Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RB Y2 ENT > Adenotonsillar Disease > Flashcards

Adenotonsillar Disease Flashcards

1
Q

describe general tonsil histology

A

luminal surface of the tonsil is covered by stratified squamous epithelium, which deeply invaginates the tonsil forming crypts

the base of the tonsil is separated from underyling muscle by a dense collagenous hemi-capsule

the parenchyma contains numerous lymphoid follicles dispersed just beneat the epithelium of the crypts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

describe adenoid histology

A

deep folds and few crypts

surface is composed of ciliated pseudostratified columnar epithelium which functions in mucociliary clearance

deep to surface lies stratified squamous layer followed by transitional layer (responsible for antigen processing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what happens to the adenoid layers with chronic infection

A

ciliated pseudostratified columnar epithelium is thinned, resulting in stasis of secretions and increased exposure of the tissue to antigenic stimuli

stratified squamous is thickened

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

describe tonsil histology

A

10-30 deep crypts

specialised squamous

lymphoid follicules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

clinical features of acute viral tonsillitis

  • able to undertake normal activity?
  • duration?
A

sore throat ± lymphadenopathy

malaise

temperature

able to undertake normal activity

lasts 3-4 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

which lymph nodes are often enlarged in tonsillitis

A

jugulo-diagastric - palatine tonsil drains here first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

clinical features of bacterial tonsillitis

  • able to undertake normal activity?
  • duration?
A

systemic upset

fever

odonyphagia

halitosis

unable to work/school

lymphadenopathy

lasts around a week and requires ABx to settle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

causes of viral tonsillitis

A
  • Rhinovirus, influenza, parainfluenza, enterovirus, adenovirus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

causes of bacterial tonsillitis

A

often caused by Group A Streps eg Strep Pyogenes

also, staphs, Moraxella catarrhalis, mycoplasma, chlamydia, haemophilus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

should suspected bacterial cases be swabbed

A

no - superficial swabs are irrelevant and can lead to over diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

management

A

paracetamol and Difflam gargle if severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ABx management?

A

most cases are viral

but if ill or Centor criteria positive, give penicillin

erythromycin if allergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

which ABx must not be given

A

amoxicillin

EBV is a DD, and this will cause a rash in those whose pharyngitis is due to EBV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

give a recommendation for analgesia

A

alternate paracetamol and ibuprofen - both are anti-pyretic and analgesic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

when should EBV be suspected

A

sore throat and malaise persist after ABX treatment, order WBC and Paul-Bunnell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

tonsillectomy

A

removal of the palatine tonsils

17
Q

outline the indications for tonsillectomy

A

recurrent severe sore throat in adults (not recommended in children)

  • sore throats due to acute tonsillitis
  • ≥5 episodes in past 2 years or ≥3 episodes in past 3 years
  • episodes that are disabling and prevent normal functioning
18
Q

post-op care

A

there is a lot of pain post-op - strong opiate recommended

otalgia is common

19
Q

risk of haemorrhage post tonsillectomy

A

5%

20
Q

differential diagnoses

A
  • URTI viral infection
  • Infectious mononucleosis (EBV)
  • Peritonsillar abscess
  • Candida infection
  • Malignancy: lymphoma, leukaemia, carcinoma
  • Diphtheria
  • Scarlet fever
21
Q

what is used to differentiate bacterial and viral cases

A

Centor clinical criteria

  • Tonsillar exudate, tender anterior cervical lymph nodes, history of fever, absence of cough
22
Q

Modified Centor Criteria

A

adds the patients age to the criteria:

  • <15 add 1 point
  • >44 subtract 1 point
23
Q

describe the outcomes of Centor Clinical Criteria

A

positive in all 4 variables indicates a 40-60% positive prediction value for a culture of the throat to test positive for Group A strep bacteria (pyogenes)

the absence of all 4 indicates a negative prediction value of greater than 80%

therefore, it is more effective for ruling out strep throat than for diagnosing it

24
Q

how many Centor points are required for ABx?

A

0-1 points: no ABx

2-3 points: receive ABx if symptoms progress

4-5 points: treat empirically with ABx

25
Q

what is quinsy

A

peri-tonsillar abscess

can occur as a complication of tonsillitis - there is usually 3-7 days of preceding tonsillitis

bacteria between muscle and tonsil produce pus

26
Q

how does quinsy present

A

unilateral sore throat, dysphagia and odonyphagia, peri-tonsillar bulge, uvular deviation, muffled voice and trismus (locked jaw)

concavity of palate is lost

27
Q

management of quinsy

A

ABx and needle aspiration (this is preferred to surgical drainage)

28
Q

what are some features of chronic/recurrent adenoiditis/tonsillitis

A
  • Chronic sore throat
  • Malodorous breath
  • Presence of tonsilliths
  • Peritonsillar erythema
  • Persistent tender cervical lymphadenopathy
29
Q

clinical features of adenoid hyperplasia

A

can obstruct the nasopharynx causing obligate mouth breathing

hyponasal voice

snoring and other signs of sleep disturbance

30
Q

what can adenoid hyperplasia cause in the ear

A

AOM/OME due to blockage of Eustachian tube

31
Q

symptoms of tonsillar hyperplasia

A

muffled voice

snoring etc

dysphagia ?

32
Q

what can cause unilateral apparent enlargement of tonsil

A

tonsil can be displaced medially by peri-tonsillar abscess or parapharyngeal mass

33
Q

which tumours are found in the tonsils

A

70% squamous cancer, benign papillomas, lymphoma

34
Q

typical patient with tonsillar malignancy

A

elderly patient, sore throat, dysphagia ± otalgia

35
Q

treatment of tonsillar malignancy

A

radiotherapy, surgery, cytotoxics

36
Q

Tonsil crypt debris/Tonsilloliths

A

calcifications that form in the crypts of the palatine tonsils

37
Q

symptoms of Tonsil crypt debris/Tonsilloliths

A

usually asymptomatic, can cause halitosis and dysphagia

metallic taste is sometimes noted

RB Y2 ENT (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions