tonsilitis

Question 1

most common causes

Answer 1

viral

strep pyogenes (group A strep)
strep pneumoniea

H influenzae
moraxella catarrhalis
staph a

Question 2

Waldeyer’s tonsillar ring

Answer 2

adenooids
tubual
palantine
lingual

Question 3

features

Answer 3

sore throat
fever
pain on swallowing 
red, enlarged, inflamed tonsils +/- exudate
anterior cervical lymphadenopathy

Question 4

Centor Criteria

Answer 4

fever > 38ºC
tonsilar exudates
absence of cough
lymphadenopathy

Question 5

centor score indicating antibiotic treatment

Answer 5

3+

40-60% probability bacterial tonsilitis

Question 6

FeverPAIN score

Answer 6

fever
pus on tonsils
attended within 3 days symptoms onset
inflamed tonsils 
no cough/coryza

Question 7

FeverPAIN score indicating antibiotic treatment

Answer 7

4+

62-65% probability bacterial tonsilitis

Question 8

when to consider hosp admission

Answer 8

immunocompromised
systemically unwell
dehydrated
stridor
resp distress
evidence peritonsilar abscess or cellulitis

Question 9

Mx - viral

Answer 9

educate
safety net - return pain not settling 3 days or fever >38.3ºC
simple analgesia

Question 10

Mx - antibiotics

Answer 10

centor score 3+
FeverPAIN 4+

penicillin V 10 days

clarithromycin if penicillin allergic

Question 11

complications

Answer 11

peritonsilar abscess
otitis media 
scarlet fever
rheumatic fever
PSGN 
reactive arthritis