Tonsillitis

Question 1

What are the causes of acute tonsillitis?

Answer 1

viral, bacterial

Question 2

What are the four types of tonsillar disease?

Answer 2

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

Question 3

What are disorders associated with tonsillitis?

Answer 3

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

Question 4

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

Answer 4

acetaminophen, ibuprofen, steroids

Question 5

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

Answer 5

3 wks

Question 6

What is chronic tonsillitis?

Answer 6

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

Question 7

What are symptoms of chronic tonsillitis?

Answer 7

chronic sore throat, halitosis, tonsiliths

Question 8

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

Answer 8

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

Question 9

What are some daytime sxs of tonsillar hypertrophy?

Answer 9

fatigue, behavior problems, school performance issues

Question 10

What is the gold standard for tonsillar hypertrophy?

Answer 10

sleep study

Question 11

What is a red flag for tonsillar hypertrophy?

Answer 11

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

Question 12

What is not seeing any tonsils at all?

Answer 12

0

Question 13

We can see tonsils but no impingement

Answer 13

2

Question 14

we can see it beyond pillars and margins of uvula

Answer 14

3

Question 15

What is tonsils into midline

Answer 15

4

Question 16

What is the key feature of peritonsillar abscess?

Answer 16

unilateral, uvula deviation

Question 17

What causes peritonsillar abscess?

Answer 17

acute infection complication of acute pharyngotonsillitis

Question 18

What is the cause of peritonsillar abscess?

Answer 18

group A hemolytic strep

polymicrobial

Question 19

What is the greatest frequency timeline for peritonsillar abscess?

Answer 19

november to december and april to may

Question 20

Who get peritonsillar abscess?

Answer 20

2nd and 3rd decades of life

Question 21

What are predisposing factors for peritonsillar abscess?

Answer 21

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

Question 22

What are the symptoms of peritonsillar abscess?

Answer 22

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

Question 23

What is the dx for peritonsillar abscess?

Answer 23

clinical

cbc with diff, blood cultures, monospot, tonsillar culture

Question 24

Do you order a CT scan for peritonsillar abscess?

Answer 24

no, only if concerned with airway or retropharyngeal abcsess

Question 25

What is indications for tonsillectomy?

Answer 25

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

Question 26

What is a key finding in peritonsillar abscess?

Answer 26

soft palate edema

Question 27

Do they give ABX after tonsillectomy?

Answer 27

NOPE, don't use tylenol and codine on kids

Question 28

What are the symptoms of tonsillitis?

Answer 28

odynophagia, fever, chills, halitosis, LAD, trismus

Question 29

Who is tonsillitis rare in?

Question 30

When does acute tonsillitis peak?

Answer 30

winter and early spring

Question 31

What age do kids get acute tonsillitis?

Answer 31

6-12 yo

Question 32

What are common causes of acute tonsillitis?

Answer 32

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

Question 33

What are serious causes of acute tonsillitls?

Answer 33

``` EBV s. aureus N. gonorrhoeae M. pneumonia Chlamydia ```

Question 34

What are rare causes of acute tonsillitlis?

Answer 34

herpes, gonorrheae

Question 35

Who is strep tonsillitis most common in?

Answer 35

5-15 yo

Question 36

Who is viral tonsillitiss more common in?

Answer 36

younger kids

Question 37

Where is viral tonsillitis common?

Answer 37

miltary and closed communities

Question 38

What is found in chronic tonsillitis?

Answer 38

white particulate matter in crypts

Question 39

Can tonsillitis and pharyngitis occur simultaneously?

Answer 39

yes

Question 40

What test do you do for suspected tonsillitis?

Answer 40

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

Question 41

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

Answer 41

acetaminophen, ibuprofen, predinose (short course)

Question 42

Who gets tonsillectomy?

Answer 42

7 cases in 1 year | obstructive symptoms - sleep study

Question 43

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

Answer 43

wait 3 days

Question 44

What do you always document for acute tonsillitis?

Answer 44

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

Question 45

What requires urgent response in acute tonsillitis?

Answer 45

``` obstruction fever >104 gray exudates - maybe dip abscess severe infection inability to swallow ```

Question 46

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

Answer 46

2-8 days

Question 47

What do you see with the uvula in peritonsillar abscess?

Answer 47

displaced medially

Question 48

what does occlusion of tonsillar crypts cause?

Answer 48

crypt abscess

Question 49

What are the signs of peritonsillar abscess?

Answer 49

palate edema contralateral deviation of uvula Fever Drooling

Question 50

What does a well defined tonsillar pillar mean?

Answer 50

cellulitis rather than abscess

Question 51

What is always present with peritonsillar abcess?

Answer 51

trismus, only time not would be retropharyngeal abscess

Question 52

Who do you admit with peritonsillar abscess?

Answer 52

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

Question 53

What is the abx therapy inpt for peritonsillar abscess?

Answer 53

clind IV or Rocephin IV and Flagyl IV | one dose of IV dexa 8 mg

Question 54

What is the outpt therapy for peritonsillar abscess?

Answer 54

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

Question 55

When do you do a tonsillectomy?

Answer 55

after acute infection resolved