Adenotonsillar Disease Flashcards
what are the function of the tonsils
trap viruses and bacteria on inhalation, present to immune system to prevent further infection
describe waldeyers ring
ring of lymphoid tissue in subepithelial layer of oro/nasopharynx
made up of palatine tonsils, adenoids, lingual tonsils and tubular tonsils
what type of cells are palatine tonsils made up of
specialised squamous epithelium with deep crypts and lymphoid follicles
what type of cells are adenoids made up of
ciliated pseudostratified columnar epithelium (respiratory type epithelium)
what type of pathogen is most likely to cause tonsillitis
viral - usually EBV, rhinovirus, influenza, parainfluenza and adenoviruses
a throat swab is/isn’t recommended in tonsillitis
isn’t - sample only swabs the surface of the tonsil which may not be the causative organism of infection
what is the most common bacterial causes of tonsillits
strep pyogenes - group A strep.
what are some other common causes of bacterial tonsillitis
haemophilus influenza
staph aureus
strep. pneumonia
list some differentials for acute tonsillitis
URTI viral glandular fever peritonsillar abscess candida infection lymphoma, leukaemia scarlet fever
list the symptoms of viral tonsillitis
malaise sore throat temperature able to complete normal activity possible lymphadenopathy unwell for 3-4 days
list the symptoms of bacterial tonsillitis
systemically unwell temperature odynophagia unable to work halitosis lasts 1 week and requires antibiotics to settle
what criteria is used to determine if a case of tonsillitis is more likely to be bacterial than viral
centor criteria
list the components of centor criteria and what each score means
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
list the supportive treatment for tonsillitis
eat and drink plenty
bed rest
analgesics
list the antibiotic treatment for tonsillitis
penicillin 500mg 4 times a day
clarithromycin if allergic
when are steroids indicated for tonsillitis
if very slow to recover, helps to shrink inflammation
list the indications for tonsillectomy
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
what is a peritonsilar abscess
build up of bacteria between the muscle and tonsil which produces pus
what is the presentation of peritonsilar abscess
sore throat peritonsilar bulge dysphagia uvular deviation - away from affected side muffled voice trismus/lockjaw
what is the management of peritonsilar abscess
aspiration of abscess using large needle
antibiotics
what pathogens causes glandular fever
Epstein-Barr virus
what are the clinical signs of glandular fever
tonsillar enlargement with membranous exudate
cervical lymphadenopathy
hepatosplenomegaly
how is glandular fever spread and what are the complications of it
spread via saliva (kissing disease)
complications include Guillan-Barre syndrome
what investigations confirm a diagnosis of glandular fever
atypical lymphocytes in peripheral blood
+ve monospot/Paul Bunnel test
low CRP <100
what is the treatment for glandular fever
symptomatic relief
steroids
antibiotics incase tonsillitis with glandular fever
which antibiotic should be avoided in glandular fever etc and why
ampicillin - causes macular rash
what are tonsilliths
tonsil stones
what is the presentation of obstructive adenoids
obligate mouth breathing
hyponasal voice
snoring
otitis media with effusion
what is the presentation of obstructive tonsils
snoring/sleep disturbance
muffled voice
dysphagia
