ENT Pathology 1 - Tonsilitis,Rheumatic fever, Glandular fever, Glue ear, Tympanometry Flashcards
What is the most common cause of acute tonsilitis?
Viral infection
What is the most common bacterial cause of tonsilitis?
Strep pyogenes - group A beta haemolytic strep (complete hemolysis)
What are other potential causes of tonsiltiis (bacterial causes) however not as common?
Haemophilus influenza B Staph aureus Strep pneumoniae
If distinguishing between viral and bacterial tonsilitis, what do you expect to find on examination if bacterial?
Tonsilar exuadate, absence of cough and fever
What are the components of the centor criteria for differentiating between viral and bacterial tonsilitis?
Centor criteria Tonsilar exudate Cervical lymphadenopathy Absence of cough Fever - approx 38
If the tonsilitis is expected to be viral, what is given?
Supportive treatment eg analgesics and bed rest
What extra does the modified centor criteria contain?
If the child is less than 15 then add a point If over 45 then deduct a point
A new score FEVERPain has been introduced to also help diagnose tonsiltiis How does this scoring system work?
The FeverPAIN criteria are: score 1 point for each (maximum score of 5) * Fever over 38°C. * Purulence (pharyngeal/tonsillar exudate). * Attend rapidly (3 days or less) * Inflamed tonsils (severe) * No cough or coryza
WHat FeverPAIN score would recommend antibiotic use?
The FeverPAIN criteria are: score 1 point for each (maximum score of 5) Fever over 38°C. Purulence (pharyngeal/tonsillar exudate). Attend rapidly (3 days or less) Inflamed tonsils (severe) No cough or coryza NHS antibitoic man - consider ABx if score >/= 4
What is the 1st line treatment for suspected strep throat?
Penicillin 500mg 4times daily for 10 days
If penicillin allergic what is given?
Clarithromycin 500mg 2times daily for 10days
If the tonsils are too swollen preventing the patient from swallowing, what can be given instead of oral medication?
IV or IM benzylpenicillin (penicillin G)
What antibiotic would be avoided in tonsilitis and why?
Avoid amoxicillin as this can cause widespread rash if the patient has glandular fever
What is the indication for surgery if recurrent tonsilitis?
Tonsillitis has happened 7 episodes in the past year 5 episodes each year for the past two years 3 episodes each year for the past three years
What are potential side effects of streptococcal sore throat?
Glomerulonephritis Rheumatic fever Peritonsilar abscess (quinsy)
What are the major criteria involved in the diagnosis of rheumatic fever? (CASES - mneominc)
- * Carditis
- * Arthritic joints
- * Subcutaneous nodules
- * Erythema marginatum (erythematous patches with central clearing)
- * Sydenham Chorea (uncontrolled muscles spasm)
• Bacteria between muscle and tonsil produces pus causes a peritonsilar abscess What is the common presentation of peritonsilar abscess?
Medial deviation of uvula Unilateral throat swelling trismus - inability to open mouth
Which muscle opens the mouth?
Lateral pterygoid muscle
Which virus causes infectious mononucleiosis?
Epsteinn Barr virus (HHV 4)
What is the classic triad of presenting symptoms of epsteinn barr virus?
Sore throat (pharyngitis) Fever Lymphadenopathy
Glandular fever can also cause a membranous exudate, what sign can be seen on the palate in EBV? What other organs can be enlarged?
Can see palatal petechia - haemorrhages on the palate also seen hepatosplenomegaly
What two tests can be done to diagnose EBV?
Monospot test or EBV antibody test (IgM if acute infection, IgG if past infection - stays positive for life If the monospot test is negative/not supportive of infectious mononucleosis due to EBV, repeat the test in 5–7 days. If the person has clinical features of glandular fever and a negative monospot test, or if a rapid diagnosis is needed (for example if an urgent return to contact sports is desired), arrange blood tests for EBV viral serology.
• Symptomatic treatment • Bed rest, avoid sport, paracetamol This is treatment of infectious mononucleiosis What are two complications of EBV?
Burkitt’s lymphoma, nasopharyngeal carcinoma
Fluid in the middle ear associated with hearing loss however no signs of fever, what is this? Will the child have earache or not?
This is otitis media with effusion aka glue ear No earache
