Tonsillitis

Question 1

Viral Causes? (3)

Answer 1

EBV
HSV
Adenovirus

Question 2

Most common bacterial cause?

Answer 2

Strep pyogens (group A beta-haemolytic strep)

Question 3

Presentation?

Answer 3

Sore throat, fever, headache, Presence of pus on tonsils suggests bacterial infection, generalised lymphadenopathy indicates glandular fever

Question 4

What criteria used to determine if Abx require and how many of criteria needs to be present?

Answer 4

CENTOR (FNTC)

3 or more

Question 5

NICE indication for Abx for sore throat?

Answer 5

features of marked systemic upset secondary to the acute sore throat
unilateral peritonsillitis
a history of rheumatic fever
an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency)
patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present

Question 6

Abx?

Answer 6

Penicillin VK

Question 7

Which antibiotic never should be given with EBV?

Answer 7

Amoxicillin - rash

Question 8

Complications? (3)

Answer 8

otitis media
quinsy - peritonsillar abscess
rheumatic fever and glomerulonephritis very rarely

Question 9

Indications for tonsillectomy are?

Answer 9

sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections)
the person has five or more episodes of sore throat per year
symptoms have been occurring for at least a year
the episodes of sore throat are disabling and prevent normal functioning

Question 10

Complications of tonsillectomy?

Answer 10

primary (< 24 hours): haemorrhage in 2-3% (most commonly due to inadequate haemostasis), pain

secondary (24 hours to 10 days): haemorrhage (most commonly due to infection), pain