tonsilitis

Question 1

what is the most common cause of viral tonsilitis?

Answer 1

rhinovirus

Question 2

what is the most common cause of bacterial tonsilitis?

Answer 2

group A beta haemolytic streptococcus

Question 3

what might be the cause of reccurent tonsilitis?

Answer 3

s.aureus, because it can be resisitant to abx

Question 4

how does tonsilitis present?

Answer 4

• sudden onset sore throat
• pyrexial >38degrees
• fever
• anterior cervical lymphadenopathy
• reduced oral intake (skin turgor and dry mucous membranes)

Question 5

which investigations can you do for tonsilitis?

Answer 5

• throat culture- gold standard but takes >48 hrs to get back
• group A streptococcus antigen test- is less acurate but faster, good for vulnerable immunosupressed people

Question 6

what are the 2 scoring systems used for tonsilitis?

Answer 6

1. CENTOR

2. Fever PAIN

Question 7

what makes up the centor criteria?

Answer 7

• fever >38
• tonsilar exudate
• absence of cough
• tender cervical lymphadenopathy

3 or more–> give abx

Question 8

what makes up the Fever PAIN score?

Answer 8

• fever in past 24 hours
  -P- pus on tonsil
  A- attended within 3 days of sxs
  I- inflamed tonsils
  N- no cough or coryza

4 or more—> consider abx

Question 9

when would you arrange hospital admission for patient with tonsilitis?

Answer 9

hospital admission is rare, but would consider for…

• inabillity to swallow
• breathing difficulty
• clinical dehydration
• peri-tonsillar abcess
• retropharangeal abcess
• sepsis
• may give IV/IM steroid for throat swelling

Question 10

what is the abx of choice for tonsilitis?

Answer 10

10 day course of PenV-

if allergic clarythromycin

Question 11

what are complciations of tonsilitis?

Answer 11

Acute otitis media: the most common complication, generally benign and self-limiting

Peri-tonsillar abscess (quinsy): local abscess formation due to bacterial tonsillitis; associated with ‘hot potato’ voice, trismus (‘lockjaw’), and uvula displacement to the unaffected side
Parapharyngeal abscess

Acute rheumatic fever: a very rare complication but should be considered as an indication for rapid antigen testing in at-risk groups

Acute post-streptococcal glomerulonephritis: also a very rare complication

Question 12

what are indications for tonsilectomy?

Answer 12

Recurrent tonsillitis or its complications (e.g. quinsy) in children <16 years and in adults

Obstructive sleep-disordered breathing in children <16 years

Question 13

what is considered reccurent tonsilitis for tonsilectomy?

Answer 13

• 7 or more clinically significant episodes in the last year
• 5 or more in each of the precedeing 2 years
• 3 or more in each of the preceding 3 years

Question 14

which tonsils are removed in tonsilectomy?

Answer 14

adenoid tonsils–> adenectomy

Question 15

what should you consider for diagnostic uncertainty of sleep apneoa?

Answer 15

overnigh pulse oximetry

Question 16

what is a complication of tonsilectomy?

Answer 16

Post-tonsillectomy haemorrhage is considered a surgical emergency
- primary haemorrhage (<24hrs ) occurs in approx 2%

• secondary haemorrhage (>24hrs) occurs in approx 4%

Question 17

which factors increase risk of tonsilitis?

Answer 17

> 5 yrs
asprin before op
chronic tonsilitis

Question 18

what are symptoms of quincy?

Answer 18

Trismus, which refers to when the patient is unable to open their mouth

Change in voice due to the pharyngeal swelling, described in textbooks as a “hot potato voice”

Swelling and erythema in the area beside the tonsils on examination

Question 19

what causes quincy?

Answer 19

• group A strep

- haemophillus influenza

Question 20

how is quincy managed?

Answer 20

Patients should be referred into hospital under the care of the ENT team for incision and drainage of the abscess under general anaesthetic