Adenotonsillar Disease

Question 1

what are the function of the tonsils

Answer 1

trap viruses and bacteria on inhalation, present to immune system to prevent further infection

Question 2

describe waldeyers ring

Answer 2

ring of lymphoid tissue in subepithelial layer of oro/nasopharynx
made up of palatine tonsils, adenoids, lingual tonsils and tubular tonsils

Question 3

what type of cells are palatine tonsils made up of

Answer 3

specialised squamous epithelium with deep crypts and lymphoid follicles

Question 4

what type of cells are adenoids made up of

Answer 4

ciliated pseudostratified columnar epithelium (respiratory type epithelium)

Question 5

what type of pathogen is most likely to cause tonsillitis

Answer 5

viral - usually EBV, rhinovirus, influenza, parainfluenza and adenoviruses

Question 6

a throat swab is/isn’t recommended in tonsillitis

Answer 6

isn’t - sample only swabs the surface of the tonsil which may not be the causative organism of infection

Question 7

what is the most common bacterial causes of tonsillits

Answer 7

strep pyogenes - group A strep.

Question 8

what are some other common causes of bacterial tonsillitis

Answer 8

haemophilus influenza
staph aureus
strep. pneumonia

Question 9

list some differentials for acute tonsillitis

Answer 9

URTI viral 
glandular fever 
peritonsillar abscess 
candida infection 
lymphoma, leukaemia 
scarlet fever

Question 10

list the symptoms of viral tonsillitis

Answer 10

malaise 
sore throat 
temperature
able to complete normal activity 
possible lymphadenopathy
unwell for 3-4 days

Question 11

list the symptoms of bacterial tonsillitis

Answer 11

systemically unwell
temperature
odynophagia 
unable to work 
halitosis 
lasts 1 week and requires antibiotics to settle

Question 12

what criteria is used to determine if a case of tonsillitis is more likely to be bacterial than viral

Answer 12

centor criteria

Question 13

list the components of centor criteria and what each score means

Answer 13

history of fever
absence of cough
tonsillar exudates
tender anterior cervical lymphadenopathy
0-1 = no antibiotic 2-3 = give antibiotic if worsens 4-5 = treat with empirical antibiotics

Question 14

list the supportive treatment for tonsillitis

Answer 14

eat and drink plenty
bed rest
analgesics

Question 15

list the antibiotic treatment for tonsillitis

Answer 15

penicillin 500mg 4 times a day

clarithromycin if allergic

Question 16

when are steroids indicated for tonsillitis

Answer 16

if very slow to recover, helps to shrink inflammation

Question 17

list the indications for tonsillectomy

Answer 17

7 or more documented and treated cases within a year
5 or more of similar cases over 2 years
3 or more of similar cases over 3 years

Question 18

what is a peritonsilar abscess

Answer 18

build up of bacteria between the muscle and tonsil which produces pus

Question 19

what is the presentation of peritonsilar abscess

Answer 19

sore throat 
peritonsilar bulge 
dysphagia 
uvular deviation - away from affected side 
muffled voice 
trismus/lockjaw

Question 20

what is the management of peritonsilar abscess

Answer 20

aspiration of abscess using large needle

antibiotics

Question 21

what pathogens causes glandular fever

Answer 21

Epstein-Barr virus

Question 22

what are the clinical signs of glandular fever

Answer 22

tonsillar enlargement with membranous exudate
cervical lymphadenopathy
hepatosplenomegaly

Question 23

how is glandular fever spread and what are the complications of it

Answer 23

spread via saliva (kissing disease)

complications include Guillan-Barre syndrome

Question 24

what investigations confirm a diagnosis of glandular fever

Answer 24

atypical lymphocytes in peripheral blood
+ve monospot/Paul Bunnel test
low CRP <100

Question 25

what is the treatment for glandular fever

Answer 25

symptomatic relief
steroids
antibiotics incase tonsillitis with glandular fever

Question 26

which antibiotic should be avoided in glandular fever etc and why

Answer 26

ampicillin - causes macular rash

Question 27

what are tonsilliths

Answer 27

tonsil stones

Question 28

what is the presentation of obstructive adenoids

Answer 28

obligate mouth breathing
hyponasal voice
snoring
otitis media with effusion

Question 29

what is the presentation of obstructive tonsils

Answer 29

snoring/sleep disturbance
muffled voice
dysphagia