Adenotonsillar disease Flashcards
What develops at 8 weeks from the first and second pharyngeal pouch
tonsillar fossa and palatine tonsil
where do tonsillar pillars originate from
2nd/3rd arches
what is th emain function of tonsils
trap bacteria and viruses on inhalation, antibodies are produced by immune system, prevent subsequent infectionsa
at what age is adenotonsillar enlargement unusual
under 2
what is the waldeyers ring
ring of lymphoid aggregation in sub epithelial layer of oropharynx and nasopharynx
what does the waldeyers ring consist of
tonsils, adenoids, lingual tonsil
what is the surface of the tonsil covered in
specialised stratified squamous epithelium
what is the tonsil and the muscle separated by
collagenous hemi-capsule cap
what is the main difference between adenoid and tonsil tissue
adenoids: deep folds and few crypts while tonsils have lots of crypts
what is the surface of adenoids covered in
pseudo stratified columnar epithelium
does the stratified squamous epithelium thin or thicken with a chronic infection
thickens
what type of epithelium lines the upper airway and digestive tract
ciliated columnar respiratory type mucosa, squamous mucosa
what type of epithelium lines the oesophagus ect
squamous
what type epithelium lines airways
columnar
What is acute tonsillitis
inflammation of the tonsils
is acute tonsillitis mainly viral or bacterial
viral
What is th emost common pathogen that presents with acute tonsillitis
H influenzaee or strep pyogenes
In patients with chronic tonsillitis, what organissms are commonly cultured
strep pyogenes, h influenza, staph aureus, strep pneumonia
If glandular fever is suspected, what tests should you order
Paul- Bunnell, WBC, atypical mononuclear cells
what would a differential list of acute tonsillitis look like
URTI viral, infectious mononucleiosis, peritonsillar abscesss, malignancy
what symptoms would you get with viral tonsillitis
malaise, sore throat, temperature, lasts 3-4 days, can usually do normal things
what symptoms would you get with bacterial tonsillitis
systemic upset, fever, odynophagia (pain on eating), halitosis (bad breath) unable to do normal activity, lymphadenopathy, lasts 1 weeks and requires antibiotics to help it settle
what is the centor criteria for tonnsillitis
fever, tonisllar exudates, teder cervical adenppathy, absence of cough, age
If one scores 0 or 1 points in centor criteria do you give antibiotics?
nah
if a person scores 2-3 points should you consider antibiotcs
should receive antibiotcs if symptoms worsen/ progress
if a patient presents with 4 or 5 points on centor criteria should you give antibiotocs?
treat empircically with antibiotics, yes
what is the treatment and management of tonsillitis
rest, eat/drink, paracetamol, Penicillin for 10 days or Clarythromycin of allergic`
what is the requirement for tonsillectomy
7 or more acute tonsillitis in a year
5 or more each year for pasty 2 years
3 or more each year for previous 3 years
what is recommended post op treatment wise
anti-emetic, paracetamol, 1 dose of dexamethasone (children)
peritonsillar abscess is not a complication of acute tonsillitis
false, it is a complication
how does one get a peritonsillar abscessq
bacteria gets trapped between muscle and tonsil to produce pus
what are symptoms of an abscess
unilateral throat pain and odynophagia, trismus (spasm of jaw), 3-7 day acute tonsillitis previously, displacement of tonsil and uvula
what is the treatment for an abscess
aspiration and antibiotics- penicillin and metronidazole
what virus causes glandular fever
EBV
what are signs of glandular fever
tonsillar enlargement with exudate, cervical lymphadenopathy, palatal haemorrhages, lymphadenopathy general, hepatosplenomegaly, jaundice
how doy uo diagnose glandular fever
atypical lymphocytes in blood, positive monospot/ paul bunnell test
how doy you treat glandular fever
usually nothing- avoid vigorous sports and alcohol. Give antibiotics- penicillin and steroids if really bad
what antibiotic should you not give in glandular fever and why
ampicillin or amoxicillin- macular rash will result
What are adenoid and tonsil causes of obstructive hyperplasia
adenoid- AOM and OME 9snoring) and tonsil- snoring, muffled voice and dysphagia
What is glue ear/ OME (effusion)
inflammation of the middle ear with accompaniment of fluid without signs and symptoms of acute inflammation.
what is acute OM
inflammation of inner ear with signs and symptoms of inflammation/ with/ without fluid
is hearing loss present in glue ear?
yup
who gets OEM
children
what are symptoms of OME
deafness, poor performance at school, behavioural problems, speech delay, balance problems, NOT EARRACHE
How do you diagnose glue ear
history, otoscopy, tuning fork tests, audiometry, tympanometry
what are sings of glue ear?
retracted tympanic membrane, reduced tympanic membrane mobility, altered tympanic membrane colour, visible fluid/ bubbles, CHL tuning fork tests
how do you treat OME
wait and see- more than 3 months with deafness, speech, balance problems, may use auto inflation… but antibiotics ect not useful
how would you surgically treat glue ear in 3 yo
3yo- grommet and adenoidectomy
how would someone present with epiglottis
drooling saliva, sore throat, pyrexia, stridor
what is th common infection of epiglottis
HiB (children now vaccinated against HiB
how do you manage acute epiglottitis
O2 by mask, nebulized adrenaline and IV dexamethasone, visual diagnosis, culture, cricothyrotomy kit, penicillin, ceftriaxone
