Adenotonsilar & OME

Question 1

When do adenoids develop in the embryo?

Answer 1

16 weeks

Question 2

What are the main functions of the tonsils?

Answer 2

Trap bacteria & viruses on inhalation
Expose to immune system
Antibodies produced by the immune cells in the tissue
Help to prime immune system and help to lrevent subsequent infections

Question 3

What is Waldeyers ring?

Answer 3

Ring of lymphoid aggregation in the subepithelial layer of oropharynx and nasopharynx

Question 4

What makes up Waldeyer’ ring?

Answer 4

Tonsils (palatine tonsil)
Adenoids (pharyngeal tonsil)
Lingual tonsil

Question 5

Histological features of normal tonsils

Answer 5

Specialised squamous epithelium
Deep crypts
Lymphoid follicles
Posterior capsule

Question 6

Histological features of normal adenoids

Answer 6

Ciliated pseudostratified columnar mucosa
Stratified squamous epithelium
Transitional
Deep folds

Question 7

What makes up the upper aerodigestive tract mucosa & epithelium?

Answer 7

Ciliated columnar respiratory type mucosa

Squamous epithelium

Question 8

What is the epithelium of the oesophagus (where food goes, high use, trauma)?

Answer 8

Squamous epithelium

Question 9

What is the histological lining of the trachea?

Answer 9

Columnar

Question 10

What are common diseases of the tonsils and adenoids

Answer 10

Acute tonsilitis 
Recurrent/chronic adenoiditis/tonsilitis 
Obstructive hyperplasia 
Malignancy 
Tonsil crypt debris/tonsilitis 
(OME) w

Question 11

What is the most common viral cause of acute tonsilitis?

Answer 11

EBV

Question 12

What are the most common bacterial causes of tonsilitis?

Answer 12

Strep. pyogenes (GABHS)
H. influenzae
Strep. pneumoniae

Question 13

Differential for acute tonsilitis

Answer 13

URTI viral infection 
Infectious mononucelosis 
Peritonsilar abscess 
Candida infection 
Malignancy 
Diotheria 
Scarlet fever

Question 14

Symptoms of viral tonsilitis

Answer 14

Malaise 
Sore throat 
Temperature
Possible lymphadenopathy 
Lasts 3-4 days

Question 15

Symptoms of bacterial tonsilitis

Answer 15

Systemic upset 
Fever 
Odynophagia 
Halitosis 
Unable to work/school 
Lymphadenopathy 
Lasts around 1 weeks

Question 16

What are the centor criteria?

Answer 16

Fever
Tonsillar exudages
No cough
Tender anterior cervical lymphadenopathy

Question 17

What is the first line antibiotic in tonsilitis?

Answer 17

Penicillin

Question 18

What should be the antibiotic of choice in tonsilitis if the patient is penicillin allergic?

Answer 18

Clarithyromycin w

Question 19

How many episodes of tonsilitis is indicative for a tonsilectomy?

Answer 19

7 or more (in the preceding year)
5 or more (each year in the preceeding 2 years)
3 or more (each year in the preceding 3 years)

Question 20

Classic history of peritonsillar abscess (quinsy)

Answer 20

Unilateral throat pain and odynophagia
Trismus
3-7 days preceding acute tonsilitis

Question 21

Examination findings of quinsy

Answer 21

Medial displacement of tonsil & uvula

Concavity of palate lost

Question 22

Treatment of quinsy

Answer 22

Aspiration & antibiotics

Question 23

What virus causes glandular fever?

Answer 23

EBV

Question 24

Presentation of glandular fever

Answer 24

Gross tonsilar enlargement with membranous exudate 
Marked cervical lymphadenopathy 
Palatal petechial haemorrhages 
Generalised lymphadenopathy 
Hepatosplenomegaly

Question 25

How is glandular fever diagnosed?

Answer 25

Atypical lymphocytes in peripheral blood +ve Monospot or Paul-Bunnell test Low CRP (

Question 26

Management of glandular fever

Answer 26

Symptomatic treatment Antibiotics (NOT amoxicillin) Steroids

Question 27

What will result if amoxicillin is prescribed in glandular fever?

Answer 27

Macular rash

Question 28

Features of chronic tonsiltis

Answer 28

Chronic sore throat Malodorous breath Presence of tonsilitis Peritonsilar erythema

Question 29

Signs of obstructive hyperplasia of adenoids

Answer 29

Obligate mouth breathing Hyponasal voice Snoring & other signs of sleep disturbance AOM/OME

Question 30

What is glue ear (OME)?

Answer 30

Inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute inflammation

Question 31

What is AOM?

Answer 31

Inflammation of the middle ear accompanied by the symptoms and signs of acute inflammation with/without an accumulation of fluid

Question 32

Is a bulging tympanic membrane more common in OME or AOM?

Answer 32

AOM

Question 33

Is hearing loss more likely in OME or AOM?

Answer 33

OME

Question 34

What causes increased incidence of OME?

Answer 34

``` Children M>F Day care Older siblings Smoking household Recurrent URTI ```

Question 35

Symptoms of OME

Answer 35

``` Deafness Poor school performance Behavioural problems Speech delay NOT OTALGIA ```

Question 36

Signs of OME on otoscopy

Answer 36

``` TM retraction Reduced TM mobility Altered TM colour Visible ME fluid/bubbles Conductive loss tuning fork tests ```

Question 37

Management of OME

Answer 37

"Watchful waiting"

Question 38

When should "watchful waiting" of OME be reviewed

Answer 38

3 months

Question 39

If OME is persistant for > 3 months what is the next step

Answer 39

ENT referral

Question 40

What would indicate an ENT referral of OME

Answer 40

> 3/12 bilateral OME CHL > 25dB Speech/language problems Developmental behavioural problems

Question 41

What is the surgical management of OME if

Answer 41

Grommets

Question 42

What is the surgical management of OME if > 3years and this is the first intervention?

Answer 42

Grommet

Question 43

What is the surgical management of OME > 3 years and this is the second intervention?

Answer 43

Grommets and adenoidectomy

Question 44

Complications of OME

Answer 44

Weak evidence for decelopmental delay

Question 45

Complications of grommets

Answer 45

``` Infection/discharge Early extrusion Retention Persistant perforation Swimming/bathing issues Scarring ```

Question 46

Which pharyngeal pouch do the tonsils develop from?

Answer 46

1st pharyngeal pouch