Understanding Tonsillitis

[Applause] [Music] hi this is tom from zero2finals.com in this video i'm going to be going through tonsillitis and you can find written notes on this topic at serodofinals.com tonsillitis or in the ear nose and throat section of the zero to finals surgery book so let's jump straight in tonsillitis refers to inflammation of the tonsils the most common cause of tonsillitis is a viral infection viral infections do not require or respond to antibiotics so antibiotics are useless in the case of viral infections the most common cause of bacterial tonsillitis is group a streptococcus or streptococcus pyogenes this can be effectively treated with penicillin v or phenoxy methyl penicillin the second most common bacterial cause of tonsillitis is streptococcus pneumoniae other causes are hemophilus influenzae morexela cateralis and staphylococcus aureus let's talk about waldia's tonsillar ring in the pharynx at the back of the throat there is a ring of lymphoid tissue there are six areas of lymphoid tissue in waldia's ring which includes the adenoids tubal tonsils palatine tonsils and the lingual tonsil the palatine tonsils are the ones typically infected and enlarged in tonsillitis these are the tonsils on either side at the back of the throat let's talk about the presentation of tonsillitis the typical presentation of acute tonsillitis is with a sore throat a fever above 38 degrees celsius and pain on swallowing examination of the throat will reveal red inflamed and enlarged tonsils with or without exudates exudates a small white patches of pass on the tonsils there may be anterior cervical lymphadenopathy which refers to swollen tender lymph nodes in the anterior triangle of the neck which is anterior to the sternocleidomastoid muscle and below the mandible or the jawline the tonsillar lymph nodes are just behind the angle of the mandible or the jaw bone let's talk about the centaur criteria the central criteria can be used to estimate the probability that tonsillitis is due to a bacterial infection and will benefit from antibiotics a centaur score of three or more gives a 40 to 60 probability that the tonsillitis is caused by a bacteria and it may be appropriate to offer antibiotics in this situation a point is given if each of the following features are present a fever above 38 degrees celsius tonsiller exudates the absence of a cough so if the patient has a cough this doesn't score a point but if they don't have a cough this does score a point and tender anterior cervical lymphadenopathy or palpable in large lymph nodes an alternative to the central criteria is the fever pain score a fever pain score of 2 to 3 gives a 34 to 40 probability of bacterial tonsillitis a score of 4 to 5 gives a 62 to 65 percent probability of bacterial tonsillitis the criteria of the fever pain score can be remembered with the mnemonic fever pain one point is given for each of the following a fever during the previous 24 hours p for purulent or pass on the tonsils a4 attended within three days of the onset of symptoms so a longer duration of illness suggests more of a viral infection than a bacterial tonsillitis i for inflamed tonsils and they have to be severely inflamed for this to count and n for no cough or chorizo and kariza refers to the typical symptoms of a cold with a blocked nose a runny nose and sneezing so if there are typical cold symptoms present this makes bacterial tonsillitis less likely let's talk about management consider admission to hospital if the patient is immunocompromised systemically unwell dehydrated there's stride or present and strider is a high-pitched noise that occurs with breathing when there's obstruction in the throat respiratory distress a peritonsillar abscess or quinzee or cellulitis when tonsillitis is the most likely diagnosis you can calculate the central criteria or the fever pain score when patients have likely viral tonsillitis provide education and information and give safety net advice about when to seek further medical advice advise about simple analgesia with paracetamol and ibuprofen to control the pain and the fever the nice clinical knowledge summaries suggest advising patients to return if the pain has not settled after three days or the fever rises above 38.3 degrees celsius starting antibiotics or exploring an alternative diagnosis should be considered consider prescribing antibiotics if the centaur score is three or more or if the fever pain score is four or more also consider antibiotics if they're at high risk of more severe infections such as young infants immunocompromised patients or those with significant comorbidities or a history of rheumatic fever delayed prescriptions of antibiotics can be considered this involves educating patients or parents about the likely viral nature of the sore throat and prescribing a prescription to be collected only if the symptoms get worse or do not improve in the next two to three days let's talk about the choice of antibiotic penicillin v which is also called phenoxyl methylpenicillin for a 10-day course is typically first line this has a relatively narrow spectrum of activity and is effective against streptococcus pyogenes which is the most common cause clarithromycin is the usual first line choice in a true penicillin allergy finally let's touch on the complications of bacterial tonsillitis and these include a peritonsillar abscess which is also known as quinzee otitis media if the infection spreads up to the middle ear scarlet fever rheumatic fever post-streptococcal glomerulonephritis and post-streptococcal reactive arthritis thank you for watching this video if you liked the video left a comment or subscribe to the channel thank you so much it really helps zero to finals is not just a youtube channel there's also a website with detailed notes illustrations and questions an instagram account where new questions are posted every day to help you test your knowledge books flash cards and much more i also have a personal channel where i share my thoughts and tips on learning medicine and you can find links to everything in the description of this video see you next time

Channel: Zero To Finals

Views: 270,277

Keywords: medical, education, medicine, doctor

Id: 9jpMQQn3R9o

Length: 8min 38sec (518 seconds)

Published: Sun Oct 17 2021