Pathology · patient case question
How do you diagnose this lesion?
Patient case: Hairy tongue
Scenario: 'I am here because I have something on my tongue' — a photograph of HAIRY TONGUE.
Show answer and explanation
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.