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ENT (Throat) > Tonsillitis > Flashcards

Tonsillitis Flashcards

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?

A

A generalised, itchy maculopapular rash can develop

22
Q

What age group does infectious mononucleosis typically affect?

A

15 to 24

23
Q

What complications of infectious mononucleosis can occur?

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?

A

Difficult

25
Q

How is step pyogenes transmitted?

A

Saliva

Nasal secretions

26
Q

Is group A streptococcus a common commensal organism?

A

Yes

27
Q

What is the incubation period of streptococcus pyogenes?

A

2-5 days (without symptoms)

28
Q

What symptoms are associated with strep throat?

A 
Acute, sudden onset sore throat 
Dysphagia 
Odonophagia 
Headache
Nausea and vomiting 
Halitosis
29
Q

What signs are associated with strep throat?

A

Tonsillitis - red, enlarged, purulent exudate
Pharyngitis - red
Soft palate petichiae
Tender, cervical lymphadenopathy

30
Q

Why are throat swabs not very useful?

A

Group A strep are commensal organisms in many patients

31
Q

What investigations can be done for strep throat?

A

Throat swab and culture or rapid antigen test

FBC - neutrophilia

32
Q

Why is early recognition and management of strep throat important?

A

Prevent complications

33
Q

How do you decide if antibiotics are required?

A

CENTOR criteria or fever pain score

34
Q

What is the fever pain score?

A 
Fever in last 24 hours
Purulence
Attends rapidly in under 3 days
Inflamed tonsils
No cough or coryza

Total = 5

35
Q

Describe the scoring system in the fever pain score

A

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
Q

If antibiotics are required, what should be prescribed?

A

Penicillin V 500 mg QDS for 10 days (phenoxymethylpenicillin)
Or
Clarithromycin 500 mg BD for 5 days

37
Q

What are the specific indications for tonsillectomy?

A

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
Q

Describe the centor criteria

A

Absence of cough
Tender anterior cervical lymphadenopathy
Temperature > 38
Tonsillar exudate

Max of 4

39
Q

In terms of fever pain score, what score is likely to benefit from antibiotics?

A

Score of 4 or 5

40
Q

In terms of the centor score, what score is likely to benefit from antibiotics?

A

3 or 4

41
Q

Patients with EBV should avoid what for 3 months?

A

Contact sports

42
Q

What supportive measures can be done?

A

Increase fluid intake
Analgaesia
Salt water gargle
Avoid hot drinks

43
Q

What safety net advise should be given?

A

Seek urgent help if:
Breathing difficulties
Severe abdominal pain
Reduced urine output

44
Q

For most patients, are antibiotics necessary?

A

No - have little effect on duration or severity of symptoms

45
Q

When should amoxicillin be avoided?

A

If possibility of infectious mononucleosis

46
Q

What complications can occur?

A 
Guttate psoriasis - occurs weeks after infection with strep throat 
Acute otitis media 
Retropharyngeal abscess
Rheumatic fever 
Post strep GN 
Quinsy - peritonsillar abscess
47
Q

What can be given to reduce tonsillar swelling ?

A

Steroids e.g IV dexamethasone 10 mg

48
Q

What differential may cause stridor and increased work of breathing?

A

Epiglottitis - requires immediate admission

49
Q

What risk factors are associated with tonsillectomy?

A

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
Q

What is haemorrhage 5-10 days post tonsillectomy commonly associated with?

A

A wound infection - should be treated with IV antibiotics

Referred to as a secondary haemorrhage

51
Q

Secondary haemorrhage occurs in around what percentage of all tonsillectomies?

A

1-2%

ENT (Throat) (20 decks)

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