Adenotonsillar disease and OME

Question 1

How do the adenoids develop?

Answer 1

subepithelial infiltration of lymphocytes

Question 2

What age is significant adenotonsilar enlargement unsual?

Answer 2

under 2

Question 3

When do the tonsils and sdenoids decrease in bulk?

Answer 3

after early teenage years

Question 4

What is Waldeyer’s ring?

Answer 4

a ring of lymphoid aggregation in the subepithelial layer of oropharynx and nasopharynx

Question 5

What does Waldeyer’s ring comprise of?

Answer 5

palatine tonsil; adenoids; lingual tonsil

Question 6

What muscle forms the anterior tonsillar pillar?

Answer 6

palatoglossus

Question 7

What muscle forms the posterior tonsillar pillar?

Answer 7

palatopharyngeus

Question 8

What covers the surface of the tonsil?

Answer 8

stratified squamous epithelium

Question 9

What separates the base of the tonsil from underlying muscle?

Answer 9

dense collagenous hemi-capsule

Question 10

What is the surface of the adenoids?

Answer 10

pseudo-stratified columnar epithelium which functions in mucociliary clearnance and stratified squamous underneath this

Question 11

What mainly causes adenotonsilitis?

Answer 11

viral- EBV; rhinovirus; influenza; parainfluenzae; enterovirus

Question 12

What are the main bacteria in tonsilitis?

Answer 12

s. pyogenes; h. influenzae; s. aureus; s. pneumoniae

Question 13

What are hte symtpoms of bacterial tonsilitis?

Answer 13

systemic upset; fever; odynophagia; halitosis; unable to work/cshool; lymphadenpathy

Question 14

What is the centor criteria?

Answer 14

hx of fever; tonsillar exudates; tender anterior cervical lymphadenopthy; absence of cough

Question 15

What antibiotic is used in tonsilitis?

Answer 15

penicillin

Question 16

What is the “bad day” post tonsillectomy?

Answer 16

day 5

Question 17

What is a quinsy?

Answer 17

a peritonsillar abscess- complication of acute tonsilitis

Question 18

What is the classic history of peritonsilar abscess?

Answer 18

unilateral throat pain and odynophagia; trismus; 3-7 days preceding acute tonsilitis

Question 19

What is trismus?

Answer 19

difficulty opening the mouth

Question 20

What is the treatment of a quinsy?

Answer 20

aspiration and antibiotics

Question 21

What is seen on exam of a quinsy?

Answer 21

medial displacement of tonsil and uvula and concavity of palate lost

Question 22

What are the signs of infectious mononucleosis?

Answer 22

groos tonsillar enlargement with membranous exudate; marked cervical lymphadenopathy; palatal petechial haemorrhages; generalised lymphadenopathy; hepatosplenomegaly

Question 23

How is glandular fever diagnosed?

Answer 23

atyi=pical lymphocytes in peripheral blood; +ve monospot; low CRP

Question 24

What is chronic tonsilitis?

Answer 24

chronic sore throat; malodorous breath; presence of tonsilliths; peritonsillar erythema; persistent tender cervical lymphadenopathy

Question 25

What does obstructive hyperplasia of the adenoids result in?

Answer 25

obligate mouth breathing; hyponasal voice; snoring and other sleep disturbance; AOM/OME

Question 26

What are the signs of tonsillar obstructive hyperplasia?

Answer 26

snoring; muffled voice; dysphagia

Question 27

What is important to identify in unilateral tonsillar enlargement?

Answer 27

if the enlargemnet is apparent or true

Question 28

What are reasons for apparent enlargement?

Answer 28

tonsil sits in more medial position; displacement medially by PTA or parapharyngeal space masss

Question 29

What are the causes of unilateral tonsillar enlargement?

Answer 29

non-neoplastic= acute or chronic infective; hypertrophy; congential
neoplastic- papilloma; lymphoma; SCC

Question 30

What is OME?

Answer 30

inflam of the middle ear accompanied by the accumulation of fluid without signs of acute inflam

Question 31

Who gets OME?

Answer 31

boys more than girls; incidence decreases with age

Question 32

What are the risk factors for OME?

Answer 32

day care; older siblings; smoking household; recurrrent URTI