Primary Herpetic Gingivostomatitis — ORE Part 1 MCQ
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Correct answer: C — Primary herpetic gingivostomatitis
Explanation lettering: C = shown as A · D = shown as B · A = shown as C · B = shown as D
Primary herpetic gingivostomatitis (PHGS) is the correct answer. The key diagnostic features are: (1) acute systemic symptoms (fever, malaise); (2) painful bilateral cervical lymphadenopathy; (3) ulcers distributed on both keratinised and non-keratinised mucosa with associated gingivitis; (4) no prior history of oral ulceration, indicating a primary infection. PHGS is caused by HSV-1 primary infection and characteristically presents with prodromal fever, followed by painful vesicles that rupture into irregular ulcers. Recurrent aphthous stomatitis (B) lacks fever, lymphadenopathy and systemic signs, and occurs only in patients with previous episodes. Hand, foot and mouth disease (C) is caused by enterovirus and typically includes characteristic hand/foot rash. Erythema multiforme (D) presents as an immune-mediated reaction with target skin lesions. Behçet disease (E) is a chronic recurrent condition incompatible with acute primary presentation.
Reference: SDCEP Acute Dental Problems guidance (2024), oral ulceration section; supported by peer-reviewed literature on PHGS clinical features (Herpes simplex virus infection and complications, J Oral Pathol Med 2006; Supportive care in PHGS systematic review, 2023), https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/common-oral-conditions/oral-ulceration/