tonsillitis COPY

Question 1

definition tonsillitis

Answer 1

acute infection of the parenchyma of the palatine tonsils

can occur in isolation or part of generalised pharyngitis

Question 2

aetiology of tonsillitis

Answer 2

viral

• common cold - rhinovirus, coronavirus and parainfluenza,
• influenza type A and B
• adenovirus
• HSV
• EBV

bacterial

• Group A B-haemolytic streptococcus (strep pyogenes)

haemophilus influenzae type B

local inflammation = oropharyngeal swellung, oedema, and pain

Question 3

RF for tonsillitis

Answer 3

5-15yrs

contact with infected people in enclosed spaces - child care centres, schools, prison

Question 4

epidemiology of tonsilitis

Answer 4

incidence 100 in 1000

Acute tonsillitis is most commonly seen in winter and early spring in temperate climates, although it may occur at any time of the year

Question 5

presenting symptoms of tonsillitis

Answer 5

acute sore throat

pain on swallowing

headache

abdo pain

nausea and vom

cough/runny nose

Question 6

signs of tonsillitis

Answer 6

fever >38degrees

tonsillar exudate

tonsillar erythema

tonsillar enlargement

enlarged anterior cervical lymph nodes

Question 7

investigations for tonsillitis

Answer 7

throat swabs shouldnt be taken routinely - culture of pathogen, definitive diagnosis but delay in results limits usefullness

rapid antistreptococcal Ab tests have no role in diagnosis, but can help confirm a history of gp A b-heamolytic strep (GABHS)

Question 8

symptoms of common cold

Answer 8

rhinorrhoea, nasal congestion and cough

Question 9

symptoms of influenza

Answer 9

headache, weakness, fatigue, myalgia, fever and dry cough

Question 10

symptoms of streptococcal infection

Answer 10

• acute onset, fever, presence of exudate and absence of cough

Question 11

symptoms of haematological malignancy

Answer 11

a rare but important cause,

suggested by fatigue, weight loss, petechial rash, bruising, adenopathy and fever

Question 12

symptoms that would warrant referral for hospital admission

Answer 12

• Drooling with resp distress - Possible causes include epiglottitis in a child and peri-tonsillar abscess (quinsy)
• Severe dehydration with difficulty taking oral fluids
• Peri-tonsillar abscess - ​​risk of airway compromise or rupture of the abscess and consequent sepsis.
• Suspected Kawasaki disease

Question 13

symptoms of scarlet fever

Answer 13

florid punctate rash over torso and limbs

strawberry tongue caused by red papillae protruding through a white coating

Question 14

late complications of scarlet fever

Answer 14

rare

rheumatic fever

post-streptococcal glomerulonephritis

Question 15

is scarlet fever a notifyable disease

Answer 15

yes