Adenotonsillar Disease Flashcards
What viruses cause acute tonsillitis?
rhino, entero, andenoviruses
influenza, parainfluenza
EBV
What percentage of acute tonsillitis is bacterial?
5-30%
What is the main bacterial cause of acute tonsillitis?
Group A B haemolytic strep - Strep. Pyogenes
What are the four Centor criteria?
1 - history of fever
2 - absence of cough
3 - tonsillar exudate
4 - tender anterior cervical lymphadenopathy
What is the Centor criteria used for?
Differentiating bacterial and viral tonsillitis
What are the Centor scorings?
0-1 no antibiotic risk
2-3 antibiotic if progresses
4-5 antibiotic
age <15 +1 point
age >44 -1 point
What is the treatment of acute tonsillitis?
supportive: NSAIDs, paracetamol, fluids, rest
if antibiotic required (Centor score 4-5): penicillin V (clarythromycin if allergic)
What are the guidelines for tonsillectomy?
7 or more cases in 1 year
5 or more cases each year in 2 years
3 or more cases each year in 3 years
Name a complication of acute tonsillitis?
Peritonsillar abscess
What is a peritonsillar abscess?
Bacteria between the muscle and tonsil producing pus
What is the clinical presentation of a peritonsillar abscess?
preceding tonsillitis 3-7 days unilateral throat pain odynophagia trismus medial displacement of tonsil and uvula
What is the treatment of peritonsillar abscess?
aspiration and antibiotics
What are the symptoms of viral acute tonsillitis?
3-4 days temperature sore throat malaise are able to undertake almost normal activity
What are the symptoms of bacterial acute tonsillitis?
More than 7 days Lymphadenopathy fever systemic upset odynophagia halitosis unable to work/ school
What is glandular fever?
infectious mononucleosis
What virus causes glandular fever?
EBV (Epstein Barr)
What are the symptoms of glandular fever?
Flu like symptoms
Malaise, fever, sore throat, enlarged lymph nodes, lethargy
What are the signs of glandular fever?
Hepatosplenomegaly
Gross tonsillar enlargement and membranous exudate
Generalised and marked cervical lymphadenopathy
Palatal petechial haemorrhage
Jaundice
How do you diagnose glandular fever?
Epstein Barr virus IgM Blood count and film Low CRP (<100) \+ve Monospot or Paul Tunnel test (heterophile Ab) LFTs
What is the management of glandular fever?
Bed rest, avoid sport
Symptomatic treatment
Antibiotics
Steroids (complicated cases)
Why can’t you prescribe amoxicillin in glandular fever?
It will cause a diagnostic generalised macular rash
What are the symptoms of obstructive hyperplasia of the adenoid/pharyngeal tonsils?
Obligate mouth breathing
hypo nasal voice
Snoring
AOM/OME
What are the symptoms of obstructive hyperplasia of the palatine tonsil?
snoring
muffled voice
?dysphagia
