medicine osce

potentially malignant and fungal

what is this condition

acute pseudomembranous candidiasis (thrush)

what is this condition

pseudomembranous candidiasis

what is this condition

acute atrophic candidiasis

what is this condition

chronic atrophic candidiasis

what is this condition

angular chelitis

what is this condition

angular chelitis

what is this condition

angular stomatitis (perieche) stage 1

what is this condition

denture stomatitis (stage 2)

what is this condition

denture stomatitis (stage 2)

what is this condition

denture stomatitis (stage 3)

what is this condition

chronic hyperplastic candidiasis

what is this condition

chronic hyperplastic candidiasis

what is this condition

chronic hyperplastic candidiasis

what is this condition

chronic hyperplastic candidiasis

what is this condition

hyperplastic candidiasis

what is this condition

median rhomboid glossitis

what is this condition

candidal leukoplakia

what is this condition

chronic mucocutaneous candidiasis

what is this condition

chronic mucocutaneous candidiasis

what is this test, and what is it used for

pas stain » used to diagnose candida

what is this test called, and what is it used for

corn meal agar candidate growth » used to diagnose candida

what is this test called, and what is it used for

gram stain with hyphae and myceliae » used to diagnose candida

what is this condition

mucormycosis

what is this condition

actinic chelitis

what is this condition

oral submucous fibrosis

what is this condition

homogenous leukoplakia

what is this condition

non-homogenous oral leukoplakia

what is this condition

verrucous oral leukoplakia

what is this condition

erythroplakia

what is this condition

peri-oral melanosis

what is this condition

OSCC developed in plaque-like oral lichen plants

actinic chelitis features

• sun overexposed individuals

• smooth or scaly friable patch OR may involve entire lip

• palpably thick with small grey-white plaques

• develops into warty nodules » OSCC

management of actinic chelitis

• PREVENTION » esp for high risk (photosensitive, xeroderma pigmentosum, transplant)

• wearing broad brimmed hats

• use UV sunscreen

oral submucous fibrosis features

• betel quid chewers

• tightening of buccal, palatal and lingual mucosa

• trismuis

grade 1 oral submucous fibrosis

oral opening >35mm

grade 2 oral submucous fibrosis

oral opening 20-35mm

grade 3 oral submucous fibrosis

oral opening <20mm

grade 4 oral submucous fibrosis

oral opening <20mm + premalignant disease

grade 5 oral submucous fibrosis

oral opening <20mm + oral squamous cell carcinoma

which grades of OSMF should be sent for biopsy

grade 4 and 5

management of oral submucous fibrosis

• physiotherapy (jaw opening exercises) + correcting nutritional deficiencies (iron and vitamin B)

• cox-2 inhibitors » hyaluronidase, intralesional corticosteroids

• ineffective but may be used: surgery, placenta, interferon gamma

what is this device and what is it used for

• physic device for grade 1 and 2 OSMF

features of homogenous leukoplakia

• white

• well demarcated plaque

• identical pattern throughout entire lesion

features of non-homogenous leukoplakia

• white patches or plaques

• intermingled with red

features of verrucous leukoplakia

• white papillary projections

management of oral leukoplakia

• excision

• cessation of tobacco, betel, alcohol

• ineffective: physio, retinoids (temporary effect, only used if difficult to access), radio/chemo (because it isn’t malignant)

when to excise vs wait+watch oral leukoplakia

• no dysplasia » wait and watch

• mild dysplasia (buccal, hard palate, dorsal tongue) » wait or remove

• mild dysplasia (anywhere else) » remove

• moderate/severe dysplasia » remove

features of erythroplakia

• red lesion

• asymptomatic; sometimes burning sensation when eating

• reverse smoking chutta

peutz-jeghers syndrome features

• multiple small pigmented macule of lips + perineal skin, hands, feet

oral lichen plants features

risk of malignant transformation in oral mucosa, not necessary with lesion

local predisposing factors for candidiasis

• dentures

• smoking

• atrophic constitution

• inhalation steroids

• topical steroids hyperkeratosis

• oral microflora imbalance

• quality and quantity of saliva

general predisposing factors for candidiasis

• immunosuppressive diseases + drugs

• chemotherapy

• endocrine disorders

• hematinic deficiencies

features of acute pseudomembraneous candidiasis

• patchy white plaque/flecks

• scrapable

• rapid onset on bad taste + burning sensation

features of acute atrophic candidiasis

• red patch » atrophic or erythematous, painful

• minimal pseudomembrane

• patient likely to have iron deficiency anemia

stage 1 denture stomatitis // chronic atrophic candidiasis

numerous palatal petichae

stage 2 denture stomatitis // chronic atrophic candidiasis

diffuse erythema

stage 3 denture stomatitis // chronic atrophic candidiasis

tissue granulation or nodularity

management of denture stomatitis

• avoid dentures for some time

• soak denture in boric acid or house bleach

• apply nystatin anti fungal cream on fitting surface of denture

features of angular stomatitis (perleche) // angular chelitis

• red-fissured scales in angle of mouth

• older patient with reduce VDO

chronic hyperplastic candidiasis

• firm white leathery plaques

• cheeks, lips, palate, tongue

• stained with PAS

features of median rhomboid glossitis

• erythematous patch of atrophic papillae in central area of dorsum of tongue

features of chronic multifocal candidiasis

• ill fitting dentures

• dorsum of tongue, midline of palate, angular chelitis, denture bearing areas

features of chronic mucocutaneous candidiasis

• localized + diffuse » nails + skin

• syndrome associated » endocrine syndromes

treatment of candidiasis in infants

nystatin syrup 100k IU » 1mL 4×day 7-10 days

treatment of candidiasis in adults

• nystatin 1 tab 4xday 7 days (sucking) » if resistant extend for 21 days

• amphotericin B 100mg/mL 4x day

• itraconazole oral suspension » 100-200mg 1xday 2 weeks

• ketaconazole 200mg 1xday 2 weeks

• fluconazole 100mg 1xday 2 weeks

management of hiv associated candidiasis

• flucoconazole

• if resistant » itraconazole

features of mucormycosis

• maxillary sinus fills with microbial colonies + necrotic tissue

• destruction of osseous antral walls

• diabetes or immunocompromised