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Year 2(B6) - E.N.T > Week 2 - B - Adenotonsillar disease OME > Flashcards

Week 2 - B - Adenotonsillar disease OME Flashcards

1
Q

What does the tonsilar fossa develop from? What is located in the tonsilar fossa?

A

The tonsilar fossa develops from the first pharyngeal arch

The palatine tonsil is located in the tonsilar fossa

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2
Q

What develops from the 2nd pharyngeal pouch?

A

The palatine tonsils

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3
Q

What develops as a subepithelial infiltration of lymphocytes at 16 weeks of gestation?

A

The adenoids - nasopharyngeal tonsils

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4
Q

What is the main function of the tonsils?

A

To trap bacteria and viruses on inhalation and expose them to the immune system

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5
Q

Ring of lymphoid aggregation in the subepithelial layer of oropharynx and nasopharynx What is this ring? What tonsils are involved?

A

Waldeyer’s ring

Consists of - lingual tonsils (lateral aspect of posterior 1/3rd of the tongue), palatine tonsil, adenoids (pharyngeal tonsil)

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6
Q

What is the most common site of nasopharyngeal carcinoma? It exists as a recess behind the eustachian tube

A

The fossa of rosenmuller - where the adenoid tonsil is located

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7
Q

Name the lines from top to bottom of pic

A

Middle conchae Adenoid tonsil Oral cavity Palatine tonsil Genioglossus muscle (extrinsic tongue muscle)

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8
Q

What is the surface of tonsils covered by and what do the invaginations of this cause?

A

Covered by stratified squamous epithelium and the invagination of this epithelium causes crypts to form

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9
Q

WHat is this on histology?

A

Tonsil - can se the invaginating stratified epithelium forming crypts

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10
Q

What separates the tonsil from the underlying muscle?

A

A dense collagenous hemi-capsule

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11
Q

How does the surface of adenoids differ from that of tonsils?

A

Surface of adenoid is covered in ciliated pseudostratified columnar epithelium

Adenoids have folds and few crypts (tonsils have 10-30 crypts)

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12
Q

In the adenoids deep to the surface epithelium of ciliated pseudostratified, what type of epithelium exists?

A

Stratified squamous epithelium followed by transitional epithelium

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13
Q

The majority of acute tonsilitis is due to viral disease Name some viruses? Can also occur due to bacterial disease, name 2 bacterial causes?

A

Viruses

EBV, rhinovirus, influenza

Bacterial causes -

strep pyogenes or H.influenza

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14
Q

What is the complication of tonsilitis that can cause a pus filled pocket beside your tonsils?

A

Peritonsilar abscess - refer to ENT for drainage

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15
Q

What are potential differential diagnoses of tonsilitis?

A

Infectious mononucleos

Candida infection

URTI

viral infection

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16
Q

How long do symptoms of viral tonsilits last?

A

They last 3-4 days

Bacterial lasts around a week and requires antibiotics to settle

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17
Q

What is the CENTOR score criteria for differentiating bacterial causes from viral? (used in tonsilits - most likely bacterial pathogen is streptococcus pyogenes)

A

C- cough absence

E - tonsilar Exudate

N - tender anterior cervical lymph Nodes

T - Temperature (fever)

18
Q

What has been added to the modified centor score for grading?

A

If the person is below 15 years of age add 1 point

If the person is above 44 years of age minus 1 point

19
Q

What is the treatment of bacterial acute tonsilitis? (1st line and 2nd line if allergic)

A

Penicillin

If pen allergic Claithromycin (erythromycin if pregnant

20
Q

When is tonsillectomy recommended in adults?

A

For recurrent severe sore throats

21
Q

In both children and adults, the SIGN guideline are strict for the recommendation of tonsillectomy Well documented, adequately treated sore throats are required for consideration of tonsillectomy HOw many of these episodes are required for sore throats?

A

Seven such episodes in the last year

Five such episodes each year for the last two years

Three such episodes each year for the last three years

22
Q

How long can pain worsen for after a tonsillectomy operation?

A

Can last upto 6 days after

23
Q

The worst day after a tonsillectomy is roughly day 5 (pain) What are cmplications of tonsillecotmy?

A

Pain Haemorrhage Infection

24
Q

A complication of acute tonsilits is a peritonsillar abscess What is the classic history triad of somebody presenting with peritonsilar abscess?

A

Unilateral throat pain and odynophagia

Trismus - lockjaw

3-7 days after acute tonsilitis

25
Q

Where does the abscess usually arise in a PTA?

A

Between the tonsils and the muscle is a collection of pus

26
Q

What is the treatment of peritonislar abscess?

A

Aspiration of pus and antibiotics

Benzylpenicillin (if unable to swallow) or Phenoxymethypenicllin

Add metronidazole if continues after 48 hours

27
Q

What is the classic triad of infectious mononucleiosis? What virus causes this?

A

Associated lymphadenopathy

Fever

Sore throat

Epstein Barr virus causes this

28
Q

What are other symptoms of glandular fever?

A

Palatal petechiae

Hepatosplenomegly

29
Q

CRP is usually low in glandular fever What test is carried out? What is management? What should not be given?

A

Carry out monospot test

Supportive management eg analgesics

Do not give amoxicillin

30
Q

What is the appearance of the tonsilar exudate described as in glandular fever?

A

Cheese on toast exudate in glandular fever

31
Q

What can occur due to obstructive hypertrophy of adenoids and tonsils?

A

Snoring problem and sleep disturbance

If blocking airway then refer to ENT and consider removal

32
Q

What is glue ear known as medically? (two other names)

A

Otitis media with effusion or Serous otitis media (SOM)

33
Q

Define OME?

A

Inflammation of the middle ear accompanied by fluid without the symptoms/signs of inflammation

34
Q

Does OME present with fever? Does AOM present with fever?

A

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35
Q

What social factor increase the risk of acute otitis media?

A

Smoking household

36
Q

What are symptoms of acute otitis media?

A

Crying Irritable ear pain Sometimes hearing loss

37
Q

What test is carried out to test compliance of the tympanic membrane? Compliance - how well sound passes through the eardrum to the middle ear system

A

Tympanogram - compliance is plotted vertically on the chart

38
Q

What is a tube surgically implanted in the eardrum to drain fluid from the middle ear? usually carried out in children under 3

A

Grommet

39
Q

If it is supected acute otitis media, how do you manage this?

A

Oral analgesia and a delayed antibiotic incase symptoms resolve

40
Q

If the child has been given analgesia and antibiotics and is still in pain, what can be done in AOM?

A

Carry out tympanocentesis to drain the fluid build up

41
Q

What has become the most widely accepted therapeutic intervention for persistent otitis media with effusion (OME)?

A

Surgery - myringotomy - small hole in the tympanic membrane , can use a grommet

42
Q

How long do 9out of 10 cases of glue ear take to resolve?

A

resolve within one year

Treatment is usually only recommended if your child has: severe hearing loss hearing loss that’s causing significant problems with their learning, development and social skills

Down’s syndrome or a cleft palate

Year 2(B6) - E.N.T (32 decks)

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