tonsillitis/ pharyngitis (URTI)

Question 1

what are 2 causative organisms of tonsilitis?

Answer 1

Epstein-Barr virus (commonly caused by a viral infection)

Group A Streptococci (Streptococcus pyogenes)

Question 2

what are investigations?

Answer 2

Throat swab

Gram Stain and cultures

Nasal swab

FBC (↑WCC, ↑CRP)

Question 3

what are 3 treatments?

Answer 3

Rest

Paracetamol

Aspirin

Question 4

list the presentations of tonsilitis:

Answer 4

Centor Symptoms (more likely to be Bacterial if >3 symptoms):
Fever over 38ºC
Tonsillar exudates
Absence of cough
Tender anterior cervical lymph nodes (lymphadenopathy)

Non-Centor Symptoms:
Hoarse voice
Pain on swallowing
Cough

Question 5

list the signs of tonsilitis on examination:

Answer 5

Red, inflamed, and enlarged tonsils

With or without exudates (small white patches of pus on the tonsils)

Anterior cervical lymphadenopathy

Question 6

what is the treatment?

Answer 6

Supportive with hydration and analgesia (as it is commonly viral)

If Centor Criteria is 4 or sometimes 3 and systemically unwell (50% Bacterial source)
-> Penicillin V (phenoxymethylpenicillin) for a 10-day course

:If penicillin allergic: Clarithromycin

Question 7

why do you not give amoxicillin if tonsilitis is caused by epstein barr virus?

Answer 7

can cause a maculopapular rash

Question 8

what is peritonsillar abscess/ quinsy?

Answer 8

it is an emergency complication of Tonsillitis that presents as unilateral swelling of the soft palate