Tonsilitis

Question 1

Tonsillitis

Answer 1

Inflammation of the tonsils

Question 2

Causes of tonsilitis

Answer 2

Viral - common

Bacterial -commonly group A streptococcus (Streptococcus pyogenes)

Question 3

How to treat bacterial tonsillitis

Answer 3

Penicillin V (phenoxymethylpenicillin)

Question 4

Causative organisms of bacterial tonsillitis

Answer 4

Streptococcus pyogenes

Streptococcus pneumoniae

Haemophilus influenzae

Moraxella catarrhalis

Staphylococcus aureus

Question 5

Waldeyer’s Tonsillar Ring lymphoid tissue

Answer 5

Adenoids

Tubal tonsils

Palatine tonsils

Lingual tonsil

Question 6

Which tonsils are commonly inflamed with tonsilitis

Answer 6

Palatine tonsils

Question 7

Presentation of acute tonsillitis

Answer 7

• Sore throat
• Fever (above 38°C)
• Pain on swallowing

Question 8

Examination of acute tonsillitis

Answer 8

Red, inflamed and enlarged tonsils, with/without exudates.

May be anterior cervical lymphadenopathy

Question 9

Centor Criteria purpose

Answer 9

Used to estimate the probability that tonsillitis is due to a bacterial infection

Question 10

Centor Criteria

Answer 10

Score of 3 + - high probability of bacterial tonsillitis

1 - Fever over 38ºC

1 - Tonsillar exudates

1- Absence of cough

1- Tender anterior cervical lymph nodes (lymphadenopathy)

Question 11

FeverPAIN score purpose

Answer 11

Used to estimate the probability that tonsillitis is due to a bacterial infection

Question 12

FeverPAIN score

Answer 12

A score of 2 – 3 gives a 34 – 40% probability, and 4 – 5 gives a 62 – 65% probability of bacterial tonsillitis:

• Fever during previous 24 hours

P – Purulence (pus on tonsils)

A – Attended within 3 days of the onset of symptoms

I – Inflamed tonsils (severely inflamed)

N – No cough or coryza

Question 13

Management of tonsillitis

Answer 13

Safety net - return if the pain has not settled after 3 days or the fever rises above 38.3ºC

Simple analgesia

Conside abx if Centor score >3 or FeverPain > 4

Delayed prescriptions

Question 14

When to admit for tonsillitis

Answer 14

Consider admission if the patient is:

• immunocompromised
• systemically unwell
• dehydrated
• stridor
• respiratory distress
• evidence of a peritonsillar abscess or cellulitis

Question 15

Penicillin allergy

Answer 15

Clarithromycin

Question 16

Complications of tonsillitis

Answer 16

Peritonsillar abscess - quinsy

Otitis media, if the infection spreads to the inner ear

Scarlet fever

Rheumatic fever

Post-streptococcal glomerulonephritis

Post-streptococcal reactive arthritis