Tonsils, adenoids, nose and airway obs

Question 1

how do tonsils help our immunity

Answer 1

trap bacteria on inhalation, contain antibodies, help prime immune system

Question 2

where and what is waldeyer’s ring

Answer 2

ring of lymphoid aggregation in oropharynx and nasopharynx

Question 3

lymph nodes are in waldeyer’s ring and where are they all (3)

Answer 3

palatine tonsils (tonsils at back of throat), naso/pharyngeal tonsils (AKA adenoids), lingual tonsils (back of tongue)

Question 4

histologically what do palatine tonsils look like

Answer 4

specialised squamous, deep crypts, lymphoid follicles, posterior capsule

Question 5

histologically what do adenoid look like

Answer 5

ciliated pseudo-stratified columnar, stratified squamous, deep transitional folds

Question 6

what are the main viral causes of acute tonsillitis

Answer 6

EBV, rhinovirus, influenza, enterovirus

Question 7

acute tonsillitis is rarely bacterial, what are the main bacterial infective organisms

Answer 7

GAS: group A beta haemolytic strep (strep pyogenes) / h influenza / staph A / strep pneumonia

Question 8

what are symptoms of viral tonsillitis

Answer 8

malaise, tired, sore red throat, temperature, possible lymphadenopathy, last 3-4 days and can function more or less ok

Question 9

what are symptoms of bacterial tonsillitis

Answer 9

systemic upset, fever, odynophagia (painful swallow), pain, lymphadenopathy, halitosis (bad breath) , white pus

Question 10

what 2 diagnostic criteria is used to diagnose tonsillitis and what are the subcategories

Answer 10

centor (fever, pus, lymphadenopathy, no cough) + fever PAIN (fever, pus, attend rapidly, inflamed tonsils, no cough

Question 11

how do you manage viral vs bacterial tonsillitis

Answer 11

VIRAL: rest and analgesia
BACTERIAL: pen V 500mg for 10 days

Question 12

what is the criteria for tonsillectomy

Answer 12

7 debilitating episode in 1 year OR 5 in each preceding 2 years (10) OR 5 in each preceding 3 years (9)

Question 13

what is a peritonsillar abscess and what usually causes it

Answer 13

pus between muscle and tonsils, normally complication of acute tonsillitis

Question 14

what are the symptoms of a Peritonsillar abscess

Answer 14

unilateral throat pain and odynophagia, trismus (lockjaw), 3-7 days acute tonsillitis

Question 15

what virus causes glandular fever

Answer 15

epstein-barr virus (EBV)

Question 16

what are symptoms of glandular fever

Answer 16

gross tonsillar enlargement with pus, marked cervical lymphadenopathy, hepatosplenomegaly, extreme malaise and tiredness (if exudate secondary bacterial infection)

Question 17

how do you diagnose glandular fever

Answer 17

atypical lymphocytes, +ive monospot or paul-bunnel, LOW CPR (<100)

Question 18

how do you manage glandular fever

Answer 18

supportive, NO AMPICILLIN/ AMOXICILLIN, steroids/ ab’s if needed

Question 19

what is chronic tonsillitis

Answer 19

chronic sore throat and slightly swollen, red tonsils that can cause halitosis - often not pathological and large size with no symptoms means nothing

Question 20

what symptoms would be seen with adenoid obstructive hyperplasia

Answer 20

mouth breathing, hyponasal voice, snoring and sleep disturbance, acute otitis media +/- effusion

Question 21

what symptoms would be seen with palatine tonsil obstructive hyperplasia

Answer 21

snoring and bad sleeping, muffled voice and dysphagia

Question 22

what cells are involved in type I hypersensitivity

Answer 22

B cells release IgE which causes mast cells to release histamines and leukotrienes

Question 23

what are some primary nasal symptoms

Answer 23

blockage, loss of smell (asomnia), discharge, facial pain

Question 24

what investigations can be done for nasal problems

Answer 24

airway patency, external nose exam, rhinoscopy

Question 25

what types of rhinitis are there

Answer 25

infective: upper viral and resp tract infection / non-infective: allergic AKA hay fever

Question 26

what is the allergic rhinitis pathway

Answer 26

macrophages activate Th0 cells --> Th2 cells --> eosinophils and B cells --> IgE

Question 27

what is classed intermittent allergic rhinitis and what causes it

Answer 27

symptoms < 4 days a week OR < 4 weeks duration - caused by grass/ tree pollen/ fungal spores

Question 28

what is classed persistent allergic rhinitis and what causes it

Answer 28

symptoms > 4 days a weeks AND > 4 weeks duration - caused by house dust mites/ cats dogs

Question 29

what is seen in mild allergic rhinitis vs moderate-severe allergic rhinitis

Answer 29

``` mild = normal sleep and no impairment day to day. moderate-severe = 1 or more: abnormal sleep, impaired day to day and troublesome sleep ```

Question 30

how do you manage allergic rhinitis

Answer 30

avoid triggers, topical antihistamine, topical steroids (beclomethasone), topical anticholinergic (ipratropium)

Question 31

how do you manage severe allergic rhinitis

Answer 31

dual therapy, immunotherapy for IgE disease, surgery for obstruction

Question 32

what is a non-allergic and non infective common cause of rhinitis

Answer 32

nasal polyps (and vasomotor)

Question 33

who commonly gets nasal polyps

Answer 33

common, worry about CF in children, associated with non-allergic asthma - treat with oral/ topical steroids and eventually surgery

Question 34

what are symptoms of acute infective rhinosinusitis

Answer 34

facial pain, discharge, nasal blockage, normally viral

Question 35

how do you manage rhinosinusitis

Answer 35

analgesia, decongestants, deteriorating --> antibiotics

Question 36

what complications can occur with rhinosinustitis

Answer 36

orbital or brain abscess: blindness or thrombosis / secondary bacterial infection: strep pneumonia or H influenza

Question 37

what are some other causes of a stuffy nose (4)

Answer 37

adenoid obstruction, foreign body (unilateral smelly discharge), mucocele (impaired drainage and swelling), maxillary sinal tumour

Question 38

what vasculitis commonly presents with nasal symtpoms

Answer 38

granulomatosis with polyangiitis (GPA) - cANCA +ive and anti-PR3

Question 39

what features of a neonate make them susceptible to airway obstruction (6)

Answer 39

large head, small nasal flares, can only breath through nose, large tongue, weak neck muscles, narrow subglottis

Question 40

how are airflow, resistance and work of breathing related and what is the equation

Answer 40

smaller diameter = increased resistance = increased work of breathing and vice versa // airflow resistance is proportion to 1/r^4

Question 41

what are common causes of airflow resistance

Answer 41

inflamm and infective causes/ allergy, foreign body, physical compression, trauma, neurological, neoplastic, burn, congenital

Question 42

what are symptoms of airflow resistance

Answer 42

SOB on exertion/ rest, stridor (high pitched), stretor (low pitched, snore, nasopharynx), coughing, choking, can't talk, dysphagia, pyrexia and cyanosis

Question 43

how do you manage airflow obstruction

Answer 43

ABCDE, O2, heliox (helium and O2), steroids, adrenaline, flexible endoscopy, secure airway (avoid tracheostomy until you can't)