Adenotonsillar Disease

Question 1

• fever
• oral vesicles
• lesions of hands, feet, buttocks and/or genitalia
• group A coxsackievirus
• children

Answer 1

hand, foot and mouth disease

Question 2

• enterovirus, commononly coxsackie A
• odynophagia (painful swallowing)
• vesicles of posterior pharynx
• fever 24-36 hours
• often associate with maculopapular eruption
• young children, frequency decreases with age

Answer 2

herpangina

Question 3

• infectious mononucleosis
• begins with malaise, headache and low grade fever
• progresses to: high fever, diffuse lymphadenopathy, tonsilitis, fatifue
• dx: clinical presentation, cbc, titers (IgM, early IgG)
• tx: supportive management (fluids, antipyretics, antiinflammatories); rest, glucocorticoids (severe cases/airway obstruction)
• avoid contact sports

Answer 3

EBV

Question 4

why should streptococcal phayngitis be treated?

Answer 4

• relief of symptoms
• prevent rheumatic fever
• prevent suppurative sequelae
• reduce transmission to close contacts

Question 5

when should you suspect group A strep?

Answer 5

• throat pain
• fever
• cervical lymphadenopathy
• edema/exudate
• scaratiniform rash
• hx of GAS
• close contact with GAS

Question 6

Diagnosis for strep?

Answer 6

• rapid antigen detection tests
• culture- consider in special populations only
• use culture in immunocompromised, patient as risk for rheumatic fever, infants, college dorms

Question 7

centor criteria?

Answer 7

• fever
• tonsillar exudate
• tender cervical lympadenopathy
• abscence of cough
• 2 or greater: consider testing and/or treating for strep

Pneumonic: C (can’t cough,) E(exudate), N(nodes) T(temperature >38C) OR (young or old)

Question 8

treatment of group A streptococcus?

Answer 8

• Penicillin V for 10 days (amoxicillin better tolerated in children for taste)
• IM penicillin G (single dose)
• cephalosporins (not recommended as first line)
• macrolides
• clindamycin

Question 9

treatment of peritonsillar abcess?

Answer 9

• urgent otolaryngology consultation
• drainage (needle aspiration (Preferred) and/or I &D)
• hydration
• antimicrobial coverage (cover gram + and anaerobes)
• pain control

Question 10

• difficulty breathin during sleep secondary to upper airway obstruction
• cessation of airflow for >10 seconds despite continued attempts to ventilate
• mild to severe, treated with PAP (positive airway pressure) mandibular advancement device (mild OSA) weight loss, surgery

Answer 10

obstructive sleep apnea

Question 11

What are risk factors for obstructive sleep apnea?

Answer 11

• snoring
• tired (dayitme somnolence)
• observed apnea
• pressure (hypertension)
• BMI >35
• Age >50
• neck circumferance >17”, 16” female
• gender -male
• > 3 yes answers

Question 12

what is sleep disordered breathing? what is generally related to?

Answer 12

• ranges from snoring alone to true obstructive sleep apnea
• generally related to adenotonsillar hypertrophy

Question 13

first line treatment for pediatric sleep disordered breathing?

Answer 13

adenotonsillectomy

Question 14

what are indications of adenotonsillectomy?

Answer 14

• obstruction
• infection
• neoplasia

Question 15

what is the criteria for recurrent strep tonsillitis?

Answer 15

• 7 episodes in a single year
• 5 episode per year for 2 years
• 3 episodes per year for 3 years

Question 16

• scarring of crypts
• retention of food and bacterial debris
• associated with tonsillitis and halitosis

Answer 16

chronic cryptic tonsillitis