Oral ulcers and mucosal disease — branching viva

Branching viva from a febrile drooling two-year-old with diffuse painful anterior gingival ulceration, through the hydration-first assessment and early oral aciclovir within 72 hours, with a pivot to a school-age child with recurrent scarring major aphthae testing the deficiency and coeliac work-up and the differential of systemic aphthosis, and a final stem on an infant with thrush and an oncology child with mucositis.

branching clinical structured oral2 min readVerification in progress

Prompt

You are the paediatric registrar in the emergency department. The examiner asks you to work through a febrile drooling two-year-old with diffuse painful gingival ulceration, then a school-age child with recurrent scarring major aphthae, and finally an infant with oral thrush. Information is released in stages.

Opening — the drooling febrile toddler

Examiner: A two-year-old boy has three days of high fever, drooling and refusal to drink, with a diffusely swollen, bleeding gingiva and shallow vesicles and ulcers across the gingiva, tongue and lips. Talk me through your immediate thoughts and your examination. [1]

Candidate should cover: the diagnosis of primary herpetic gingivostomatitis from the fever, drooling and diffuse anterior gingival vesicles and ulcers; the recognition that dehydration from refusal to drink is the practical threat; and a focused assessment of hydration (moist mucous membranes, capillary refill, urine output) alongside the oral and systemic examination. [1]

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You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References5Show ledger

[1]Amir J; Harel L; Smetana Z; et al Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study. BMJ, 1997.PMID 9224082
[2]Coppola N; Cantile T; Adamo D; et al Supportive care and antiviral treatments in primary herpetic gingivostomatitis: a systematic review. Clin Oral Investig, 2023.PMID 37733027
[8]Pankhurst CL Candidiasis (oropharyngeal). BMJ Clin Evid, 2013.PMID 24209593
[9]Lau CB; Smith GP Recurrent aphthous stomatitis: A comprehensive review and recommendations on therapeutic options. Dermatol Ther, 2022.PMID 35395126
[10]Barrons RW Treatment strategies for recurrent oral aphthous ulcers. Am J Health Syst Pharm, 2001.PMID 11194135