Year 4 > Sinusitis And Tonsillitis > Flashcards

Sinusitis And Tonsillitis Flashcards

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1
Q

What is the duration for acute sinusitis?

A

less than 6 weeks

Acute sinusitis is characterized by a shorter duration of symptoms.

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2
Q

What is the duration for chronic sinusitis?

A

over 12 weeks

Chronic sinusitis involves prolonged symptoms and may require different management.

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3
Q

What is the cause of sinusitis?

A

Sinusitis arises from blockage of the Ostia that allow the sinuses to drain into the nasal cavity.

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4
Q

List the predisposing factors for chronic rhinosinusitis.

A
  • atopy: hay fever, asthma
  • nasal obstruction (e.g., septal deviation, nasal polyps)
  • recent local infection (e.g., rhinitis, dental extraction)
  • swimming/diving
  • smoking

These factors can increase the risk of developing chronic sinusitis.

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5
Q

What are the four sinuses?

A
  • Frontal
  • Ethmoid
  • Maxillary
  • Sphenoidal

These sinuses are involved in drainage into the nasal cavity.

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6
Q

What are common symptoms of sinusitis?

A
  • Nasal congestion
  • Nasal discharge
  • Facial pain/headache
  • Facial pressure and swelling
  • Anosmia
  • Ear pain
  • Sore throat
  • Headache

Clinical examination will find tenderness on palpation, inflammation and oedema inside the nose, discharge and fever

These symptoms often follow a viral upper respiratory tract infection.

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7
Q

What is the aetiology of sinusitis?

A

Infection from viral URTI

Allergies like hay fever

Obstruction from polyp, trauma or foreign body

Smoking

Asthma increases risk

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8
Q

What are the red flag symptoms for chronic sinusitis?

A
  • Unilateral symptoms
  • Persistent symptoms despite compliance with 3 months of treatment
  • Epistaxis

These symptoms may indicate a more serious condition requiring further investigation.

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9
Q

What investigations can be done for sinusitis?

A
  • Cultures For suspected bacterial sinusitis
  • Computed tomography (CT): * Provides detailed images of the sinuses and can reveal evidence of sinus inflammation or obstruction.
  • Nasal endoscopy: Allows for the visual examination of the internal nasal passages and the sinus openings.

These investigations help in diagnosing bacterial sinusitis and assessing sinus inflammation.

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10
Q

According to NICE guidelines, when should antibiotics be prescribed for sinusitis?

A

For symptoms over 10 days
* Delayed antibiotic prescription can be given if symptoms don’t improve for 21 days, with phenoxymethylpenicllin

​
*Addition of steroid nasal spray is indicated for 14 days like mometasone 200mcg twice a day

Antibiotics are not recommended for symptoms less than 10 days as they are likely viral.

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11
Q

What is the first-line treatment for chronic sinusitis?

A
  • Avoiding allergens
  • Saline nasal irrigation
  • Steroid nasal spray or drops
  • Functional endoscopic sinus surgery (in extreme cases)

These treatments aim to reduce inflammation and improve sinus drainage.

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12
Q

What is the technique for using a nasal spray?

A
  • Tilt head forward
  • Perform with left hand into right nostril
  • Gently inhale

If patient can taste spray, it is too far back

Proper technique ensures effective delivery of the medication.

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13
Q

Which surgery can be done for sinusitis?

A

Functional endoscopic sinus surgery is when an endoscope is inserted into the nostril for investigating functional causes of sinusitis like bones, polyp, deviated septum. CT scan is necessary prior to confirm diagnosis

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14
Q

What are the five groups of tonsils?

A
  • Palatine
  • Lingual
  • Tubal
  • Adenoid

These tonsils play a role in the immune response.

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15
Q

What are the palatine tonsils?

A

single tonsil located in the roof of the nasopharynx

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16
Q

What are the lingual tonsils?

A
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17
Q

What are the adenoid tonsils?

A
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18
Q

What are the tubal tonsils?

A
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19
Q

What are common causes of tonsillitis?

A
  • Viral
  • Bacterial (most commonly Streptococcus pyogenes)

Bacterial tonsillitis can be treated with penicillin V.

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20
Q

What are the bacterial agents causing tonsillitis?

A

Streptococcus pneumonia

*Haemophilius influenzae

*Moraxella catarrhal is

*Staphylococcus aureus

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21
Q

What are the symptoms of tonsillitis?

A

*sore throat
*Fever
*Pain on swallowing

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22
Q

List the clinical signs of tonsillitis.

