• A: is known to be due to bacterial infection
• B: should be treated with amoxicillin as first-line treatment
• C: in cases referred to hospital, a Paul-Bunnell test is usually indicated
• D: is known as quinsy if accompanied by a retropharyngeal abscess
• E: may be associated with an acute glomerulonephritis

Answer: C & E

Explanation: The aetiology of tonsillitis is usually unclear, with many presumed to be due to a viral infection. If the patient is admitted to hospital, a glandular fever test should be performed, and amoxicillin should not be given for fear of precipitating a maculo-papular rash. Quinsy is the development of peritonsillar abscess after tonsillitis, and is treated by drainage and antibiotics. other complications include septicaemia and glomerulonephritis.

• A: is indicated if a child is having tonsillitis twice a year
• B: leads to postoperative haemorrhage in 10% of cases
• C: may require suturing of the faucial pillars in intractable secondary bleeding
• D: can cause bleeding, most likely from the tonsillar branch of the facial artery
• E: may affect the voice quality

Answer: C, D & E

Explanation: There is no definite rule, but a child having tonsillitis five times a year for at least 2 years is a good candidate for tonsillectomy. Poatoperative haemorrhage occurs in 2% of cases, and is likely to be from the tonsillar branch of the facial artery. Intractable bleeding may require a return to theatre and suturing of the faucial pillars over kaltostat gauze. The voice quality may be affected, because of stiffening of the palate.

• A: Enlarged pharyngeal tonsils 
• B: Cleft palate
• C: Eustachian tube dysfunction
• D: Otosclerosis
• E: Hypertrophic adenoids

Answer: B, C & E 

Explanation: Glue ear is a serous viscous effusion that may occur after an episode of acute otitis media. Conditions predisposing to the condition are Eustachian tube dysfunction, adenoidal hypertrophy, cystic fibrosis and allergic conditions.

• A: connects the middle ear to the oropharynx
• B: opens by the palatine tonsil
• C: has a bony portion in the sphenoid bone
• D: has a cartilaginous medial segment
• E: is more horizontal in the child

Answer: D & E

Explanation: The Eustachian tube in a child is shorter and more horizontal. The opening of the auditory tube lies above the soft palate, adjacent to the tubal tonsil. The bony part of the Eustachian tube perforates the petrous temporal bone.

• A: cholesteatoma
• B: acute glomerulonephritis
• C: quinsy
• D: endotoxaemia
• E: vocal cord palsy

Answer: B & C 

Explanation: The complication of acute glomerulonephritis following tonsillitis is more common in men. The particular condition has a latency of 1 – 3 weeks. Group A B-haemolytic streptococcal infection commonly occurs in children > 10 years old. Peritonsillar abscess or quinsy cause medial displacement of the soft palate or uvula. Pulmonary hypertension, heart failure and secondary chronic hypoxia have all been described. Odynophagia and otalgia can also occur. Cholesteatoma is keratinized stratified squamous epithelium growing in the middle ear (which is usually lined by columnar epithelium). It should be treated aggressively as it can be invasive and fatal.

• A: may require a postaural incision if in the ear.
• B: may require an immediate barium swallow if in the throat
• C: Usually wedge at the thyropharyngeus if in the oesophagus
• D: usually go down the right main bronchus, if in the bronchi
• E: in the throat can be excluded on the basis of a clear lateral neck X-ray

Answer: A & D 

Explanation: Ear foreign bodies usually can be removed via suction or hooks, but may occasionally require a postaural incision. Patients with throat foreign bodies should never have a barium swallow because it interferes with future oesophagoscopies, although an Omnopaque swallow may be possible. Oesophageal foreign bodies usually wedge at the cricopharyngeus, but may also occur at the cardia or at the crossing of the left main bronchus. Bronchial foreign bodies usually go down the right main bronchus, as it is larger and straighter. Lateral neck X-rays show low sensitivity and specificity for foreign bodies, and they should not be used to make management decisions without taking clinical symptoms into account.

• A: It is usually caused by B-haemolytic streptococci
• B: it is most common between the ages of 2 and 6 years
• C: Its incidence has been reduced by 2 –year old receiving the Hib vaccine
• D: The larynx/throat should be examined immediately
• E: Chloramphenicol is an appropriate antibiotic

Answer: B & E 

Explanation: Epiglottitis is usually caused by Haemophilus influenza type B, despite the advent Hib vaccine given at 2 months. The peak incidence is between 3 and 4 years. Clinically, the child will present with a sorethroat, leading to muffled voice and respiratory obstruction. The child may be sitting up and dribbling. No attempt should be made to examine the throat, or to distress the child, as laryngospasm may result. The primary concern is to secure a safe airway. Once this is done, iv antibiotics such as chloramphenicol should be started, and the child transferred to intensive care facilities if necessary.

• A: usually present as an emergency when bilateral
• B: may be associated with an ear abnormality
• C: is associated in 50% of cases with facial nerve palsy
• D: is associated in two-thirds with a laryngotracheal abnormality
• E: Coften requires multiple redilatations after being successfully repaired.

Answer: A, B, C & E 

Explanation: Choanal atresia is a failure of rupture of the bucconasal membrane before birth. It is usually unilateral, in which case diagnosis may be delayed, but is sometimes bilateral, in which case it presents as an emergency shortly after birth owing to the obligate nasal breathing pattern of the infant. In 50% of cases there is an associated facial palsy, and one-third have laryngotracheal abnormalities. All babies with choanal atresia should be screened for the CHARGE association, namely C-coloboma, H-heart disease, A- choanal atresia, R- retarded growth, G- genital abnormalities, and E- ear abnormalities. Treatment in symptomatic cases is perforation/drilling of the occlusion, with or without the simultaneous placement of stents. Regular dilation is usually necessary at first, and some centres are using mitomycin-C as an adjuvant treatment to prevent re-stenosis.

• A: A more caudally placed larynx
• B: Smaller angle of the jaw
• C: A more U-shaped epiglottis
• D: A relatively large tongue
• E: A larger head size compared with the body size.

Answer: 

Explanation:

Children have a larger head, which tends to flex the head on the neck, making airway obstruction more likely. The relatively larger tongue tends to flop back and obstruct the airway in the obtunded child and means there is less room in the mouth when they are being intubated. The larynx is more cephalic (glottis at 3 in infants compared with C6 in adults) and the angle of the jaw is larger in children (140⁰ in infants, 120⁰ in adults), both making intubation more difficult. In addition, the trachea is shorter and the cricoid ring is the narrowest part of the airway (compared with the glottis in the adult).