Tonsillitis/Pharyngitis Flashcards
Tonsillitis is primarily an infection of which of the following?
1 - adenoid tonsils
2 - palatine tonsils
3 - tubal tonsils
4 - lingual tonsils
2 - palatine tonsils
- located in oropharynx
Can also cause adenoiditis and pharyngitis
What is the incidence of tonsillitis?
1 - 5 in 100,000
2 - 50 in 100,000
3 - 500 in 100,000
4 - 5000 in 100,000
3 - 500 in 100,000
Does tonsillitis affect males or females more?
- equally affected
What age does tonsillitis typically occur?
1 - 1-3 y/o
2 - 1-7 y/o
3 - 6-15 y/o
4 - 10-20 y/o
3 - 6-15 y/o
Is bacterial or viral cause of tonsillitis more common?
- viral
But both can cause them
Virus are the most common cause of tonsillitis. All of the following can cause tonsillitis, but which is the most common?
1 - rhinovirus
2 - coronavirus
3 - parainfluenza
4 - adenovirus (4%)
5 - influenza virus type A and B
6 - herpes simplex virus
7 - epstein-Barr virus (glandular fever)
1 - rhinovirus
Rhinovirus, coronavirus and parainfluenza account for 25% of all causes of tonsillitis
Which of the following bacteria is the most common bacterial cause of tonsillitis?
1 - E. coli
2 - S. aureus
3 - Group A streptococci
4 - Group C streptococci
3 - Group A streptococci
Often referred to as strep throat and causes purulent appearance
Which of the following does not typically occur in the pathophysiology of tonsillitis?
1 - micro-organisms infiltrate palatine tonsils epithelium
2 - B and T cells phagocytes micro-organisms
3 - macrophages present micro-organisms antigens to B and T cells stimulating an immune response
4 - phospholipase A2 (inflammatory cytokines are produced.
5 - pyrexia, oropharyngeal swelling, pain and erythema occur following immune response
2 - B and T cells phagocytes micro-organisms
Macrophages phagocytose the micro-organisms and present the antigens to B and T cells
Patients can have all of the following symptoms in tonsillitis, but which is by far the most common?
1 - coryzal symptoms (nasal congestion, headache, earache, cough).
2 - Fever >38ºC
3 - Dysphagia
4 - Sore throat and refusal of foods
5 - enlarged lymph nodes
4 - Sore throat and refusal of foods
- occurs in 99% of patients
In tonsillitis, is a cough more common if the cause is viral or bacterial?
- viral
If no cough, suspect bacterial cause
In tonsillitis, is a high temperature more common if the cause is viral or bacterial?
- bacterial
In a patient with tonsillitis, which of the following may be visible upon examining the pharynx?
1 - severely inflamed tonsils
2 - enlarged and painful anterior cervical lymph nodes
3 - purulent tonsils
4 - all of the above
4 - all of the above
If there is pus on the tonsils, is this more likely to be bacterial or viral as the cause?
- bacterial
Which of the following patients should NOT have a throat examination in someone presenting with symptoms of tonsillitis?
1 - suspect asthma exacerbation
2 - suspect anaphylaxis
3 - suspect epiglottitis
4 - suspect sepsis
3 - suspect epiglottis
- epiglottis folds over when we swallow, blocking the trachea so we do not aspirate food into the lungs
Suspect epiglottis if a young child, muffled voice and excessive drooling and pooling of saliva.
Call for an anaesthetist and an ENT surgeon.
Is tonsillitis is suspected, is the diagnosis confirmed with testing or is this clinical diagnosis?
- clinical
Tonsillitis is typically a clinical diagnosis, however, according to NICE, which of the following requires an antigen test in patients who are immunocompromised, such as very old or young, with severe symptoms?
1 - rhinovirus
2 - group A streptococci
3 - influenza virus type A and B
4 - herpes simplex virus
5 - epstein-Barr virus (glandular fever)
2 - group A streptococci
If antigen is negative, then a throat swab should be performed
If a child presents with tonsillitis, which 2 scoring systems can be used to help identify the risk of a group A streptococci infection, aka strep throat?
1 - Wells Score
2 - Centor Score
3 - CURB65
4 - FeverPAIN score
2 - Centor Score
4 - FeverPAIN score
Which of the following are likely differentials in a patient with suspected tonsillitis?
1 - Viral upper respiratory tract infection
2 - Peritonsillar abscess (quinsy)
3 - Epiglottitis
4 - Retropharyngeal abscess
5 - Primary HIV infection
6 - all of the above
6 - all of the above
Peritonsillar abscess, also called a quinsy is a complication of tonsillitis. Image is of a quinsy
All of the following are typical treatments for patients with suspected tonsillitis, EXCEPT which one?
1 - antibiotics
2 - reassurance that symptoms will subside <1 week
3 - paracetamol / NSAIDs (oral spray)
4 - adequate fluid intake
1 - antibiotics
Antibiotics are not typically used in the treatment of tonsillitis. However, if any of the following criteria are identified they can be used. Which one of the following is NOT one of the NICE guidelines?
1 - marked systemic upset secondary to the acute sore throat
2 - unilateral peritonsillitis abscess (quinsy)
3 - history of rheumatic fever
4 - history of asthma
5 - immunodeficiency
6 - acute sore throat/acute pharyngitis/acute tonsillitis when >3 or more Centor criteria are present
4 - history of asthma
Both the Centor and FeverPAIN criteria are used to quantify the likelihood of isolating Streptococci
All of the following are potential complications of tonsillitis, but which is the least likely?
1 - Acute otitis media
2 - Acute post-streptococcal glomerulonephritis
3 - Acute sinusitis
4 - Peritonsillar abscess (quinsy)
2 - Acute post-streptococcal glomerulonephritis
- very rare, but patients present with haematuria, oedema, vomiting and anorexia.
Following can also occur but are rare:
- Scarlet fever
- Acute rheumatic fever
- Streptococcal toxic shock syndrome
Why should penicillins be avoided if you suspect a patient has glandular fever?
1 - results in anaphylaxis
2 - can cause respiratory depression
3 - leads to systemic rash, suggesting penicillin allergy
4 - need to treat with antivirals
3 - leads to systemic rash, suggesting penicillin allergy
Patients are then identified as having a penicillin allergy
