Tonsilitis

Question 1

Etiology

Answer 1

1. GA strep

2. S pneumoniae, S aureua, H influenza, M cattarrhalis

Question 2

Symptoms

Answer 2

1. Sore throat
2. Dyphagia
3. Trismus (lock jaw)
4. Malaise, fever
5. Otalgia

Question 3

Signs

Answer 3

1. Tender cervical lymphadenopathy
2. Enlarged tonsils
3. Exudate
4. Look for scarlet rash
5. Look for mucosal petechiae (IM)

Question 4

Investigations

Answer 4

1. FBC
2. NPA
3. Monospot test, although less reliable in children

Question 5

Management

Answer 5

1. Soft diet, fluids
2. Warm saline gargle
3. Simple analgesia
4. May need lignocaine gel
5. Consideration for antibiotics

Question 6

Antibiotics in which groups

Answer 6

1. High risk of non-suppurative
2. 2-25 w/ sore throat in high incidence for RF area
3. Any age with RHD
4. Scarlet fever

Question 7

Antibiotic of choice

Answer 7

1. Phenoxymethylmenicillin 500mg PO BD for 10 days

2. Non-compliant, nil oral->benzyl penicilline IM as single dose

Question 8

Management of quinsy

Answer 8

• secure airway
• surgical drainage (incision or needle aspiration) with C&S
• warm saline irrigation
• IV penicillin G x 10 d if cultures positive for GAS
• add PO/IV metronidazole or clindamycin x 10 d if culture positive for Bacteroides
• consider tonsillectomy after second episode

Question 9

What is quinsy

Answer 9

Cellulitis of space behind tonsillar capsule extending into soft palate

Question 10

Triad of quinsy

Answer 10

1. Trismus
2. Uvular deviation
3. Dysphonia (hot potato voice)