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ENT > 2.5: Adenotonsillar Disease > Flashcards

2.5: Adenotonsillar Disease Flashcards

1
Q

Function of the adenoids and tonsils?

A

Trap inhaled bacteria and viruses They present these to immune system to allow antibody production This primes immune system and prevents subsequent infection

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2
Q

What is Waldeyer’s Ring?

A

A ring of lymphoid tissue in the oropharynx and nasopharynx Contains: - Tonsils (Palatine Tonsil) - Adenoids (Pharyngeal Tonsil) - Lingual Tonsil

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3
Q

Describe the histology of the tonsils?

A

Stratified Squamous Epithelium (part of the digestive) Deep crypts (also lined with squamous) Lined with lymphoid follicules (immune tissue)

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4
Q

Describe the histology of the adenoids?

A

Ciliated columnar epithelium (respiratory) They have FOLDS that are squamous epithelium

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5
Q

Differences between tonsils and adenoids - Epithelium - Structures - What system are they part of?

A

Tonsils: Stratified Squamous Adenoids: Ciliated Columnar Tonsils: Crypts Adenoids: Folds Tonsils: Digestive Adenoids: Respiratory

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6
Q

Common disease of the tonsils and adenoids?

A

Acute Tonsillitis Recurrent/Chronic Tonsillitis/Adenoidtis Obstructive Hyperplasia Malignancy Tonsil Crypt Debris/Tonsilithis

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7
Q

Describe acute tonsillitis? - Another name - Cause?

A

Adenotonsillitis - VIral (95%) - Bacterial (5%)

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8
Q

Viral causes of tonsillitis?

A

Adenovirus Rhinovirus Influenza Parainfluenza Enterovirus EBV (less common but important)

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9
Q

Bacterial causes of tonsillitis - Main and others

A

Group A Beta Haemolytic Strep Staph Aureus Strep pyogenes

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10
Q

Throat swab in Tonsillitis?

A

Not helpful Doesn’t show causative organism, just organisms present in mouth

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11
Q

Symptoms of viral tonsillitis?

A

Malaise Sore throat temperature Can undertake normal activity Some lymphadenopathy

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12
Q

Symptoms of bacterial tonsillitis?

A

Systemic upset Worse than viral Fever Odynophagia Halitosis (Bad breathe) Unable to carry out normal activity Lymphaednopathy

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13
Q

Differences between viral and bacterial tonsillitis?

A

Fever (Higher in bacteria) Tonsillar Exudates Tender Cervical Adenopathy No cough

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14
Q

Treatment for - Viral - Bacterial tonsillitis?

A

No treatment - supportive, mild analgesia Bacterial - Assess using Centor Criteria for antibiotics

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15
Q

Centor Criteria?

A

44 years = -1 - Fever - Tonsil Exudates - Lymphadenopathy - No cough One point for each of these 0-1 = No antibiotic 2-3= Culture and possible antibiotic 4-5 = Antibiotic

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16
Q

What antibiotic is used in bacterial tonsillitis?

A

Penicillin (Clarithromycin if allergic)

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17
Q

Surgery in tonsillitis?

A

Watchful waiting is indicated in children Surgery in adults with: - Recurrent and debilitating - 7 cases in one year - 5 cases every year for 2 years - 3 Cases every year for 3 years

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18
Q

Describe recovery from surgery?

A

Takes lots of rest Worst day is day 5 Requires strong opiates

19
Q

What is peritonsillar abscess?

A

Complication of acute tonsillitis Bacterial between tonsil and muscle producing pus Also called Quincy

20
Q

Classic history of peritonsillar abscess?

A

Bilateral throat pain and odynophagia for a few days One side suddenly gets much worse

21
Q

Treatment of Peritonsillar Abscess?

A

Aspiration (Referred to ENT) Antibiotics (This provides immediate relief)

22
Q

What is infective mononucleosis?

A

Glandular Fever/Mono Infectious viral disease Caused by EBV

23
Q

Classic case of glandular fever/mono?

A

Freshers week Sore throat Swollen lymph nodes Feeling under the weather

24
Q

Signs of glandular fever/mono?

A

Tonsillar enlargement and exudate ‘Cheese on toast appearance’ Lymphadenopathy Swollen palate Haemorrhagic uvula Fatigue

25
Q

Diagnosis of glandular fever/mono?

A

Clotted blood for EBV IgM Monospot

26
Q

Treatment for glandular fever/mono? Antibiotics?

A

Supportive Amoxicillin –> RASH

27
Q

Why do you not give amoxicillin in Tonsillitis?

A

Could be glandular fever This would cause a rash Give penicillin

28
Q

Complications of strep throat?

A

Glomerulonephritis Rheumatic Fever

29
Q

Patient with glandular fever is on antibiotics but immune system is really failing - what can you give?

A

Short course of steroids for boost

30
Q

What is Chronic Tonsillitis? - What is causing this? - What makes this worse?

A

This is chronic sore throat, chronic bad breath, chronic tonsilliths Normal squamous epithelium being shredded, caught in crypts Cotton buds poking at the tonsils causes the lining to enclose this debris - increases bad breath

31
Q

Describe obstructive hyperplasia of the adenoids? - THINK EILIDH

A

Causes obligate mouth breathers Can occur when you have a cold Snoring sounds/sleep disturbance

32
Q

Describe obstructive hyperplasia of tonsils? - Dysphagia

A

Snoring sounds Sleep disturbance Muffled voice Unlikely to cause dysphagia

33
Q

What is the difference between true enlargement and apparent enlargement?

A

True enlargement = Got bigger apparent = Just look bigger, probably due to the way they’re sitting

34
Q

What is glue ear also caused?

A

Otitis Media with Effusion (OME)

35
Q

What is glue ear?

A

This is a build up of fluid in the inner ear (behind the ear drum) in the absence of infection

36
Q

What is acute otitis media?

A

This is accumulation of pus and inflammation of the middle ear caused by infection

37
Q

Describe hearing loss in AOM and OME?

A

Acute = No hearing loss Effusion = Hearing loss

38
Q

Describe fluid in AOM and OME?

A

Acute = No fluid Effusion = Fluid

39
Q

Look at this picture

A

x

40
Q

Who gets OME?

A

Children

41
Q

Diagnosis of OME?

A

Otoscopy Tuning forks test Audiometry

42
Q

Signs of OME?

A

Retraction of TM Loss of mobility of TM

43
Q

Treatment?

A

Watchful Waiting Grommets

ENT (17 decks)

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