ENT Flashcards
What is the most common cause of tonsillitis?
Viral infection
What is the most common cause of bacterial tonsillitis?
Group A streptococcus (strep pyogenes)
How can bacterial tonsillitis be treated?
Penicillin V
What is the most common cause of otitis media, rhinosinusitis and alternative bacterial cause of tonsillitis?
Streptococcus pneumoniae
What are some other common causes of tonsillitis?
Haemophilus influenzae
Morazella catarrhalis
Staphylococcus aureus
What is the throat made up of?
Oral cavity (teeth + tongue)
Pharynx
Tonsils
Larynx
What is the key anatomical difference in throat anatomy in childs compared to adults?
Narrowest point in children is the subglottis compared to the glottis in adults
What are the six areas of lympoid tissue in the throat?
Adenoid
Tubal tonsils
Palatine tonsils
Lingual tonsil
What tonsils are most commonly enlarged and infected in tonsillitis?
Palatine tonsials (at either side at back of throat)
What is Waldeyer’s tonsillar ring?
The ring of lymphoid tissue in the pharynx
What age range is most affected by tonsillitis?
5-10
How does tonsillitis usually present?
Fever
Sore throat
Painful swallowing
How may tonsillitis present in younger children?
Fever Poor oral intake Headache Vomiting Abdominal pain
What are exudates?
Small white patches of pus on the tonsil
What should you also assess when examining a child with tonsillitis/
The ears to visualise the tympanic membranes
Palpate for any cervical lymphadenopathy
What is the Centor criteria used to estimate?
The probability that tonsillitis is due to baacterial infection and will benefit from antibiotics
What are the features included in the centor criteria and how many ponts would qualify to offer antibiotics?
Fever >38
Tonsillar exudates
Absence of cough
Lymphadenopathy
(3 or more)
What are the FeverPAIN criteria when considering antibiotics in tonsillitis?
Fever Purulence Attended within 3 days of onset of symptoms Inflamed tonsils No cough or coryza
What should be excluded when diagnosing tonsillitis?
Meningitis
Epiglottitis
Peritonsillar abscess
Calculate centor/ feverPAIN score
How is viral tonsillitis managed?
Give safety net advice (if not settled after 3 days or fever above 38.3)
Advise simple analgesia with paracetamol and ibuprofen
How is bacterial tonsillitis managed?
Penicillin V 10- day course
Clarithromycin= second choice
(can give delayed prescription if needed)
What are the complications of tonsillitis?
Chronic tonsillitis Peritonsillar abscess Otitis media Scarlet fever Rheumatic fever Post-strep glomerulonephritis Post-strep reactive arthritis
What is a quinsy?
Peritonsillar abscess
What causes a quinsy?
When there is a bacterial infection with trapped pus that forms an abscess on the tonsils