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ENT > Adenotonsillar disease > Flashcards

Adenotonsillar disease Flashcards

1
Q

What develops at 8 weeks from the first and second pharyngeal pouch

A

tonsillar fossa and palatine tonsil

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2
Q

where do tonsillar pillars originate from

A

2nd/3rd arches

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3
Q

what is th emain function of tonsils

A

trap bacteria and viruses on inhalation, antibodies are produced by immune system, prevent subsequent infectionsa

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4
Q

at what age is adenotonsillar enlargement unusual

A

under 2

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5
Q

what is the waldeyers ring

A

ring of lymphoid aggregation in sub epithelial layer of oropharynx and nasopharynx

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6
Q

what does the waldeyers ring consist of

A

tonsils, adenoids, lingual tonsil

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7
Q

what is the surface of the tonsil covered in

A

specialised stratified squamous epithelium

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8
Q

what is the tonsil and the muscle separated by

A

collagenous hemi-capsule cap

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9
Q

what is the main difference between adenoid and tonsil tissue

A

adenoids: deep folds and few crypts while tonsils have lots of crypts

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10
Q

what is the surface of adenoids covered in

A

pseudo stratified columnar epithelium

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11
Q

does the stratified squamous epithelium thin or thicken with a chronic infection

A

thickens

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12
Q

what type of epithelium lines the upper airway and digestive tract

A

ciliated columnar respiratory type mucosa, squamous mucosa

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13
Q

what type of epithelium lines the oesophagus ect

A

squamous

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14
Q

what type epithelium lines airways

A

columnar

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15
Q

What is acute tonsillitis

A

inflammation of the tonsils

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16
Q

is acute tonsillitis mainly viral or bacterial

A

viral

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17
Q

What is th emost common pathogen that presents with acute tonsillitis

A

H influenzaee or strep pyogenes

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18
Q

In patients with chronic tonsillitis, what organissms are commonly cultured

A

strep pyogenes, h influenza, staph aureus, strep pneumonia

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19
Q

If glandular fever is suspected, what tests should you order

A

Paul- Bunnell, WBC, atypical mononuclear cells

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20
Q

what would a differential list of acute tonsillitis look like

A

URTI viral, infectious mononucleiosis, peritonsillar abscesss, malignancy

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21
Q

what symptoms would you get with viral tonsillitis

A

malaise, sore throat, temperature, lasts 3-4 days, can usually do normal things

22
Q

what symptoms would you get with bacterial tonsillitis

A

systemic upset, fever, odynophagia (pain on eating), halitosis (bad breath) unable to do normal activity, lymphadenopathy, lasts 1 weeks and requires antibiotics to help it settle

23
Q

what is the centor criteria for tonnsillitis

A

fever, tonisllar exudates, teder cervical adenppathy, absence of cough, age

24
Q

If one scores 0 or 1 points in centor criteria do you give antibiotics?

A

nah

25
Q

if a person scores 2-3 points should you consider antibiotcs

A

should receive antibiotcs if symptoms worsen/ progress

26
Q

if a patient presents with 4 or 5 points on centor criteria should you give antibiotocs?

A

treat empircically with antibiotics, yes

27
Q

what is the treatment and management of tonsillitis

A

rest, eat/drink, paracetamol, Penicillin for 10 days or Clarythromycin of allergic`

28
Q

what is the requirement for tonsillectomy

A

7 or more acute tonsillitis in a year

5 or more each year for pasty 2 years

3 or more each year for previous 3 years

29
Q

what is recommended post op treatment wise

A

anti-emetic, paracetamol, 1 dose of dexamethasone (children)

30
Q

peritonsillar abscess is not a complication of acute tonsillitis

A

false, it is a complication

31
Q

how does one get a peritonsillar abscessq

A

bacteria gets trapped between muscle and tonsil to produce pus

32
Q

what are symptoms of an abscess

A

unilateral throat pain and odynophagia, trismus (spasm of jaw), 3-7 day acute tonsillitis previously, displacement of tonsil and uvula

33
Q

what is the treatment for an abscess

A

aspiration and antibiotics- penicillin and metronidazole

34
Q

what virus causes glandular fever

A

EBV

35
Q

what are signs of glandular fever

A

tonsillar enlargement with exudate, cervical lymphadenopathy, palatal haemorrhages, lymphadenopathy general, hepatosplenomegaly, jaundice

36
Q

how doy uo diagnose glandular fever

A

atypical lymphocytes in blood, positive monospot/ paul bunnell test

37
Q

how doy you treat glandular fever

A

usually nothing- avoid vigorous sports and alcohol. Give antibiotics- penicillin and steroids if really bad

38
Q

what antibiotic should you not give in glandular fever and why

A

ampicillin or amoxicillin- macular rash will result

39
Q

What are adenoid and tonsil causes of obstructive hyperplasia

A

adenoid- AOM and OME 9snoring) and tonsil- snoring, muffled voice and dysphagia

40
Q

What is glue ear/ OME (effusion)

A

inflammation of the middle ear with accompaniment of fluid without signs and symptoms of acute inflammation.

41
Q

what is acute OM

A

inflammation of inner ear with signs and symptoms of inflammation/ with/ without fluid

42
Q

is hearing loss present in glue ear?

A

yup

43
Q

who gets OEM

A

children

44
Q

what are symptoms of OME

A

deafness, poor performance at school, behavioural problems, speech delay, balance problems, NOT EARRACHE

45
Q

How do you diagnose glue ear

A

history, otoscopy, tuning fork tests, audiometry, tympanometry

46
Q

what are sings of glue ear?

A

retracted tympanic membrane, reduced tympanic membrane mobility, altered tympanic membrane colour, visible fluid/ bubbles, CHL tuning fork tests

47
Q

how do you treat OME

A

wait and see- more than 3 months with deafness, speech, balance problems, may use auto inflation… but antibiotics ect not useful

48
Q

how would you surgically treat glue ear in 3 yo

A

3yo- grommet and adenoidectomy

49
Q

how would someone present with epiglottis

A

drooling saliva, sore throat, pyrexia, stridor

50
Q

what is th common infection of epiglottis

A

HiB (children now vaccinated against HiB

51
Q

how do you manage acute epiglottitis

A

O2 by mask, nebulized adrenaline and IV dexamethasone, visual diagnosis, culture, cricothyrotomy kit, penicillin, ceftriaxone

ENT (16 decks)

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