Oral Medicine OSCE

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

what is this disease

Rubeola/mumps/measles

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. multiple apthous, Recurrent, painful mouth ulcers (canker sores), often appearing as multiple small or numerous ulcers on non-keratinized oral mucosa. Includes minor, major, or herpetiform types depending on size/severity.

2. Mild cases: topical corticosteroids (e.g., triamcinolone), pain relief (lidocaine/benzydamine), chlorhexidine mouthwash, correct iron/B12/folate deficiencies.Severe or persistent cases: systemic steroids, colchicine, dapsone, or specialist evaluation for underlying systemic disease.

3. group 2 less commonly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. kaposi sarcoma

2. antiretroviral therapy (ART)

3. group 1 strongly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. kaposi sarcoma

2. antiretroviral therapy (ART)

3. group 1 strongly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. kaposi sarcoma

2. antiretroviral therapy (ART)

3. group 1 strongly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. oral hairy leukoplakia

2. antiretroviral therapy (ART)

3. group 1 strongly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. oral candidiasis

2. Topical antifungals: nystatin suspension, clotrimazole troches. Severe/recurrent cases: systemic antifungals like fluconazole.

3. group 1 strongly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. Pseudomembraneous candidiasis

2. First-line: topical antifungals such as nystatin oral suspension or clotrimazole troches. Severe/recurrent cases: fluconazole orally.

3. group 1 strongly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. oral hairy leukoplakia

2. antiretroviral therapy (ART)

3. group 1 strongly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. linear gingiva erythema

2. Professional cleaning + meticulous oral hygiene, chlorhexidine mouth rinse, and often antifungal therapy if Candida is involved.

3. group 1 strongly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. NUG(necrotizing ulcerative gingivitis)

2. Immediate gentle debridement, chlorhexidine mouthwash, improved oral hygiene, pain control, and removal of contributing factors. Metronidazole may be used in severe cases or systemic involvement; ensure nutrition and hydration.

3. group 1 strongly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. Necrotizing ulcerative periodontitis

2. Urgent debridement, chlorhexidine rinses, pain control, and systemic antibiotics (commonly metronidazole). Intensive periodontal care, improved oral hygiene, nutritional support, and treatment of underlying immune suppression (e.g., HIV management).

3. group 1 strongly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. Necrotizing ulcerative periodontitis

2. Urgent debridement, chlorhexidine rinses, pain control, and systemic antibiotics (commonly metronidazole). Intensive periodontal care, improved oral hygiene, nutritional support, and treatment of underlying immune suppression (e.g., HIV management).

3. group 1 strongly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. Oral lymphoma

2. Requires urgent biopsy and oncologic diagnosis. Main treatment: chemotherapy ± radiotherapy depending on type/stage; HIV-associated cases also require antiretroviral therapy (ART).

3. group 1 strongly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. Human papilloma virus infection

2. Benign lesions: surgical excision, laser removal, cryotherapy, or observation depending on lesion type. Prevention: HPV vaccination and reducing transmission risk. Suspicious/persistent lesions require biopsy to rule out dysplasia or malignancy.

3. group 2 less commonly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. Pox virus infection

2. Often supportive care (pain control, hydration, hygiene); many lesions are self-limiting depending on the specific virus. Severe, extensive, or immunocompromised cases may need antiviral/specialist management depending on the poxvirus type.

3. group 3 possibly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. Parotid enlargement, salivary gland disease causing facial swelling and sometimes dry mouth.

2. Evaluate cause (infection, stones, tumors, autoimmune disease, HIV-related disease). HIV-related cases: antiretroviral therapy (ART), monitoring, aspiration/surgery if symptomatic, and xerostomia management.

3. Group 2 less commonly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. Recurrent herpes , Recurrent reactivation of Herpes Simplex Virus (usually HSV-1) causing repeated painful vesicles/ulcers, commonly on lips (herpes labialis) or oral mucosa.

2. Antivirals: acyclovir, valacyclovir, or famciclovir. Pain relief, hydration, and trigger avoidance (stress, trauma, sun exposure). Severe or chronic cases may need prolonged antiviral therapy.

3. Group 2 less commonly associated

1.what is this lesion?

2. how to treat/ manage it?

1. Squamous papilloma, A benign epithelial growth, usually caused by low-risk HPV types (6, 11), appearing as a small painless papillary or cauliflower-like oral lesion (common on tongue, palate, uvula).

2. Surgical excision is the standard treatment. Laser or cryotherapy may also be used. Biopsy confirms diagnosis and excludes dysplasia.

describe the pic

Gross specimen

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. Verruca vulgaris, A benign HPV-related lesion (commonly HPV 2, 4) that may occur orally as a painless, rough, papillary or verrucous growth, often on lips, tongue, or labial mucosa.

2. Surgical excision, laser, cryotherapy, or observation depending on size/location. Biopsy may be needed to confirm diagnosis.

3. Group 2 less commonly associated

1.what is this lesion?

2. how to treat/ manage it?

3. classification of oral lesion in HIV?

1. Condyloma accuminatum, A STI HPV-related lesion (commonly HPV 6, 11) presenting as soft, pink, multiple sessile papillary/cauliflower-like growths in the oral cavity.

2. Surgical excision, laser removal, cryotherapy, or other lesion-directed therapy. Biopsy may be needed, and sexual health evaluation is important due to STI association.

3. Group 2 less commonly associated

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