Hairy tongue

Correct answer: B. Incisional biopsy

• A. Culture and sensitivity may grow Candida or chromogenic bacteria, but these are secondary colonisers rather than the cause, so culture does not establish the diagnosis.
• B. Keyed per the source options. If a biopsy is required at all, an INCISIONAL biopsy is the appropriate technique, showing marked HYPERKERATOSIS and ELONGATION OF THE FILIFORM PAPILLAE with bacterial and fungal colonisation of the surface.
• C. Excisional biopsy is inappropriate for a diffuse condition covering the tongue dorsum.
• D. Immunofluorescence is used for autoimmune vesiculobullous disease.

Note: ⚠️ IMPORTANT CAVEAT. Hairy tongue is a CLINICAL diagnosis and biopsy is NOT normally required — the appearance of elongated filiform papillae with brown/black/yellow discoloration on the dorsum is characteristic. The recall's option list contained no 'clinical examination' choice, which forces the biopsy answer. Note also that this file's Day 1 and other files in the series have keyed this question DIFFERENTLY — flag it for group discussion.

Correct answer: D. Oral hygiene instruction, including tongue brushing or scraping

• A. Antifungals are not first-line. Candida is a secondary coloniser, and treating it does not address the underlying papillary hyperkeratosis.
• B. Surgical excision is unnecessary for a benign, reversible condition.
• C. Essential oil rinses may help freshen the mouth but do not remove the elongated papillae, which requires mechanical debridement.
• D. Correct. Management is mechanical DEBRIDEMENT and improved hygiene — brushing or scraping the tongue dorsum to remove the elongated keratinised papillae — together with eliminating predisposing factors: tobacco, excessive coffee or tea, poor oral hygiene, oxidising mouthrinses (chlorhexidine, hydrogen peroxide) and broad-spectrum antibiotics.

Note: The related item in this file describes 'a tongue between green and yellow' with the answer being HYPERKERATINISATION OF THE FILIFORM PAPILLAE — the same underlying process. The colour varies with the chromogenic bacteria and dietary staining present.