A
  • Tonsillitis exudates with white patches and pus
  • Red and inflamed enlarged tonsils
  • Anterior cervical lymphadenopathy

These signs help in diagnosing tonsillitis.

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23
Q

What are the complications of tonsillitis?

A
  • Scarlet fever
  • Rheumatic fever
  • Post-streptococcal glomerulonephritis
  • Reactive arthritis
  • Quinsy (peritonsillar abscess)
  • Otitis media

These complications can arise if tonsillitis is untreated.

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24
Q

What determines porbability to determine bacterial infection in tonsillitis?

A

Centor criteria is used to estimate the probability of bacterial infection a score of 3 or more indicates 40-60% probability.

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25
What are the features of the Center criteria?
* Fever over 38 degrees * Tonsillar exudates * Absence of cough * Tender anterior cervical lymphadenoapthy
26
What does a **Centor score** of 3 or more indicate?
40-60% probability of bacterial infection ## Footnote Points are given for fever, tonsillar exudates, absence of cough, and tender anterior cervical lymphadenopathy.
27
What are the features of the fever pain score?
* Fever during previous 24 hours * Purulent/pus * Attended within 3 days of symptom onset * Inflamed tonsils * No cough or coryza ( symptoms of cold like runny nose)
28
What are the criteria for **referral to ENT** for tonsillitis?
* 7+ episodes in one year * 5+ episodes per year for two years * 3+ episodes per year for three years ## Footnote These criteria help determine the need for surgical intervention.
29
What are the indications for antibiotics in tonsillitis?
Center score of 3 or more Fever pain 4 or more High risk patients like young infants, history of rheumatic fever, immunocompromised patients and co-morbidity
30
What is the **first-line antibiotic** for bacterial tonsillitis?
Phenoxymethylpenicillin which is a 10 day course, best for streptococcus pyogenes. ## Footnote This antibiotic is effective against Streptococcus pyogenes.
31
What is the duration for **chronic sinusitis**?
over 12 weeks ## Footnote Chronic sinusitis involves prolonged symptoms and may require different management.
31
What is given alternative to penicillin for tonsillitis?
clarithromycin
32
List the **predisposing factors** for chronic rhinosinusitis.
* atopy: hay fever, asthma * nasal obstruction (e.g., septal deviation, nasal polyps) * recent local infection (e.g., rhinitis, dental extraction) * swimming/diving * smoking ## Footnote These factors can increase the risk of developing chronic sinusitis.
32
What are the indications for hospital admission in tonsillitis?
* Immunocompromised patinets * Systemically unwell * Dehydrated * Stridor * Respiratory distress * Peritonsillar abscess * Cellulitis
33
What are indications for **tonsillectomy**?
* Sore throats due to tonsillitis * 7 episodes per year for one year OR 5 episodes per year for two years OR 3 episodes per year for three years with no other explanation * Disabling episodes preventing normal functioning ## Footnote Tonsillectomy is considered when recurrent tonsillitis significantly impacts quality of life.
33
What are the **four sinuses**?
* Frontal * Ethmoid * Maxillary * Sphenoidal ## Footnote These sinuses are involved in drainage into the nasal cavity.
34
What are the **complications** of tonsillectomy?
* Primary (less than 24 hours): haemorrhage, pain * Secondary (24 hours to 10 days): haemorrhage, pain ## Footnote Complications can arise from inadequate haemostasis or infection.
34
What are common **symptoms** of sinusitis?
* Nasal congestion * Nasal discharge * Facial pain/headache * Facial pressure and swelling * Anosmia * Ear pain * Sore throat * Headache ## Footnote These symptoms often follow a viral upper respiratory tract infection.
35
What are the **red flag symptoms** for chronic sinusitis?
* Unilateral symptoms * Persistent symptoms despite compliance with 3 months of treatment * Epistaxis ## Footnote These symptoms may indicate a more serious condition requiring further investigation.
35
When does haemorrhage occur in tonsillectomy?
Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre. Secondary haemorrhage occurs between 5 and 10 days after surgery and is often associated with a wound infection
36
What investigations can be done for sinusitis?
* Cultures * Computed tomography (CT) * Nasal endoscopy ## Footnote These investigations help in diagnosing bacterial sinusitis and assessing sinus inflammation.
36
What is the treatment of Secondary haemorrhage with tonsillectomy?
Treatment is usually with admission and antibiotics. Severe bleeding may require surgery. Secondary haemorrhage occurs in around 1-2% of all tonsillectomies
37
According to NICE guidelines, when should **antibiotics** be prescribed for sinusitis?
For symptoms over 10 days ## Footnote Antibiotics are not recommended for symptoms less than 10 days as they are likely viral.
37
What are the complications of tonsillitis?
* recurrent tonsillItis * Retropharyngeal abscess * Peritonsillar abscess * lemierre’s syndrome
38
What are the features of Retropharyngeal abscess?
A rare complication characterised by soft tissue swelling, more common in young children. Symptoms include a stiff and extended neck and refusal to eat or drink.
39
What are the features of quinsy?
Presents with sore throat, difficulty swallowing, peritonsillar bulge, uvular deviation, trismus, and muffled voice. Treatment has shifted from surgical drainage to antibiotics and aspiration.
40
What are the features of lemierre’s syndrome?
In this rare complication, inflammation leads to pharyngotonsilitis, inflammation within the internal jugular vein, and septic emboli. Treatment may require high-dose benzylpenicillin and debridement.
41
What are the complications of streptococcal tonsillitis?
* Scarlet fever * Acuterheumatic fever * Post-streptococcal glomerulonephritis * Reactive arthritiS
42
What are the differentials of tonsillitis?
* **Pharyngitis:**Symptoms include sore throat, fever, andheadache. Unliketonsillitis, patients do not usually present with lymphadenopathy. * **Infectious mononucleosis:characterised by fatigue, sore throat, fever, and swollen lymph nodes. A key difference is the presence of severe fatigue andsplenomegaly
43
What is **quinsy**?
Peritonsillar abscess, from untreated tonsillitis. However, it is more common in adults than in children, and it tends to occur more frequently in individuals with a history of recurrent tonsillitis ## Footnote Quinsy is a rare complication of untreated acute tonsillitis.
44
What is the aetiology of quinsy?
Quinsy is most commonly caused by a bacterial infection, typically group A streptococi pyogenes or less commonly by Staphylococcus aureus/haemophilius influenza. It can occur when an infection spreads from the tonsil to the surrounding tissues, causing an abscess to form.
45
What is the presentation of quinsy?
* Sore throat * This is where they are unable to open their mouth * Change in voice like a hot potato * Swelling and erythema in region other than the tonsil * Uni-tonsillar bulge * Uvula deviation
46
What are the **key investigations** for suspected quinsy?
* Physical examination * Imaging tests (CT scan or ultrasound) ## Footnote These investigations help confirm the diagnosis of quinsy.
47
What is the management for **quinsy**?
* Antibiotics * Aspiration ## Footnote Aspiration is preferred over traditional incision and drainage for treating quinsy.
48
What is the duration for **acute sinusitis**?
less than 6 weeks ## Footnote Acute sinusitis is characterized by a shorter duration of symptoms.
49
What is the first-line treatment for **chronic sinusitis**?
* Avoiding allergens * Saline nasal irrigation * Steroid nasal spray or drops * Functional endoscopic sinus surgery (in extreme cases) ## Footnote These treatments aim to reduce inflammation and improve sinus drainage.
50
What is the **technique** for using a nasal spray?
* Tilt head forward * Perform with left hand into right nostril * Gently inhale ## Footnote Proper technique ensures effective delivery of the medication.
51
What are the **five groups of tonsils**?
* Palatine * Lingual * Adenoid ## Footnote These tonsils play a role in the immune response.
52
What are common **causes** of tonsillitis?
* Viral * Bacterial (most commonly Streptococcus pyogenes) ## Footnote Bacterial tonsillitis can be treated with penicillin V.
53
List the **clinical signs** of tonsillitis.
* Tonsillitis exudates with white patches and pus * Red and inflamed enlarged tonsils * Anterior cervical lymphadenopathy ## Footnote These signs help in diagnosing tonsillitis.
54
What are the **complications** of tonsillitis?
* Scarlet fever * Rheumatic fever * Post-streptococcal glomerulonephritis * Reactive arthritis * Quinsy (peritonsillar abscess) * Otitis media ## Footnote These complications can arise if tonsillitis is untreated.
55
What does a **Centor score** of 3 or more indicate?
40-60% probability of bacterial infection ## Footnote Points are given for fever, tonsillar exudates, absence of cough, and tender anterior cervical lymphadenopathy.
56
What are the criteria for **referral to ENT** for tonsillitis?
* 7+ episodes in one year * 5+ episodes per year for two years * 3+ episodes per year for three years ## Footnote These criteria help determine the need for surgical intervention.
57
What is the **first-line antibiotic** for bacterial tonsillitis?
Phenoxymethylpenicillin ## Footnote This antibiotic is effective against Streptococcus pyogenes.
58
What are indications for **tonsillectomy**?
