Adenotonsillar Disease

Question 1

Between what ages do the tonsils usually develop fully?

Answer 1

2-10 yrs

Question 2

State the main function of the tonsils

Answer 2

Trap inhaled bacteria + viruses and present to immune system

Question 3

What is Waldeyer’s ring?

Answer 3

Ring of MALT between the oropharynx and nasopharynx

Comprises tonsils, adenoids + lingual tonsils

Question 4

How does the histology of the tonsils differ from that of the adenoids?

Answer 4

Tonsils: specialised squamous, crypts
Adenoids: resp epithelium, folds, transitional

Question 5

Acute tonsillitis is usually bacterial. True/False?

Answer 5

False

Usually viral

Question 6

List the main viruses that cause acute tonsillitis

Answer 6

EBV
Influenza
Rhinovirus
Enterovirus
Adenovirus

Question 7

What is the most commonest bacterial cause of acute tonsillitis?

Answer 7

Group A Strep.

Question 8

Throat swabs are not recommended in acute tonsillitis. Why?

Answer 8

Surface bacteria do not always reflect core species

Question 9

List symptoms of acute viral tonsillitis

Answer 9

Malaise
Sore throat
Temperature
Able to do daily tasks
Mainly self-limiting: lasts 3-4 days

Question 10

List symptoms of acute bacterial tonsillitis

Answer 10

Systemic upset
Fever
Odynophagia
Halitosis
Unable to work/school
Lasts 1 week +

Question 11

Which criteria helps differentiate between viral and bacterial tonsillitis?

Answer 11

Centor Criteria

Question 12

How many points on the Centor Criteria warrants antibiotic use for acute tonsillitis?

Answer 12

2 or 3 points if progressing

4 or 5 points = treat empirically

Question 13

Outline conservative management for acute tonsillitis

Answer 13

Bed rest
Fluids
Analgesia (paracetamol, NSAID)

Question 14

Which antibiotics can be given for acute tonsillitis?

Answer 14

Penicillin for 10 days

Clarithromycin if pen-allergic

Question 15

Surgery (tonsillectomy) is often done for tonsillitis. True/False?

Answer 15

False

Not as often as it used to be

Question 16

List indications for tonsillectomy

Answer 16

Recurrent severe tonsillitis
Well-documented visits to practice for tonsillitis
Numerous episodes in 2-3 years

Question 17

The risk of mortality from tonsillitis is less than the risk of complications of tonsillectomy. True/False?

Answer 17

True

Question 18

What is peritonsillar abscess?

Answer 18

Complication of tonsillitis where infection moves to space between tonsil and muscle

Question 19

What is the classic history/presentation of peritonsillar abscess?

Answer 19

Tonsillitis improving but developing unilateral throat pain and odynophagia
Medial displacement of tonsil + uvula contralaterally

Question 20

How is peritonsillar abscess treated?

Answer 20

Aspiration

Antibiotics (penicillin)

Question 21

What is glandular fever?

Answer 21

Infectious mononucleosis caused by EBV

Question 22

List signs and symptoms of glandular fever

Answer 22

Feeling washed out
Malaise
Gross tonsillar enlargement with membranous exudate
Lymphadenopathy

Question 23

How is glandular fever diagnosed?

Answer 23

+ve Monospot or Paul-Bunnell test

Question 24

CRP is very high in glandular fever. True/False?

Answer 24

False

Usually below 100

Question 25

What is the antibiotic of choice for glandular fever?

Answer 25

Penicillin

Question 26

Do not prescribe amoxicillin for tonsillitis or glandular fever. True/False?

Answer 26

True