GASTROENTEROLOGY - OSCE OTC MATERIAL
OSPAP MSC
APPLIED CLINICAL SKILLS
Gastroenterology
Mouth ulcers
Symptoms/diagnosing questions
• Painful oral lesions
• Usually grey-white in colour and small in size
• Can make eating and drinking painful
• Location of ulcer (usually at side of cheeks, tongue and inside of lips)
• Is it painless (refer can indicate something more sinister)?
• Occurs in small crops (a single large ulcer indicates something sinister)
REFER
▪ Children under 10 (possible hand foot and mouth disease)
▪ Ulcers greater than 1cm in diameter
▪ Ulcers in crops of five to ten or more
▪ Duration longer than 14days
▪ Painless ulcer
▪ Irregular shaped ulcers
▪ Eye involvement
Treatment
1. Corticosteroids e.g. Hydrocortisone sodium succinate pellets
2. Antibacterial agents e.g. Chlorhexidine
3. Choline salicylate- Bonjela
4. Benzydamine
5. Local anaesthetics e.g. lidocaine, benzocaine
6. Protectorants
Other differential diagnosis that must be referred
1. Major aphthous ulcers- usually larger in diameter and slower to heal
2. Trauma- can be due to tongue biting or traumatic event
3. Oral thrush- creamy white soft patches
4. Herpes simplex- usually small and many in number and may show signs
of systemic infection such as fever
5. Medicine induced fever- some drugs like nsaids, beta-blockers, cytotoxic
agents can induce ulcer
, 6. Oral carcinoma- painless bumps at first then later become painful over
time, change colour and bleed
OSPAP MSC
APPLIED CLINICAL SKILLS
Gastroenterology
Mouth ulcers
Symptoms/diagnosing questions
• Painful oral lesions
• Usually grey-white in colour and small in size
• Can make eating and drinking painful
• Location of ulcer (usually at side of cheeks, tongue and inside of lips)
• Is it painless (refer can indicate something more sinister)?
• Occurs in small crops (a single large ulcer indicates something sinister)
REFER
▪ Children under 10 (possible hand foot and mouth disease)
▪ Ulcers greater than 1cm in diameter
▪ Ulcers in crops of five to ten or more
▪ Duration longer than 14days
▪ Painless ulcer
▪ Irregular shaped ulcers
▪ Eye involvement
Treatment
1. Corticosteroids e.g. Hydrocortisone sodium succinate pellets
2. Antibacterial agents e.g. Chlorhexidine
3. Choline salicylate- Bonjela
4. Benzydamine
5. Local anaesthetics e.g. lidocaine, benzocaine
6. Protectorants
Other differential diagnosis that must be referred
1. Major aphthous ulcers- usually larger in diameter and slower to heal
2. Trauma- can be due to tongue biting or traumatic event
3. Oral thrush- creamy white soft patches
4. Herpes simplex- usually small and many in number and may show signs
of systemic infection such as fever
5. Medicine induced fever- some drugs like nsaids, beta-blockers, cytotoxic
agents can induce ulcer
, 6. Oral carcinoma- painless bumps at first then later become painful over
time, change colour and bleed
