A 78 year-old man comes to the clinic because of discoloration of his tongue and bad breath. The color of the tongue changed slowly and occurred with halitosis over several weeks. He feels well and has no symptoms otherwise. His medical history is unremarkable. He smokes a half-pack of cigarettes per day and drinks two to three glasses of wine or beer each night. He takes no medications.
On examination, the patient is afebrile and vital signs are normal. A picture of the tongue is shown.
Which of the following is the most appropriate management of this condition?
A. Give an antibiotic like Amoxicillin-clavulanate
B. Take a biopsy of the discolored area to evaluate for cancer
C. Tell the patient to brush the tongue
D. Give an antifungal like Fluconazole
Reference:
Nisa L, Giger R. Black hairy tongue. Am J Med. 2011 Sep;124(9):816-7. PMID: 21854889
D is the answer I think. I have heard that referred to as black tong (I don't know the medical term) and I am pretty sure it is a fungus. The doctor would probably tell them to come back in a few days if it doesn't inprove and try something else at that point though.
Answer:
https://steemit.com/steemstem/@rsc227/medical-challenge-question-4-answer