Pathology · patient case with 1 question
Solitary raised swelling of the hard palate
Patient: Female, 48 years old
Chief Complaint: “There is a bump on the roof of my mouth.”
Background: No systemic disease. Non-smoker. Notes it has been present for several months without change.
Vital Signs: BP 124/78 mmHg · HR 72 bpm
Findings: A dome-shaped, solid, non-fluctuant swelling of the left hard palate. A calibrated periodontal probe placed alongside it shows the lesion measures approximately 9 mm across and is elevated above the surrounding mucosa. The overlying mucosa is intact and normal in colour.
Question 1
Which term correctly describes this lesion?
Show answer and explanation
Correct answer: A. Nodule
- A. CORRECT. A NODULE is a solid, elevated lesion GREATER than 5 mm in diameter, extending deeper into the submucosa than a papule. Placing a calibrated probe alongside the lesion is exactly how the examiner supplies the measurement, and here it converts the description from papule to nodule. A palatal nodule of this description would prompt consideration of a minor salivary gland tumour, and biopsy is warranted.
- B. A VESICLE is a FLUID-filled elevation under 1 cm, which appears translucent and ruptures to leave an ulcer. This lesion is explicitly described as solid, and the overlying mucosa is intact.
- C. A MACULE is a circumscribed change in COLOUR that is FLAT — no elevation and no depression, detectable by sight but not by touch. An amalgam tattoo, a melanotic macule and a petechia are examples. This lesion is elevated, so it cannot be a macule.
- D. A PAPULE is a solid ELEVATED lesion measuring LESS than 5 mm. The morphology fits, but the size does not — the probe establishes about 9 mm, and that is the discriminator the question is built around.
Note: The elevated-lesion scale, memorised by size: PAPULE under 5 mm, solid; NODULE over 5 mm, solid; PLAQUE elevated but FLAT-topped and wider than it is thick; VESICLE under 1 cm, fluid-filled; BULLA over 1 cm, fluid-filled; PUSTULE, pus-filled. When a photograph shows a probe beside a lesion, the probe is there to give you the measurement — read it.