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Paediatrics finals > Tonsillitis > Flashcards

Tonsillitis Flashcards

1
Q

What is tonsillitis

A

Inflammation of the palatine tonsils as a result of bacterial or viral infection

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2
Q

What are the palatine tonsils?

A

A concentration of lymphoid tissue within the oropharynx

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3
Q

Name inflammation of other areas occurring in conjunction with the tonsils

A

Tonsillopharyngitis

Adenotonsillitis

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4
Q

What does the size of tonsils change with?

A

Growth and development

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5
Q

When are the tonsils at their largest?

A

Age 4-8 yo

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6
Q

What causes most tonsillitis

A

Viruses

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7
Q

Name the common viral causes of tonsillitis

A

Adenovirus

EBV

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8
Q

Name the common bacterial cause of tonsillitis

A

Group A streptococcus (Strep pyogenes)

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9
Q

What is a risk factor for tonsillitis

A

Smoking

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10
Q

Describe the clinical history of tonsillitis

A 
Odynophagia
Fever
Reduced oral intake
Halitosis
New onset snoring
Shortness of breath
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11
Q

Describe the clinical examination findings of tonsillitis

A

Red inflamed tonsils
White pus/exudate on the tonsils
Cervical lymphadenopathy - region of the upper 3rd of the sternocleidomastoid

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12
Q

How many days does tonsillitis last for?

A

5-7

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13
Q

How many days does glandular fever symptoms last for?

A

> 7 days

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14
Q

List the differentials for tonsillitis

A 
Glandular fever
Pharyngitis
Peritonsillar abscess
Tonsillar malignancy 
Epiglottitis
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15
Q

What scoring systems are used to determine the likelihood of a bacterial infection compared to a viral infection causing tonsillitis

A

CENTOR
feverPAIN
Streptococcal score card

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16
Q

Describe the centor criteria

A

Tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
Fever or history of fever
Absence of cough

A score >3 is highly suggestive of a bacterial infection (40-60% likely)
A score <2 means a bacterial infection is unlikely (80% unlikely)

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17
Q

Describe the feverPAIN score

A 
Fever 
Purulence
Attend rapidly (within 3 days after onset of symptoms)
Inflamed (severely) tonsils 
No cough or coryza

Score 0-1 = 13-18% chance of streptococcal infection
Score 2-3 = 34-40% chance of streptococcal infection
Score 4-5 = 62-65% chance of streptococcal infection

18
Q

Describe the streptococcal score card

A 
Age 5-15
Season - late autumn and early spring
Fever >38.3
Cervical lymphadenopathy 
Pharyngeal oedema 
No viral URTI symptoms - cough or coryza

5 Criteria = 59% GAS
6 criteria = 75% GAS

19
Q

How is tonsillar size graded?

A

By the proportion of the oropharynx taken up by the tonsils

Grade 0 - tonsils not visible/not present
Grade 1 - <25% 
Grade 2 - 25-50%
Grade 3 - 25-75%
Grade 4 - tonsils meet in midline
20
Q

At what age are grade 2 and 3 tonsils at peak incidence?

A

4-5yo

21
Q

At what age are grade 2 tonsils predominant?

A

6yo

22
Q

What may cause enlarged tonsils

A

Scarring from recurrent infection

23
Q

What investigations may be considered for tonsillitis?

A

FBC - infection - neutrophils in bacterial
LFT - glandular fever
U&E - dehydration

24
Q

How is tonsillitis managed?

A

Decide whether or not admission is necessary
Antibiotics for 7-10 days dosed according to child’s weight -benzylpenicillin, switch to oral penicillin V when able to swallow
Analgesia - paracetamol and ibuprofen

25
Q

When is tonsillectomy considered

A

> 7 episodes in 1 year
5 episodes per year in 2 years
3 episodes per year in 3 years

26
Q

List some complications of tonsillitis

A

Quinsy - peritonsillar abscess
Deep neck space abscess - retropharyngeal or parapharyngeal
Recurrent tonsillitis

27
Q

List two post streptococcal complications

A

Post streptococcal glomerulonephritis

Rheumatic fever

28
Q

At what age does post streptococcal glomerulonephritis tend to present?

A

6-8yo

29
Q

What are the symptoms of post streptococcal glomerulonephritis?

A

Hypertension
Haematuria
Oedema
Proteinuria but without true nephrotic syndrome

30
Q

What is rheumatic fever?

A

An autoimmune reaction to group A streptococcus

31
Q

When does rheumatic fever present?

A

2-5 weeks after GAS infection

32
Q

What are the symptoms of rheumatic fever?

A

Prolonged fever
Arthritis
Pancarditis
Anaemia

33
Q

What age commonly gets rheumatic fever?

A

5-14yo

34
Q

What is a peritonsillar abscess?

A

Quinsy

Collection of pus in the peritonsillar space

35
Q

Where is the peritonsillar space?

A

Potential space that surrounds the palatine tonsils

36
Q

What are the common causative organisms of a peritonsillar abscess?

A

Fusobacterium necrophorum - 15-24yo

Group A streptococcus - 30-39yo

37
Q

Describe how peritonsillar abscesses develop

A

Result of tonsillitis causing irritation in the peritonsillar space resulting in pus accumulation

38
Q

How do patients with peritonsillar abscess present?

A

Severe sore throat - unilateral mostly
Trismus - muscle spasm preventing jaw opening fully
Hot potato voice
Uvula deviation away from the affected side

39
Q

What is the definitive management of peritonsillar abscess?

A

Aspiration and drainage

Antibiotics due to mixed organism causes - cover of anaerobes and aerobes

40
Q

What is the definitive management of peritonsillar abscess?

A

Aspiration and drainage
Antibiotics due to mixed organism causes - cover of anaerobes and aerobes
IV rehydration
Analgesia

41
Q

Which antibiotic should you not give in glandular fever and why?

A

Co-amoxiclav - risk of skin reaction

Paediatrics finals (37 decks)

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