Clinical (5-7) Flashcards by Daniel Part

By what age during gestation are the tonsillar fossa and pillars and palatine tonsils begining to form?

8 weeks

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Where are the tonsillar fossa and palatine tonsils formed from?

Dorsal wing of the 1st pharyngeal pouch and ventral wing of second pouch

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Where are the tonsillar pillars formed from?

2nd and 3rd arches

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At what point in gestation are the tonsillar crypts formed?

3-6 months

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At what gestational age is the tonsillar capsule present?

5 months

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When and from what do the adenoids develop?

During the 16 gestational week

Develop as a subepithelial infiltration of lymphocytes

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What are the main functions of the tonsils and adenoids?

Trap microbes
Expose microbes to immune system
Antibodies produced
Prime immune system

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Under what age is significant adenotonsillar enlargement unusual?

2 years

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What happens to the tonsils and adenoids after the early teenage years?

They decrease in size

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What is the Waldeyer’s ring?

A ring of lymphoid aggregation:

- In subepithelial layer of oro- and nasopharynx

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What is Waldeyer’s ring comprised of?

Tonsils (palatine)
Adenoids (pharyngeal tonsils)
Lingual tonsil

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What are the histological features of the tonsils?

Specialised squamous
Deep crypts
Lymphoid follicles in parenchyma
Separated from underlying muscle:
     - By dense, collagenous hemi-capsule

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What are the histological features of the adenoids?

Ciliated, pseudostratified columnar:
     -> Mucociliary clearance
Deep to that is a stratified squamous layer
Deep to that is a transitional layer:
     - For antigen processing
Deep folds and few crypts

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What are the most common causes of acute tonsillitis?

Viral (EBV, Rhinovirus, Flu, Parainfluenza, Adenovirus)

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What bacterial cause of acute tonsillitis is important due to its potential sequelae?

Group A β-haemolytic Strep

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Is a throat swab recommended in acute tonsillitis?

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What are the most common bacteria that cause tonsillitis?

Strep. pyogenes (GABHS)
Haem. influenzae
Staph. aureus
Strep. pneumoniae

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When should infectious mononucleosis be suspected?

If there is a sore throat and malaise:

- Both persisting with antibiotics

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How long does a viral tonsillitis usually last?

3-4 days

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How long does a bacterial tonsillitis usually last?

~1 week

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What features suggest a bacterial tonsillitis?

Systemic upset
Odynophagia
Halitosis
Unable to work

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What are the Centor criteria?

History of fever -> 1 point
Tonsillar exudates -> 1 point
Tender anterior cervical lymphadenopathy -> 1 point
NO cough -> 1 points

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What treatments are offered at the following Centor criteria scores:

0/1 points
2/3 points
4 points

0/1 -> No antibiotics
2/3 -> Antibitotics if symptoms progress
4 -> Antibiotics

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What is part of the modified Centor criteria?

Age >44 years -> Subtract 1 points

Age Add 1 point

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What is the antibiotics treatment of tonsillitis?

Penicillin 500mg 4 times daily for 10 days | Clarithromycin if allergic

When does SIGN 117 suggest that a tonsillectomy be offered?

>=7 episodes in one year OR >=5 episodes in each of two previous years OR >=3 episodes in each of three previous years

What day is worst post-tonsillectomy?

Day 5

What causes a peritonsillar abscess?

Bacteria between muscle and tonsil -> Pus

What is the classical history of a peritonsillar abscess?

Unilateral throat pain and odynophagia Trismus -> Jaw muscle spasm (?locking) 3-7 days of a preceding tonsillitis

What happens to the tonsil and uvula in quinsy?

Medial displacement

What happens to the concavity of the palate in quinsy?

It is lost

How is a peritonsillar abscess treated?

Aspirate | Antibiotics

What causes glandular fever?

