Department Of ENT

• Student Name: MUHAMMAD SULAMAN AKHTAR

•
• Student Id: 2023-065
•
• Lecturer Name: Dr. SAIRA IFTIKHAR
•
• Degree: M.B.B.S
•
• Year: 3rd
•
• Rotation: ENT
•
• Submission Date: 1/05/2021
•
• Due Date: 2/5/2021
•
• Total Pages: 9
•
• Title of Assignment:
Assignment #1

• DECLARATION:

I hereby certify that no part of this assignment has

been copied from any other student’s work and that all sources have
been acknowledged.

Shifa College of Medicine - STMU

 Assignment no. 1

Q1. Define the boundaries of the oral cavity.

Q2. Enumerate causative organisms of acute tonsillitis.
Q3. What are various types of acute tonsillitis?
Q4. Enumerate symptoms and signs of acute tonsillitis.
Q5. How will you differentiate between acute membranous tonsillitis
and diphtheria on the basis of history and examination?
Q1. Define the boundaries of the oral cavity?
Answer:
Vestibule:
Lips: Anterior Boundary
Cheeks: Laterally & Externally
Gingivae & the Teeth: Internally
Mouth proper:
FLOOR:
Inferior Surface of the Tongue & Sublingual Fold
It’s the area between the gingivae and undersurface of tongue.
Frenulum and sublingual papillae with openings of submandibular ducts
can be easily seen.
ROOF:
Formed by Hard & Soft Palate
Oropharyngeal Isthmus: Present Posteriorly
*Only anterior 2/3rd of tongue is included in oral cavity.
Q2. Enumerate causative organisms of acute tonsillitis.
• Group A-Hemolytic Streptococcus
• Staphylococcus
• Pneumococci
• Haemophilus influenza

Q3. What are various types of acute tonsillitis?

Acute infections of tonsil and are classified as:

• Acute catarrhal or superficial tonsillitis

• Acute follicular tonsillitis
• Acute parenchymatous tonsillitis
• Acute membranous tonsillitis

1. Acute catarrhal or superficial tonsillitis:

Tonsillitis is a part of
generalized pharyngitis.

2. Acute follicular tonsillitis:

Infection spreads into the crypts which

become filled with purulent material, presenting at the openings
of crypts as yellowish spots.
 3. Acute parenchymatous tonsillitis:

Tonsil substance is affected.

Tonsils become enlarged and red.

4. Acute membranous tonsillitis:

It is a stage ahead of acute

follicular tonsillitis when exudation from the crypts coalesces to
form a membrane on the surface of tonsil.

Q4. Enumerate symptoms and signs of acute tonsillitis.

SYMPTOMS

The symptoms vary with severity of infection.

The predominant symptoms are:

1. Sore throat.

2. Difficulty in swallowing.

3. Fever. It may vary from 38 to 40 °C

4. Earache. It is either referred pain from the tonsil or the result

of acute otitis media which may occur as a complication.
5. Constitutional symptoms. These may include:

• Headache,
• General body aches
• Malaise and
• Constipation.
• May be abdominal pain due to mesenteric lymphadenitis
simulating a clinical picture of acute appendicitis.

SIGNS:

1. Breath is foetid and tongue is coasted.

2. There is hyperemia of pillars, soft palate and uvula.

3. Tonsils are red and swollen with yellowish spots of purulent

material presenting at the opening of crypts (acute follicular
tonsillitis) or there may be a whitish membrane on the medial
surface of tonsil which can be easily wiped away with a swab
(acute membranous tonsillitis). The tonsils may be enlarged and
congested (acute parenchymatous tonsillitis).

4. The jugulodigastric lymph nodes are enlarged and tender.

Q5. How will you differentiate between acute membranous tonsillitis
and diphtheria on the basis of history and examination?

ACUTE MEMBRANOUS DIPHTHERIA

TONSILLITIS
HISTORY: (Differentiating points)

Patient presents with

• Sudden Onset • Slow and gradual Onset

• Sore Throat • Difficulty in breathing

• Difficulty in Swallowing • Patient may come from

crowded or congested area

• • Poor socio-economic status

• May complain of Earache • