidia to feline keratinocytes. M. canis strains with the highest keratinolytic activities in vitro are responsible for more symptomatic infections in dogs and cats. The protective response against dermatophytosis is a cell-mediated delayed type hypersensitivity with macrophages as key effector cells. Woods lamp examination for fluorescence causes certain strains of M. canis only to produce a positive yellow-green colour on infected hairs. Continued over page 5. With respect to Demodex mites and demodicosis in veterinary species, which of the following is incorrect? Demodicosis has been reported in kangaroos. In cats there is good evidence to recommend 2% lime sulphur dips once a week and fair evidence for the use of amitraz rinses at 0.01250.025% once a week and doramectin 600ug/kg once a week by subcutaneous injection. In a SCID-mouse model D. canis was able to proliferate in the canine and hamster skin xenografts, but not murine allografts. Terrier breeds appear predisposed to infestation by D. injai. Demodicosis has been reported in koalas. 6. Which of the following regarding flea biology and treatment is incorrect? Up to 89% of cat fleas are blood fed within five minutes of finding a host. 89% of fleas placed on cats 6 days after application of imidacloprid consumed blood prior to death. In cats treated with oral nitenpyram there was at least 98.37% reduction in blood consumption compared with fleas placed on untreated controls. Imidacloprid provided 100% reduction in flea egg production at 13 days post treatment on cats but on days 2731 post treatment flea egg production ranged from 73.796.7%. Selamectin has shown to produce a 72.385.6% reduction in flea egg production up to Day 23 post treatment. Continued over page 7. With respect to Malassezia, which of the following reported findings is incorrect? Atopic dogs, with or without cytological evidence of M. pachydermatis overgrowth have significantly higher serum titres of Malassezia-specific IgG than healthy dogs as measured by ELISA. Higher concentrations of Malassezia-specific IgE measured by ELISA are detectable in atopic dogs with or without Malassezia dermatitis and/or otitis, than healthy dogs or non-atopic dogs with Malassezia overgrowth of the skin and/or ear canals. No significant difference in Malassezia-specific IgE measured by ELISA was seen between atopic dogs without Malassezia infection, and atopic dogs with Malassezia dermatitis and/or otitis. No significant difference in reactions to Malassezia extracts by intradermal test was seen between atopic dogs without Malassezia infection, and atopic dogs with Malassezia dermatitis and/or otitis. Serum titres of Malassezia-specific IgG and IgA in seborrhoeic Bassett Hounds and other breeds with higher skin colonisation of M. pachydermatitis. 8. Which of the following regarding IgE-reactive antigens in spontaneously food allergic dogs with pruritus is incorrect? Bovine serum albumin has been identified as an IgE-reactive antigen. Bovine IgG has been identified as an IgE-reactive antigen. Ovine phosphoglucomutase has been identified as an IgE-reactive antigen. Casein has been identified as an IgE-reactive antigen. Identified IgE-antigens have been between 2766 kDa in mass. Continued over page 9. Which of the following has not been reported as a possible cutaneous adverse drug reaction in dogs? panniculitis pemphigus vulgaris bullous pemphigoid mucous membrane pemphigoid superficial suppurative necrolytic dermatitis. 10. Which of the following is incorrect with regard to canine mucous membrane pemphigoid? Histopathology shows the lamina densa on the roof of dermoepidermal clefts. Immunoreactivity to the NC16A of collagen XVII (BP180) peptide has been reported. Immunoreactivity to the carboxy terminus of collagen XVII (BP180) has been reported. Immunoreactivity to the BP230 has been reported. Indirect immunofluorescence using a salt-split substrate can show deposition of IgG on the epidermal side of the split. Continued over page 11. Which of the following is incorrect with regard to erythema multiforme (EM)? In dogs, dietary allergens have been reported as a possible trigger for disease. In dogs, parvovirus has been reported as a possible trigger for disease. In dogs, the clinical criteria for EM major are erythematous patchy lesions with ulcerations on less than 10% of the body surface and one or less mucosa affected. In humans, EM is associated with elevated expression of Fas ligand in keratinocytes. In cats, human intravenous immunoglobulins have been used for successful treatment of EM. 12. Which of the following heritable epidermal diseases is not correctly matched to its defective molecule? Epidermolytic ichthyosis of Norfolk terriers/keratin 10 Nonepidermolytic (lamellar) ichthyosis of Jack Russell Terrier/transglutaminase 1 Hailey-Hailey disease/SERCA2 Non-lethal junctional epidermolysis bullosa of German shorthaired pointers / laminin-5 Netherton Syndrome/LETKI. 13. Which of the following regarding Chediak-Higashi syndrome is incorrect? It is associated with abnormal platelet function and photophobia. In cats it has only been reported in blue-smoke Persians and in cattle only Herefords. A mutation in CHS1, a lysosomal trafficking regulator has been identified as the likely cause for this disease in humans, mice and cattle. It is associated with decreased bactericidal activity of leukocytes. It is associated with formation of macromelanosomes in hairs. Continued over page 14. Which of the following has not been reported as a clinical sign associated with inherited occipital hypoplasia/syringomyelia (similar to Chiari type I in humans) in dogs? scoliosis towards the side of the lesion persistent scratching of the neck and shoulder region unilaterally, often when walking unilateral thoracic limb lower motor neuron dysfunction spine and limb-associated hyperaesthesia apparent pain. 15. Which of the following regarding zinc, zinc metabolism and zinc related diseases in animals and humans, is incorrect? Zinc deficiency can produce greying of the hair in dogs. The main gene families of zinc transporters identified are Zip (which decreases intracellular zinc) and ZnT (which increases intracellular zinc). High calcium diets can interfere with zinc absorption. Iron supplementation may interfere with zinc absorption. High cereal diets can inhibit zinc absorption. Continued over page 16. Which of the following regarding papillomavirus is incorrect? Bovine papillomavirus has been associated with cutaneous fibropapillomas (feline sarcoids) in cats. Sessile cutaneous hyperkeratotic plaques in cats have been associated with feline papillomavirus-1. Papillomaviruses with homology with human papillomavirus-9 have been associated with feline cutaneous viral papilloma. Papillomavirus was isolated from 100% of bowenoid in situ carcinomas in a recent study of cats. Papillomavirus has been isolated in greater than 30% of normal and non-squamous cell carcinoma samples. 17. The Vaccine-Associated Feline Sarcoma Task Force has recommended that masses at vaccine sites be treated if the mass is: evident >3 months after vaccination > 2cm diameter increasing in size >4 weeks after vaccine administration either a, b or c neither a, b or c. Continued over page 18. Which of the following regarding epitheliotophic cutaneous lymphoma (ECL) is incorrect? Neoplastic T-cells consistently express CD3 in canine ECL. Neoplastic T-cells express CD8 in approximately 80% of cases of canine ECL. 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