Throat Disease

Question 1

What is the function of the tonsils and adenoids?

Answer 1

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

Question 2

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

Answer 2

stratified squamous epithelium which deeply invaginates into the tonsil causing crypts

Question 3

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

Answer 3

dense collagenous hemi-capsule

Question 4

What does parenchyma mean?

Answer 4

functional tissue of an organ

Question 5

What is the histology of the parenchyma of the tonsils?

Answer 5

numerous lymphoid follicles dispersed just beneath the epithelium of the crypts

Question 6

What is histology of the luminal surface of the adenoids?

Answer 6

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

Question 7

What is deep to the luminal surface of the adenoids?

Answer 7

stratified squamous layer and a transitional layer

Question 8

What layer of the adenoids is responsible for antigen processing?

Answer 8

transitional layer

Question 9

What layer of the adenoids is thickened by chronic infection?

Answer 9

stratified squamous layer

Question 10

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

Answer 10

stasis of secretions

increased exposure of tissue to antigenic stimuli

Question 11

What causes acute tonsillitis (adenotonsilitis)?

Answer 11

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

Question 12

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

Answer 12

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

Question 13

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

Answer 13

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

Question 14

What is the centor criteria used for?

Answer 14

differentiating bacterial from viral acute tonsillitis/adenotonsilitis

Question 15

What are the centor criteria?

Answer 15

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

Question 16

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

Answer 16

no antibiotic

Question 17

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

Answer 17

should receive an antibiotic if symptoms progress

Question 18

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

Answer 18

treat empirically with an antibiotic

Question 19

What is the supportive treatment for acute tonsillitis/adenotonsillits?

Answer 19

eat
drink
rest
analgesia

Question 20

What antibiotic is given in acute tonsillitis/adenotnsilitis?

Answer 20

pencillin or clarithromycin/erythromycin if penicllin allergic

Question 21

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

Answer 21

amoxicillin and ampicillin

diagnostic generalised macular rash

Question 22

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

Answer 22

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

Question 23

What criteria are required for a tonsillectomy?

Answer 23

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

Question 24

What are the complications of a tonsillectomy?

Answer 24

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

Question 25

What is a peritonsillar abscess?

Answer 25

complication of acute tonsillitis | bacteria between muscle and tonsil produce pus

Question 26

What is the classical history of a peritonsillar abscess?

Answer 26

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

Question 27

What is halitosis?

Answer 27

bad breath

Question 28

What is trismus?

Answer 28

lock jaw - reduced opening of jaws

Question 29

What are the signs of a peritonsillar abscess?

Answer 29

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

Question 30

What is the treatment of a peritonsillar abscess?

Answer 30

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

Question 31

What causes glandular fever/infectious mononucleosis (mono)?

Answer 31

EBV

Question 32

What are the signs of glandular fever/infectious mononucleosis?

Answer 32

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

Question 33

How is glandular fever/infectious mononucleosis diagnosed?

Answer 33

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

Question 34

What is the management of glandular fever/infectious mononucleosis?

Answer 34

symptomatic treatment antibiotics steroids

Question 35

What are the symptoms of chronic tonsillitis?

Answer 35

chronic sore throat | halitosis

Question 36

What are the signs of chronic tonsillitis?

Answer 36

presence of tonsiliths | persistent tender cervical lymphadenopathy

Question 37

What are tonsilliths?

Answer 37

tonsil stones

Question 38

What are the clinical features of obstructive adenoid hyperplasia?

Answer 38

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

Question 39

What are the clinical features of obstructive tonsil hyperplasia?

Answer 39

snoring and other symptoms of sleep disturbance muffled voice possible dysphagia

Question 40

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

Answer 40

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

Question 41

What are the neoplastic causes of unilateral tonsillar enlargement?

Answer 41

benign papillomas lymphoma SCC

Question 42

What is the management of true unilateral tonsillar enlargement?

Answer 42

biopsy to exclude malignancy

Question 43

What is apparent unilateral tonsillar enlargement?

Answer 43

tonsil sits in more medial position

Question 44

What are the causes of apparent unilateral tonsillar enlargement?

Answer 44

displacement medially by peritonsillar abscess or parapharyngeal space mass

Question 45

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

Answer 45

infectious mononucleosis

Question 46

What are the characteristics of Strep. pyogenes?

Answer 46

gram positive cocci chains | beta-haemolysis

Question 47

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

Answer 47

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

Question 48

What is pancarditis?

Answer 48

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

Question 49

What are the complications of glandular fever/infective mononucleosis?

Answer 49

``` anaemia thrombocytopenia splenic rupture upper airway obstruction increased risk of lymphoma especially in the immunosuppressed ```

Question 50

What is thrombocytopenia?

Answer 50

abnormally low levels of platelets in the blood

Question 51

What is the aetiology of laryngeal polyps/nodules?

Answer 51

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

Question 52

Where are laryngeal nodules located?

Answer 52

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

Question 53

What is the typical patient with laryngeal nodules?

Answer 53

young woman

Question 54

What is the gross appearance of a laryngeal polyp?

Answer 54

unilateral and pedunculated

Question 55

What does pedunculated mean?

Answer 55

elongated stalk of tissue

Question 56

What is a contact ulcer?

Answer 56

benign response to injury commonly located on the posterior vocal cord

Question 57

What is the aetiology of a contact ulcer?

Answer 57

chronic throat clearing voice abuse GORD intubation

Question 58

What are the complications of tonsillitis?

Answer 58

otitis media | quinsy/peritonsillar abscess rheumatic fever and glomerulonephritis very rarely