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Year Two - Ears, Nose & Throat > Tonsillitis > Flashcards

Tonsillitis Flashcards

1
Q

What are the palantine tonsils?

A

They are lymphoid tissues located in the lateral walls of the oropharynx

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2
Q

What are tonsillitis?

A

It is defined as a condition in which there is inflammation of the palatine tonsils

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3
Q

What are the two classifications of tonsillitis?

A

Viral Tonsillitis

Bacterial Tonsillitis

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4
Q

What is the most common tonsillitis classification?

A

Viral Tonsillitis

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5
Q

What is viral tonsillitis?

A

It is defined as tonsillitis related to viral infection

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6
Q

What four causative organisms are associated with viral tonsillitis?

A

Rhinovirus

Coronavirus

Parainfluenza Virus

Epstein Barr Virus

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7
Q

What is the most comon causative organism associated with viral tonsillitis?

A

Rhinovirus

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8
Q

What is bacterial tonsillitis?

A

It is defined as tonsillitis related to bacterial infection

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9
Q

What five causative organisms are associated with bacterial tonsillitis?

A

Streptococcus Pyogenes

Streptococcus Pneumoniae

Staphylococcus Aureus

Haemophilus Influenzae

Moraxella Catarrhalis

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10
Q

What is the most comon causative organism associated with bacterial tonsillitis?

A

Streptococcus Pyogenes

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11
Q

What are the ten clinical features of tonsillitis?

A

Fever > 38C

Sore Throat

Odynophagia

Dysphagia

Dysphonia

Swollen Palatine Tonsils

Erythematous Palatine Tonsils

Palantine Tonsil Exudates

Peritonsillar Abscess

Cervical Lymphadenopathy

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12
Q

What is odynophagia?

A

It is defined as painful swallowing

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13
Q

What is dysphagia?

A

It is defined as difficulty in swallowing

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14
Q

What is dysphonia?

A

It is defined as an abnormal voice

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15
Q

What are tonsilar exudates?

A

They are defined as white patches of pus on the tonsils

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16
Q

What are the two investigations used to diagnose tonsillitis?

A

CENTOR Criteria

FeverPAIN Criteria

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17
Q

How is the CENTOR criteria used to investigate tonsilitis?

A

It is used to determine the probability that tonsillitis is due to bacterial infection, and will therefore benefit from antibiotic management

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18
Q

What is the CENTOR criteria?

A

Tonsillar Exudate = 1 Score

Tender Anterior Cervical
Lymphadenopathy = 1 Score

Fever > 38C = 1 Score

Cough Absence = 1 Score

19
Q

What does a CENTOR criteria score of 0-2 indicate?

A

It indicates that there is a low probability of bacterial infection, and therefore it should be managed conservatively

20
Q

What does a CENTOR criteria score of > 3 indicate?

A

It indicates that there is a high probability of bacterial infection, and therefore it should be managed pharmacologically with antibiotics

21
Q

How is the FeverPAIN criteria used to investigate tonsillitis?

A

It is used to determine the probability that tonsillitis is due to bacterial infection, and will therefore benefit from antibiotic management

22
Q

What is the FeverPAIN criteria?

A

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

23
Q

What does a FeverPAIN criteria score of 0 - 1?

A

It indicates that there is a low probability of bacterial infection, and therefore it should be managed conservatively

24
Q

What does a FeverPAIN criteria score of 2 - 3 indicate?

A

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

25
Q

What does a FeverPAIN criteria score of 4 - 5 indicate?

A

It indicates that there is a high probability of bacterial infection, and therefore it should be managed pharmacologically with antibiotics

26
Q

When is conservative management used to treat acute tonsillitis?

A

CENTOR criteria score < 3

OR

FeverPAIN score < 4

27
Q

What are the three conservative management options of acute tonsillitis?

A

Rest

Hydration

Paracetamol +/- Ibuprofen

28
Q

What safety netting advice should be provided when acute tonsillitis is managed conservatively?

A

It is recommended to return if clinical features have not settled after 3 days or the fever rises above 38.3C

29
Q

When is pharmacological management used to treat acute tonsillitis?

A

CENTOR criteria score > 3

OR

FeverPAIN score > 4

30
Q

What are the two pharmacological management options of acute tonsillitis?

A

Beta-Lactam Antibiotics

Macrolide Antibiotics

31
Q

When are beta-lactam antibiotics used to manage acute tonsillitis?

A

They are the first line pharmacological management option

32
Q

Name a beta-lactam antibiotic used to manage acute tonsillitis. How long is the antibiotic course?

A

Phenoxymethylpenicillin

10 day course

33
Q

When are macrolide antibiotics used to manage acute tonsillitis?

A

They are the second line pharmacological management option

34
Q

Name two macrolide antibiotics used to manage acute tonsillitis. How long is the antibiotic course?

A

Clarithromycin

Erythromycin

5 day course

35
Q

What is the surgical management option of chronic tonsillitis?

A

Tonsillectomy

36
Q

When is tonsillectomy used to manage chronic tonsillitis?

A

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
37
Q

What is a common complication of tonsillectomies?

A

Post-Tonsillectomy Haemorrhage

38
Q

What is the most appropriate management option in suspected post-tonsillectomy haemorrhage?

A

Urgent ENT surgeon and anaesthetist referral

39
Q

What is primary post-tonsillectomy haemorrhage?

A

It is defined as haemorrhage which occurs within 24 hours of tonsillectomy

40
Q

What is the management option of primary post-tonsillectomy haemorrhage?

A

Immediate return to theatre

41
Q

What is secondary post-tonsillectomy haemorrhage?

A

It is defined as haemorrhage which occurs between 24 horus and 10 days of tonsillectomy

42
Q

What is the management option of secondary post-tonsillectomy haemorrhage?

A

Secondary care admission

IV antibiotics

43
Q

What are the eight complications associated with tonsillitis?

A

Chronic Tonsillitis

Peritonsillar Abscess (Quinsy)

Otitis Media

Sinusitis

Scarlet Fever

Rheumatic Fever

Post-Streptococcal Glomerulonephritis

Post-Streptococcal Reactive Arthritis

Year Two - Ears, Nose & Throat (12 decks)

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