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ENT > Adenotonsillar Disease > Flashcards

Adenotonsillar Disease Flashcards

1
Q

Describe the histology of the tonsils

A
  • Luminal surface covered by stratified squamous epithelium
  • Invaginates the tonsil forming crypts
  • Dense collagenous semi-capsule separates the base from muscles
  • Lymphoid follicles are dispersed beneath the epithelium of crypts
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2
Q

Describe the histology of adenoids

A
  • Surface is covered by ciliated pseudostratified columnar epithelium
  • Deeps folds with fewer crypts
  • stratified squamous layer thickens in chronic infection
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3
Q

What causes acute tonsillitis?

A

Viral - EBV, rhinovirus, H.influenza, parainfluenza, adenovirus
Group A beta haemolytic strep

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4
Q

What is the serious complication of GABHS?

A

Rheumatic fever

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5
Q

Is a throat swab recommended in tonsillitis?

A

no

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6
Q

How will viral tonsillitis typically present?

A

Malaise, sore throat, temperature, lasts 3-4 days but can continue with daily tasks

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7
Q

How will bacterial tonsillitis typically present?

A

Systemic upset, fever, odynophagia and halitosis, unable to work, 1 week off

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8
Q

Name two criteria that can be used to assess if antibiotics are required in tonsillitis

A
  • Centor

- Fever pain

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9
Q

How is acute tonsillitis treated?

A

Supportive

Penicillin 500mg QID for 10 days (clarithromycin if allergic)

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10
Q

When will a tonsillectomy be considered?

A

> 7 adequately treated sore throats in 1 year
5 episodes in each of the preceding 2 years
3 episodes in each of the preceding 3 years

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11
Q

Name the most common complication of acute tonsillitis

A

Peritonsillar abscess/quinsy

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12
Q

What is the classic history of peritonsillar abscess?

A

Unilateral sore throat, odynophagia, trimus (lockjaw), 3-7 days after tonsillitis

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13
Q

On examination what might be seen in a patient with a peritonsillar abscess?

A

Medial displacement of the tonsil and uvula

Concavity of the palate lost

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14
Q

What is the name for glandular fever and what causes it?

A

Infectious mononucleosis - Ebstein Barr Virus

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15
Q

How will glandular fever present?

A

Gross tonsillar enlargement with membrane exudate
Cervial lymphadenopathy
Palatial petechial haemorrhages
Hepatosplenomegaly (no sport to prevent rupture)

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16
Q

How can glandular fever be diagnosed?

A

Atypical lymphocytes in peripheral blood, low CRP, specific antibody test

17
Q

How is glandular fever managed?

A

Symptomatically, antibiotics for secondary bacterial infection, steroids

18
Q

What antibiotic should not be given in tonsillitis?

A

Amoxicillin/Ampicillin

19
Q

Why should amoxicillin and ampicillin not be given in tonsillitis?

A

EBV may be present and will result in a rash that scars

20
Q

How will adenoid hyperplasia present?

A

Obligate mouth breathing
Hypo nasal voice
Snoring/sleep disturbance
AOM/OME

21
Q

How will tonsil hyperplasia present?

A

Snoring/sleep disturbance
Muffled voice
Dysphagia

22
Q

What might cause unilateral tonsillar enlargement?

A

Non-neoplastic - infective, hypertrophy, congenital

Neoplastic - papilloma, lymphoma

23
Q

What would indicate neoplasm of the tonsils?

A

Change in appearance - colour/ulceration

24
Q

Define glue ear

A

Inflammation of the middle ear accompanied by accumulation of fluid without sings/symptoms of acute inflammation

25
Q

Define acute otitis media

A

Inflammation of the middle ear accompanied by signs/symptoms of acute inflammation but no accumulation of fluid

26
Q

What disease results in fluid accumulation and hearing loss?

A

Glue ear

27
Q

What is glue ear formally known as?

A

Otitis Media with Effusion

28
Q

What are the risk factors for glue ear?

A

Day care, older siblings, smoking household, recurrent URTI

29
Q

What causes glue ear?

A

Recurrent URTI/AOM
Craniofacial/genetic abnormalities
Immunodeficiency
Seasonal

30
Q

What abnormalities predispose to glue ear?

A

Cleft palate

Downs syndrome

31
Q

How is glue ear diagnosed?

A

Age dependent

- audiometry, tuning forks, otoscopy, tympanometry

32
Q

What are the typical signs of glue ear?

A

Tympanic membrane retraction, dull appearance with visible bubbles

33
Q

Name the type of hearing loss in glue ear

A

Conductive hearing loss

34
Q

How is glue ear managed?

A

Watchful waiting and auto-inflation then review

Surgery

35
Q

When are grommets indicated?

A

OME persistent for >3/12 months with symptoms of deafness, speech or balance problems

36
Q

If a child is >3 years old what is the second intervention?

A

Grommets and adenoidectomy

37
Q

When is adenoidectomy first line?

A

If nasal symptoms are present

38
Q

What are the complications of grommets?

A

Infection/discharge, early extrusion, retention, perforation, swimming/bath problems

ENT (11 decks)

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