ENT Flashcards
Describe acute bacterial tonsillitis
Primarily caused by Streptococcus pyogenes (Group A Streptococcus, GAS),
Infection of palatine tonsils, often following viral pharyngitis, with bacterial superinfection leading to inflammation, exudates, and systemic features.
what are clinical features of acute bacterial tonsillitis?
sore throat, fever >38C, dsyphagia, tender anterior cervical lymphadenopathy.
tonsillar erythema/enlargement/purulent exudates.
list 3 local complications of bacterial tonsillitis?
- retropharyngeal abscess
- peritonisllar abscess (quinsy)
- mastoiditis
list 3 systemic complications of bacterial tonsillitis?
- bacteraemia/sepsis
- meningitis/cerebral abscess
- mediatinitis
- rheumatic fever
what pathogen is most likely for bacterial tonsillitis and treatment
GAS: phenoxymethylpenicillin 500mg bd for adults for 10 days.
analgesia, hydration, rest.
what examination features present with quinsy (peritonsillar abscess)?
- unilateral tonsillar swelling
- uvula deviation to the contralateral side
- trismus (jaw stiffness due to pterygoid irritation)
- tender cervical lymphadenopathy. Drooling or respiratory distress signals advanced disease or airway risk.
what does this CT show
widening of retropharyngeal space with air pockets, most likely retropharyngeal abscess
what is the classic presentation for quinsy? (peritonisillar abscess)
severe unilateral sore throat, fever, dysphagia, and “hot potato” voice (muffled speech).
what is the treatment for quinsy?
- Airway: Asses/ secure if compromised, steroids (dexamethasone 8 mg IV)
- Drainage: Definitive treatment via needle aspiration (avoid carotid artery injury)
Antibiotics: IV benzylpenicillin (1.2-2.4 g QID) + metronidazole (500 mg BD) for anaerobic cover; clindamycin (600 mg TDS) if penicillin-allergic. - Supportive: IV fluids, analgesia
- Disposition: Admit if systemically unwell, airway risk, or failed outpatient management
You diagnose peri-tonsillar abscess and consider surgical drainage in the ED. Name two (2) patient-specific contraindications.
- Severe trismus limiting visibility/ access
- Patients on oral anticoagulants, or with a known bleeding disorder
- Patients who refuses/ are uncooperative
List three (3) complications associated with incision and drainage of a peritonsillar abscess.
- Haemorrhage from carotid artery injury
- Aspiration pneumonitis/ lung abscess / aspiration
- Airway obstruction / laryngospasm
- Extension of infection into deep tissue of the neck.
