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ENT (Throat) > Tonsillitis > Flashcards

Tonsillitis Flashcards

(51 cards)

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1
Q

Generally when talking about the tonsils, what are we referring to?

A

The palatine tonsils

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2
Q

Other than the palatine tonsils, what other tonsils are there?

A

Adenoids - pharyngeal
Lingual
Tubal

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3
Q

What do the tonsils contain?

A

Macrophages
B cells
T cells

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4
Q

What is the role of the the tonsils?

A

Leading and building up immune response

Important in early years - cells in tonsils exposed to many antigens

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5
Q

By what age do the tonsils tend to shrink?

A

12

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6
Q

The palatine tonsils have a strong blood supply from how many different vessels?

A

5

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7
Q

Tonsillitis is usually accompanied by what…

A

Pharyngitis

So a better term would pharyngotonsillitis

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8
Q

Are the majority of cases of tonsillitis viral or bacterial?

A

Viral

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9
Q

What viruses typically cause tonsillitis?

A 
EBV 
Adenovirus
Rhinovirus
Influenza 
Respiratory syncytial virus
CMV 
Herpes simplex
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10
Q

If tonsillitis is caused by a bacterial infection, what is the most common type?

A

Group A beta haemolytic streptococcus (streptococcus pyogenes)
Also called strep throat

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11
Q

Other than group A beta haemolytic strep, what other bacteria cause tonsillitis?

A

Staphylococcus aureus
Strep pneumoniae
Mycoplasma pneumoniae
Chlamydia pneumoniae

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12
Q

EBV is usually asymptomatic. If it produces symptoms it can be part of a condition called…

A

Infectious mononucleosis (glandular fever)

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13
Q

How does infectious mononucleosis usually begin?

A

Insidiously
Fatigue
Malaise

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14
Q

What symptoms are associated with infectious mononucleosis?

A 
Fatigue
Malaise
Sore throat 
Headache 
Fever 
Abdominal pains with nausea and vomiting sometimes occurs
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15
Q

What signs are associated with infectious mononucleosis?

A 
Hepatomegaly 
Spenomegaly 
Swollen posterior cervical lymph nodes
Enlarged tonsils with exudate (similar to that seen in strep throat) 
Petechiae on roof of mouth
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16
Q

What viral family is EBV part of?

A

Herpes

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17
Q

How is EBV transmitted?

A

Via saliva

“The kissing disease”

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18
Q

What investigations for infectious mononucleosis can be done?

A

FBC -lymphocytosis, thrombocytopenia
U&E
LFT
CRP
Mono spot test - looks for heterophile antibodies (produced by B cells infected by EBV)
EBV specific antibodies
Throat swab to look for differential diagnosis

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19
Q

What is the management for infectious mononucleosis?

A

Conservative:
Analgaesia - paracetamol and ibuprofen
Fluids
Rest

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20
Q

How long do symptoms usually last in infectious mononucleosis?

A

2-4 weeks

However, fatigue and malaise may last for months

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21
Q

What can happen if given amoxicillin or ampicillin when patient has infectious mononucleosis?

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A

A generalised, itchy maculopapular rash can develop

22
Q

What age group does infectious mononucleosis typically affect?

23
Q

What complications of infectious mononucleosis can occur?

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A 
Upper airway obstruction 
Splenic rupture 
Burkitt’s lymphoma 
Lymphoproliferative disorders 
Leukoplakia
24
Q

Is it difficult or easy to distinguish between viral and bacterial tonsillitis?

25
How is step pyogenes transmitted?
Saliva | Nasal secretions
26
Is group A streptococcus a common commensal organism?
Yes
27
What is the incubation period of streptococcus pyogenes?
2-5 days (without symptoms)
28
What symptoms are associated with strep throat?
``` Acute, sudden onset sore throat Dysphagia Odonophagia Headache Nausea and vomiting Halitosis ```
29
What signs are associated with strep throat?
Tonsillitis - red, enlarged, purulent exudate Pharyngitis - red Soft palate petichiae Tender, cervical lymphadenopathy
30
Why are throat swabs not very useful?
Group A strep are commensal organisms in many patients
31
What investigations can be done for strep throat?
Throat swab and culture or rapid antigen test | FBC - neutrophilia
32
Why is early recognition and management of strep throat important?
Prevent complications
33
How do you decide if antibiotics are required?
CENTOR criteria or fever pain score
34
What is the fever pain score?
``` Fever in last 24 hours Purulence Attends rapidly in under 3 days Inflamed tonsils No cough or coryza ``` Total = 5
35
Describe the scoring system in the fever pain score
0-1 = no antibiotics 2-3 = consider 3 day delay before antibiotics 4 or more = antibiotics if severe, if not 48 hour delay prescription
36
If antibiotics are required, what should be prescribed?
Penicillin V 500 mg QDS for 10 days (phenoxymethylpenicillin) Or Clarithromycin 500 mg BD for 5 days
37
What are the specific indications for tonsillectomy?
The episodes are disabling and prevent normal functioning Seven or more well documented, clinically significant, adequately treated sore throats in preceding year OR 5 or more episodes in each of preceding 2 years OR 3 or more episodes in each of preceding 3 years Suspected malignancy Sleep apnoea Peritonsillar abscess formation
38
Describe the centor criteria
Absence of cough Tender anterior cervical lymphadenopathy Temperature > 38 Tonsillar exudate Max of 4
39
In terms of fever pain score, what score is likely to benefit from antibiotics?
Score of 4 or 5
40
In terms of the centor score, what score is likely to benefit from antibiotics?
3 or 4
41
Patients with EBV should avoid what for 3 months?
Contact sports
42
What supportive measures can be done?
Increase fluid intake Analgaesia Salt water gargle Avoid hot drinks
43
What safety net advise should be given?
Seek urgent help if: Breathing difficulties Severe abdominal pain Reduced urine output
44
For most patients, are antibiotics necessary?
No - have little effect on duration or severity of symptoms
45
When should amoxicillin be avoided?
If possibility of infectious mononucleosis
46
What complications can occur?
``` Guttate psoriasis - occurs weeks after infection with strep throat Acute otitis media Retropharyngeal abscess Rheumatic fever Post strep GN Quinsy - peritonsillar abscess ```
47
What can be given to reduce tonsillar swelling ?
Steroids e.g IV dexamethasone 10 mg
48
What differential may cause stridor and increased work of breathing?
Epiglottitis - requires immediate admission
49
What risk factors are associated with tonsillectomy?
Pain - may increase for up to 6 days following tonsillectomy Haemorrhage - all should be assessed by ENT Primary or reactionary haemorrhage most commonly occurs in first 6-8 hours following surgery. Managed by immediate return to theatre Secondary haemorrhage - occurs between 5 and 10 days after surgery and often associated with wound infection - admit and antibiotics
50
What is haemorrhage 5-10 days post tonsillectomy commonly associated with?
A wound infection - should be treated with IV antibiotics Referred to as a secondary haemorrhage
51
Secondary haemorrhage occurs in around what percentage of all tonsillectomies?
1-2%

ENT (Throat) (20 decks)

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