Tonsils + Adenoids

Question 1

Give four functions of the tonsils

Answer 1

1. Trap bacteria and viruses on inhalation
2. Expose to immune system
3. Antibodies produced by the immune cells in the tissue
4. Help to prime immune system and help to prevent subsequent infections

Question 2

What is the name given to the ring of lymphoid tissue in the oropharynx and nasopharynx?

Answer 2

Waldeyer’s ring

Question 3

Which muscles make up the anterior and posterior tonsillar pillars?

Answer 3

Palatoglossus

Palatopharyngeus

Question 4

Give four features of the histology for each of:

• Tonsils
• Adenoids

Answer 4

Tonsils 
- Specialized squamous 
- Deep crypts 
- Lymphoid follicles 
- Posterior capsule 
Adenoids
- Ciliated pseudostratified columnar 
- Stratified squamous 
- Transitional 
- Deep folds

Question 5

Give the histology and examples of each of the following areas:

• Upper aerodigestive
• Where food goes/high use/trauma
• Where air goes

Answer 5

Upper aerodigestive
- Ciliated columnar respiratory type mucosa
- Squamous epithelium 
Where food goes/high use/trauma
- Squamous
- Oral, pharyngeal, vocal cords, oesophagus 
Where air goes
- Columnar 
- Nose, PNS, larynx, trachea

Question 6

What is the ratio of viral to bacterial tonsillitis?

Answer 6

Majority viral
- EBV
- Rhinovirus, influenza, parainfluenza, enterovirus, adenovirus
5-30% bacterial.

Question 7

Which bacteria is the most important to remember in acute tonsilitis?

Answer 7

Group A beta-haemolytic strep e.g. Strep Pyogenes

Question 8

Describe the symptoms of viral vs bacterial tonsillitis

Answer 8

Viral 
- Malaise 
- Sore throat, mild analgesia requirement 
- Temperature 
- Able to undertake near normal activity 
- Possible lymphadenopathy 
- Lasts 3-4 days
Bacterial 
- Systemic upset
- Fever 
- Odynophagia
- Halitosis
- Unable to work/school
- Lymphadenopathy
- Lasts around 1 week, requires antibiotics to settle

Question 9

What is the Centor criteria used for?

Answer 9

Differentiating bacterial and viral tonsillitis

Question 10

Treatment for tonsillitis?

Answer 10

Supportive 
- Eat + drink 
- Rest 
- OTC analgesia – paracetamol, NSAID
Antibiotic
- Penicillin 500 mg QID for 10 days
- Clarithromycin if allergic
Hospital 
- If not managing to eat/drink/take oral antibiotics 
- IV fluids + antibiotics 
- Steroids

Question 11

Peritonsillar abscess

• Complication of?
• Pathology?
• Classic history?
• Treatmemt?

Answer 11

Complication of acute tonsillitis.
Bacteria between muscle and tonsil produce pus.
Classic history
- Unilateral throat pain and odynophagia
- Trismus (unable to open the jaw)
- 3-7 days of preceding acute tonsillitis
- Medial displacement of tonsil and uvula
- Concavity of palate lost
Treatment – aspiration and antibiotics.

Question 12

Infectious mononucleosis

- Which virus?

Answer 12

Ebstein-Barr virus

Question 13

Give some signs of infective mononucleosis

Answer 13

• Gross tonsillar enlargement with membranous exudate
• Marked cervical lymphadenopathy
• Palatal petechial haemorrhages
• Generalised lymphadenopathy
• Hepatosplenomegaly

Question 14

Give three criteria for diagnosis of infective mononucleosis

Answer 14

• Atypical lymphocytes in peripheral blood
• Positive Monospot or Paul-Bunnell test
• Low CRP (<100)

Question 15

What happens if you give amoxicillin to mono?

Answer 15

Macular rash

Question 16

WHAT SHOULD YOU NOT GIVE FOR TONSILLITIS?

Answer 16

AMOXICILLIN

Question 17

Give five features of chronic adenoiditis/tonsillitis

Surgery?

Answer 17

• Chronic “sore throat”
• Malodorous breath
• Presence of tonsilliths
• Peritonsillar erythema
• Persistent tender cervical lymphadenopathy
  Surgery has a controversial role and is rarely offered

Question 18

What are two possible causes of obstructive hyperplasia in the pharynx?
Give some features of each

Answer 18

Adenoid 
- Obligate mouth breathing 
- Hyponasal voice
- Snoring and other signs of sleep disturbance 
 AOM/OME 
Tonsil 
- Snoring and other symptoms of sleep disturbance 
- Muffled voice 
- ?Dysphagia