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My2 ENT > Tonsils, adenoids, nose and airway obs > Flashcards

Tonsils, adenoids, nose and airway obs Flashcards

1
Q

how do tonsils help our immunity

A

trap bacteria on inhalation, contain antibodies, help prime immune system

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2
Q

where and what is waldeyer’s ring

A

ring of lymphoid aggregation in oropharynx and nasopharynx

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3
Q

lymph nodes are in waldeyer’s ring and where are they all (3)

A

palatine tonsils (tonsils at back of throat), naso/pharyngeal tonsils (AKA adenoids), lingual tonsils (back of tongue)

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4
Q

histologically what do palatine tonsils look like

A

specialised squamous, deep crypts, lymphoid follicles, posterior capsule

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5
Q

histologically what do adenoid look like

A

ciliated pseudo-stratified columnar, stratified squamous, deep transitional folds

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6
Q

what are the main viral causes of acute tonsillitis

A

EBV, rhinovirus, influenza, enterovirus

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7
Q

acute tonsillitis is rarely bacterial, what are the main bacterial infective organisms

A

GAS: group A beta haemolytic strep (strep pyogenes) / h influenza / staph A / strep pneumonia

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8
Q

what are symptoms of viral tonsillitis

A

malaise, tired, sore red throat, temperature, possible lymphadenopathy, last 3-4 days and can function more or less ok

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9
Q

what are symptoms of bacterial tonsillitis

A

systemic upset, fever, odynophagia (painful swallow), pain, lymphadenopathy, halitosis (bad breath) , white pus

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10
Q

what 2 diagnostic criteria is used to diagnose tonsillitis and what are the subcategories

A

centor (fever, pus, lymphadenopathy, no cough) + fever PAIN (fever, pus, attend rapidly, inflamed tonsils, no cough

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11
Q

how do you manage viral vs bacterial tonsillitis

A

VIRAL: rest and analgesia
BACTERIAL: pen V 500mg for 10 days

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12
Q

what is the criteria for tonsillectomy

A

7 debilitating episode in 1 year OR 5 in each preceding 2 years (10) OR 5 in each preceding 3 years (9)

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13
Q

what is a peritonsillar abscess and what usually causes it

A

pus between muscle and tonsils, normally complication of acute tonsillitis

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14
Q

what are the symptoms of a Peritonsillar abscess

A

unilateral throat pain and odynophagia, trismus (lockjaw), 3-7 days acute tonsillitis

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15
Q

what virus causes glandular fever

A

epstein-barr virus (EBV)

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16
Q

what are symptoms of glandular fever

A

gross tonsillar enlargement with pus, marked cervical lymphadenopathy, hepatosplenomegaly, extreme malaise and tiredness (if exudate secondary bacterial infection)

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17
Q

how do you diagnose glandular fever

A

atypical lymphocytes, +ive monospot or paul-bunnel, LOW CPR (<100)

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18
Q

how do you manage glandular fever

A

supportive, NO AMPICILLIN/ AMOXICILLIN, steroids/ ab’s if needed

19
Q

what is chronic tonsillitis

A

chronic sore throat and slightly swollen, red tonsils that can cause halitosis - often not pathological and large size with no symptoms means nothing

20
Q

what symptoms would be seen with adenoid obstructive hyperplasia

A

mouth breathing, hyponasal voice, snoring and sleep disturbance, acute otitis media +/- effusion

21
Q

what symptoms would be seen with palatine tonsil obstructive hyperplasia

A

snoring and bad sleeping, muffled voice and dysphagia

22
Q

what cells are involved in type I hypersensitivity

A

B cells release IgE which causes mast cells to release histamines and leukotrienes

23
Q

what are some primary nasal symptoms

A

blockage, loss of smell (asomnia), discharge, facial pain

24
Q

what investigations can be done for nasal problems

A

airway patency, external nose exam, rhinoscopy

25
Q

what types of rhinitis are there

A

infective: upper viral and resp tract infection / non-infective: allergic AKA hay fever

26
Q

what is the allergic rhinitis pathway

A

macrophages activate Th0 cells –> Th2 cells –> eosinophils and B cells –> IgE

27
Q

what is classed intermittent allergic rhinitis and what causes it

A

symptoms < 4 days a week OR < 4 weeks duration - caused by grass/ tree pollen/ fungal spores

28
Q

what is classed persistent allergic rhinitis and what causes it

A

symptoms > 4 days a weeks AND > 4 weeks duration - caused by house dust mites/ cats dogs

29
Q

what is seen in mild allergic rhinitis vs moderate-severe allergic rhinitis

A 
mild = normal sleep and no impairment day to day. 
moderate-severe = 1 or more: abnormal sleep, impaired day to day and troublesome sleep
30
Q

how do you manage allergic rhinitis

A

avoid triggers, topical antihistamine, topical steroids (beclomethasone), topical anticholinergic (ipratropium)

31
Q

how do you manage severe allergic rhinitis

A

dual therapy, immunotherapy for IgE disease, surgery for obstruction

32
Q

what is a non-allergic and non infective common cause of rhinitis

A

nasal polyps (and vasomotor)

33
Q

who commonly gets nasal polyps

A

common, worry about CF in children, associated with non-allergic asthma - treat with oral/ topical steroids and eventually surgery

34
Q

what are symptoms of acute infective rhinosinusitis

A

facial pain, discharge, nasal blockage, normally viral

35
Q

how do you manage rhinosinusitis

A

analgesia, decongestants, deteriorating –> antibiotics

36
Q

what complications can occur with rhinosinustitis

A

orbital or brain abscess: blindness or thrombosis / secondary bacterial infection: strep pneumonia or H influenza

37
Q

what are some other causes of a stuffy nose (4)

A

adenoid obstruction, foreign body (unilateral smelly discharge), mucocele (impaired drainage and swelling), maxillary sinal tumour

38
Q

what vasculitis commonly presents with nasal symtpoms

A

granulomatosis with polyangiitis (GPA) - cANCA +ive and anti-PR3

39
Q

what features of a neonate make them susceptible to airway obstruction (6)

A

large head, small nasal flares, can only breath through nose, large tongue, weak neck muscles, narrow subglottis

40
Q

how are airflow, resistance and work of breathing related and what is the equation

A

smaller diameter = increased resistance = increased work of breathing and vice versa // airflow resistance is proportion to 1/r^4

41
Q

what are common causes of airflow resistance

A

inflamm and infective causes/ allergy, foreign body, physical compression, trauma, neurological, neoplastic, burn, congenital

42
Q

what are symptoms of airflow resistance

A

SOB on exertion/ rest, stridor (high pitched), stretor (low pitched, snore, nasopharynx), coughing, choking, can’t talk, dysphagia, pyrexia and cyanosis

43
Q

how do you manage airflow obstruction

A

ABCDE, O2, heliox (helium and O2), steroids, adrenaline, flexible endoscopy, secure airway (avoid tracheostomy until you can’t)

My2 ENT (10 decks)

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