Oral Medicine & Pathology for ORE Part 1
Comprehensive guide to Oral Lichen Planus, Pemphigus/Pemphigoid, mucosal ulcers, Sjögren syndrome, and 2-week-wait cancer referrals.
Key Syllabus Concepts Tested in Oral Medicine & Pathology
- Oral Lichen Planus (Wickham striae) OPMD transformation risk (~0.5-1%) and topical betamethasone
- Vesiculobullous: Pemphigus vulgaris intraepithelial tombstone acantholysis vs Pemphigoid subepithelial splitting
- Recurrent aphthous stomatitis, Primary Herpetic Gingivostomatitis, and Behçet disease triad
- NICE 2-week-wait urgent referral pathway for unexplained oral ulcers/patches persisting > 2 weeks
Sample SBA Practice Questions
Sample Question 1 (Paper A)
A 60-year-old male smoker presents with a persistent painless red velvet patch on the lateral border of the tongue. Biopsy reveals severe epithelial dysplasia. What is the diagnosis?
- Erythroplakia
- Oral lichen planus
- Oral candidosis
- Erythroleukoplakia
✅ Correct Answer: Erythroplakia
Explanation: Erythroplakia is a red clinical lesion with high malignant transformation rate (>80% demonstrating dysplasia or carcinoma in situ).
Clinical Pearl: Anterior-posterior palatal strap provides maximum structural rigidity for upper RPD.
Sample Question 2 (Paper A)
Which blistering mucosal condition demonstrates a positive Nikolsky sign and intraepithelial acantholysis with autoantibodies against Desmoglein-3?
- Paraneoplastic pemphigus
- Pemphigus vulgaris
- Pemphigus foliaceus
- Mucous membrane pemphigoid
✅ Correct Answer: Pemphigus vulgaris
Explanation: Pemphigus vulgaris involves IgG autoantibodies against desmoglein-3, leading to suprabasal intraepithelial splitting and Nikolsky sign.
Clinical Pearl: A 1.5–2.0mm vertical sound dentin ferrule is required to prevent post/core root fractures.
Sample Question 3 (Paper A)
Oral Hairy Leukoplakia presenting on the lateral borders of the tongue in immunocompromised patients is caused by which virus?
- Herpes Simplex Virus 1 (HSV-1)
- Epstein-Barr Virus (EBV)
- Coxsackievirus A
- Human Papillomavirus (HPV)
✅ Correct Answer: Epstein-Barr Virus (EBV)
Explanation: Oral Hairy Leukoplakia is an opportunistic EBV infection causing hyperkeratotic white corrugated patches on tongue margins.
Clinical Pearl: Dry socket management is gentle saline irrigation and Alvogyl dressing (no routine antibiotics).
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