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B - Paediatrics MANAGEMENT > Tonsillitis > Flashcards

Tonsillitis Flashcards

1
Q

What is tonsillitis?

A

A form of pharyngitis where there is intense inflammation of the tonsils

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2
Q

What often accompanies tonsillitis?

A

Purulent exudate

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3
Q

What are the two main types of tonsillitis?

A

Bacterial and Viral

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4
Q

What is the main cause of bacterial tonsillitis?

A

Group A beta-haemolytic streptococci

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5
Q

What is a cause of viral tonsillitis?

A

EBV

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6
Q

What are the risk factors for tonsillitis?

A

Smoking - second hand in younger and personal in older

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7
Q

What are the potnetial symptoms of tonsillitis?

A
  • Sore throat
  • Fever
  • Dysphagia/odynophagia
  • Halitosis
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8
Q

What are the possible signs seen on examination?

A
  • Enlargement of tonsils
  • Enlarged cervical lymph nodes
  • Red, inflamed tonsils
  • White exudate spots on the tonsils
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9
Q

What are the differentials for tonsillitis?

A
  • Quinsy
  • Pharyngitis
  • Glandular fever
  • Tonsillar malignancy e.g. lymphoma
  • Epiglottitis
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10
Q

What is the first step for determining management?

A

Distinguishing between viral and bacterial tonsillitis

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11
Q

How does the causative organism affect management?

A

Bacterial tonsillitis is an indication for antibiotic therapy

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12
Q

What criteria can be used to distinguish between viral and bacterial tonsillitis?

A

Centor criteria

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13
Q

How does the Centor criteria work?

A

A series of symptoms (or absence of) should be looked for with each symptom (or absence of) scoring +1 point.

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14
Q

What score suggests bacterial infection?

A

3+ is highly suggestive of a bacterial infection

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15
Q

What are the symptoms screened for in the Centor criteria?

A
  • Tonsillar exudate
  • Tender anterior cervical lymphadenopathy
  • Fever, or history of fever
  • Absence of cough
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16
Q

What is the typical antibiotic used in tonsillitis if the patient requires IV?

A

Benzylpenicillin

17
Q

How is benzylpenicillin dosed in children?

A

According to weight

18
Q

How long are antibiotics typically given for in tonsillitis?

A

7-10 days

19
Q

What should happen if or when the child is able to tolerate oral antibiotics?

A

Switch to penicillin V

20
Q

What antibiotic is often avoided in tonsillitis?

A

Co-amoxiclav

21
Q

Why is co-amoxiclav avoided?

A

There is a risk leaving a permanent skin rash if the tonsillitis is due to glandular fever

22
Q

What are the indications for hospital admission with tonsillitis?

A
  • Respiratory compromise
  • Inability to eat or drink
  • Failure to respond to community antibiotics
23
Q

What may show respiratory compromise in tonsillitis?

A
  • Tachypnoea
  • Low sats
  • Use of accessory muscles
  • Apnoeic episodes
24
Q

What does inability to eat or drink risk?

A

Dehydration

25
Q

What types of analgesia may be useful in tonsillitis?

A
  • Paracetamol
  • Ibuprofen
  • Topical treatments
26
Q

What topical treatments are available in tonsillitis?

A

Difflam spray/mouthwash

27
Q

Why are topical analgesics particularly useful?

A

They can reduce pain enough for the child to take oral analgesics

28
Q

What other medication (besides antibiotics and analgesics) can sometimes be used in tonsillitis?

A

Oral steroids

29
Q

Why are steroids sometimes helpful?

A

They can accelerate the resolution of pain and inflammation

30
Q

Is tonsillectomy routinely performed?

A

No, there are set criteria reserved for children with recurrent episodes

31
Q

What criteria are used to determine if tonsillitis is indicated?

A

SIGN criteria

32
Q

When do the S|GN criteria indicate tonsillitis?

A
  • 7 or more episodes in 1 year
  • 5 or more per year for 2 years
  • 3 or more per year for 3 years
33
Q

What are the potential complications of tonsillitis?

A
  • Quinsy

- Deep neck space abscess

34
Q

How can tonsillitis become quinsy?

A

Infection can spread into the peritonsillar space and form an abscess

35
Q

How can tonsillitis lead to a deep neck space abscess?

A

Spread into the retropharyngeal or parapharyngeal space

36
Q

How is a deep neck abscess treated?

A

Prolonged IV antibiotics and sometimes surgical drainage

B - Paediatrics MANAGEMENT (106 decks)

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