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ENT - Fearghal > Adenotonsillar disease and OME > Flashcards

Adenotonsillar disease and OME Flashcards

1
Q

What is the main function of the tonsils and adenoids? Are they large or small usually?

A

Usually small. main function, trap pathogens and present to the immune system.

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2
Q

There is usually significant adenotonsillar enlargement between ___years and ____years. after this enlargement is likely/unlikely and why?

A

2-teen years

Unlikely as they begin to reduce in bulk

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3
Q

What is Waldeyer’s ring?

A

A ring of lymphoid tissue in the sub-epithelial layer of the oro and nasal pharynx.

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4
Q

What structures comprise waldeyer’s ring?

A

Adenoids, palatine tonsils and lingual tonsils.

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5
Q

The luminal surface of the tonsil is covered by _____ epithelium which deeply invaginates to form crypts.

A

Stratified squamous epithelium.

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6
Q

The base of the tonsil is separated from the underlying muscles by ______

A

The dense collagenous hem-capsule.

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7
Q

The parenchyma contains few lymphoid follicles disperse just superficial to the epithelium of the crypts; true/false

A

False - many lymphoid follicles dispersed deep to the epithelium of the crypts.

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8
Q

They adenoids differ from the tonsils as they have fewer crypts and deeper folds - true/false

A

true

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9
Q

How do the adenoids differ from the tonsils histologically?

A

They are composed of ciliated pseudo stratified columnar epithelium which carry out mucociliary clearance

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10
Q

With chronic infection the pseudo stratified columnar epithelium of the adenoids gets thickened/thinned and the secretions become hypermobile/stagnant.

A

Thinned

Stagnant

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11
Q

Thinned epithelium and decreased mucociliary clearance in the adenoids increases exposure to antigenic materials - true/false

A

True

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12
Q

Deep to the surface epithelium of the adenoids lies a layer of _______ followed by a __________ layer deep to that.

A

Deep to the surface epithelium of the adenoids lies a layer of stratified squamous epithelium followed by a transitional layer deep to that.

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13
Q

In the adenoids the stratified squamous layer is the layer that processes antigens - true/false

A

False it is the transitional layer

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14
Q

The transitional layer of the adenoids thickens with chronic infection - true/false

A

true

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15
Q

Viral tonsillitis is more common that bacterial - true/false. What % is bacterial vs viral?

A

true

5-30% are bacterial while 70-95% are viral.

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16
Q

What are the most common causes for viral tonsillitis?

A
  • EBV
  • rhinovirus
  • influenza virus
  • parainfluenza virus
  • enterovirus
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17
Q

Are throat swabs recommended for tonsillitis?

A

No as most people will have some bacterial growth even in a viral infection.

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18
Q 
Most common organisms for bacterial tonsillitis include:
1.
2.
3.
4.
A
  1. Strep. pyogenes
  2. H. influenza
  3. Strep. pneumoniae
  4. S. aureus
    39% are beta-lactamase producing organisms.
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19
Q

Give some differential diagnoses for tonsillitis

A 
URTI viral infection
Infectious mononucleosis
Quinsy
Candidi
malignancy
Diphtheria
Scarlet fever
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20
Q

Give the symptoms of a viral tonsillitis

A 
malaise
sore throat
pyrexia
loss of normal activities 
possible lymphadenopathy
3-4 days and self-limiting
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21
Q

Give the symptoms of a bacterial tonsillitis

A 
Systemic upset
Pyrexia
odynophagia 
halitosis 
unable to work/school
lymphadenopathy
1 week and needs ABx
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22
Q

What is the censor criteria used for>

A

Differentiating bacterial and viral tonsilitis

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23
Q

Explain how to use the centor criteria.

A

ask about/look for (and award 1 point for):

  • history of fever?
  • Tonsilar exudates
  • tender anterior cervical adenopathy
  • absence of cough
  • younger than 15; + 1 point, older than 44; -1 point.
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24
Q

What do the different scores mean in the centor criteria?

A

0-1 - no ABx; risk of bacterial less than 10%
2-3 - ABx if symptoms persist
4-5 - empirical ABx; risk of infection being bacterial is 56%.

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25
Q

Three possibility for tonsillitis treatment - what are they?

A

Supportive
Medical treatment
Surgical treatment

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26
Q

Explain supportive treatment for tonsillitis

A
  • make sure they eat and drink enough
  • rest
  • OTC analgesia e.g. paracetamol and NSAIDs
27
Q

Explain medical treatment for tonsillitis

A

Penicillin 500mg QID for 10 days orally or clarithromycin if pen allergic; out of host.
In hosp. IV fluids, IV ABx and steroids.

28
Q

What is a Quinsy?

A

peritonsillar abscess - usually complication of acute tonsillitis. bacterial between muscle and tonsil producing pus.

29
Q

What are the symptoms of a Quinsy?

A

Unilateral throat pain,
Odynophagia
3-7/7 of acute tonsillitis and truisms.

30
Q

What may be seen on examination in a Quinsy?

A

Medial displacement of tonsil and uvula; concave nature of palate is lost.

31
Q

How is a quinsy treated?

