Pharyngitis and Tonsillitis

Question 1

What is Acute Tonsillitis?

Answer 1

Characterised by pharyngitis, fever, malaise and lymphadenopathy

Question 2

What is the most common bacterial causative organism of Acute Tonsillitis?

Answer 2

Streptococcus Pyogenes

Question 3

What is the appearance of the tonsils in Acute Tonsillitis?

Answer 3

• Oedematous and yellow

- White pustules may be present

Question 4

What are the viral causes of Acute Tonsillitis?

Answer 4

• EBV
• Adenovirus
• Rhinovirus
• Influenza

Question 5

What are the investigations in suspected Acute Tonsillitis?

Answer 5

=> FBC

• Lymphocytosis and Thrombocytopenia
• LFTs
• CRP

Question 6

Under what conditions may immediate antibiotic therapy for a sore throat be considered?

Answer 6

• Patients with acute sore throat when 3 or more Centor criteria satisfied
• Children < 2 with bilateral acute ottitis media
• Children with otorrhoea who have acute ottitis media

Question 7

What is the Centor Criteria?

Answer 7

• Presence of tonsillar exudate
• Tender anterior cervical lymphadenopathy or lymphadenitis
• History of fever
• Absence of cough

=> If 3 or more of these criteria are present, there is a 40-60% chance that the sore throat is caused by Group A Streptococcus

Question 8

What are the NICE guidelines for the immediate administration of antibiotics?

Answer 8

• Patient systemically unwell
• Have signs and symptoms of a serious illness
• Have high risk of developing serious complications due to pre-existing co-morbidity

=> Being > 65 with 2 or more of following OR >80 with 1 or more of the following:

• hospitalisation within previous year
• type 1 or 2 diabetes
• history of CHF
• current use of PO glucocorticoids

Question 9

What are the durations of the following respiratory tract infections?

Answer 9

=> Acute Ottitis Media - 4 days
=> Acute Sore Throat - 1 week
=> Common cold - 1.5 weeks
=> Acute Rhinosinusitus - 2.5 weeks
=> Acute cough/ bronchitis - 3 week