QuestionSBA
QuestionChoice
A quinsey is another term for a peritonsillar abscess. This is a more common complication of under-treated bacterial throat infections and often requires incision and drainage. A quinsey can develop into a parapharyngeal abscess if left untreated, but as with parapharyngeal abscess it does not always have an associated thrombosis and therefore is not the correct answer here
32540
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Quinsey
QuestionChoice
Reye's syndrome is acute encephalopathy and liver failure after a febrile viral illness such as influenza and upper respiratory tract infections. It does not present with neck swelling and liver failure is more commonly associated with bleeding as opposed to thrombosis. This is therefore not the correct answer
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Reye's syndrome
QuestionChoice
A parapharyngeal abscess is another recognised complication of under-treated bacterial throat infections. It may present with a neck swelling and can lead to Lemierre's syndrome, but not all parapharyngeal abscesses have an associated thrombus, therefore this is not the correct answer. It can be life threatening as it may lead to airway compromise and thus must be surgically drained under general anaesthetic
32539
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Parapharyngeal abscess
QuestionChoice
This is a combination of symptoms that arise from damage to the sympathetic trunk. The classical signs are of miosis (constricted pupil), partial ptosis (weak droopy eyelid) and anhydrosis (reduced sweating). This presentation is more in keeping with an acute inflammatory/infective process as opposed to disruption of nerve signals
32542
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Horner's syndrome
QuestionChoice
Lemierre's syndrome is an infective thrombophlebitis that can develop as a result of untreated bacterial throat infections in otherwise healthy young adults. It can lead to other further systemic complications such as bacteraemia and septic emboli
32538
a
Lemeirre's syndrome
QuestionComment
Lemierre not "Lemeirre"
12033
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Name checks out
16265
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Otitis Wilsons
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Abscess Otitis
QuestionComment
When in doubt go for the most funny name
22960
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Intravenous Prone
QuestionComment
Low yield asf
23507
QuestionComment
Low yield until you're the ENT SHO, miss the diagnosis and pt has a stroke 
30438
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Brucie
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Retrograde Vitamin
QuestionComment
diagnosis of exclusion..
28100
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Sir Pep Guardiola
Concept
Chapter
# Summary
 
 
Tonsillitis is a condition characterised by the inflammation of the tonsils due to infection. The main signs and symptoms include sore throat, headache, fever, and lymphadenopathy. Investigation methods such as throat swabs are not routinely performed, and blood tests are reserved for patients with immunodeficiency. Management strategies primarily include treatment with paracetamol and ibuprofen, with antibiotics prescribed in certain cases.
 
 
# Definition
 
 
Tonsillitis is a medical condition that is characterised by the inflammation of the tonsils, which are the masses of lymphoid tissue located at the back of the throat. This inflammation is primarily due to an infection.
 
 
# Epidemiology
 
 
Sore throat is a very common presenting complaint. Cases are highest in children during the winter months.
 
# Aetiology
 
 
The aetiology of tonsillitis is usually due to a viral or bacterial infection. Common viruses include the Epstein-Barr virus, influenza virus, adenovirus, and rhinovirus. Bacterial tonsillitis can be caused by Group A streptococcus, which is also responsible for strep throat.
 
 
# Signs and Symptoms
 
 
Patients with tonsillitis typically present with the following symptoms:
 
 
 - Sore throat
 - Headache
 - Fever (pyrexia)
 - Enlarged and tender lymph nodes (lymphadenopathy)
 - Enlarged & erythematous tonsils
 - Tonsillar exudate
 - Some people may also experience abdominal pain, and nausea & vomiting
 - There may be signs of dehydration
 
 
# Differential Diagnosis
 
 
When diagnosing tonsillitis, it's important to differentiate it from other conditions with similar symptoms such as: 
 
 - **Pharyngitis:** Symptoms include sore throat, fever, and headache. Unlike tonsillitis, 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 and splenomegaly.
 
 
# Investigations
 
 
Investigations for tonsillitis typically involve clinical examination and patient history. Additional tests such as throat swabs are only used when an alternative bacterial cause is suspected. Blood tests are primarily reserved for those with suspected immunodeficiency.
 
## Scoring systems to predict the need of antibiotic treatment:
 
 
### Centor Criteria
 
 
The Centor Criteria is a set of clinical predictors used to identify patients with Group A streptococcal pharyngitis:
 
 
 - History of fever
 - Presence of tonsillar exudates
 - Absence of cough
 - Tender anterior cervical lymphadenopathy
 
 
Patients presenting with three or four of these criteria should be considered for antibiotic treatment.
 
FeverPAIN criteria:
 
 - Fever
 - Purulence (exudate)
 - Attended within 3 days of symptom onset
 - Inflamed tonsils
 - No cough or coryza (suggests viral origin)
 
A score of four or five indicates a high probability of streptococcal infection and hence the need for antibiotics.
 
 
# Management
 
 
Management strategies for tonsillitis include:
 
 
 - Symptomatic treatment with paracetamol and ibuprofen
 - Antibiotic therapy in cases featuring (phenoxymethylpenicillin is first-line):
 - Marked systemic upset
 - Three or more Centor criteria, or four or more FeverPAIN criteria
 - Underlying immunodeficiency
 - Increased risk of complications 
 - Clarithromycin can be used if there is penicillin allergy 
 - In some cases a delayed antibiotic prescription may be indicated
 
If a patient appears severely unwell, dehydrated or presents with complications, refer urgently to hospital or for specialist assessment.
 
Patients may be referred to ENT for tonsillitis if they have recurrent episodes of tonsillitis. The criteria for this is:
 
 - 7+ episodes in one year
 - 5+ episodes per year for two years
 - 3+ episodes per year for three years
 
# Complications
 
 
Potential complications of tonsillitis include:
 
 
 - Recurrent Tonsillitis: This is the most common complication. The evidence base for tonsillectomies as a treatment is poor, leading to stricter referral criteria.
 - 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.
 - Peritonsillar Abscess (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.
 - 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.
 
 
Complications of streptococcal tonsillitis include:
 
 - Scarlet fever
 - Acute rheumatic fever
 - Post-streptococcal glomerulonephritis
 - Reactive arthritis
 
# NICE Guidelines 
 
[Click here for NICE CKS on sore throat - acute](https://cks.nice.org.uk/topics/sore-throat-acute/)
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An example of a right sided quinsy.
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Bilateral exudate seen on the tonsils of someone with tonsilitis.
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Acute Tonsillitis
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Ear, Nose & Throat
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Lemierre's syndrome is a serious condition arising from untreated bacterial throat infections, leading to jugular vein thrombosis.
An 18 year old female with recurrent tonsillitis presents to her local accident and emergency with a four day history of sore throat, fever and inability to swallow her own saliva. She has a tender swelling over the lateral aspect of her neck and targetted ultrasound reveals a thrombus in her jugular vein.

What is the name of the likely condition?
a