Adenotonsillar Disease

Question 1

What viruses cause acute tonsillitis?

Answer 1

rhino, entero, andenoviruses
influenza, parainfluenza
EBV

Question 2

What percentage of acute tonsillitis is bacterial?

Answer 2

5-30%

Question 3

What is the main bacterial cause of acute tonsillitis?

Answer 3

Group A B haemolytic strep - Strep. Pyogenes

Question 4

What are the four Centor criteria?

Answer 4

1 - history of fever
2 - absence of cough
3 - tonsillar exudate
4 - tender anterior cervical lymphadenopathy

Question 5

What is the Centor criteria used for?

Answer 5

Differentiating bacterial and viral tonsillitis

Question 6

What are the Centor scorings?

Answer 6

0-1 no antibiotic risk
2-3 antibiotic if progresses
4-5 antibiotic

age <15 +1 point
age >44 -1 point

Question 7

What is the treatment of acute tonsillitis?

Answer 7

supportive: NSAIDs, paracetamol, fluids, rest

if antibiotic required (Centor score 4-5): penicillin V (clarythromycin if allergic)

Question 8

What are the guidelines for tonsillectomy?

Answer 8

7 or more cases in 1 year
5 or more cases each year in 2 years
3 or more cases each year in 3 years

Question 9

Name a complication of acute tonsillitis?

Answer 9

Peritonsillar abscess

Question 10

What is a peritonsillar abscess?

Answer 10

Bacteria between the muscle and tonsil producing pus

Question 11

What is the clinical presentation of a peritonsillar abscess?

Answer 11

preceding tonsillitis 3-7 days 
unilateral throat pain 
odynophagia 
trismus 
medial displacement of tonsil and uvula

Question 12

What is the treatment of peritonsillar abscess?

Answer 12

aspiration and antibiotics

Question 13

What are the symptoms of viral acute tonsillitis?

Answer 13

3-4 days 
temperature 
sore throat 
malaise 
are able to undertake almost normal activity

Question 14

What are the symptoms of bacterial acute tonsillitis?

Answer 14

More than 7 days 
Lymphadenopathy 
fever 
systemic upset 
odynophagia 
halitosis 
unable to work/ school

Question 15

What is glandular fever?

Answer 15

infectious mononucleosis

Question 16

What virus causes glandular fever?

Answer 16

EBV (Epstein Barr)

Question 17

What are the symptoms of glandular fever?

Answer 17

Flu like symptoms

Malaise, fever, sore throat, enlarged lymph nodes, lethargy

Question 18

What are the signs of glandular fever?

Answer 18

Hepatosplenomegaly
Gross tonsillar enlargement and membranous exudate
Generalised and marked cervical lymphadenopathy
Palatal petechial haemorrhage
Jaundice

Question 19

How do you diagnose glandular fever?

Answer 19

Epstein Barr virus IgM
Blood count and film
Low CRP (<100)
\+ve Monospot or Paul Tunnel test (heterophile Ab)
LFTs

Question 20

What is the management of glandular fever?

Answer 20

Bed rest, avoid sport
Symptomatic treatment
Antibiotics
Steroids (complicated cases)

Question 21

Why can’t you prescribe amoxicillin in glandular fever?

Answer 21

It will cause a diagnostic generalised macular rash

Question 22

What are the symptoms of obstructive hyperplasia of the adenoid/pharyngeal tonsils?

Answer 22

Obligate mouth breathing
hypo nasal voice
Snoring
AOM/OME

Question 23

What are the symptoms of obstructive hyperplasia of the palatine tonsil?

Answer 23

snoring
muffled voice
?dysphagia