* Sore throats due to tonsillitis * 7 episodes per year for one year * 5 episodes per year for two years * 3 episodes per year for three years * Disabling episodes preventing normal functioning ## Footnote Tonsillectomy is considered when recurrent tonsillitis significantly impacts quality of life.
59
What are the **complications** of tonsillectomy?
* Primary (less than 24 hours): haemorrhage, pain * Secondary (24 hours to 10 days): haemorrhage, pain ## Footnote Complications can arise from inadequate haemostasis or infection.
60
What is **quinsy**?
Peritonsillar abscess ## Footnote Quinsy is a rare complication of untreated acute tonsillitis.
61
What are the **key investigations** for suspected quinsy?
* Physical examination * Imaging tests (CT scan or ultrasound) ## Footnote These investigations help confirm the diagnosis of quinsy.
62
What is a key clinical sign for tonsillitis?
A uni-tonsillar bulge and uvula deviation are characteristic findings.
63
What is the management for **quinsy**?
* Antibiotics With broad spectrum * Aspiration ## Footnote Aspiration is preferred over traditional incision and drainage for treating quinsy.
64
What to suspect in adult onset asthma?
Eosinophilic granulomatous is with polyangitis: causes rhinitis, bilateral nasal polyps and systemic symptoms of fatigue
65
What is an indicator for hospital admission?
*systemically unwell child *dehydration from not being able to drink for a prolonged period of time * any suggestion of airway compromise
66
What is the criteria for tonsillectomy?
7 or more significant sore throats (with impact to patient and family) in the preceding 12 months, 5 or more episodes in each of the preceding two years, or 3 or more in each of the preceding three years. However, this child is acutely unwell
67
What is the diagnosis for sinusitis?
anterior rhinoscopy or nasal endoscopy
68
What is the first line management of nasal polyps?
Topical steroid drops to shrink polyp along with nasal saline irrigation . The patient must be counselled to tilt their head upside down when administering the drops, not backwards
69
When to suspect cancer in sinusitis?
any adult that presents with chronic (>12 weeks) rhinosinusitis for the first time. Additional alarm symptoms include blood-stained nasal discharge and swelling overlying the sinus
70
What causes nasal obstruction, rhinorrhea, and decreased sense of smell?
Nasal polyps
71
What feature points away from nasal polyps?
Persistent bleeding/crusting
72
What causes persistent bleeding with unilateral nasal obstruction?
Sinonasal caricnoma
73
What is the classic features of cow’s of sinusitis pain?
facial pain (classically described as frontal pressure pain which is worse on bending forward), nasal discharge (usually thick and purulent) and difficulty breathing
74
When is medical management indicated for sinusitis?
Symptoms over 10 days
75
What to do first line for sinusitis over 10 days?
phenoxymethylpenicillin first-line, co-amoxiclav if 'systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications'
76
What causes sinusitis to suddenly worsen
Secondary bacterial infection
77
What should be done in all cases of post-tonsillectomy bleeding?
Referral immediately to ENT
78
What is the criteria for antibiotic prescribing in tonsillitis?
3 of the following should be present: *Presence of tonsillar exudate *Tender anterior cervical lymphadenopathy or lymphadenitis *History of fever *Absence of cough
79
Wha it’s samter;s triad?
asthma, aspirin sensitivity and nasal polyposis
80
What should patients with nasal polyps avoid?
Aspirin due to likelihood of aspirin sensitivity
81
Which syndromes are associated with nasal polyps?
Eosinophilic granulomatous is with poylangitis Kartaganer;s syndrome
82
What des the centor criteria describe?
Likelihood that a diagnosis of pharyngitis or tonsillitis is due to a bacterial source GERD, with erythema of pharynx and longstanding cough and throat. Hoarseness
83
What causes bilateral nasal obstruction, cough at night and a clear nasal discharge?
Allergic rhinitis
84
How to differentiate rhinitis from nasal polyps?
Polyps will have anosmia and feeling of fullness in the place
85
What is a clinical sign of tonsillitis?
kissing tonsils', which are tonsils that meet in the mid-line due to swelling.
86
How to inferential Epiglottitis and tonsillitis?
acute onset, relatively normal respiratory rate, forward lean and stridor
87
What causes uvulae deviation with sore throat?
Peritonsillar abscess
88
What is first line for chronic rhinosinusitis?
Nasal irrigation with saline
89
When are steroids used in rhinosinusitis?
reserved for severe cases or those refractory to topical treatment plus adjuncts like saline irrigation
90
why is post tonsillectomy haemorrhage so dangerous?
Airway obstruction and hypovolaemic shock
91
What is **gingivitis** usually secondary to?
