Oral Medicine OSCE (extended version)

what is this lesion and how is it caused

herpetic whitlow

direct contact with an infected lesion without gloves

what is this lesion

acute herpetic gingivostomatitis

what is this lesion associated with and what are they called

acute herpetic gingivostomatitis

vesicles on the tonsilar pillars

what is this lesion and what is it associated with

acute marginal gingivitis

HSV 1

what is this lesion and what is it associated with

Acute marginal gingivitis

HSV-1

what is this lesion and what is it associated with

acute generalized gingivitis

HSV 1

what is this lesion

recurrent intraoral herpes simplex

vesicles/ulcers

what is this lesion

herpes labialis

vesicles

what is this lesion

recurrent intraoral herpes simplex

vesicles

what is this lesion associated with and how did it form

recurrent intraoral herpes simplex

coaslesced vesicles

what are these cells called and which disease can you see these cells

multinucleated giant cells

herpes simplex virus

what is this medicine used for and what is the dose

herpes simplex virus

Acyclovir suspensions/ cream 5g 5 times a day

what is this medicine used for and what is the dose

Acyclovir (Zovirax) - Herpes simplex virus

400 mg TID (3x a day) × 7days

what is this medicine and what is the dose

penciclovir 1% - Herpes Simplex Virus

every 2 hours

what are these lesions associated with

Herpangina - Coxsackie A4

what are these lesions associated with

Acute lymphonodular pharyngitis - Coxsackie A10

what is this lesion and what is it associated with

oral vesicle/ulcer

hand foot and mouth disease - A16

what are these lesions associated with

hand foot and mouth disease

what are these lesions associated with

hand foot and mouth disease

what is this lesion associated with and why is it black

shingles/herpes zoster

the vesicles turned into ulcers which turned into scabs

what are these lesions associated with and what is it called

shingles/herpes zoster

post-herpetic neuralgia

what are these lesions associated with

herpes zoster/shingles

post-herpetic neuralgia

what is this lesion associated with

herpes zoster/shingles

post-herpetic neuralgia (spinal nerve)

what virus is this lesion associated with and how do you determine?

Herpes Zoster (shingles)

the lesion doesnt cross the midline

what is this lesion called and what virus is it associated with

oral hairy leukoplakia

Epstein-Barr virus

what is this associated with

pharyngitis and tonsilitis

infectious mononucleosis/glandular fever

epstein barr virus

what are these lesions associated with

Infectious mononucleosis/glandular fever

Epstein Barr Virus

what are these lesions associated with

Rubeola/measles

what are these cells and what are they associated with

Downey cells - atypical lymphocytes

infectious mononucleosis/EBV

Viral infections causing oral ulceration

HSV-1, HSV-2, Varicella zoster virus

Human herpes viruses list

HSV-1, HSV-2, VZV (HHV-3), CMV, EBV (HHV-4), HHV-6, HHV-7, HHV-8

HSV-1 common locations

Above the waist

HSV-2 common infection

Genital infection, venereal transmission, mother to newborn

Peak age of primary HSV-1 infection

2–3 years

Herpetic whitlow definition

HSV infection of fingers from direct contact (e.g., dentist without gloves)

Prodromal symptoms of primary oral herpes

Fever, headache, malaise, nausea, vomiting (1–2 days before)

Initial lesion of primary oral herpes

Small thin-walled vesicles like drops of dew on inflammatory base

What happens to HSV vesicles

They rupture → shallow round ulcers → coalesce into larger irregular lesions

Key diagnostic sign of primary HSV

Generalized acute marginal gingivitis with edematous inflamed gingiva

Vesicle size in HSV lesions

1–3 mm diameter

HSV intraoral predilection site

Heavily keratinized gingiva

Acute herpetic gingivostomatitis age

6 months – 5 years (peak 2–3 years)

