Pathology of the throat Flashcards
What is Waldeyer’s ring?
Ring of tonsillar/lymphoid aggregation in the subepithelial layer of the oropharynx and nasopharynx
What does Waldeyer’s ring consist of?
Palantine tonsils
Adenoids (pharyngeal tonsil)
Lingual tonsil
What are the histological characteristics of tonsils?
Specialised squamous epithelium
Deep crypts
Lymphoid follicles
What are the histological characteristics of adenoids?
Ciliated pseudostratified columnar epithelium
Stratified squamous
Transitional
Deep folds
What are some of the causal organisms of acute tonsilitis?
Usually viral:
Epstein-Barr virus
Rhinovirus
Influenza
Adenovirus
Enterovirus
What are some of the causal organisms in chronic tonsilitis?
Usually bacterial:
Strep. pyogenes
H. influenza
Staph. aureus
Strep. pneumonaie
What are some of the symptoms of viral tonsilitis?
Malaise
Sore throat
Temperature
Lymphadenopathy
3-4 days duration
What are some of the symptoms of bacterial tonsilitis?
Systemic upset
Fever
Odonophagia
Halitosis
Lymphadenopathy
~1 week duration
What is the treatment for tonsilitis?
Rest
Analgesia
Antibiotics - penecillin, clarithromycin if allergic
Surgery
What are some of the complications of tonsillectomy?
Very painful afterwards - day 5 worst day
5% risk of haemorrhage
What is a peritonsillar abscess?
A collection of pus in a tonsil - a complication of acute tonsilitis
What are the symptoms of peritonsilar abscess?
Unilateral throat pain and odonophagia
Occurs 3-7 days post tonsilitis
What signs on examination indicate peritonsillar abscess?
Loss of concavity of palatine arches
Medial displacement of tonsils and uvula
What is the treatment for peritonsillar abscess?
Aspiration and antibiotics
What is the causal organism of glandular fever/infectious mononucleosis?
Epstein-Barr virus
What signs on examination indicate glandular fever?
Gross tonsillar enlargement with membranous exudate
Marked cervical lympadenopathy
Palatal petechial haemorrhages
Generalised lymphadenopathy
Hepatosplenomegaly
How is the diagnosis of glandular fever made?
Atypical lymphocytes in peripheral blood
Positive monospot or Paul-Bunnell test
Low CRP
What is the treatment for glandular fever?
Antibiotics
Steroids
Which antibiotic should not be used for glandular fever and why?
Ampicillin/amoxicillin
Casuses a macular rash
What are the symptoms of chronic tonsilitis?
Chronic sore throat
“Bad breath”
Tonsil stones
Peritonsillar erythema
Persistant tender cervical lymphadenopathy
What are the symptoms of tonsil hyperplasia?
Dysphagia
Snoring and other sleep disturbance
Muffled voice
What are the symptoms of adenoid hyperplasia?
Obligate mouth breathing
AOM/OME
Hyponasal voice
Snoring and other sleep disturbance