Poor dental hygiene ## Footnote Gingivitis can range from simple forms to more severe conditions.
92
Describe the clinical presentation of **simple gingivitis**.
* Painless * Red swelling of the gum margin * Bleeds on contact ## Footnote This is a common form of gingivitis that indicates poor dental hygiene.
93
What are the symptoms of **acute necrotizing ulcerative gingivitis**?
* Painful bleeding gums * Halitosis * Punched-out ulcers on the gums ## Footnote This condition is more severe than simple gingivitis and requires immediate attention.
94
What should a patient with **simple gingivitis** be advised to do?
Seek routine regular review by a dentist ## Footnote Antibiotics are not usually necessary for simple gingivitis.
95
What is the recommended management for **acute necrotizing ulcerative gingivitis**?
* Refer to a dentist * Oral metronidazole for 3 days * Chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash * Simple analgesia ## Footnote The BNF also suggests that amoxicillin may be used.
96
What is Vincent's angina?
Acute necrotising ulcerative gingivitis of the pharynxm more common in immunodeficiency states such as malnutrition and HIV infection
97
What is the medical management of gingivitis?
Paracetamol to address pain and fever+ oral metronidazole + chlorhexidine mouthwash to reduce bacterial load and promote healing.
98
What is the aetiology of gingivitis?
fusospirochaetal infection, primarily involving Fusobacterium nucleatum and Treponema vincentii
99
What to suspect in patient with new fever and trismus with inability to protrude tongue after dental procedure?
Ludwig’s angina, requiring emergency hospital transfr
100
When to start medical management for sinusitis?
Symptoms for 10 days or more-> give Intra-nasal corticosteroid Oti
101
How to differentiate tonsillitis ww from quinsy?
Quinsy causes severe sore throat that can cause difficulty in opening mouth (trismus), drooling, foul-smelling breath and deviation of uvula towards unaffected side due to swelling on one side of the throat
102
Hat to suspect in sore throa with splenomegaly?
Infectious mononucleosis
103
How to differentiate tonsillitis and retropharyngeal abscess?
high fever, severe sore throat and difficulty swallowing along with neck stiffness or swelling at back of neck (nuchal rigidity)
104
When to refer to anaesthetics vs ENT for antibiotics with post-tonsillectomy haemorrhage?
Anaesthetics for active bleeding or patient instability
105
What antibiotic should be given for patient with tonsillitis?
Phenoxymethylpenicllin with analgesia due to association with group A beta-haemolytic streptococcus (GABHS) infection
106
What causes fever and unilateral tonsil swelling?
Quinsy
107
What is **black hairy tongue**?
A condition resulting from defective desquamation of the filiform papillae ## Footnote The tongue may appear brown, green, pink, or another color despite its name.
108
List the **predisposing factors** for black hairy tongue.
* Poor oral hygiene * Antibiotics * Head and neck radiation * HIV * Intravenous drug use ## Footnote These factors can contribute to the development of the condition.
109
What should be done to exclude **Candida** in cases of black hairy tongue?
The tongue should be swabbed ## Footnote This step is important for proper diagnosis and management.
110
What are the **management** options for black hairy tongue?
* Tongue scraping * Topical antifungals if Candida ## Footnote These treatments help alleviate the condition and address any underlying infections.
111
What is the FEVERPAIN criteria?
Fever over 38°C. Purulence (pharyngeal/tonsillar exudate). Attend rapidly (3 days or less) Severely Inflamed tonsils No cough or coryza
112
What is the cause of tonsillectomy post 5 days?
Associated with wound infection so treat with antibiotics
113
How to differentiate bacterial sinusitis from other causes?
double sickening' associated with bacterial sinusitis - an initial period of recovery followed by a sudden worsening of symptoms. It is thought to be caused by a secondary bacterial infection following a viral rhinosinusitis. There will be fever and purulent discharge
114
How to manage bleeding post-tonsillectomy other than return to theatre?
Haemorrhage 5-10 days after tonsillectomy is commonly associated with a wound infection and should therefore be treated with antibiotics
115
What are he indications for adenoidectomy?
nasal obstruction, mouth breathing, recurrent otitis media, and/or sleep apnea. Other indications include chronic rhinosinusitis and chronic adenoiditis.
116
What is first line for allergic rhinitis?
regular intranasal corticosteroid therapy
117
What is second line for allergic rhinitis?
combination intranasal corticosteroid and antihistamine spray (e.g fluticasone-azelastine
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