Tonsils & Adenoids Disease Flashcards
What is acute tonsillitis aka
Adenotonsilitis
Acute tonsillitis aetiology
Usually viral!
- EBV (mono)
- Rhinovirus/ influenza etc
If bacterial
- Group A beta-hemolytic streptococcus
- H influenza/ strep pneumonia etc
Sore throat differentials
what symptoms would make you think bacteria over viral tonsillitis
FeverPAIN
•Fever (during previous 24 hours)
•Purulence (pus on tonsils)
•Attend rapidly (within 3 days after onset of symptoms)
•Severely Inflamed tonsils
•No cough or coryza (inflammation of mucus membranes in the nose)
+/- lymphadenopathy (tho could be EBV)
Tonsils with lymphadenopathy - what are the top two differentials
Mono (very large lymphadenopathy)
Bacterial tonsillitis
Acute tonsillitis treatment
- Supportive treatment (eat, drink, rest, analgesia)
- Antibiotic if FeverPAIN criteria (Penicillin 500mg QID 10 days)
Tonsillectomy requirements
- 7 or more in one year
- 5 or more per year for past 2 years
- 3 or more per year for past 3 years
What is peritonsilar abscess aka
Quinsy
Peritonsilar abscess aetiology
Complication of acute tonsillitis
What is a peritonsilar abscess
Bacteria between muscle and tonsil produce pus
Peritonsilar abscess history
→Unilateral throat pain and odynophagia
→Trismus
→3-7 days of preceding acute tonsillitis
Peritonsillar abscess signs
Medial displacement of tonsil and uvula
Concavity of palate lost
Peritonsilar abscess treatment
Aspiration and antibiotics
Glandular fever clinical features
→Gross tonsillar enlargement with membranous exudate
→Marked cervical lymphadenopathy
→Palatal petechial haemorrhages
→Generalised lymphadenopathy
→Hepatosplenomegaly
→Lymphocytosis with atypical lymphocytes
Glandular fever diagnosis
Clinical diagnosis
FBC with atypical lymphocytes & low CRP
What medication should patients with glandular fever not be given & why
Amoxicillin - causes macular rash
Glandular fever treatment
Self limiting, symptomatic treatment
Antibiotics but not penicillin (prevent secondary infection)
Systemic steroids if severe
Avoid sports for 6 weeks due to splenic rupture
Chronic tonsilitis clinical features
Chronic “sore throat”
“Malodorous breath”
Presence of tonsilliths
Peritonsillar erythema
Persistent tender cervical lymphadenopathy
Chronic tonsillitis treatment
Non surgical, self limiting
Dental mouthwash
Enlarged adenoids effects
→Obligate mouth breathing
→Hyponasal voice
→Snoring and other signs of sleep disturbance
→AOM / OME
Tonsil enlargement effects
→Snoring and other symptoms of sleep disturbance
→Muffled voice
Unilateral tonsilar enlargement differentials
Acute or chronic infection
Hypertrophy
Congenital
Neoplastic
