MFDS Oral Medicine

Question 1

A 55-year-old female presents with bilateral white lace-like striations on the buccal mucosa with areas of erythema and ulceration. She reports episodes of soreness. What is the most likely diagnosis?

Accepted Answer

Oral lichen planus

Answer

The bilateral white lace-like striations (Wickham's striae) on the buccal mucosa with areas of erythema and erosion are characteristic of oral lichen planus. This chronic mucocutaneous condition affects approximately 1-2% of the population, predominantly middle-aged women. The reticular form is the most common pattern, while the erosive form causes the most symptoms. It requires long-term monitoring due to a small malignant transformation risk (approximately 1-2%).

Question 2

A patient presents with a painful, solitary ulcer on the lateral border of the tongue that has been present for three weeks. There is no obvious local cause. What is the most important next step?

Accepted Answer

Arrange an urgent two-week-wait referral for biopsy to exclude malignancy

Answer

A solitary ulcer on the lateral border of the tongue persisting for more than three weeks without an identifiable local cause (such as a sharp tooth or denture) requires urgent investigation to exclude squamous cell carcinoma. Under NICE guidelines, this warrants a two-week-wait urgent referral. The lateral border of the tongue is the most common intraoral site for oral squamous cell carcinoma.

Question 3

Which of the following conditions is MOST commonly associated with a geographic tongue (erythema migrans)?

Accepted Answer

Psoriasis

Answer

Geographic tongue (erythema migrans/benign migratory glossitis) shows a strong association with psoriasis, and some authorities consider it an oral manifestation of psoriasis. Both conditions share histopathological similarities including spongiform pustulation. Other associations include fissured tongue and atopy. Geographic tongue is benign, affecting 1-3% of the population, and is characterised by migratory areas of depapillation with raised white borders.

Question 4

A patient with a history of coeliac disease presents with recurrent aphthous ulceration and angular cheilitis. Blood tests reveal a haemoglobin of 10.2 g/dL. Which deficiency is most likely contributing to the oral manifestations?

Accepted Answer

Iron deficiency secondary to malabsorption

Answer

Coeliac disease causes malabsorption of iron, folate, and vitamin B12 from the proximal small intestine. Iron deficiency is the most common cause of anaemia in coeliac disease and commonly manifests orally as recurrent aphthous ulceration, angular cheilitis, glossitis (smooth, depapillated tongue), and oral mucosal atrophy. The combination of oral signs with anaemia in a coeliac patient strongly suggests iron deficiency.

Question 5

A 70-year-old male who wears a complete upper denture presents with erythema confined to the denture-bearing area of the palate. He is otherwise asymptomatic. What is the most likely diagnosis?

Accepted Answer

Erythematous candidiasis (denture stomatitis)

Answer

Denture stomatitis (chronic erythematous candidiasis) is the most common form of oral candidiasis, classified by Newton into three types: I (pinpoint hyperaemia), II (diffuse erythema of the denture-bearing mucosa), and III (granular/papillary hyperplasia). It is caused by Candida albicans colonising the fitting surface of the denture. Management includes denture hygiene instruction, antifungal treatment (miconazole oral gel or nystatin), and ensuring the denture is removed at night.

MFDS Part 1 Practice Test

MFDS Part 1 Practice Test

MFDS Oral Medicine