adenotonsillar disease

Question 1

what is waldeyer’s ring

Answer 1

ring of lymphoid aggregation in the subepithelial layer of oropharynx and nasopharynx
-comprised of tonsils, adenoids and lingual tonsil

Question 2

what epithelium is tonsils

Answer 2

specialized squamous

Question 3

what epithelium is the adenoids

Answer 3

ciliated pseudostratified columnar

and some stratified squamous in the folds

Question 4

cause of tonsilitis

Answer 4

• EBV
• rhinovirus, influenza etc
• group A beta-haemolytic strep important because of potential sequelae

Question 5

what are the most common organisms cultured from patients with chronic tonsillar disease

Answer 5

• strep pyogenes
• H.influenza
• S.aureus
• strep pneumonia
• BLPO

Question 6

viral symptoms of tonsillitis

Answer 6

• malaise
• sore throat, mild analgesia required
• temperature
• able to undertake normal activity
• possible lymphadenopathy
• lasts 3-4 days

Question 7

bacterial symptoms of tonsillitis

Answer 7

• systemic upset
• fever
• odynophagia
• halitosis
• unable to work
• lymphadenopathy
• lasts around 1 week

Question 8

feverPAIN criteria

Answer 8

• fever
• Purulence
• Attend rapidly (within 3 days after onset of symptoms)
• severely inflamed tonsils
• No cough or coryza

Question 9

what does a higher feverPAIN score mean

Answer 9

highest association with streptococcus so antibiotics needed

Question 10

supportive treatment for tonsillitis

Answer 10

• eat and drink
• rest
• OTC analgesia (paracetamol, NSAIDS)

Question 11

antibiotic treatment for tonsillitis

Answer 11

• penicillin 500mg qid for 10 days

- clarithromycin if allergic

Question 12

hospital treatment for tonsillitis

Answer 12

• IV fluids
• IV antibiotics
• steroids

Question 13

what are the criteria for tonsillectomy

Answer 13

• sore throats are due to acute tonsillitis
• the episodes are disabling and prevent normal functioning
• seven or more well documented, clinically significant, adequately treated sore throats in the preceding year
• five or more such episodes in each preceding two years
• three or more episodes in each of the preceding three years

Question 14

what is a peritonsilar abscess

Answer 14

bacteria gets in between the muscle and tonsil and produces pus
-complication of tonsillitis

Question 15

presentation of peritonsilar abscess

Answer 15

• unilateral throat pain and odynophagia
• trismus
• 3-7 days of preceding acute tonsilitis
• medial displacement of tonsil and uvula
• concavity of palate lost

Question 16

treatment for peritonsilar abscess

Answer 16

aspiration and antibiotics

Question 17

what is glandular fever

Answer 17

infectious mononucleosis

-EBV

Question 18

signs of glandular fever

Answer 18

• gross tonsillar enlargement with membranous exudate
• marked cervical lymphadenopathy
• palatal petechial haemorrhages
• generalised lymphadenopathy
• hepatosplenomegaly

Question 19

diagnosis of glandular fever

Answer 19

• atypical lymphocytes in peripheral blood
• low CRP (<100)
• +ve monospot or paul-bunnell test

Question 20

management of glandular fever

Answer 20

• symptomatic treatment
• do not prescribe ampicillin (macular rash will result)
• antibiotics
• steroids

Question 21

what antibiotic should not be given in tonsillitis

Answer 21

amoxicillin

Question 22

signs of adenoidal enlargement (hyperplasia)

Answer 22

• obligate mouth breathing
• hyponasal voice
• snoring and other signs of sleep disturbance
• AOM/OME

Question 23

signs of tonils enlargement

Answer 23

• snoring
• muffled voice
• potential dysphagia

Question 24

what is glue ear

Answer 24

otitis media with effusion
-inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute inflammation

Question 25

what is acute otitis media

Answer 25

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

Question 26

what are the differences in OME and AOM

Answer 26

Question 27

who gets OME

Answer 27

most commonly children

• males
• day care
• older siblings
• smoking household
• recurrent URTI

Question 28

causes of OME

Answer 28

• recurrent URTI
• recurrent AOM
• prematurity
• craniofacial abnormalities
• genetic abnormalities
• immunodeficiency

Question 29

symptoms of OME

Answer 29

• deafness
• poor school performance
• behavioural problems
• speech delay
• potential balance problems
• TV volume raised
• NOT otalgia

Question 30

diagnosis of OME

Answer 30

• history
• otoscopy
• tuning fork tests
• audiometry
• tympanometry

Question 31

signs of OME

Answer 31

• TM retraction
• reduced TM mobility
• altered TM colour
• visible ME fluid/bubbles
• CHL tuning fork tests

Question 32

is this a normal or abnormal tympanogram?

Answer 32

normal

Question 33

what does this tympanogram show about the ear

Answer 33

there is fluid in it

Question 34

what does this audiometry mean?

Answer 34

conductive hearing loss of 40-30

Question 35

what is normal hearing in an audiometry

Answer 35

20

Question 36

treatment for OME

Answer 36

• watchful waiting (3months)
• after 3 months there is a review (otoscopy, tympanometry etc)
• then referral if needed

Question 37

treatment fr OME that has persisted over 3 months and is symptomatic

Answer 37

• autoinflation (5 to 10 times a day)

- referral

Question 38

surgical management of OME

Answer 38

if under 3yrs
-grommets

over 3 and first intervention
-grommets

over 3, second intervention
-grommets and adenoidectomy

Question 39

complications of grommets

Answer 39

• infection/discharge
• early extrusion
• retention
• persistent perforation
• swimming/bathing issues