Tonsillitis and Adenoids

Question 1

What are the main functions of the tonsils and adenoids?

Answer 1

• Trap bacteria and viruses on inhalation
• Expose to immune system
• Antibodiesproduced are present in these tissues

Question 2

What is Waldeyer’s ring?

Answer 2

Ring of lymphoid tissue in subepithelial layer

In nasalpharynx and oropharynx

Question 3

What structures are found in Waldeyer’s ring?

Answer 3

Tonsils
Adenoids
Lingual Tonsil

Question 4

Describe the difference in epithelium between Palatine tonsils and the adenoids?

Answer 4

Palatine = Stratified squamous epithelium with CRYPTS

Adenoids = Respiratory epithelium (as they are in nasopharynx) and less crypts than palatine

Question 5

The majority of tonsillitis is bacterial. TRUE/FALSE?

Answer 5

FALSE
Most = viral
e.g. EBV

Question 6

What viruses often cause tonsillitis?

Answer 6

Epstein Barr 
Rhinovirus
Influenza/ Parainfluenza
Enterovirus
Adenovirus

Question 7

Why are throat swabs not recommended in tonsillitis?

Answer 7

They dont always culture the bacterium causing the infection

Question 8

What are the most common bacterial causes of tonsillitis?

Answer 8

Strep. pyogenes (Group A beta-hemolytic strep)
Haemophilus influenza
Staph. aureus
Strep. pneumonia

Question 9

What are the main differences between the symptoms of bacterial and viral tonsillitis?

Answer 9

Viral

• Malaise
• Able to undertake near normal activity
• Lasts 3-4 days, but certain symptoms grumble on for weeks

Bacterial

• Systemic upset
• Fever
• Odynophagia
• Unable to work / school
• Lasts 1 week, usually need antibiotics to settle

Question 10

What antibiotic is given in bacterial tonsillitis if the patient is penicillin allergic?

Answer 10

Clarithromycin

DO NOT GIVE ERYTHROMYCIN - PT WILL VOMIT

Question 11

How many occurences of tonsilliitis must a patient experience before they are eligible for a tonsillectomy?

Answer 11

7 cases in 1 year (where they have been prescribed antibiotics)
5 cases each year for 2 consecutive years
3 cases each year for 3 consecutive years

Question 12

Following a tonsillectomy, what day of recovery is thought to present the worst pain?

Answer 12

Day 5

Question 13

What is the largest risk with regards to a tonsillectomy operation?

Answer 13

Haemorrhage (5%)

Question 14

What is a peritonsilar abscess?

Answer 14

• Complication of Acute tonsillitis

- Bacteria between muscle and tonsil produce pus

Question 15

What symptoms can indicate a peritonsilar abscess?

Answer 15

Unilateral throat pain and odynophagia

3-7 days of preceding acute tonsillitis

Question 16

What signs may be seen in a peritonsilar abscess?

Answer 16

Medial displacement of tonsil and uvula

Concavity of palate lost

Question 17

What is the treatment for a peritonsilar abscess?

Answer 17

Needle aspiration of pus

Antibiotics

Question 18

Infectious mononucleosis is the name for what condition?

Answer 18

Glandular Fever

Question 19

What signs of glandular fever are different from normal tonsillitis?

Answer 19

• Palatal petechial haemorrhages
• Generalised lymphadenopathy
• Hepatosplenomegaly

Question 20

What tests are used to diagnose infectious mononucleosis?

Answer 20

Atypical lymphocytes in peripheral blood
+ve specific EBV IgM
+ve Monospot (LESS SPECIFIC)

Question 21

What antibiotic should NOT be given in glandular fever (according to clinicians) as it causes a rash?

Answer 21

Amoxicillin

try to decide if the exam question is clinical or microbio as they disagree on this subject

Question 22

What can result from obstructive hyperplasia of the adenoid?

Answer 22

• Obligate mouth breathing
• Hyponasal voice
• Snoring/other signs of sleep disturbance
• Acute Otitis Media / Otitis Media with Effusion

Question 23

If a tonsil is enlarged unilaterally, what can be the potential causes?

Answer 23

Non-neoplastic:
Infection
Hypertrophy
Congenital

Neoplastic:
Benign Papilloma
Lymphoma