Adenotonsillar Disease

Question 1

between what ages do the tonsils usually develop fully?

Answer 1

2 to 10 years

Question 2

state the main function of the tonsils

Answer 2

trap inhaled pathogens and present to immune system

Question 3

what is Waldeyer’s ring?

Answer 3

ring of MALT between the oropharynx and the nasopharynx

comprises tonsils, adenoids and 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

true or false: acute tonsillitis is usually bacterial

Answer 5

false

viral

Question 6

list the main viruses that cause acute tonsillitis

Answer 6

EBV
influenza 
rhinovirus 
enterovirus
adenovirus

Question 7

what is the most common bacterial cause of acute tonsillitis?

Answer 7

group A strep

Question 8

why are throat swabs not recommended in acute tonsillitis?

Answer 8

surface bacteria do not always reflect core species

Question 9

list symptoms of acute viral tonsillitis

Answer 9

malaise
sore throat
temperature
lasts less than a week

Question 10

list symptoms of acute bacterial tonsillitis

Answer 10

systemic upset 
fever 
odynophagia 
halitosis
unable to work 
lasts over a 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

2/3 if progressing

4/5 treat empirically

Question 13

outline conservative management for acute tonsillitis

Answer 13

bed rest
fluids
analgesia

Question 14

which antibiotics can be given for acute tonsillitis?

Answer 14

penicillin for 10 days

clarithromycin if allergic

Question 15

true or false: surgery is often done for tonsillitis

Answer 15

false

Question 16

list indications for tonsillectomy

Answer 16

recurrent severe tonsillitis
well documented visits for tonsillitis
numerous episodes in 2-3 years

Question 17

true or false: the risk of mortality from tonsillitis is less than the risk of complications of tonsillectomy

Answer 17

true

Question 18

what is a peritonsillar abscess?

Answer 18

a complication of tonsillitis where infection moves to the space between the tonsil and the muscle

Question 19

what is the classic history/presentation of a peritonsillar abscess?

Answer 19

tonsillitis improving but developing unilateral throat pain and odynophagia

medial displacement of tonsil and uvula contralaterally

Question 20

how is peritonsillar abscess treated?

Answer 20

aspiration

antibiotics

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
tonsillar enlargement with membranous exudate
lymphadenopathy

Question 23

how is glandular fever diagnosed?

Answer 23

positive monospot or paul bunnell test

Question 24

true or false: CRP is very high in glandular fever

Answer 24

false

usually below 100

Question 25

what is the antibiotic of choice for glandular fever?

Answer 25

penicillin

Question 26

true or false: do not prescribe amoxicillin for tonsillitis or glandular fever

Answer 26

true