Adenotonsillar disease

Question 1

Waldeyer ring

Answer 1

Circular structure of lymphoid tissue in NP and OP

• Palatine tonsils
• Pharyngeal tonsils or adenoids
• Tubal or Gelach tonsils surrounding eustachian tube opening
• Lingual tonsils

Question 2

Composition of waldeyer ring lymphoid tissue

Answer 2

B cell lymphs
T cell lymphs
Few mature plasma cells
Function: primarily secretory immunity, regulates Ig production

Question 3

How are antigens acquired in waldeyer ring

Answer 3

Independently from lymphatic drainage via specialized endothelium-covered channels that facilitate Ag uptake directly into the tissue

Question 4

Palatine tonsils

Answer 4

Largest component of Waldeyer ring
Sit within tonsillar fossa formed by 3 muscles
-Ant pillar: palatoglossus
-Post pillar: Palatopharyngeus
-Base: Pharyngeal constrictor (esp sup)
Fibrous capsule is attached to fascia of the pharyngeal muscles

Question 5

Where does a PTA form?

Answer 5

In the potential space b/w the fibrous palatine capsule and the pharyngeal muscle

Question 6

What nerves provides sensation to the palatine tonsils?

Answer 6

• Glossopharyngeal n lies deep to the superior pharyngeal constrictor and supplies sensation via the tonsillar branch
• Descending branches of the lesser palatine nerve

Question 7

What causes referred otalgia from tonsillar inflammation or after tonsillar surgery?

Answer 7

The tympanic branch of the glossopharyngeal nerve

Question 8

Blood supply of palatine tonsils

Answer 8

Inferior pole (primary provider)

• Tonsillar branch of the dorsal lingual artery
• Ascending branch of the palatine artery
• Tonsillar branch of the facial artery

Superior pole

• Ascending pharyngeal artery
• Lesser palatine artery

Question 9

Viral acute pharyngotonsillitis

Answer 9

P/w: sore throat, dysphagia, fever, tender cervical LAD, tonsillar inflammation, erythema, possible exudate
Etiologies: adeno, rhino, reo, RSV, flu, paraflu
Tx: supportive

Question 10

Herpangina

Answer 10

Coxsackie virus tonsillar infxn
Ulcerative vesicles over the tonsils, post pharynx, and palate
Usu < 16 yo
P/w generalized sx of HA, high fever, anorexia, and odynophagia

Question 11

Infectious mono

Answer 11

EBV
Oral transmission
P/w: fever, generalized malaise, LAD, HSM, pharyngitis, severely enlarged tonsils w/ extensive grayish-white exudate
Transforms B cells --> proliferation
2-6 wk incubation
Atypical cytotoxic T lymphs
Tx: fluids, rest, analgesics

Question 12

What happens in immunosuppressed pts infected w/ EBV

Answer 12

Hyperplasia of lymphoid tissues from uncontrolled proliferation of B cells (the T cell response is limited)
Happens in AIDS, X-linked lymphoproliferative d/o, post-txp I/S

Question 13

Dx of IM

Answer 13

Clinical observation of absolute lymphocytosis
Atypical lymphocytes in peripheral smear
Heterophile antibodies
EBV-specific antibodies

Question 14

What if airway obstruction in IM?

Answer 14

Short course of steroids
Rarely:
-NP airway
-NT intubation
-Tonsillectomy
-Trach