Tonsillitis Flashcards

1
Q

What are the causes of acute tonsillitis?

A

viral, bacterial

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2
Q

What are the four types of tonsillar disease?

A

acute tonsillitis, recurrent acute tonsillitis, chronic tonsillitis, obstructive tonsillar hyperplasia

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3
Q

What are disorders associated with tonsillitis?

A

acute pharyngitis, acute adenoiditis, acute laryngitis, infectious mononucleosis, thyroiditis, otitis media

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4
Q

What can you give to relieve fever, sore throat, tonsillar swelling?

A

acetaminophen, ibuprofen, steroids

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5
Q

When should pt follow-up for recurrent tonsillitits or infections lasting how long?

A

3 wks

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6
Q

What is chronic tonsillitis?

A

7 episodes in 1 year
5 episodes/year x 2 years
3 episodes/year x 3 years

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7
Q

What are symptoms of chronic tonsillitis?

A

chronic sore throat, halitosis, tonsiliths

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8
Q

What will a pt with tonsillar hypertrophy have a hx of?

A

snoring, pauses in breathing, grasping and choking, restless sleep, mouth breathing, enuresis

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9
Q

What are some daytime sxs of tonsillar hypertrophy?

A

fatigue, behavior problems, school performance issues

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10
Q

What is the gold standard for tonsillar hypertrophy?

A

sleep study

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11
Q

What is a red flag for tonsillar hypertrophy?

A

unilateral tonsillary hypertrophy w/o evidence of infection or abscess - MALIGANCY

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12
Q

What is not seeing any tonsils at all?

A

0

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13
Q

We can see tonsils but no impingement

A

2

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14
Q

we can see it beyond pillars and margins of uvula

A

3

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15
Q

What is tonsils into midline

A

4

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16
Q

What is the key feature of peritonsillar abscess?

A

unilateral, uvula deviation

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17
Q

What causes peritonsillar abscess?

A

acute infection complication of acute pharyngotonsillitis

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18
Q

What is the cause of peritonsillar abscess?

A

group A hemolytic strep

polymicrobial

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19
Q

What is the greatest frequency timeline for peritonsillar abscess?

A

november to december and april to may

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20
Q

Who get peritonsillar abscess?

A

2nd and 3rd decades of life

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21
Q

What are predisposing factors for peritonsillar abscess?

A
Previous pharyngotonsillar infection 
Chronic or recurrent tonsillitis
May be preceded by a viral respiratory tract infection 
Immune deficiency 
Recent dental work 
Alcohol abuse 
Cocaine abuse
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22
Q

What are the symptoms of peritonsillar abscess?

A
Unilateral, severe throat pain 
Dysphagia 
Odynophagia 
Trismus (difficulty opening the mouth wide) 
Neck pain 
Referred ear pain 
Drooling 
Muffled ('hot potato') voice
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23
Q

What is the dx for peritonsillar abscess?

A

clinical

cbc with diff, blood cultures, monospot, tonsillar culture

24
Q

Do you order a CT scan for peritonsillar abscess?

A

no, only if concerned with airway or retropharyngeal abcsess

25
Q

What is indications for tonsillectomy?

A

recurrent infection, multiple ABX allergies, hx of peritonsillar abscess, hypertrophy & SDB/OSA

26
Q

What is a key finding in peritonsillar abscess?

A

soft palate edema

27
Q

Do they give ABX after tonsillectomy?

A

NOPE, don’t use tylenol and codine on kids

28
Q

What are the symptoms of tonsillitis?

A

odynophagia, fever, chills, halitosis, LAD, trismus

29
Q

Who is tonsillitis rare in?

A
30
Q

When does acute tonsillitis peak?

A

winter and early spring

31
Q

What age do kids get acute tonsillitis?

A

6-12 yo

32
Q

What are common causes of acute tonsillitis?

A

influenza A and B
RSV
Adenovirus
Strep A and G, GAS

33
Q

What are serious causes of acute tonsillitls?

A
EBV
s. aureus
N. gonorrhoeae
M. pneumonia
Chlamydia
34
Q

What are rare causes of acute tonsillitlis?

A

herpes, gonorrheae

35
Q

Who is strep tonsillitis most common in?

A

5-15 yo

36
Q

Who is viral tonsillitiss more common in?

A

younger kids

37
Q

Where is viral tonsillitis common?

A

miltary and closed communities

38
Q

What is found in chronic tonsillitis?

A

white particulate matter in crypts

39
Q

Can tonsillitis and pharyngitis occur simultaneously?

A

yes

40
Q

What test do you do for suspected tonsillitis?

A
throat swab for culture
RDAT
CBC
Monospot - if cervical lymph nodes swollen
Lateral neck x ray - rule out epiglottis
CT- rule out pharyngeal abcess
41
Q

How do you relieve fever, sore throat and tonsillar swelling in acute tonsillitis?

A

acetaminophen, ibuprofen, predinose (short course)

42
Q

Who gets tonsillectomy?

A

7 cases in 1 year

obstructive symptoms - sleep study

43
Q

What is the timeline to return to work/school for acute tonsillitis?

A

wait 3 days

44
Q

What do you always document for acute tonsillitis?

A

lymph, exudates, stridor, drooling or wheexing and last PO intake

45
Q

What requires urgent response in acute tonsillitis?

A
obstruction
fever >104
gray exudates - maybe dip
abscess
severe infection
inability to swallow
46
Q

What is the timeline for onset of symptoms to abscess formation in peritonsillar?

A

2-8 days

47
Q

What do you see with the uvula in peritonsillar abscess?

A

displaced medially

48
Q

what does occlusion of tonsillar crypts cause?

A

crypt abscess

49
Q

What are the signs of peritonsillar abscess?

A

palate edema
contralateral deviation of uvula
Fever
Drooling

50
Q

What does a well defined tonsillar pillar mean?

A

cellulitis rather than abscess

51
Q

What is always present with peritonsillar abcess?

A

trismus, only time not would be retropharyngeal abscess

52
Q

Who do you admit with peritonsillar abscess?

A

peds, septic, cant handle secretions, airway compromised, unreliable to follow up

53
Q

What is the abx therapy inpt for peritonsillar abscess?

A

clind IV or Rocephin IV and Flagyl IV

one dose of IV dexa 8 mg

54
Q

What is the outpt therapy for peritonsillar abscess?

A

clinda PO
augmentin PO
Cephalexin + metro (anaerobes)
Medrol dose pack (steroid taper)

55
Q

When do you do a tonsillectomy?

A

after acute infection resolved