Tonsillitis, adenoids and glue ear

Question 1

embryologically. at what week do they tonsils begin to develop?

Answer 1

week 8

Question 2

emryologically, when do the crypts of the tonsils begin to form?

Answer 2

3-6 months

Question 3

at how many weeks into gestation does the adenoids develop?

Answer 3

16 weeks

Question 4

what is Waldeyer’s ring?

Answer 4

ring of lymphoid aggregation in the subepithelial layer of oropharynx and nasopharynx

Question 5

where is the adenoid?

Answer 5

positioned in the midline of the posterior wall of the nasopharynx

Question 6

what is the fossa of Rosenmuller?

Answer 6

the space created lateral to the adenoid and posteromedial to the eustachian tube orifice.

Question 7

what is inside the fossa of Rosenmuller?

Answer 7

Gerlach’s tonsil

Question 8

what is the luminal surface of the tonsil covered by?

Answer 8

stratified squamous epithelium

Question 9

what separates the base of the tonsil from underlying muscle?

Answer 9

dense collagenous hemi-capsule

Question 10

what does the surface of the tonsil have all over it?

Answer 10

deep crypts

Question 11

what is different about the surface of the adenoids compared to the tonsils?

Answer 11

adenoids have deep folds and few crypts and adenoids are covered with pseudostratifed columnar epithelium

Question 12

what is underneath the pseudostratified columnar epithelium on the adenoids?

Answer 12

stratified squamous layer

Question 13

what is underneath the stratified squamous layer of adenoids?

Answer 13

a transitional layer

Question 14

what layer of the adenoids thickens with chronic infection?

Answer 14

the stratified squamous layer

Question 15

what is the transitional layer of the adenoids responsible for?

Answer 15

antigen processing

Question 16

what is the most common viruses that cause acute tonsillitis?

Answer 16

EBV, rhinovirus, influenza, parainfluenza, enterovirus, adenovirus

Question 17

what % of acute tonsillitis is bacterial?

Answer 17

5-30%

Question 18

most common bacterial cause of acute tonsillits?

Answer 18

group A beta-haemolytic strep (strep.pyogenes)

Question 19

symptoms of a viral tonsillitis?

Answer 19

• malaise
• sore throat, mild analgesia requirement
• temperature
• able to undertake near normal activity
• possible lymphadenopathy

Question 20

how long does a viral tonsillitis typically last?

Answer 20

3-4 days

Question 21

symptoms of a bacterial tonsillitis?

Answer 21

systemic upset, fever, painful swallowing, bad breath, unable to work/school, lymphadenopathy,

Question 22

how long does a bacterial tonsillitis last?

Answer 22

about 1 week

Question 23

what is the Centor Criteria used for?

Answer 23

differentitating bacterial tonsillitis from viral

Question 24

what is the 4 features that suggest a bacterial tonsillitis over a viral tonsillitis?

Answer 24

• history of fever
• tonsillar exudates
• tender anterior cervical adenopathy
• absence of cough

Question 25

what is the age aspect in the modified centor criteria?

Answer 25

add one point if they are under 15. subtract one point if they are over 44

Question 26

if a patient has 0-1 points on the centor criteria, how should they be treated?

Answer 26

no antibiotic

Question 27

if a patient has 2-3 points in the centor criteria how should they be treated?

Answer 27

should receive an antibiotic if symptoms progress

Question 28

if a patient has 4-5 points on the centor criteria, how should they be treated?

Answer 28

treat empirically with an antibiotic

Question 29

what antibiotic should be given to treat tonsillitis and at what dose for how long?

Answer 29

penicillin, 500mg 4 times a day for 10 days

Question 30

how many episodes of tonsillitis must a patient have in in the preceding year to be considered for a tonsillectomy?

Answer 30

seven or more

Question 31

how many episodes of tonsillitis over the preceding 2 years must a patient have to be considered for a tonsillectomy?

Answer 31

5 or more

Question 32

how many episodes of tonsillitis over the preceding 3 years must a patient have to be considered for a tonsillectomy?

Answer 32

three or more

Question 33

how many days post- tonsillectomy does the pain peak?

Answer 33

day 5

Question 34

what causes a peritonsilar abscess?

Answer 34

bacteria gets between the muscle and tonsil and area fills with pus

Question 35

what is the classic history of a peritonsilar abscess?

Answer 35

- unilateral throat pain and pain on swallowing | - trismus

Question 36

what is trismus?

Answer 36

inability to open the mouth due to spasm of the facial muscles

Question 37

how long after tonsillitis does a peritonsillar abscess typically occur?

Answer 37

3-7 days

Question 38

what might be seen on examination of the oral cavity in a peritonsillar abscess?

Answer 38

- medial displacement of tonsil and uvula | - concavity of palate lost

Question 39

what is the treatment for a peritonsilar abscess?

Answer 39

aspiration and antibiotics

Question 40

what is the other name for a peritonsilar abscess?

Answer 40

quinsy

Question 41

what virus causes glandular fever?

Answer 41

ebstein-barr virus (EBV)

Question 42

systemic features of glandular fever out-with the oral cavity?

Answer 42

- generalised lymphadenopathy | - hepatosplenomegaly

Question 43

signs of glandular fever in the oral cavity?

Answer 43

- gross tonsillar enlargement with membranous exudate | - palatal petechial haemorrhages

Question 44

what can be seen in the peripheral blood in glandular fever?

Answer 44

atypical lymphocytes

Question 45

what is the diagnostic test for glandular fever?

Answer 45

-positive monospot test or clotted blood EBV IgM

Question 46

what would happen if someone with glandular fever was given amoxicillin?

Answer 46

they would get a widespread red rash

Question 47

what are the non-neoplastic causes of unilateral tonsillar enlargement?

Answer 47

acute infection, chronic infection, hypertrophy, congenital

Question 48

what is otitis media with effusion (glue ear)?

Answer 48

inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute infection

Question 49

how does glue ear affect the TM and hearing?

Answer 49

impairs TM mobility and there is hearing loss

Question 50

is glue ear more common in males or females?

Answer 50

males

Question 51

how can glue ear affect a childs school performance and behaviour?

Answer 51

they can be deaf, so they cant understand instructions

Question 52

does glue ear cause ear pain?

Answer 52

no

Question 53

on examination, what are the signs of glue ear?

Answer 53

- TM retraction - reduced TM mobility - altered TM colour - visible fluid

Question 54

what would you expect in glue ear when doing the tuning fork tests?

Answer 54

conductive HL

Question 55

if there is an airborne gap in the audiometry, what does this suggest?

Answer 55

conductive hearing loss