Dental OSCE (Objective Structured Clinical Examination) Practice Exam

A patient presents with multiple white lesions under the tongue, fever of 101, and sore gums. What is the most likely diagnosis?

1. Candidiasis

2. Primary herpes

3. Lichen planus

4. Aphthous ulcers

The correct answer is: Primary herpes

The presence of multiple white lesions under the tongue, accompanied by fever and sore gums, strongly suggests primary herpes, also known as primary herpetic gingivostomatitis. This condition often affects children but can occur in adults, particularly those who have not previously been exposed to the herpes simplex virus (HSV-1). Primary herpes typically presents with vesicular lesions that can rupture, leading to painful ulcers. These lesions can appear anywhere in the oral cavity but are commonly seen on the gingiva, tongue, and other mucosal surfaces. The systemic symptoms, including fever and malaise, are also significant indicators, as they often accompany the initial outbreak of the virus. In contrast, candidiasis usually presents as a white patch or a creamy, curd-like lesion that can be scraped off, often without associated systemic symptoms like fever. Lichen planus can cause white lesions in the oral cavity, often with a characteristic lacy appearance and is not typically associated with fever. Aphthous ulcers, while they can be painful and are often seen in the mouth, do not generally present with systemic symptoms like fever and are typically singular or few in number rather than multiple lesions. Thus, the combination of white lesions, fever, and oral discomfort in this scenario