Lecture Notes on Tonsillitis

Introduction

• Presenter: Tom from zero2finals.com
• Tonsillitis: Inflammation of the tonsils
• Common sources:
  • Viral infections (most common)
  • Bacterial infections (notably Group A Streptococcus)

Causes of Tonsillitis

• Viral:
  • Does not respond to antibiotics
• Bacterial:
  • Group A Streptococcus (Streptococcus pyogenes)
  • Treated with Penicillin V
  • Other bacteria: Streptococcus pneumoniae, Hemophilus influenzae, Morexela cateralis, Staphylococcus aureus

Waldia's Tonsillar Ring

• Located in the pharynx, back of the throat
• Six areas of lymphoid tissue:
  • Adenoids
  • Tubal tonsils
  • Palatine tonsils (common site of infection)
  • Lingual tonsil

Presentation of Tonsillitis

• Common symptoms:
  • Sore throat
  • Fever >38°C
  • Pain on swallowing
• Physical examination:
  • Red, inflamed, enlarged tonsils
  • Possible exudates (white patches)
  • Anterior cervical lymphadenopathy (swollen lymph nodes)

Diagnostic Criteria

Centor Criteria

• Estimates probability of bacterial infection
• Score of 3+ indicates potential for antibiotics
• Points for:
  • Fever >38°C
  • Tonsillar exudates
  • No cough
  • Tender anterior cervical lymphadenopathy

FeverPAIN Score

• Alternative measure
• FeverPAIN mnemonic:
  • Fever in last 24 hours
  • Purulent tonsils
  • Attended within 3 days of symptoms
  • Inflamed tonsils
  • No cough/coryza
• Score implications:
  • 2-3: 34-40% probability
  • 4-5: 62-65% probability

Management

• Consider hospital admission in severe cases
• Use Centor or FeverPAIN scores for guidance
• Viral tonsillitis:
  • Educate about viral nature
  • Advise analgesia (Paracetamol/Ibuprofen)
  • Safety net advice for worsening symptoms
• Antibiotics:
  • Consider if Centor 3+ or FeverPAIN 4+
  • High risk patients (infants, immunocompromised)
  • Delayed prescriptions for possible bacterial cases
  • First-line: Penicillin V
  • Alternative for allergy: Clarithromycin

Complications

• Peritonsillar abscess (Quinzee)
• Otitis media
• Scarlet fever
• Rheumatic fever
• Post-streptococcal glomerulonephritis
• Reactive arthritis

Additional Resources

• Website: zero2finals.com
• Materials: Notes, flash cards, questions, and more
• Personal insights and tips on learning medicine
• Social media: Instagram for daily questions