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Year 2(B6) - E.N.T > ENT Pathology 1 - Tonsilitis,Rheumatic fever, Glandular fever, Glue ear, Tympanometry > Flashcards

ENT Pathology 1 - Tonsilitis,Rheumatic fever, Glandular fever, Glue ear, Tympanometry Flashcards

1
Q

What is the most common cause of acute tonsilitis?

A

Viral infection

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2
Q

What is the most common bacterial cause of tonsilitis?

A

Strep pyogenes - group A beta haemolytic strep (complete hemolysis)

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3
Q

What are other potential causes of tonsiltiis (bacterial causes) however not as common?

A

Haemophilus influenza B Staph aureus Strep pneumoniae

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4
Q

If distinguishing between viral and bacterial tonsilitis, what do you expect to find on examination if bacterial?

A

Tonsilar exuadate, absence of cough and fever

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5
Q

What are the components of the centor criteria for differentiating between viral and bacterial tonsilitis?

A

Centor criteria Tonsilar exudate Cervical lymphadenopathy Absence of cough Fever - approx 38

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6
Q

If the tonsilitis is expected to be viral, what is given?

A

Supportive treatment eg analgesics and bed rest

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7
Q

What extra does the modified centor criteria contain?

A

If the child is less than 15 then add a point If over 45 then deduct a point

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8
Q

A new score FEVERPain has been introduced to also help diagnose tonsiltiis How does this scoring system work?

A

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

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9
Q

WHat FeverPAIN score would recommend antibiotic use?

A

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

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10
Q

What is the 1st line treatment for suspected strep throat?

A

Penicillin 500mg 4times daily for 10 days

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11
Q

If penicillin allergic what is given?

A

Clarithromycin 500mg 2times daily for 10days

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12
Q

If the tonsils are too swollen preventing the patient from swallowing, what can be given instead of oral medication?

A

IV or IM benzylpenicillin (penicillin G)

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13
Q

What antibiotic would be avoided in tonsilitis and why?

A

Avoid amoxicillin as this can cause widespread rash if the patient has glandular fever

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14
Q

What is the indication for surgery if recurrent tonsilitis?

A

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

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15
Q

What are potential side effects of streptococcal sore throat?

A

Glomerulonephritis Rheumatic fever Peritonsilar abscess (quinsy)

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16
Q

What are the major criteria involved in the diagnosis of rheumatic fever? (CASES - mneominc)

A
  • * Carditis
  • * Arthritic joints
  • * Subcutaneous nodules
  • * Erythema marginatum (erythematous patches with central clearing)
  • * Sydenham Chorea (uncontrolled muscles spasm)
17
Q

• Bacteria between muscle and tonsil produces pus causes a peritonsilar abscess What is the common presentation of peritonsilar abscess?

A

Medial deviation of uvula Unilateral throat swelling trismus - inability to open mouth

18
Q

Which muscle opens the mouth?

A

Lateral pterygoid muscle

19
Q

Which virus causes infectious mononucleiosis?

A

Epsteinn Barr virus (HHV 4)

20
Q

What is the classic triad of presenting symptoms of epsteinn barr virus?

A

Sore throat (pharyngitis) Fever Lymphadenopathy

21
Q

Glandular fever can also cause a membranous exudate, what sign can be seen on the palate in EBV? What other organs can be enlarged?

A

Can see palatal petechia - haemorrhages on the palate also seen hepatosplenomegaly

22
Q

What two tests can be done to diagnose EBV?

A

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.

23
Q

• Symptomatic treatment • Bed rest, avoid sport, paracetamol This is treatment of infectious mononucleiosis What are two complications of EBV?

A

Burkitt’s lymphoma, nasopharyngeal carcinoma

24
Q

Fluid in the middle ear associated with hearing loss however no signs of fever, what is this? Will the child have earache or not?

A

This is otitis media with effusion aka glue ear No earache

25
Q

What effect can hearing loss have an a childs development?

A

poor school performance, speech delay, behavioural problems, conductive HL

26
Q

What is the treatment for glue ear?

A

Watchful waiting for at least three months

27
Q

If the otitis media with effusion persists for greater than 3months of the year with symptoms continuing that affect development, treatment is required (this is now known as chronic otitis media with effusion)

What is the 1st line treatment?

A

Grommet - small ventilation tube placed into the tympanic membrane to allow for fluid drainage

28
Q

What can cause the build up of fluid in glue ear?

A

A blocked eustachian tube therefore preventing drainage eg due to enlarged adenoids

29
Q

What is the best way to confirm glue ear? - this is used in association with the history where infection and inflammation is ruled out

A

Tympanometry

30
Q

What type of tympanommetry shows glue ear? ie type a,b,c ad,as

A

Type A - normal Type B - fluid behind the ear causing bad compliance to pressure or tympanic membrane perforation - GLUE EAR Type C - Represents negative pressure in the eardrum eg resolving or preceding an otitis media, eustachian tube dysfiunction

31
Q

The tympanic membrane would most likely have an impaired motility, would it be bulging or retracted in glue ear?

A

Likely to be retracted

32
Q

In otitis media with effusion, what two conditions require urgent treatment of the effusion?

A

Down’s syndrome and cleft palate

33
Q

What does tympanometry measure?

A

It measures the compliance of the eardrum and the middle ear function

34
Q

What does type A tympanommetry show?

A

Normal ear function

35
Q

Which type of tympanogram is this and what does it suggest?

A

This is Type B Suggests fluid in the middle ear reducing compliance of the tympanic membrane, or tympanic membrane perforation

36
Q

What does type C tympanogram suggest?

A

Negative pressure in the ear drum associated with fluid before or after an infection - Eustachian tube dysunction

37
Q

There is aslo a type As and Ad Which is increased compliance?

A

Ad increased compliance As decreased compliace

38
Q

What can cause decreased compliance of the tympanic membrane?

A

Osteosclerosis - ossicular chain fixation

Year 2(B6) - E.N.T (32 decks)

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