CPD SPOT DIAGNOSIS ,

Self-Recorded CPD: Spot Dx – Oral and Dental – DEN001

You can self-report this CPD/PDP activity by logging it online with the RACGP/ACRRM. The activity has been allocated 1 hour (0.5 hour EA and 0.5 hour RP). Certificates are not available for this CPD.

Test your clinical knowledge by taking the 6 quizzes below. If you select the wrong answer, have another go — you can try as many times as you like.

RACGP Activity Number: DEN001

ACRRM Activity Number: DEN001

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1. What’s causing these tongue blisters?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><span style=”font-size: 14px”>A 12-year-old male presents with a two-year history of altered appearance of the dorsal tongue, with occasional ‘blood blisters’. The area is not painful and does not interfere with speech, swallowing or eating. He has no significant past medical history and appears fit and well. Oral examination reveals multiple clear vesicular-like lesions, measuring 1-2 mm in diameter — with a few areas appearing blood filled, involving the mid-dorsal surface of the tongue. The tongue is soft, although somewhat enlarged in this area.</span></p></p> <ul> <li>a. Oral lymphangioma</li> <li>b. Mucous membrane pemphigoid.</li> <li>c. Oral haemangioma.</li> <li>d. Multiple mucocoeles.</li> </ul> </section> <p> </p> <p> </p> <p></p>

Author

Author: Dr Jacinta Vu is an oral medicine specialist and clinical senior lecturer at the University of WA Dental School, who practises in Perth, WA.

2. Is the answer on the tip of the tongue?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Jeremy, 32, is an account manager who’s had plaque psoriasis since adolescence, which he manages with topical steroids as needed.</strong><br><br><strong>He presents at the suggestion of his dentist, who noted the tongue findings pictured at a recent routine review. Jeremy was not aware of these lesions before this.</strong><br><br><strong>He is otherwise well, has no other medical history of note, takes no regular medications, does not smoke or use illicit drugs, and drinks alcohol socially.</strong><br><br><strong>Examination reveals thick scaly erythematous plaques on the extensor surfaces of elbows and knees with no evidence of joint or nail involvement. Oral examination reveals a reddish area on the tongue, 15mm in diameter, with absent filiform papillae (pictured, dotted arrow), and fissuring (pictured, black arrows).</strong></p></p> <ul> <li>a. Erythematous candidiasis</li> <li>b. Geographic and fissured tongue</li> <li>c. Lichen planus</li> <li>d. Erythroplakia</li> </ul> </section> <p> </p> <p></p>Photo: Reproduced from BMJ, Ota M; 379:e071453, 2022 with permission from BMJ Publishing Group Ltd.

Author

Author: Dr Paul Muthiah is a GP and a former medical co-editor of Australian Doctor.

3. What’s causing these sudden painful tongue lesions?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Davina, a 25-year-old dancer, presents with a one-week history of expanding painful vegetative lesions on her dorsal tongue and upper gingiva. She has also noticed some tiny yellow lesions on the tip of her tongue, with many also on her inner lips and cheeks.</strong></p><p><strong>She has used no new products and is apyrexial with an otherwise unremarkable physical examination. </strong></p><p><strong>Davina was diagnosed with ulcerative colitis three years ago; her symptoms have remained in a quiescent state since being on oral mesalazine. She takes no other regular medications and has no known drug allergies.</strong></p><p><strong>Mucosal biopsies are sent for histopathological assessment. These identify microabscesses within the epidermis alongside multiple eosinophils.</strong></p><p><strong>Direct immunofluorescence is negative (antibody test). </strong></p><p><strong>On blood tests, indirect immunofluorescence is negative, and a moderate eosinophilia is noted on her FBC. </strong></p><p><strong>Swabs of the lesions culture only normal oral flora.</strong></p></p> <ul> <li> a. Pyostomatitis vegetans (PSV)</li> <li>b. Bullous pemphigoid</li> <li>c. Herpes simplex (HSV)</li> <li>d. Pemphigus vulgaris (PV)</li> </ul> </section> <p></p>

Author

Author: Dr Paul Muthiah is a GP and a former medical co-editor of Australian Doctor.

4. What’s causing this facial swelling and ulceration?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Ken, 19 years old, attends complaining of several weeks’ history of recurrent left facial swelling over the left angle of the mandible. The swelling lasts for about a week before resolving and is not painful. Ken denies any fever or systemic symptoms. He does note that his left third molar is erupting. His medical history is unremarkable, and he does not have any known allergies. He has never smoked and does not consume alcohol regularly.</strong></p><p><strong>Extra-oral examination demonstrates a mild soft swelling over the left angle of the mandible. There is no erythema, and the area is not hot. Intra-oral examination demonstrates deep linear ulcers along the left buccal sulcus and gingival tissues of the left mandibular first and second molars. The left third molar is partially erupted, and the operculum does not appear to be inflamed. CT of the mandible does not demonstrate any pericoronal or periapical pathology associated with the third molar, but a diffuse non-specific soft tissue swelling is noted in the buccal sulcus and mucosa adjacent to the left mandibular molars.</strong></p></p> <ul> <li>a. Pericoronitis of the left mandibular third molar.</li> <li>b. Recurrent aphthous ulcers.</li> <li>c. Angiodema.</li> <li>d. Orofacial granulomatosis.</li> </ul> </section> <p></p>

Author

Author: Dr Jacinta Vu is an oral medicine specialist and clinical senior lecturer at the University of WA Dental School, who practises in Perth, WA.

5. Why does this lesion keep coming back?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Ryan, a 60-year-old bus driver, presents asking for a second opinion regarding a recurrent lesion on his chin. He reports that, over the past six months, a pimple has been forming on his chin in a cyclical pattern. The pimple ruptures and releases pus. Within five days, the lesion stops discharging and then forms a scab-like lesion (pictured). Within two months, the cycle repeats itself. Ryan has seen his GP three times for this and has been issued amoxicillin and clavulanate, metronidazole, and cefalexin. Each of these seemed to help in the short term, but the cycle continues and has resulted in growing frustration. Ryan has no medical history and takes no medications. He reports no facial or dental pain. He has recently stopped using a razor for shaving and instead now uses a beard trimmer, but this has not helped.</strong></p></p> <ul> <li>a. Cutaneous melanoma</li> <li>b. Pyogenic granuloma</li> <li>c. Dental sinus</li> <li>d. Folliculitis</li> </ul> </section> <p></p>Photo: Dermnet NZ

Author

Author: Dr Paul Muthiah is a GP and a former medical co-editor of Australian Doctor.

6. Does something sinister lie beneath?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Melissa, 38 years old, complains of a two-week history of a left<br>palatal swelling, initially associated with a severe burning, stabbing pain. In the past three days, the pain has resolved, and she now reports there is a ‘hole’ in the area. She cannot recall any trauma and is systemically well. Her medical history is unremarkable, and she has no known allergies. She has never smoked and does not consume alcohol. Oral examination reveals an 8mm crater-like ulcer involving the left hard palate. There is no evidence of regional cervical lymphadenopathy, and examination is otherwise unremarkable.</strong></p></p> <ul> <li>a. Lymphoma</li> <li>b. Oral SCC</li> <li>c. Necrotising sialometaplasia</li> <li>d. Erythroplakia</li> </ul> </section> <p></p>

Author

Author: Dr Jacinta Vu is an oral medicine specialist and clinical senior lecturer at the University of WA Dental School, who practises in Perth, WA.

References on request from kate.kelso@adg.com.au