2 - adenotonsillar disease & stuff nose Flashcards
when do tonsils grow/shrink?
as child grows = tonsils grow
after teenage years = tonsils decrease in bulk
what is cells of tonsils and adenoids? (histology lining)
tonsils = covered in squamous epithelium (back of tonsils is fibrous capsule layer which where abscess forms)
adenoids = ciliated pseudostratified columnar epithelium
what is common organisms that cause acute tonsillitis?
strep pyogenes, h.influenza, staph aureus
= EBV common infection to cause it
what is difference in presentation of viral vs bacterial tonsillitis?
viral not as bad with malaise, sore throat, temp but keep doing normal activity and recover 3-4 days
bacterial is more severe with more systemically ill (fever, pain swallowing) and unable to work, recover in 1 week
what is FeverPAIN cirteria?
criteria to assess severity fo symptoms (distinguishes between bacterial & viral)
- fever
- purulence
- attend rapidly
- inflamed tonsils
- no cough or coryza
what is treatment of acute tonsillitis?
mostly just supportive but if not work then penicillin/clarithromycin for 10 days
(surgery done under strict guidelines)
what is peritonsillar abscess/quinsy?
complication of acute tonsillitis where bacteria between muscle & tonsil make pus
what is typical presentation of quinsy?
sudden worsening of unilateral throat pain, odynophagia, trismus 3-7 days after tonsilitis
- also medial displacement of tonsil & uvula & concavity of palate lost
what is treatment of quinsy?
aspiration & antibiotics
what is management of glandular fever?
also called infectious mononucleosis - mono
(caused by EBV)
= manage like normal viral sore throat even though systemic infection - can give antibiotics if need (but no amoxicillin)
what antibiotics should NOT be given in tonsillitis?
amoxicillin!! (gives rash)
what is chronic tonsillitis?
chronic discomfort, bad breath, debris in tonsil crypts, persistent lymphadenopathy
= self limiting condition, reassurance
what are signs of adenoid obstructive hyperplasia?
- obligate mouth breathing
- hyponasal voice (like cold all time)
- snoring & sleep disturbance
what is tonsil obstructive hyperplasia signs?
- snoring & sleep disturbance
- muffled voice
- dysphagia
what is unilateral tonsillar enlargement?
= can be concerning for neoplastic process (need to rule out)
what is glue ear?
chronic presence of fluid in middle ear without signs & symptoms of acute inflammation
what is presentation of glue ear?
tympanic membrane sucked in, hearing loss, poor school performance, behavioural issues, speech delay
- no fever or otalgia
what is involved in diagnosis of glue ear?
history, otoscopy, tuning fork test, audiometry, tympanometry (age appropriate hearing test)
what is treatment of glue ear?
watchful waiting, most resolve in a month or 3 months - so reassess at 3 months
- can give grommets
what is candida risk factor?
post antibiotics, immunosuppression, smoking, inhaled corticosteroid use
- presents as white patches
- treat w nystatin & fluconazole
what bug causes diphtheria?
corynebacterium diphtheriae = gram +ve bacilli
