Tonsilitis

Question 1

Tonsilitis most common bacterial cause

Answer 1

Group A strep - strep pyogenes

Question 2

What antibiotic targets group A strep?

Answer 2

Phenoxymthylpenicillin - pen V

Question 3

Most common cause of otitis media, rhinosinusititis and alternative bacterial cause of tonsilitis

Answer 3

strep pneumoniae

Question 4

Other causes of bacterial tonsilitis

Answer 4

• Haemophilus influenzae
• Morazella catarrhalis
• Staphylococcus aureus

Question 5

Where are the 6 ares of lymphoid tissue?

Answer 5

Adenoid, tubal tonsils, palatine tonsils and lingual tonsil

Question 6

What area of lymphoid tissue is infected in tonsilitis

Answer 6

Palatine

Question 7

What is waldeyers tonsilar ring

Answer 7

Ring of lymphoid tissue

Question 8

Features of tonsilitis

Answer 8

Fever, sore throat and painful swallowing

Question 9

What age group of children are most affected by tonsilitis?

Answer 9

5-10
15-20

Question 10

What is the criteria for a referral fro tonsilectomy?

Answer 10

7 infections with antibiotics in 12-18 months

Question 11

How can tonsilitis present in younger children?

Answer 11

Non sepcific -
fever
Poor oral intake
Headache
Vomitting
Abdominal pain

Question 12

What always examine with tonisilitis?

Answer 12

Otoscopy
Palplate for cervical lymphadenopathy

Question 13

Centor score

Answer 13

> 3 score = 40-60% bacterial cause + offer antibitoics
Fever > 38
Tonsilar exudates
Absence of cough
Tendor anterior cervical lymph nodes

Question 14

FeverPAIN score that prescribe antibiotics

Answer 14

> 4

Question 15

FeverPAIN criteria

Answer 15

Fevere past 24 hours
Purulence
Attended rapidly - 48 hours
inflamed tonsils - severely
No cough or coryza

Question 16

What need to exclude with tonislitis presentation

Answer 16

Meninigitis
Epiglottitis
Peritonsilar abscess

Question 17

What to do if viral tonsilitis? What safety netting advice give?

Answer 17

Educate patients/parents
Safety net advice
Advise simple analgesia w paracetemol and ibuprofen
Suggest return if pain not setteld after 3 days or fever >38

Question 18

What score on FeverPAIN means how likely bacterial

Answer 18

2-3 = 35-40% chacne bacterial
4-5 = 62-65% chance

Question 19

When start antibiotics tonsilitis

Answer 19

> 4 FeverPAIN, >3 centor
Immunocompromised
Young infants
Significant comorbidity
History of rheumatic fever

Question 20

When consider admission with tonsilitis

Answer 20

Immunocomp
Systemically undwell
Dehydrated
Stridor
Resp distress
Evidence of peritonsilar abscess or cellulitis

Question 21

First line for bacterial tonsilitis

Answer 21

Penicillin V
Clarithromycin if penicillin allergy

Question 22

Complications of tonsilitis

Answer 22

Chronci
Peritonsilar abscess - quinsy
Otitis media
Scarlet fever
Rheumatic fever
Post strep glomerulonephritis
Post strep reactive arthritis