9: Tonsils

Question 1

go back over the 1st half of this

Question 2

What are the symptoms and duration of viral tonsilitis?

Answer 2

Malaisae

Sore throat

Mild fever

Lymphadenopathy

Lasts 3-4 days

Question 3

What are the symptoms and duration of bacterial tonsilitis?

Answer 3

Much more severe:

Systemic upset

Fever

Odynophagia

Halitosis

Lymphadenopathy

Reduced capability to do daily activities

+ 1 week

Question 4

Which criteria are used to decide if a sore throat requires antibiotics?

Answer 4

Centor criteria

Question 5

Which infection is indicated by 4 or 5 Centor points?

Answer 5

GAS infection

Question 6

What does tonsilitis look like?

Answer 6

Inflamed throat

Enlarged tonsils

Exudate

Question 7

What is the supportive treatment for tonsilitis?

Answer 7

Fluids

Rest

Analgesia

Question 8

What antibiotics are given for severe tonsilitis?

For how long?

Answer 8

Penicillin / Clarithromycin

10 days

Question 9

If tonsilitis is to be managed in hospital, what treatments are given?

Answer 9

IV fluids

IV antibiotics

IV steroids

Question 10

If tonsilitis is persistent and recurrent, what is done?

Answer 10

Tonsilectomy

Question 11

What are the durations of tonsilitis required for tonsilectomy?

Why is this so strictly follow?

Answer 11

7 episodes in one year

5 episodes a year for 2 years

3 episodes a year for 3 years

Surgery is incredibly painful

Question 12

What analgesia is required following tonsillectomy?

Answer 12

Strong opioids e.g morphine

Question 13

What is a local complication of untreated acute tonsilitis?

Answer 13

Peritonsilar abscess / Quinsy

Question 14

What is a peritonsilar abscess?

Answer 14

Stretching of tonsil by pus produced by bacteria

Question 15

What are the symptoms of peritonsillar abscess?

Answer 15

UNILATERAL throat pain, odynophagia

Trismus (lockjaw)

Question 16

What does a peritonsilar abscess look like?

Answer 16

Swelling over tonsil

Uvula deviates away from abscess

Question 17

How is a peritonsilar abscess treated?

Answer 17

Aspiration

Antibiotics

Question 18

Which disease, caused by EBV, produces a severe tonsilitis, lymphadenopathy and hepatosplenomegaly?

Answer 18

Infectious mononucleosis

Question 19

How is glandular fever diagnosed?

Answer 19

Atypical lymphocytes on blood film

Positive antibody test (Monospot or Paul-Bunnell)

Question 20

How is glandular fever treated?

Answer 20

Supportive

NO AMOXICILLIN (amoxicillin causes rash with EBV) - penicillin and steroids PRN

Question 21

Which antibiotic should not be given to someone with tonsilitis?

Answer 21

Amoxicillin

may produce a macular rash

Question 22

What pathology of the tonsils may cause stertor or sleep apnoea?

Answer 22

Hyperplasia of palatine tonsils

Question 23

What pathology of the tonsils may cause otitis media or a hyponasal voice?

Answer 23

Hyperplasia of adenoid tonsils

Question 24

What should your suspicion be if a patient has unilateral tonsilar enlargement?

Answer 24

Neoplasia

Question 25

What is the difference between **acute otitis media** and **glue ear**?

Answer 25

**OME** caused by **fluid buildup** e.g blockage of Eustachian tube Both involve acute inflammation of **middle ear**

Question 26

In which variant of otitis media is **pain, fever** and **irritability** seen?

Answer 26

**Acute otitis media** NOT a feature with effusion

Question 27

What group is **glue ear** common in?

Answer 27

**Children**

Question 28

**(Boys / girls)** are more likely to develop glue ear.

Answer 28

**Boys**

Question 29

What is thought to cause glue ear?

Answer 29

**Eustachian tube blockage**

Question 30

How does **glue ear** present in children?

Answer 30

**Hearing loss** but they won't tell you that **No earache** because that's not seen in OME **Misbehaviour** **School performance is poor** **SPEECH AND LANGUAGE DEVELOPMENTAL DELAY**

Question 31

How is glue ear investigated?

Answer 31

**Ear examination** - bulging TM, possibly rupture ## Footnote **Tuning fork tests** **Audiogram**

Question 32

What kind of hearing loss does glue ear cause?

Answer 32

**Conductive**

Question 33

When should you refer a patient with glue ear?

Answer 33

**Persistent symptoms for 3 months**

Question 34

What is the treatment for **severe bilateral glue ear**?

Answer 34

**Grommets**

Question 35

What may be done in addition to inserting grommets in patients with severe bilateral glue ear?

Answer 35

**Removal of adenoids** to unblock Eustachian tube

Question 36

Is there any evidence that children with developmental delay due to OME **catch** **up** once grommets have been inserted?

Answer 36

**No**

Question 37

What are some complications of grommets?

Answer 37

**Need reinserted** **Infection** **Perforation** **Problems bathing / swimming**

Question 38

tm retrudes because outer pressure \> inner pressure, due to eustachian tube blockage, pushing it in