每日一题_2023.06.30

A 64-year-old man who reported current use of tobacco presented with a 2-week history of tongue discoloration. He reported no associated dysgeusia or tongue pain. Approximately 21 days before presentation, he had completed a course of clindamycin to treat a periodontal infection. After the tongue discoloration began, a course of fluconazole was prescribed to treat possible oral candidiasis. However, the tongue changes had persisted. Which of the following is the appropriate next step in management?

一名报告目前吸烟的64岁男性有2周的舌头变色病史。患者自诉无相关味觉障碍或舌痛。就诊前约21日，患者已完成克林霉素治疗牙周感染的一个疗程。患者开始出现舌头变色后，医师开了一个疗程的氟康唑治疗可能的口腔念珠菌病。然而，舌头的变化持续了下来。下面哪一项是管理的下一步?

A. Apply topical budesonide 外用布地奈德

B. Counsel patient to stop smoking 建议患者戒烟

C. Perform a biopsy 进行活检

D. Prescribe nystatin 开制霉菌素

E. Screen for high risk sexual behaviors 筛查高危性行为

答案解析：

医师建议患者每天用牙刷轻轻擦洗舌头表面4次，并建议患者戒烟。毛舌是一种良性疾病，涉及舌背侧的丝状乳头延长和变色。危险因素包括吸烟、脱水、口腔卫生不良和使用抗微生物药物。

正确答案：B