Tonsillitis Flashcards
What are the palantine tonsils?
They are lymphoid tissues located in the lateral walls of the oropharynx
What are tonsillitis?
It is defined as a condition in which there is inflammation of the palatine tonsils
What are the two classifications of tonsillitis?
Viral Tonsillitis
Bacterial Tonsillitis
What is the most common tonsillitis classification?
Viral Tonsillitis
What is viral tonsillitis?
It is defined as tonsillitis related to viral infection
What four causative organisms are associated with viral tonsillitis?
Rhinovirus
Coronavirus
Parainfluenza Virus
Epstein Barr Virus
What is the most comon causative organism associated with viral tonsillitis?
Rhinovirus
What is bacterial tonsillitis?
It is defined as tonsillitis related to bacterial infection
What five causative organisms are associated with bacterial tonsillitis?
Streptococcus Pyogenes
Streptococcus Pneumoniae
Staphylococcus Aureus
Haemophilus Influenzae
Moraxella Catarrhalis
What is the most comon causative organism associated with bacterial tonsillitis?
Streptococcus Pyogenes
What are the ten clinical features of tonsillitis?
Fever > 38C
Sore Throat
Odynophagia
Dysphagia
Dysphonia
Swollen Palatine Tonsils
Erythematous Palatine Tonsils
Palantine Tonsil Exudates
Peritonsillar Abscess
Cervical Lymphadenopathy
What is odynophagia?
It is defined as painful swallowing
What is dysphagia?
It is defined as difficulty in swallowing
What is dysphonia?
It is defined as an abnormal voice
What are tonsilar exudates?
They are defined as white patches of pus on the tonsils
What are the two investigations used to diagnose tonsillitis?
CENTOR Criteria
FeverPAIN Criteria
How is the CENTOR criteria used to investigate tonsilitis?
It is used to determine the probability that tonsillitis is due to bacterial infection, and will therefore benefit from antibiotic management
What is the CENTOR criteria?
Tonsillar Exudate = 1 Score
Tender Anterior Cervical
Lymphadenopathy = 1 Score
Fever > 38C = 1 Score
Cough Absence = 1 Score
What does a CENTOR criteria score of 0-2 indicate?
It indicates that there is a low probability of bacterial infection, and therefore it should be managed conservatively
What does a CENTOR criteria score of > 3 indicate?
It indicates that there is a high probability of bacterial infection, and therefore it should be managed pharmacologically with antibiotics
How is the FeverPAIN criteria used to investigate tonsillitis?
It is used to determine the probability that tonsillitis is due to bacterial infection, and will therefore benefit from antibiotic management
What is the FeverPAIN criteria?
Fever > 38C = 1 Score
Purulence (Tonsillar Pus) =.1 Score
Attended Within 3 Days of Clinical Onset = 1 Score
Severely Inflamed Tonsils = 1 Score
No Cough/Coryza = 1 Score
What does a FeverPAIN criteria score of 0 - 1?
It indicates that there is a low probability of bacterial infection, and therefore it should be managed conservatively
What does a FeverPAIN criteria score of 2 - 3 indicate?
It indicates that there is a moderate probability of bacterial infection, and therefore it can either be managed conservatively OR pharmacologically with a delayed antibiotic prescription – which should be used if clinical features don’t resolve within 3 – 5 days or if they deteriorate
What does a FeverPAIN criteria score of 4 - 5 indicate?
It indicates that there is a high probability of bacterial infection, and therefore it should be managed pharmacologically with antibiotics
When is conservative management used to treat acute tonsillitis?
CENTOR criteria score < 3
OR
FeverPAIN score < 4
What are the three conservative management options of acute tonsillitis?
Rest
Hydration
Paracetamol +/- Ibuprofen
What safety netting advice should be provided when acute tonsillitis is managed conservatively?
It is recommended to return if clinical features have not settled after 3 days or the fever rises above 38.3C
When is pharmacological management used to treat acute tonsillitis?
CENTOR criteria score > 3
OR
FeverPAIN score > 4
What are the two pharmacological management options of acute tonsillitis?
Beta-Lactam Antibiotics
Macrolide Antibiotics
When are beta-lactam antibiotics used to manage acute tonsillitis?
They are the first line pharmacological management option
Name a beta-lactam antibiotic used to manage acute tonsillitis. How long is the antibiotic course?
Phenoxymethylpenicillin
10 day course
When are macrolide antibiotics used to manage acute tonsillitis?
They are the second line pharmacological management option
Name two macrolide antibiotics used to manage acute tonsillitis. How long is the antibiotic course?
Clarithromycin
Erythromycin
5 day course
What is the surgical management option of chronic tonsillitis?
Tonsillectomy
When is tonsillectomy used to manage chronic tonsillitis?
It is recommended in recurrent tonsillitis, which meets all of the following criteria…
- > 5 Tonsillitis Episodes In One Year
- Clinical Features Persisting For > 1 Year
- Sore Throat Related To Tonsillitis
- Tonsillitis Episodes Functionally Impairing
What is a common complication of tonsillectomies?
Post-Tonsillectomy Haemorrhage
What is the most appropriate management option in suspected post-tonsillectomy haemorrhage?
Urgent ENT surgeon and anaesthetist referral
What is primary post-tonsillectomy haemorrhage?
It is defined as haemorrhage which occurs within 24 hours of tonsillectomy
What is the management option of primary post-tonsillectomy haemorrhage?
Immediate return to theatre
What is secondary post-tonsillectomy haemorrhage?
It is defined as haemorrhage which occurs between 24 horus and 10 days of tonsillectomy
What is the management option of secondary post-tonsillectomy haemorrhage?
Secondary care admission
IV antibiotics
What are the eight complications associated with tonsillitis?
Chronic Tonsillitis
Peritonsillar Abscess (Quinsy)
Otitis Media
Sinusitis
Scarlet Fever
Rheumatic Fever
Post-Streptococcal Glomerulonephritis
Post-Streptococcal Reactive Arthritis
