Tonsillitis Flashcards
most common cause of tonsillitis
viral infections
most common cause of bacterial tonsillitis
-second most common
-other causes 3
most common - group A strep (streptococcus pyogenes)
2nd most common - sterptoccus pneumonia
other
-H influenza
-Moraxella catarrhalis
-Staph A
how is strep A tonsillitis treated
penicillin V (phenoxymethylpenicillin)
what is the name of the tonsill locations combined
waldeyers tonsillar ring
-in the pharyx at the back of the throat there is a ring of lymphoid tissue
state the 4 locations of tonsills
adenoids
tubal tonsils
palatine tonsils
lingual tonsils
which tonsils are most commonly the cause of tonsillitis
palatine tonsils
presentaion of tonsillitis 3
sore throat
fever (above 38)
pain on swallowing
what will examiantion of teh throat reveal in tonsillitis
red inflamed and enlarged tonsils
with or without exudates
what lymphadenioapthy can be presetn in tonsillitis
anterior cervical lymphadenopathy
tonsillar lymph nodes are just behind the angle of the mandible (jawbone)
what criteria can be used to assess the probibilty of bacterial tonsillitis
centor criteria
what are the components of the centor criteria and what score is used to assess bacterial probelsm
4 components
-fever over 38
-tonsillar exudates
-absence of cough
-tender anterior cervical LNs
3 or more= 40-60% bacterial tonsillitis probability
describe the feverPAIN score as an alternative to cenotr criteria for assessing bacterial tonsillitis probability
The FeverPAIN score is an alternative to the Centor criteria. 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
when would admission be considered for tonsilitis 6
immunocompromsied
systemically unwell
dehydrated
stridor
respiraory distress
evidence of peritonisallar abscesss or cellulitis
Mx of viral tonsilitis
educate patients about why Abx not helpful
adise simple analgesia -PCM or ibru
if pain not settled after 3 days or fever goes above 38.3 ADVISE PATIENT RETURNS then consider alternative dx or ABx
Mx of bacterial tonsilitis
consider ABx if centor ≥3 or fevrePAIN ≥4
or if patient at risk of more sever infection:
-young infants
-immunocompromise
-signiicant co-morbidity
-history of rheumatic fever
delayed ABx considered
-explain likelihood of viral cause and only use if syx do not improve or worsen in next 2-3 days
(if ptx penicillin allergic- clarithromycin)
