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ENT Week 2 2017/18 > 9: Tonsils > Flashcards

9: Tonsils Flashcards

1
Q

go back over the 1st half of this

A
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2
Q

What are the symptoms and duration of viral tonsilitis?

A

Malaisae

Sore throat

Mild fever

Lymphadenopathy

Lasts 3-4 days

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3
Q

What are the symptoms and duration of bacterial tonsilitis?

A

Much more severe:

Systemic upset

Fever

Odynophagia

Halitosis

Lymphadenopathy

Reduced capability to do daily activities

+ 1 week

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4
Q

Which criteria are used to decide if a sore throat requires antibiotics?

A

Centor criteria

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5
Q

Which infection is indicated by 4 or 5 Centor points?

A

GAS infection

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6
Q

What does tonsilitis look like?

A

Inflamed throat

Enlarged tonsils

Exudate

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7
Q

What is the supportive treatment for tonsilitis?

A

Fluids

Rest

Analgesia

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8
Q

What antibiotics are given for severe tonsilitis?

For how long?

A

Penicillin / Clarithromycin

10 days

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9
Q

If tonsilitis is to be managed in hospital, what treatments are given?

A

IV fluids

IV antibiotics

IV steroids

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10
Q

If tonsilitis is persistent and recurrent, what is done?

A

Tonsilectomy

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11
Q

What are the durations of tonsilitis required for tonsilectomy?

Why is this so strictly follow?

A

7 episodes in one year

5 episodes a year for 2 years

3 episodes a year for 3 years

Surgery is incredibly painful

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12
Q

What analgesia is required following tonsillectomy?

A

Strong opioids e.g morphine

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13
Q

What is a local complication of untreated acute tonsilitis?

A

Peritonsilar abscess / Quinsy

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14
Q

What is a peritonsilar abscess?

A

Stretching of tonsil by pus produced by bacteria

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15
Q

What are the symptoms of peritonsillar abscess?

A

UNILATERAL throat pain, odynophagia

Trismus (lockjaw)

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16
Q

What does a peritonsilar abscess look like?

A

Swelling over tonsil

Uvula deviates away from abscess

17
Q

How is a peritonsilar abscess treated?

A

Aspiration

Antibiotics

18
Q

Which disease, caused by EBV, produces a severe tonsilitis, lymphadenopathy and hepatosplenomegaly?

A

Infectious mononucleosis

19
Q

How is glandular fever diagnosed?

A

Atypical lymphocytes on blood film

Positive antibody test (Monospot or Paul-Bunnell)

20
Q

How is glandular fever treated?

A

Supportive

NO AMOXICILLIN (amoxicillin causes rash with EBV) - penicillin and steroids PRN

21
Q

Which antibiotic should not be given to someone with tonsilitis?

A

Amoxicillin

may produce a macular rash

22
Q

What pathology of the tonsils may cause stertor or sleep apnoea?

A

Hyperplasia of palatine tonsils

23
Q

What pathology of the tonsils may cause otitis media or a hyponasal voice?

A

Hyperplasia of adenoid tonsils

24
Q

What should your suspicion be if a patient has unilateral tonsilar enlargement?

A

Neoplasia

25
Q

What is the difference between acute otitis media and glue ear?

A

OME caused by fluid buildup e.g blockage of Eustachian tube

Both involve acute inflammation of middle ear

26
Q

In which variant of otitis media is pain, fever and irritability seen?

A

Acute otitis media

NOT a feature with effusion

27
Q

What group is glue ear common in?

A

Children

28
Q

(Boys / girls) are more likely to develop glue ear.

A

Boys

29
Q

What is thought to cause glue ear?

A

Eustachian tube blockage

30
Q

How does glue ear present in children?

A

Hearing loss but they won’t tell you that

No earache because that’s not seen in OME

Misbehaviour

School performance is poor

SPEECH AND LANGUAGE DEVELOPMENTAL DELAY

31
Q

How is glue ear investigated?

A

Ear examination - bulging TM, possibly rupture

Tuning fork tests

Audiogram

32
Q

What kind of hearing loss does glue ear cause?

A

Conductive

33
Q

When should you refer a patient with glue ear?

A

Persistent symptoms for 3 months

34
Q

What is the treatment for severe bilateral glue ear?

A

Grommets

35
Q

What may be done in addition to inserting grommets in patients with severe bilateral glue ear?

A

Removal of adenoids

to unblock Eustachian tube

36
Q

Is there any evidence that children with developmental delay due to OME catch up once grommets have been inserted?

A

No

37
Q

What are some complications of grommets?

A

Need reinserted

Infection

Perforation

Problems bathing / swimming

38
Q

tm retrudes because outer pressure > inner pressure, due to eustachian tube blockage, pushing it in

A

ENT Week 2 2017/18 (10 decks)

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