Tonsils Flashcards
What is the main function of the tonsils?
Trap bacteria and expose the antigens to the immune system allowing antibody production. Random environmental sampling.
What is Waldeyers ring?
A ring of lymphoid tissue within the sub epithelial layer of the oropharynx.
What lymphoid tissue makes up waldeyers ring?
Adenoid Palatine and Lingual tonsils
What do palatine tonsils look like histologically?
Specialised squamous cover with deep crypts
What do the adenoid tonsils look like histologically?
Ciliated pseudostratified columnar with deep folds.
The majority of acute tonsillitis cases are bacterial? T/F
False the vast majority are viral, up to 30% are bacterial.
List some common viral causes of acute tonsilitis
EBV
Rhino, Aden, Coronavirus
Influenza
Parainfluenza
If someone presents with chronic tonsilitis what are the common causative pathogens?
Strep pyogenes
H.Influenza
S.Aureus
S.Pneumonia
How would someone with a viral acute tonsillitis present?
Malaise Sore throat Temperature Near normal activity 3-4 days duration
How would someone with a bacterial acute tonsillitis present?
Systemic upset Fever Halitosis Lymphadenopathy Odynophagia Unable to work 1 week duration
What is the supportive treatment for someone with acute tonsillitis?
Eat Drink Rest NSAIDs
What is the antibiotic treatment used for someone with a severe bacterial tonsillitis?
Penicillin 500mg 10 days
Clarythromycin if allergic
If someone is admitted to hospital with acute tonsillitis what is the treatment plan?
IV Fluids
IV Antibiotics
IV steroids
In order to undergo a tonsillectomy what criteria must be met?
7x Antibiotically treated cases within 1 year.
What risk is there of haemorrhage as a result of a tonsillectomy?
5%
How long does the pain post tonsillectomy last and at what day does it peak?
Lasts for 7 days and pain is worst on the 5th
What is required post operatively for a tonsillectomy and should be taken daily rather than required?
Strong Opiates
What is a major risk of acute tonsilitis?
Peritonsillar abscess
What is the clinical presentation of someone with a peritonsillar abscess?
Unilateral throat pain and odynophagia
Trismus - limited jaw movement
3-7 days of preceding tonsilitis
What is a peritonsillar abscess?
Puss formation between the underlying muscle and the tonsil.
What will you see in the mouth of someone with a peritonsillar abscess?
Medial displacement of the uvula and tonsils
Loss of the palate concave shape.
What is the treatment for a peritonsillar abscess?
Canula aspiration
Antibiotics
What is infectious mononucleosis also called?
Glandular fever
What is the causative organism behind glandular fever?
Epstein Barr Virus
What is the clinical presentation of someone with glandular fever?
Gross tonsillar enlargement with membranous exudate
Palatial Petechiae
Splenomegally
What are Palatial Petechiae?
Haemorrhage marks on the roof of the mouth
What is required to diagnose glandular fever?
Atypical lymphocytes
+ve monospot
Low CRP <100
What is important to remember in the treatment of glandular fever?
NEVER prescribe Ampicillin or Amoxicillin
Risk of macular rash
What is the mainstay of treatment for glandular fever?
Systemic treatment
Antibiotics and Steroids
What signs indicate a obstructive hyperplasia of the adenoids?
Obligate mouth breather Hyponasal voice Snoring Sleep Disturbances OME
What signs indicate an obstructive hyperplasia of the palatines?
Snoring
Sleep Disturbances
Muffled voice
Dysphagia
