Week 2 - B - Adenotonsillar disease OME Flashcards
What does the tonsilar fossa develop from? What is located in the tonsilar fossa?
The tonsilar fossa develops from the first pharyngeal arch
The palatine tonsil is located in the tonsilar fossa
What develops from the 2nd pharyngeal pouch?
The palatine tonsils
What develops as a subepithelial infiltration of lymphocytes at 16 weeks of gestation?
The adenoids - nasopharyngeal tonsils
What is the main function of the tonsils?
To trap bacteria and viruses on inhalation and expose them to the immune system
Ring of lymphoid aggregation in the subepithelial layer of oropharynx and nasopharynx What is this ring? What tonsils are involved?
Waldeyer’s ring
Consists of - lingual tonsils (lateral aspect of posterior 1/3rd of the tongue), palatine tonsil, adenoids (pharyngeal tonsil)
What is the most common site of nasopharyngeal carcinoma? It exists as a recess behind the eustachian tube
The fossa of rosenmuller - where the adenoid tonsil is located
Name the lines from top to bottom of pic
Middle conchae Adenoid tonsil Oral cavity Palatine tonsil Genioglossus muscle (extrinsic tongue muscle)
What is the surface of tonsils covered by and what do the invaginations of this cause?
Covered by stratified squamous epithelium and the invagination of this epithelium causes crypts to form
WHat is this on histology?
Tonsil - can se the invaginating stratified epithelium forming crypts
What separates the tonsil from the underlying muscle?
A dense collagenous hemi-capsule
How does the surface of adenoids differ from that of tonsils?
Surface of adenoid is covered in ciliated pseudostratified columnar epithelium
Adenoids have folds and few crypts (tonsils have 10-30 crypts)
In the adenoids deep to the surface epithelium of ciliated pseudostratified, what type of epithelium exists?
Stratified squamous epithelium followed by transitional epithelium
The majority of acute tonsilitis is due to viral disease Name some viruses? Can also occur due to bacterial disease, name 2 bacterial causes?
Viruses
EBV, rhinovirus, influenza
Bacterial causes -
strep pyogenes or H.influenza
What is the complication of tonsilitis that can cause a pus filled pocket beside your tonsils?
Peritonsilar abscess - refer to ENT for drainage
What are potential differential diagnoses of tonsilitis?
Infectious mononucleos
Candida infection
URTI
viral infection
How long do symptoms of viral tonsilits last?
They last 3-4 days
Bacterial lasts around a week and requires antibiotics to settle
What is the CENTOR score criteria for differentiating bacterial causes from viral? (used in tonsilits - most likely bacterial pathogen is streptococcus pyogenes)
C- cough absence
E - tonsilar Exudate
N - tender anterior cervical lymph Nodes
T - Temperature (fever)
What has been added to the modified centor score for grading?
If the person is below 15 years of age add 1 point
If the person is above 44 years of age minus 1 point
What is the treatment of bacterial acute tonsilitis? (1st line and 2nd line if allergic)
Penicillin
If pen allergic Claithromycin (erythromycin if pregnant
When is tonsillectomy recommended in adults?
For recurrent severe sore throats
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?
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
How long can pain worsen for after a tonsillectomy operation?
Can last upto 6 days after
The worst day after a tonsillectomy is roughly day 5 (pain) What are cmplications of tonsillecotmy?
Pain Haemorrhage Infection
A complication of acute tonsilits is a peritonsillar abscess What is the classic history triad of somebody presenting with peritonsilar abscess?
Unilateral throat pain and odynophagia
Trismus - lockjaw
3-7 days after acute tonsilitis
