Candidiasis: The Daily PANCE Blueprint
A 20-year-old female with asthma presents to the clinic with “white stuff” in her mouth for the past few days. On physical exam, you notice a few white plaques on the buccal mucosa and tongue. The lesions are easily scraped off with a tongue depressor. Which of the following is the best initial treatment of choice for the most likely diagnosis?
A. Fluconazole
B. Amphotericin B
C. Lidocaine solution
D. Nystatin
E. Bactrim
Answer and topic summary
The answer is D. Nystatin
The patient has oropharyngeal candidiasis, which is a local infection in patients with certain risk factors (e.g., AIDs, dentures, radiation, inhaled glucocorticoids, etc). This patient has asthma so the likely causative culprit is her inhaled glucocorticoids. The most common cause of oropharyngeal candidiasis is C. albicans. On a physical exam, you will see white plaques in the mouth (which can be scrapped). In smokers, the lesions may look more yellow/brown.
Diagnosis is usually clinical but can be confirmed by scraping the lesion. A KOH test can be performed on the scrapings — budding yeast with pseudohyphae are seen. Treatment of choice is nystatin swish and swallow or topical clotrimazole. If a patient has a severe disease or fails topical therapy, oral fluconazole can be given.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Dermatology ⇒ ⇒
Also covered as part of the Internal Medicine EOR and Pediatric Rotation EOR topic list