Why HSV rare before 6 months

Maternal anti-HSV antibodies protection

Systemic signs of acute herpetic gingivostomatitis

Anterior cervical LN, chills, fever 103–105°F, sore throat, malaise, headache

Location of vesicles in acute herpetic gingivostomatitis

Tonsils and posterior pharynx

Recurrent HSV definition

Reactivation of latent virus, not reinfection

Triggers for recurrent HSV

Trauma, fever, immunosuppression, menstruation

Lab diagnosis cytology finding HSV

Multinucleated giant cells and ballooning degeneration

Stains used for HSV cytology

Giemsa, Wright’s, Papanicolaou

Most definitive HSV test

Virus isolation in tissue culture

Antibody titer significance in HSV

4-fold rise indicates primary infection

Drug of choice for HSV

Acyclovir within 72 hours

Acyclovir dose systemic HSV

400 mg TID for 7 days

Topical acyclovir concentration

5% ointment every 3 hours during day

Topical anesthetic for HSV

Dyclonine hydrochloride 0.5%

Diphenhydramine mixture for HSV

Diphenhydramine 5 mg/ml + milk of magnesia

What must be avoided in HSV

Corticosteroids contraindicated

Supportive care HSV

Analgesics, hydration, antipyretics

Drugs reducing HSV pain

Gabapentin, carbamazepine, phenytoin

Mechanism of acyclovir

Incorporates into viral DNA and stops chain elongation

Other antivirals for HSV

Valacyclovir, vidarabine

Coxsackie virus type

RNA virus

Coxsackie groups

Group A and Group B

Oral infections mainly caused by

Coxsackie Group A

Three Coxsackie oral diseases

Herpangina, Hand-foot-mouth disease, Acute lymphonodular pharyngitis

Herpangina season

June to October epidemics

Herpangina age

3–10 years

Herpangina incubation

2–10 days

Herpangina symptoms

Fever, chills, anorexia, sore throat, dysphagia

Herpangina lesion sites

Posterior pharynx, tonsils, faucial pillars, soft palate

Herpangina less common sites

Buccal mucosa, tongue, hard palate

Herpangina ulcer size

1–2 mm ulcers after rupture

Cytology difference herpangina vs HSV

No multinucleated giant cells or ballooning degeneration

Herpangina treatment

Self-limiting, hydration, topical anesthesia

Acute lymphonodular pharyngitis virus

Coxsackie A10

Lesion in lymphonodular pharyngitis

Yellow-white nodules, no vesicles or ulcers

HFMD (hand foot and mouth disease) oral findings

Vesicles and ulcers

HFMD skin findings

Non-pruritic macules, papules, vesicles on hands and feet extensor surfaces

HFMD complications

CNS involvement, myocarditis

VZV other name

HHV-3

VZV primary disease

Chickenpox (varicella)

VZV reactivation disease

Shingles (herpes zoster)

Chickenpox incubation

14 days

Where VZV remains latent

Dorsal root ganglia and cranial nerve ganglia

Who gets herpes zoster

Elderly, immunosuppressed, HIV, immunosuppressive therapy

Herpes zoster prodromal period

2–4 days pain/tingling

Herpes zoster lesion pattern

Unilateral vesicles along single dermatome

Healing time herpes zoster

Scab in 1 week, heals in 2–3 weeks

Most common complication HZ (herpes zoster)

Post herpetic neuralgia (PHN)

Oral HZ involvement

Division of trigeminal nerve

Ramsay Hunt syndrome definition

Geniculate ganglion HZ + Bell’s palsy + ear and oral vesicles

Topical Post-herpetic neuralgia relief

Lidocaine, capsaicin

EMLA cream use

Topical anesthetic for PHN

Capsaicin mechanism

Depletes substance P neurotransmitter

Drugs for PHN

Amitriptyline, nortriptyline, doxepin, desipramine

Most reliable VZV test

Fluorescent antibody stained smear

VZV antiviral dose

Acyclovir 800 mg five times/day for 1 week

EBV other name

HHV-4