A

Aspiration and ABx

32
Q

Infectious mononucleosis (glandular fever) signs include:

A

Gross Tonsillar Enlargement
Membranous exudate
Cervical lymphadenopathy, palatal petechial haemorrhages, generalised lymphadenopathy and hepatosplenomegally (more rare).

33
Q

how is glandular fever diagnosed?

A

Atypical lymphocyte presence in peripheral blood

postive monospot test/Paul Bunnell test. Often has low CRP.

34
Q

How is glandular fever treated?

A

Symptomatic treatment.

35
Q

You should never give Ampicillin/amoxicillin to a patient with suspects glandular fever - why not?

A

All patients with glandular fever will develop a macular rash on ampicillin/amoxicillin - this is NOT allergy.

36
Q

in some severe cases of glandular fever, what can be prescribed?

A

Abx (NOT ampicillin/amoxicillin)

Steroids

37
Q

What characterises chronic tonsillitis?

A

Chronic sore throat and malodorous breath

38
Q

there will rarely be tonsiliths (stones) in chronic tonsillitis - true/false

A

False - there is often stones.

39
Q

What signs will you see in chronic tonsillitis?

A

peritonsillar erythema

tender cervical lymphadenopathy

40
Q

Surgery is often/rarely offered for chronic tonsillitis

A

Rarely offered.

41
Q

Obstructive hyperplasia of the adenoids results in:

  4. (Possibly)
A
  1. Obligate mouth breathing
  2. hyponasal voice
  3. Snoring
  4. Acute Otitis media or OME (possibly)
42
Q 
Obstructive hyperplasia of the tonsils results in: 
1.
2.
3.
4. (Queried)
A
  1. Snoring
  2. sleep disturbance
  3. Muffled voice
  4. Dysphagia is queried.
43
Q

Non-Neoplastic causes of unilateral tonsillar enlargement include:
1.
2.
3.

A
  1. Acute/chronic infection
  2. congenital unilateral enlargement
  3. hypertrophy
44
Q

Chronic infectious causes of unilateral tonsillar enlargement include:
1.
2.
3.

A
  1. Tubercular tonsilitis
  2. Actinomycosis
  3. congenital syphillis
45
Q 
Congenital causes of unilateral tonsillar enlargement include: 
1. 
2.
3.
4.
A
  1. teratoma
  2. Hemangioma
  3. lymphangioma
  4. cystic hygroma
46
Q

Neoplastic cause of unilateral tonsillar enlargement include:
1.
2.
3.

A
  1. Benign papilloma
  2. Lymphoma (usually Non-hodgekins B-cell)
  3. Squamous cell carcinoma
47
Q

What is the medical name for glue ear?

A

Otitis media with effusion

48
Q

Give some symptoms of OME

A 
No earache 
Middle ear effusion
Opaque tympanic membrane/fluid seen behind membrane
tympanic membrane not bulging
Impaired tympanic membrane mobility 
Hearing loss
49
Q

What is the trend of incidence of glue ear with age?

A

Age goes up, incidence comes down

50
Q

Females are higher risk than males of developing glue ear - true/false

A

False - other way around

51
Q

of children under four what percentage will have glue ear at any one time?

52
Q

Increased incidence is associated with four things; what are they?

A

Day care
Older siblings
Smoking households
recurrent URTIs

53
Q

patient who were premature experience no extra risk than those born at term - true/false

A

false - higher risk

54
Q

Craniofacial abnormality
Generic abnormality
Immunocompromisation
These all cause a decreased risk of glue ear - true/false

A

False - increase the risk

55
Q

Give the symptoms which may present with glue ear.

A 
Deafness
Poor school performance
behavioural problems 
speech delay,
balance issue 
TV volume up
NOT otalgia
56
Q

Diagnosis relies on:

A

History/otoscopy/tuning fork testing

audiometry and tympanometry are often done also

57
Q

What are the clinical signs of OME?

A

TM retraction
Reduced TM mobility
Altered colour of the TM
Visible fluid or bubbles in middle ear

58
Q

How is OME treated?

A

60% resolve in one month/90% in 3months with watchful waiting
Review at three months and carry out otoscopy, pure tone audiometry and tympanometry.
Still persistent, with speech, hearing or balance issue; more treatment needed.

59
Q

After three months, with persistent OME it should be treated with _____

A

ENT referral.

60
Q

A 2 year old child is now in your ENT clinic with OME that is persistent and needs managed; what are you going to do?

61
Q

A 3 year old child is now in your ENT clinic with OME that is persistent and needs managed; they have never received any other interventions. what are you going to do?

A

Over 3 and no previous interventions, give grommets

62
Q

A 3 year old child is now in your ENT clinic with OME that is persistent and needs managed; they have previously received grommets. what are you going to do?

A

3+ with previous intervention; give grommet’s and do an adenoidectomy
If they have nasal symptoms also, adenoidectomy may be consider earlier than this.

63
Q

What are some complications of grommets?

A 
Infection/discharger
Early extrusion
Retention
Persistent perforation
Swimming/bathing issues

ENT - Fearghal (9 decks)

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