Rosh Psychiatry Board Practice Exam

The presence of a painless white patch on the tongue that does not bleed suggests the diagnosis of oral leukoplakia. Oral leukoplakia is characterized by a white patch or plaque that cannot be easily scraped off and is often associated with chronic irritation, smoking, or other irritants. Unlike oral candidiasis, which typically presents as a creamy white patch that can be scraped off and may bleed, oral leukoplakia is not associated with pain or bleeding during examination.

Oral lichen planus may also present with white lesions in the mouth but usually includes additional features, such as a lacy white pattern called Wickham's striae, and can be itchy or painful. Squamous cell carcinoma of the tongue might present as a white patch but typically has other alarming features, such as induration, ulceration, or bleeding, and is more likely to be painful.

The specific characteristics of the white patch being painless and non-bleeding align closely with oral leukoplakia, making it the most likely diagnosis in this scenario.