Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Waldeyer’s ring?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What structures comprise waldeyer’s ring?

A

Adenoids, palatine tonsils and lingual tonsils.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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

A

Stratified squamous epithelium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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

A

The dense collagenous hem-capsule.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

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

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

False it is the transitional layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

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

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the most common causes for viral tonsillitis?

A
  • EBV
  • rhinovirus
  • influenza virus
  • parainfluenza virus
  • enterovirus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Are throat swabs recommended for tonsillitis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Give some differential diagnoses for tonsillitis

A 
URTI viral infection
Infectious mononucleosis
Quinsy
Candidi
malignancy
Diphtheria
Scarlet fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the censor criteria used for>

A

Differentiating bacterial and viral tonsilitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Three possibility for tonsillitis treatment - what are they?
Supportive Medical treatment Surgical treatment
26
Explain supportive treatment for tonsillitis
- make sure they eat and drink enough - rest - OTC analgesia e.g. paracetamol and NSAIDs
27
Explain medical treatment for tonsillitis
Penicillin 500mg QID for 10 days orally or clarithromycin if pen allergic; out of host. In hosp. IV fluids, IV ABx and steroids.
28
What is a Quinsy?
peritonsillar abscess - usually complication of acute tonsillitis. bacterial between muscle and tonsil producing pus.
29
What are the symptoms of a Quinsy?
Unilateral throat pain, Odynophagia 3-7/7 of acute tonsillitis and truisms.
30
What may be seen on examination in a Quinsy?
Medial displacement of tonsil and uvula; concave nature of palate is lost.
31
How is a quinsy treated?
Aspiration and ABx
32
Infectious mononucleosis (glandular fever) signs include:
Gross Tonsillar Enlargement Membranous exudate Cervical lymphadenopathy, palatal petechial haemorrhages, generalised lymphadenopathy and hepatosplenomegally (more rare).
33
how is glandular fever diagnosed?
Atypical lymphocyte presence in peripheral blood | postive monospot test/Paul Bunnell test. Often has low CRP.
34
How is glandular fever treated?
Symptomatic treatment.
35
You should never give Ampicillin/amoxicillin to a patient with suspects glandular fever - why not?
All patients with glandular fever will develop a macular rash on ampicillin/amoxicillin - this is NOT allergy.
36
in some severe cases of glandular fever, what can be prescribed?
Abx (NOT ampicillin/amoxicillin) | Steroids
37
What characterises chronic tonsillitis?
Chronic sore throat and malodorous breath
38
there will rarely be tonsiliths (stones) in chronic tonsillitis - true/false
False - there is often stones.
39
What signs will you see in chronic tonsillitis?
peritonsillar erythema | tender cervical lymphadenopathy
40
Surgery is often/rarely offered for chronic tonsillitis
Rarely offered.
41
Obstructive hyperplasia of the adenoids results in: 1. 2. 3. 4. (Possibly)
1. Obligate mouth breathing 2. hyponasal voice 3. Snoring 4. Acute Otitis media or OME (possibly)
42
``` Obstructive hyperplasia of the tonsils results in: 1. 2. 3. 4. (Queried) ```
1. Snoring 2. sleep disturbance 3. Muffled voice 4. Dysphagia is queried.
43
Non-Neoplastic causes of unilateral tonsillar enlargement include: 1. 2. 3.
1. Acute/chronic infection 2. congenital unilateral enlargement 3. hypertrophy
44
Chronic infectious causes of unilateral tonsillar enlargement include: 1. 2. 3.
1. Tubercular tonsilitis 2. Actinomycosis 3. congenital syphillis
45
``` Congenital causes of unilateral tonsillar enlargement include: 1. 2. 3. 4. ```
1. teratoma 2. Hemangioma 3. lymphangioma 4. cystic hygroma
46
Neoplastic cause of unilateral tonsillar enlargement include: 1. 2. 3.
1. Benign papilloma 2. Lymphoma (usually Non-hodgekins B-cell) 3. Squamous cell carcinoma
47
What is the medical name for glue ear?
Otitis media with effusion
48
Give some symptoms of OME
``` No earache Middle ear effusion Opaque tympanic membrane/fluid seen behind membrane tympanic membrane not bulging Impaired tympanic membrane mobility Hearing loss ```
49
What is the trend of incidence of glue ear with age?
Age goes up, incidence comes down
50
Females are higher risk than males of developing glue ear - true/false
False - other way around
51
of children under four what percentage will have glue ear at any one time?
30%
52
Increased incidence is associated with four things; what are they?
Day care Older siblings Smoking households recurrent URTIs
53
patient who were premature experience no extra risk than those born at term - true/false
false - higher risk
54
Craniofacial abnormality Generic abnormality Immunocompromisation These all cause a decreased risk of glue ear - true/false
False - increase the risk
55
Give the symptoms which may present with glue ear.
``` Deafness Poor school performance behavioural problems speech delay, balance issue TV volume up NOT otalgia ```
56
Diagnosis relies on:
History/otoscopy/tuning fork testing | audiometry and tympanometry are often done also
57
What are the clinical signs of OME?
TM retraction Reduced TM mobility Altered colour of the TM Visible fluid or bubbles in middle ear
58
How is OME treated?
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
After three months, with persistent OME it should be treated with _____
ENT referral.
60
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?
Grommets
61
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?
Over 3 and no previous interventions, give grommets
62
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?
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
What are some complications of grommets?
``` Infection/discharger Early extrusion Retention Persistent perforation Swimming/bathing issues ```

ENT - Fearghal (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions