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ENT > Throat Disease > Flashcards

Throat Disease Flashcards

1
Q

What is the function of the tonsils and adenoids?

A

trap bacteria and viruses on inhalation - expose to immune system - antibodies produced by the immune cells in the tissue - help to prime immune system and help prevent subsequent infections

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2
Q

What is the histology of the luminal surface of the tonsils?

A

stratified squamous epithelium which deeply invaginates into the tonsil causing crypts

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3
Q

What separates the base of the tonsils from the underling muscle?

A

dense collagenous hemi-capsule

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4
Q

What does parenchyma mean?

A

functional tissue of an organ

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5
Q

What is the histology of the parenchyma of the tonsils?

A

numerous lymphoid follicles dispersed just beneath the epithelium of the crypts

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6
Q

What is histology of the luminal surface of the adenoids?

A

ciliated pseudostratified columnar epithelium - mucocillary clearance
deep folds and few crypts

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7
Q

What is deep to the luminal surface of the adenoids?

A

stratified squamous layer and a transitional layer

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8
Q

What layer of the adenoids is responsible for antigen processing?

A

transitional layer

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9
Q

What layer of the adenoids is thickened by chronic infection?

A

stratified squamous layer

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10
Q

What is the result of the luminal surface of the adenoids being thinned by chronic infection?

A

stasis of secretions

increased exposure of tissue to antigenic stimuli

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11
Q

What causes acute tonsillitis (adenotonsilitis)?

A

majority viral - EBV, rhinovirus, influenza, parainfluenza, enterovirus, adenovirus
5-30% bacterial - Strep. pyogenes, H. influenza, S. aureus, Strep. pneumonia - 40% are beta-lactamase producing

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12
Q

What are the clinical features of viral acute tonsillitis/adenotonsilitis?

A 
malaise 
sore throat
temperature 
able to undertake near normal activity 
possible lymphadenopathy 
lasts 3-4 days
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13
Q

What are the clinical features of bacterial acute tonsillitis/adenotonsillitis?

A 
systemic upset 
fever 
odynophagia 
halitosis 
unable to go to work or school 
lymphadenopathy 
lasts one week
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14
Q

What is the centor criteria used for?

A

differentiating bacterial from viral acute tonsillitis/adenotonsilitis

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15
Q

What are the centor criteria?

A

history of fever
tonsillar exudates
tender anterior cervical lymphadenopathy
absence of cough

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16
Q

What is the management for 0 points on the centor criteria?

A

no antibiotic

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17
Q

What is the management for 2 points in the centor criteria?

A

should receive an antibiotic if symptoms progress

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18
Q

What is the management for 3-4 points on the centor criteria?

A

treat empirically with an antibiotic

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19
Q

What is the supportive treatment for acute tonsillitis/adenotonsillits?

A

eat
drink
rest
analgesia

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20
Q

What antibiotic is given in acute tonsillitis/adenotnsilitis?

A

pencillin or clarithromycin/erythromycin if penicllin allergic

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21
Q

What antibiotics should be avoided in acute tonsillitis/adenotonsilitis and glandular fever and why?

A

amoxicillin and ampicillin

diagnostic generalised macular rash

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22
Q

What is the treatment for adenotonsillits/acute tonsillitis in hospital?

A

IV fluids
IV antibiotics - benzylpenicillin or clarithromycin if penicllin allergic
steroids

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23
Q

What criteria are required for a tonsillectomy?

A

recurrent sore throat is due to tonsillitis
episodes are debilitating and prevent normal functioning
at least 7 well documented, clinically treated sore throats in the preceding year OR at least 5 in the previous 2 years OR at least 3 in the preceding 3 years

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24
Q

What are the complications of a tonsillectomy?

A

primary haemorrhage - <24hrs - return to theatre - commonly due to inadequate haemostasis
secondary haemorrhage - >24hrs but commonly 5-10 days - ENT emergency - most commonly due to infection - admit for IV antibiotics

25
Q

What is a peritonsillar abscess?

A

complication of acute tonsillitis

bacteria between muscle and tonsil produce pus

26
Q

What is the classical history of a peritonsillar abscess?

A

unilateral throat pain and odynophagia
trismus
3-7 days of preceding acute tonsillitis
reduced neck mobility

27
Q

What is halitosis?

A

bad breath

28
Q

What is trismus?

A

lock jaw - reduced opening of jaws

29
Q

What are the signs of a peritonsillar abscess?

A

medial displacement of the tonsil
uvula concavity of the palate lost
deviation of uvula to affected side

30
Q

What is the treatment of a peritonsillar abscess?

A

aspiration
antibiotics - penicllin (clindamycin if penicllin allergic) - if not resolving in 48hrs consider metronidazole (not if on clindamycin as it provides anaerobic cover)
tonsillectomy considered in 6 weeks

31
Q

What causes glandular fever/infectious mononucleosis (mono)?

A

EBV

32
Q

What are the signs of glandular fever/infectious mononucleosis?

A 
gross tonsillar enlargement with membranous exudate 
marked cervical lymphadenopathy 
palatal petechial haemorrhages 
generalised lymphadenopathy 
hepatosplenomegaly 
rash 
jaundice
33
Q

How is glandular fever/infectious mononucleosis diagnosed?

A

atypical lymphocytes in peripheral blood
+ve monospot or Paul-Bunnell test
low CRP - <100
LFTs

34
Q

What is the management of glandular fever/infectious mononucleosis?

A

symptomatic treatment
antibiotics
steroids

35
Q

What are the symptoms of chronic tonsillitis?

A

chronic sore throat

halitosis

36
Q

What are the signs of chronic tonsillitis?

A

presence of tonsiliths

persistent tender cervical lymphadenopathy

37
Q

What are tonsilliths?

A

tonsil stones

38
Q

What are the clinical features of obstructive adenoid hyperplasia?

A 
obligate mouth breathing 
hyponasal voice 
snoring and other signs of sleep disturbance 
acute otitis media 
glue ear
39
Q

What are the clinical features of obstructive tonsil hyperplasia?

A

snoring and other symptoms of sleep disturbance
muffled voice
possible dysphagia

40
Q

What are the non-neoplastic causes of unilateral tonsillar enlargement?

A

acute infective
chronic infective (e.g. TB)
hypertrophy
congenital

41
Q

What are the neoplastic causes of unilateral tonsillar enlargement?

A

benign papillomas
lymphoma
SCC

42
Q

What is the management of true unilateral tonsillar enlargement?

A

biopsy to exclude malignancy

43
Q

What is apparent unilateral tonsillar enlargement?

A

tonsil sits in more medial position

44
Q

What are the causes of apparent unilateral tonsillar enlargement?

A

displacement medially by peritonsillar abscess or parapharyngeal space mass

45
Q

What should be suspected if a sore throat and lethargy persist into the second week, especially if the person is 15-25 years old?

A

infectious mononucleosis

46
Q

What are the characteristics of Strep. pyogenes?

A

gram positive cocci chains

beta-haemolysis

47
Q

What are the late complications of tonsillitis caused by Strep. pyogenes?

A

rheumatic fever - 3 weeks post sore throat - fever, arthritis, pancarditis
glomerulonephritis - 1-3 weeks post sore throat - haematuria, albuminuria, oedema

48
Q

What is pancarditis?

A

inflammation of the entire heart - the epicardium, myocardium and endocardium

49
Q

What are the complications of glandular fever/infective mononucleosis?

A 
anaemia 
thrombocytopenia 
splenic rupture 
upper airway obstruction 
increased risk of lymphoma especially in the immunosuppressed
50
Q

What is thrombocytopenia?

A

abnormally low levels of platelets in the blood

51
Q

What is the aetiology of laryngeal polyps/nodules?

A

reactive change in laryngeal mucosa secondary to vocal abuse, infection or smoking
occasionally seen in hypothyroidism

52
Q

Where are laryngeal nodules located?

A

bilateral on middle to posterior 1/3rd of vocal cord

53
Q

What is the typical patient with laryngeal nodules?

A

young woman

54
Q

What is the gross appearance of a laryngeal polyp?

A

unilateral and pedunculated

55
Q

What does pedunculated mean?

A

elongated stalk of tissue

56
Q

What is a contact ulcer?

A

benign response to injury commonly located on the posterior vocal cord

57
Q

What is the aetiology of a contact ulcer?

A

chronic throat clearing
voice abuse
GORD
intubation

58
Q

What are the complications of tonsillitis?

A

otitis media

quinsy/peritonsillar abscess rheumatic fever and glomerulonephritis very rarely

ENT (21 decks)

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