Adenotonsillar Disease Flashcards
Between what ages do the tonsils usually develop fully?
2-10 yrs
State the main function of the tonsils
Trap inhaled bacteria + viruses and present to immune system
What is Waldeyer’s ring?
Ring of MALT between the oropharynx and nasopharynx
Comprises tonsils, adenoids + lingual tonsils
How does the histology of the tonsils differ from that of the adenoids?
Tonsils: specialised squamous, crypts
Adenoids: resp epithelium, folds, transitional
Acute tonsillitis is usually bacterial. True/False?
False
Usually viral
List the main viruses that cause acute tonsillitis
EBV Influenza Rhinovirus Enterovirus Adenovirus
What is the most commonest bacterial cause of acute tonsillitis?
Group A Strep.
Throat swabs are not recommended in acute tonsillitis. Why?
Surface bacteria do not always reflect core species
List symptoms of acute viral tonsillitis
Malaise Sore throat Temperature Able to do daily tasks Mainly self-limiting: lasts 3-4 days
List symptoms of acute bacterial tonsillitis
Systemic upset Fever Odynophagia Halitosis Unable to work/school Lasts 1 week +
Which criteria helps differentiate between viral and bacterial tonsillitis?
Centor Criteria
How many points on the Centor Criteria warrants antibiotic use for acute tonsillitis?
2 or 3 points if progressing
4 or 5 points = treat empirically
Outline conservative management for acute tonsillitis
Bed rest
Fluids
Analgesia (paracetamol, NSAID)
Which antibiotics can be given for acute tonsillitis?
Penicillin for 10 days
Clarithromycin if pen-allergic
Surgery (tonsillectomy) is often done for tonsillitis. True/False?
False
Not as often as it used to be
List indications for tonsillectomy
Recurrent severe tonsillitis
Well-documented visits to practice for tonsillitis
Numerous episodes in 2-3 years
The risk of mortality from tonsillitis is less than the risk of complications of tonsillectomy. True/False?
True
What is peritonsillar abscess?
Complication of tonsillitis where infection moves to space between tonsil and muscle
What is the classic history/presentation of peritonsillar abscess?
Tonsillitis improving but developing unilateral throat pain and odynophagia
Medial displacement of tonsil + uvula contralaterally
How is peritonsillar abscess treated?
Aspiration
Antibiotics (penicillin)
What is glandular fever?
Infectious mononucleosis caused by EBV
List signs and symptoms of glandular fever
Feeling washed out
Malaise
Gross tonsillar enlargement with membranous exudate
Lymphadenopathy
How is glandular fever diagnosed?
+ve Monospot or Paul-Bunnell test
CRP is very high in glandular fever. True/False?
False
Usually below 100
What is the antibiotic of choice for glandular fever?
Penicillin
Do not prescribe amoxicillin for tonsillitis or glandular fever. True/False?
True
