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ENT week 2 lectures > Tonsillitis, adenoids and glue ear > Flashcards

Tonsillitis, adenoids and glue ear Flashcards

1
Q

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

A

week 8

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2
Q

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

A

3-6 months

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3
Q

at how many weeks into gestation does the adenoids develop?

A

16 weeks

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4
Q

what is Waldeyer’s ring?

A

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

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5
Q

where is the adenoid?

A

positioned in the midline of the posterior wall of the nasopharynx

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6
Q

what is the fossa of Rosenmuller?

A

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

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7
Q

what is inside the fossa of Rosenmuller?

A

Gerlach’s tonsil

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8
Q

what is the luminal surface of the tonsil covered by?

A

stratified squamous epithelium

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9
Q

what separates the base of the tonsil from underlying muscle?

A

dense collagenous hemi-capsule

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10
Q

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

A

deep crypts

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11
Q

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

A

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

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12
Q

what is underneath the pseudostratified columnar epithelium on the adenoids?

A

stratified squamous layer

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13
Q

what is underneath the stratified squamous layer of adenoids?

A

a transitional layer

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14
Q

what layer of the adenoids thickens with chronic infection?

A

the stratified squamous layer

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15
Q

what is the transitional layer of the adenoids responsible for?

A

antigen processing

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16
Q

what is the most common viruses that cause acute tonsillitis?

A

EBV, rhinovirus, influenza, parainfluenza, enterovirus, adenovirus

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17
Q

what % of acute tonsillitis is bacterial?

A

5-30%

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18
Q

most common bacterial cause of acute tonsillits?

A

group A beta-haemolytic strep (strep.pyogenes)

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19
Q

symptoms of a viral tonsillitis?

A
  • malaise
  • sore throat, mild analgesia requirement
  • temperature
  • able to undertake near normal activity
  • possible lymphadenopathy
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20
Q

how long does a viral tonsillitis typically last?

A

3-4 days

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21
Q

symptoms of a bacterial tonsillitis?

A

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

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22
Q

how long does a bacterial tonsillitis last?

A

about 1 week

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23
Q

what is the Centor Criteria used for?

A

differentitating bacterial tonsillitis from viral

24
Q

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

A
  • history of fever
  • tonsillar exudates
  • tender anterior cervical adenopathy
  • absence of cough
25
Q

what is the age aspect in the modified centor criteria?

A

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

26
Q

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

A

no antibiotic

27
Q

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

A

should receive an antibiotic if symptoms progress

28
Q

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

A

treat empirically with an antibiotic

29
Q

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

A

penicillin, 500mg 4 times a day for 10 days

30
Q

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

A

seven or more

31
Q

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

A

5 or more

32
Q

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

A

three or more

33
Q

how many days post- tonsillectomy does the pain peak?

A

day 5

34
Q

what causes a peritonsilar abscess?

A

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

35
Q

what is the classic history of a peritonsilar abscess?

A
  • unilateral throat pain and pain on swallowing

- trismus

36
Q

what is trismus?

A

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

37
Q

how long after tonsillitis does a peritonsillar abscess typically occur?

A

3-7 days

38
Q

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

A
  • medial displacement of tonsil and uvula

- concavity of palate lost

39
Q

what is the treatment for a peritonsilar abscess?

A

aspiration and antibiotics

40
Q

what is the other name for a peritonsilar abscess?

A

quinsy

41
Q

what virus causes glandular fever?

A

ebstein-barr virus (EBV)

42
Q

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

A
  • generalised lymphadenopathy

- hepatosplenomegaly

43
Q

signs of glandular fever in the oral cavity?

A
  • gross tonsillar enlargement with membranous exudate

- palatal petechial haemorrhages

44
Q

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

A

atypical lymphocytes

45
Q

what is the diagnostic test for glandular fever?

A

-positive monospot test or clotted blood EBV IgM

46
Q

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

A

they would get a widespread red rash

47
Q

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

A

acute infection, chronic infection, hypertrophy, congenital

48
Q

what is otitis media with effusion (glue ear)?

A

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

49
Q

how does glue ear affect the TM and hearing?

A

impairs TM mobility and there is hearing loss

50
Q

is glue ear more common in males or females?

A

males

51
Q

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

A

they can be deaf, so they cant understand instructions

52
Q

does glue ear cause ear pain?

A

no

53
Q

on examination, what are the signs of glue ear?

A
  • TM retraction
  • reduced TM mobility
  • altered TM colour
  • visible fluid
54
Q

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

A

conductive HL

55
Q

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

A

conductive hearing loss

ENT week 2 lectures (5 decks)

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