EBV

What are signs and symptoms of glandular fever?

``` Gross tonsillar enlargement + membranous exudate Marked cervical lymphadenopthy Palatal petechial haemorrhages Generalise lymphadenopathy Hepatosplenomegaly ```

How is glandular fever diagnosed?

Atypical lymphocytes in peripherl blood Positive monospot/Paul-Bunnell test Low CRP (

What happens if ampicillin/amoxicillin is given in glandular fever?

Generalised macular rash

What are the following features of: - Obligatory mouth breathing - Hyponasal voice - SNoring - AOM/OME

Obstructive adneoid hyperplasia

What causes apparent tonsillar enlargement?

Tonsil is more medial: | - Quinsy or Pharyngeal mass

What chronic infections can result in unilateral tonsillar enlargement?

Tubercular tonsillitis Actinomycosis Congenital syphillis

What are some congenital causes of unilateral tonsillar enlargement?

Teratoma Haemangioma Lymphangioma Cystic hygroma

What is meant by 'glue ear'?

Middle ear inflammation With fluid accumulation Without signs/symptoms of AOM

What is typically more painful and likely to cause discomfort, OME or AOM?

AOM

What is an opaque tympanic membrane usually seen in?

AOM

What is more likely to cause hearing loss, OME or AOM?

OME

Who is most likely to get OME?

Males (Under age of 4)

What are risk factors for OME?

Daycare Older siblings Smoking household Recurrent URTI

What are signs of OME?

``` TM retraction Reduced TM mobility Altered TM colour Visibile mid-ear fluid/bubbles Conductive hearing loss tuning fork tests ```

When should OME be treated

If persistent for >3 months with: - Deafness - Speech - Balance

When should a patient with OME be referred?

Persistent (>3 months) and bilateral Conductive hearing loss >25 dB Speech and language problems Behavioural problems

What is the surgical management of OME in a patient aged

Grommets

What is the 1st line surgical management of OME in a patient aged >3 years?

Grommets

What is the 2nd line surgical management of OME in a patient aged >3 years?

Grommets and adenoidectomy

What symptoms would suggest that an adenoidectomy should be carried out earlier?

Nasal symptoms

What are the common allergens in intermittent allergic rhinitis?

Grass pollen Tree pollen FUngal spores

What are the common allergens in persistent allergic rhinitis?

House dust mite Cat Dog

What are the ARIA criteria for intermittent allergic rhinitis?

Symptoms

What are the ARIA criteria for persistent allergic rhinitis?

Symtpoms >4 days per week AND Symptoms >4 weeks duration

What are the ARIA criteria for mild allergic rhinitis?

Normal sleep AND No impairment of daily tasks AND Normal work and school AND No troublesome symptoms

What are the ARIA criteria for Moderate-Severe allergic rhinitis?

Abnormal sleep Impairment of daily tasks Missing work/school Troublesome symptoms

What is the step up treatment for allergic rhinitis?

1. Antihistamines 2. Topical steroids 3. Topical steroids and antihistamines

When is immunotherapy recommended in allergic rhinitis?

IgE-Mediated disease

What are nasal polyps associated with?

Non-allergic asthma

How is nasal polyps treated?

Oral then topical steroids

What are facial pain, nasal discharge and nasal blockage symptoms of?

Acute infective rhinosinusitis

What is a complication of acute infective rhinosinusitis?

Orbital cellulitis

What is the usual cause of acute infective rhinosinusitis?

Viral (98%)

How is acute infective rhinosinusitis treated?

Analgesia Decongestants Antibiotics if worsening

How is allergic rhinitis investigated?

Skin prick | RAST (IgE) (Radioallergosorbent Test)

When are blood tests recommended in head and neck cancers?

If lymphoma suspected: - Fatigue - Night sweats - Extensive lymphadenopathy

What is the first line investigation for a head/neck cancer?

USS: - Solid lesion? - Cystic lesion? - FNA at same time

What is used to stage a head/neck cancer?

CT: - TNM - Often spread to LNs - Rarely metastasise

What is also investigated in head and neck cancers and why?

Lungs for primary cancers: | - Most patients are smokers

What are common causes of head and neck cancers? What stain can indentify them?

HPV 16 + 18: | - P16 stain

What cancers does HPV tend to cause in the head and neck?

Tonsillar and posterior tongue

What cancers does EBV tend to cause in the head and neck?

Nasopharyngeal cancers

What are symptoms of nasopharyngeal cancers?

No nasal/throat symptoms Conductive hearing loss: - Eustachian tube blocked - Fluid builds up in middle ear

What cancer does Betel nut cause?

Oral cavity cancer

What cancer does Hardwood cause?

Nasal and paranasal sinus cancers

What symptoms suggest a head and neck cancer?

The following for greater than 3 weeks: - Sore throat - Hoarseness - Stridor - Dysphagia - Neck lump - Unilateral ear pain

What are the majority of head and neck cancers?

Squamous

What are major risk factors for head and neck cancers?

Alcohol | Tobacco

What are features of HPV-associated head and neck cancers?

Younger patients Different presentation Sexual transmission Better prognosis

Clinical (5-7) Flashcards

(82 cards)