ENT

Question 1

Describe acute bacterial tonsillitis

Answer 1

Primarily caused by Streptococcus pyogenes (Group A Streptococcus, GAS),

Infection of palatine tonsils, often following viral pharyngitis, with bacterial superinfection leading to inflammation, exudates, and systemic features.

Question 2

what are clinical features of acute bacterial tonsillitis?

Answer 2

sore throat, fever >38C, dsyphagia, tender anterior cervical lymphadenopathy.

tonsillar erythema/enlargement/purulent exudates.

Question 3

list 3 local complications of bacterial tonsillitis?

Answer 3

• retropharyngeal abscess
• peritonisllar abscess (quinsy)
• mastoiditis

Question 4

list 3 systemic complications of bacterial tonsillitis?

Answer 4

• bacteraemia/sepsis
• meningitis/cerebral abscess
• mediatinitis
• rheumatic fever

Question 5

what pathogen is most likely for bacterial tonsillitis and treatment

Answer 5

GAS: phenoxymethylpenicillin 500mg bd for adults for 10 days.
analgesia, hydration, rest.

Question 6

what examination features present with quinsy (peritonsillar abscess)?

Answer 6

• unilateral tonsillar swelling
• uvula deviation to the contralateral side
• trismus (jaw stiffness due to pterygoid irritation)
• tender cervical lymphadenopathy. Drooling or respiratory distress signals advanced disease or airway risk.

Question 7

what does this CT show

Answer 7

widening of retropharyngeal space with air pockets, most likely retropharyngeal abscess

Question 8

what is the classic presentation for quinsy? (peritonisillar abscess)

Answer 8

severe unilateral sore throat, fever, dysphagia, and “hot potato” voice (muffled speech).

Question 9

what is the treatment for quinsy?

Answer 9

• Airway: Asses/ secure if compromised, steroids (dexamethasone 8 mg IV)
• Drainage: Definitive treatment via needle aspiration (avoid carotid artery injury)
  Antibiotics: IV benzylpenicillin (1.2-2.4 g QID) + metronidazole (500 mg BD) for anaerobic cover; clindamycin (600 mg TDS) if penicillin-allergic.
• Supportive: IV fluids, analgesia
• Disposition: Admit if systemically unwell, airway risk, or failed outpatient management

Question 10

You diagnose peri-tonsillar abscess and consider surgical drainage in the ED. Name two (2) patient-specific contraindications.

Answer 10

• Severe trismus limiting visibility/ access
• Patients on oral anticoagulants, or with a known bleeding disorder
• Patients who refuses/ are uncooperative

Question 11

List three (3) complications associated with incision and drainage of a peritonsillar abscess.

Answer 11

• Haemorrhage from carotid artery injury
• Aspiration pneumonitis/ lung abscess / aspiration
• Airway obstruction / laryngospasm
• Extension of infection into deep tissue of the neck.