Kim! Hi! It’s your dad!👋 ▪ Khalilah, I’m proud of you for taking a risk for your dream.Everyone’s explanations tend to be so on-point, and the commiseration makes me feel better, too—thanks for the support & good luck studying!                       want to add a message here? just email us!
share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
search for anything NEW!
NBME 24 Answers

nbme24/Block 4/Question#21 (34.6 difficulty score)
An otherwise healthy 45-year-old man comes to ...
Aphthous ulcers🔍,📺

Login to comment/vote.

Tutor box

Members from the Leaderboard offering 1-on-1 help: Want to be listed here? Email us!

submitted by thisshouldbefree(36),

I get these VERY often. I seem to get them only after eating something that can damage the mucosa in my mouth such as hard chips (Tostitos, very jagged very pain). These are NOT cold sores (HSV). This is simply a aphthous ulcer; they can be stress induced (studying for hard test). they are very painful and do reoccur. there are no associated sx with them.

j44n  they're also caused by stress. I got 3 in my mouth the day after Prometric canceled my test for the 3rd time! +12  
ih8payingfordis  In layman terms, these things are called canker sores. I also get them on my tongue sometimes - super painful especially when it makes contact with anything salty. Just like @thisshouldbefree, it's usually preceded by mucosa damage (ie biting my tongue accidentally while eating) +  
xmen  test in 2 weeks. i have them now +  
drdoom  The physiological corollary of psychological “stress” is cortisol and its many cousins (corticosteroids, et cetera). Cortisol suppresses the “normal” but energetically costly process of dermal maintenance and growth (basal stem cell division, skin + epidermal turnover, including in the mucosa). So, in the presence of high “stress”, normal mucosal maintenance is sacrificed. This is because some other, more important existential threat is happening in the body. The result is stuff like aphthous ulcers, since your body is literally neglecting your mucosa, allowing it to “thin out” to preserve energy to address some other major systemic issue. +  
drdoom  From The glucocorticoid receptor (GR) is highly expressed in the basal cells but it is barely detectable in the other layers of the epidermis (22). The localization of the GR in basal corneocytes, as well as the negative effects of glucocorticoids on keratinocyte growth factor and type-I and-III collagen gene expression (23–26) suggest that endogenous cortisol in CS suppresses not only wound healing but also normal skin growth and turnover. +  
drdoom  ^ btw, CS = Cushing Syndrome (hypercortisolism) +  
jbrito718  Herpangia would occur in the posterior oropharynx--> caused by Coxsakie A NOT HSV +  

submitted by medstruggle(12),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Wyh is it shhatuop ursecl fi eethr are on GI spymo?stm Wyh tnac’ ti eb ephesr r?zoste

colonelred_  It’s just canker sores, they come and go. I think in herpes the gingivostomatitis really only happens when you first get infected. After that you just get recurrent cold sores. +4  
hyoid  Herpes zoster is not the same as herpes simplex virus. +29  
bigjimbo  you would see dermatome rash in zoster +3  
kateinwonderland  cf) Just in case someone wanted to know the causative organism of aphthous ulcers :The precise cause of canker sores remains unclear, though researchers suspect that a combination of factors contributes to outbreaks, even in the same person. Unlike cold sores, canker sores are not associated with herpes virus infections. +9  
charcot_bouchard  Herpes Zoster doesnt cause gingivostomatitis. Herpengina can cause vesicular lesion in mouth but happens to children in summer season by entero virus +  
drdeeznuts1  I'm wondering if this could be a mild case of Behcet syndrome without genital involvement +  
sherry  It sure can be Behcet or Pemphigus if the q provides us with more info. Canker sores just come and go for years with unclear mechanism. Also herpes zoster is shingles by VZV, not HSV1. +2  
avocadotoast  Most pictures on google show herpangina being present on the hard palate/throat, while aphthous ulcers are commonly on the lower lip. I think his lack of genital lesions are pointing us away from herpangina. +  
drdoom  Anyone still curious about the pathophys of aphthous ulcers can check out the thread above: +