Adenotonsillar disease

Question 1

What develops at 8 weeks from the first and second pharyngeal pouch

Answer 1

tonsillar fossa and palatine tonsil

Question 2

where do tonsillar pillars originate from

Answer 2

2nd/3rd arches

Question 3

what is th emain function of tonsils

Answer 3

trap bacteria and viruses on inhalation, antibodies are produced by immune system, prevent subsequent infectionsa

Question 4

at what age is adenotonsillar enlargement unusual

Answer 4

under 2

Question 5

what is the waldeyers ring

Answer 5

ring of lymphoid aggregation in sub epithelial layer of oropharynx and nasopharynx

Question 6

what does the waldeyers ring consist of

Answer 6

tonsils, adenoids, lingual tonsil

Question 7

what is the surface of the tonsil covered in

Answer 7

specialised stratified squamous epithelium

Question 8

what is the tonsil and the muscle separated by

Answer 8

collagenous hemi-capsule cap

Question 9

what is the main difference between adenoid and tonsil tissue

Answer 9

adenoids: deep folds and few crypts while tonsils have lots of crypts

Question 10

what is the surface of adenoids covered in

Answer 10

pseudo stratified columnar epithelium

Question 11

does the stratified squamous epithelium thin or thicken with a chronic infection

Answer 11

thickens

Question 12

what type of epithelium lines the upper airway and digestive tract

Answer 12

ciliated columnar respiratory type mucosa, squamous mucosa

Question 13

what type of epithelium lines the oesophagus ect

Answer 13

squamous

Question 14

what type epithelium lines airways

Answer 14

columnar

Question 15

What is acute tonsillitis

Answer 15

inflammation of the tonsils

Question 16

is acute tonsillitis mainly viral or bacterial

Answer 16

viral

Question 17

What is th emost common pathogen that presents with acute tonsillitis

Answer 17

H influenzaee or strep pyogenes

Question 18

In patients with chronic tonsillitis, what organissms are commonly cultured

Answer 18

strep pyogenes, h influenza, staph aureus, strep pneumonia

Question 19

If glandular fever is suspected, what tests should you order

Answer 19

Paul- Bunnell, WBC, atypical mononuclear cells

Question 20

what would a differential list of acute tonsillitis look like

Answer 20

URTI viral, infectious mononucleiosis, peritonsillar abscesss, malignancy

Question 21

what symptoms would you get with viral tonsillitis

Answer 21

malaise, sore throat, temperature, lasts 3-4 days, can usually do normal things

Question 22

what symptoms would you get with bacterial tonsillitis

Answer 22

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

Question 23

what is the centor criteria for tonnsillitis

Answer 23

fever, tonisllar exudates, teder cervical adenppathy, absence of cough, age

Question 24

If one scores 0 or 1 points in centor criteria do you give antibiotics?

Answer 24

nah

Question 25

if a person scores 2-3 points should you consider antibiotcs

Answer 25

should receive antibiotcs if symptoms worsen/ progress

Question 26

if a patient presents with 4 or 5 points on centor criteria should you give antibiotocs?

Answer 26

treat empircically with antibiotics, yes

Question 27

what is the treatment and management of tonsillitis

Answer 27

rest, eat/drink, paracetamol, Penicillin for 10 days or Clarythromycin of allergic`

Question 28

what is the requirement for tonsillectomy

Answer 28

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

Question 29

what is recommended post op treatment wise

Answer 29

anti-emetic, paracetamol, 1 dose of dexamethasone (children)

Question 30

peritonsillar abscess is not a complication of acute tonsillitis

Answer 30

false, it is a complication

Question 31

how does one get a peritonsillar abscessq

Answer 31

bacteria gets trapped between muscle and tonsil to produce pus

Question 32

what are symptoms of an abscess

Answer 32

unilateral throat pain and odynophagia, trismus (spasm of jaw), 3-7 day acute tonsillitis previously, displacement of tonsil and uvula

Question 33

what is the treatment for an abscess

Answer 33

aspiration and antibiotics- penicillin and metronidazole

Question 34

what virus causes glandular fever

Answer 34

EBV

Question 35

what are signs of glandular fever

Answer 35

tonsillar enlargement with exudate, cervical lymphadenopathy, palatal haemorrhages, lymphadenopathy general, hepatosplenomegaly, jaundice

Question 36

how doy uo diagnose glandular fever

Answer 36

atypical lymphocytes in blood, positive monospot/ paul bunnell test

Question 37

how doy you treat glandular fever

Answer 37

usually nothing- avoid vigorous sports and alcohol. Give antibiotics- penicillin and steroids if really bad

Question 38

what antibiotic should you not give in glandular fever and why

Answer 38

ampicillin or amoxicillin- macular rash will result

Question 39

What are adenoid and tonsil causes of obstructive hyperplasia

Answer 39

adenoid- AOM and OME 9snoring) and tonsil- snoring, muffled voice and dysphagia

Question 40

What is glue ear/ OME (effusion)

Answer 40

inflammation of the middle ear with accompaniment of fluid without signs and symptoms of acute inflammation.

Question 41

what is acute OM

Answer 41

inflammation of inner ear with signs and symptoms of inflammation/ with/ without fluid

Question 42

is hearing loss present in glue ear?

Answer 42

yup

Question 43

who gets OEM

Answer 43

children

Question 44

what are symptoms of OME

Answer 44

deafness, poor performance at school, behavioural problems, speech delay, balance problems, NOT EARRACHE

Question 45

How do you diagnose glue ear

Answer 45

history, otoscopy, tuning fork tests, audiometry, tympanometry

Question 46

what are sings of glue ear?

Answer 46

retracted tympanic membrane, reduced tympanic membrane mobility, altered tympanic membrane colour, visible fluid/ bubbles, CHL tuning fork tests

Question 47

how do you treat OME

Answer 47

wait and see- more than 3 months with deafness, speech, balance problems, may use auto inflation... but antibiotics ect not useful

Question 48

how would you surgically treat glue ear in 3 yo

Answer 48

3yo- grommet and adenoidectomy

Question 49

how would someone present with epiglottis

Answer 49

drooling saliva, sore throat, pyrexia, stridor

Question 50

what is th common infection of epiglottis

Answer 50

HiB (children now vaccinated against HiB

Question 51

how do you manage acute epiglottitis

Answer 51

O2 by mask, nebulized adrenaline and IV dexamethasone, visual diagnosis, culture, cricothyrotomy kit, penicillin, ceftriaxone