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ENT > Adenotonsillar Disease > Flashcards

Adenotonsillar Disease Flashcards

1
Q

What are the main functions of the tonsils?

A

Trap bacteria and viruses on inhalation
Expose to immune system
Antibodiesproduced by the immune cells in the tissue
Help to prime immune system and help to prevent subsequent infections.

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2
Q

What is the Waldeyer’s Ring?

A

Ring of lymphoid aggregation in the subepithelial layer of oropharynx and nasopharynx

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3
Q

What structures is the Waldeyer’s ring composed of?

A

Tonsils (palatine tonsil)
Adenoids (pharyngeal tonsil)
Lingual Tonsil

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4
Q

What two muscles form the fossa where the tonsils lye?

A

palatoglossus and palatopharyngeus

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5
Q

What is the luminal layer of the palatine tonsils?

A

Stratified squamous epithelium

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6
Q

What is the luminal layer of the adenoid tonsils?

A

Ciliated pseudostratified columnar epithelium

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7
Q

Epithelium of Upper aerodigestive?

A

Ciliated columnar respiratory type mucosa

Squamous epithelium

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8
Q

Epithelium where food goes/ high use / trauma?

A

Squamous

Oral, pharyngeal, vocal cords, oesophagus

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9
Q

Epithelium where air goes?

A

Columnar

Nose, PNS, Larynx, Trachea

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10
Q

Viral causes of acute tonsillitis?

A 
EBV (not most common but most significant) 
Rhinovirus,
Influenza
Parainfluenza
Enterovirus
Adenovirus
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11
Q

What is the most common bacterial cause of acute tonsillitis?

A

GABHS - Streptococcus pyogens

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12
Q

What are the 4 most common causes of bacterial tonsillitis?

A

Streptococcus pyogenes (Group A beta-hemolytic streptococcus)
H.influenza
S. aureus
Streptococcus pneumonia

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13
Q

What percentage of bacterial tonsillitis is beta-lactamase-producing ?

A

39%

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14
Q

What are the symptoms of bacterial tonsillitis?

A 
Systemic upset,
Fever
Odynophagia
Halitosis
Unable to work / school
Lymphadenopathy – particular tonsilar nodes
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15
Q

What are the symptoms of viral tonsillitis?

A 
Malaise
Sore throat, mild analgesia requirement
Temperature
Able to undertake near normal activity
Possible lymphadenopathy
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16
Q

How long does bacterial tonsillitis last?

A

Lasts ~1 week, requires antibiotics to settle.

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17
Q

How long does viral tonsillitis last?

A

Lasts 3-4 days

18
Q

What criteria is used for diagnosing bacterial tonsillitis?

A

Centor criteria

19
Q

Treatment for viral tonsillitis?

A

Supportive: eat, drink, rest, OTC analgesia e.g. paracetamol or NSAIDs

20
Q

Treatment for bacterial tonsillitis?

A

Supportive: Eat & Drink, Rest, OTC analgesia Paracetamol, NSAID

Antibiotic:
Penicillin 500mg qid for 10 days
Clarithromycin if allergic

21
Q

What is the criteria to allow a individual to get their tonsils taken out?

A

Sore throats are due to acute tonsillitis
Episode of sore throat are disabling and prevent normal functioning
Seven or more well documented, clinically significant, adequately treated sore throats in the past two years
OR
Three or more such episodes in each of the preceding three years

22
Q

if someone can to A&E with severe tonsillitis, how would you treat?

A

IV Fluids
IV antibiotics
Steroids

23
Q

What is a pertonsillar abscess (quinsy)?

A

Complication of Acute tonsillitis

Bacteria between muscle and tonsil produce pus

24
Q

What is the classical history for a quinsy?

A

Unilateral throat pain and odynophagia
Trismus
3-7 days of preceding acute tonsillitis

25
Q

What does a quinsy appear to the naked eye anatomically?

A

Medial displacement of tonsil and uvula

Concavity of palate lost

26
Q

What is the treatment for a quinsy?

A

Aspiration and antibiotics

27
Q

What are the classic sings of infectious mononucleosis?

A 
Gross tonsillar enlargement with membranous exudate
Marked cervical lymphadenopathy
Palatal petechial haemorrhages
Generalised lymphadenopathy
Hepatosplenomegaly
28
Q

How does “chronic tonsillitis” present?

A 
Chronic sore throat
Malodorous breath
Tonsillitis 
Pertonsillar erythema 
Persistent tender cervical lymphadenopathy
29
Q

What symptoms suggest that obstructive hyperplasia is being caused by the Adenoids?

A

Obligate mouth breathing
Hyponasal voice
Snoring and other signs of sleep disturbance
AOM / OME

30
Q

What symptoms suggest that obstructive hyperplasia is being caused by the tonsils?

A

Snoring and other symptoms of sleep disturbance
Muffled voice
?Dysphagia

31
Q

What is apparent unilateral tonsillar enlargement?

A

tonsil sits in more medial position, displacement medially by PTA or parapharyngeal space mass not pathological

32
Q

Causes of unilateral tonsillar enlargement?

A

Non-neoplastic:
Acute infective
Chronic infective (tebercular tonsillitis, congenital syphilis)
Hypertrophy
Congenital (teratoma, hemangioma, lymphangioma or cystic hygroma)

Neoplastic:
Benign papillomas
Lymphoma (usually non-Hodgkins B-cell) and squamous cell

33
Q

What is acute otitis media?

A

Inflammation of the middle ear accompanied by the symptoms and signs of acute inflammation with / without an accumulation of fluid

34
Q

What is glue ear/ otitis media with effusion/ serous otitis media?

A

Inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute inflammation

35
Q

What does AOM have the OME doesn’t?

A

Earache
fever
irritability
Opaque TM

36
Q

Who does OME effect?

A

Children between the years 2-8

37
Q

What increases a child’s chance of getting OME?

A 
Day care
Older siblings
Smoking household
Recurrent URTI
Allergy 
Recuurent AOM 
Craniofacial abnormalities 
Genetic abnormalities 
Immunodeficiency
38
Q

What are the 4 signs of OME?

A

TM retraction
Reduced TM mobility
Altered TM colour
Visible ME fluid/bubbles

39
Q

What is the criteria for a child to be referred to ENT for OME?

A

Persistent (> 3/12), bilateral OME
CHL >25dB
Speech/language problems
Developmental behavioral problems

40
Q

What is the surgical management for OME?

A 
3yrs, first intervention
Grommets
> 3yrs, second intervention
Grommets and adenoidectomy
If nasal symptoms, adenoids may be considered earlier
41
Q

What are the complications of grommets?

A 
Infection/discharge
Early extrusion
Retention
Persistent perforation
Swimming/bathing issues

ENT (8 decks)

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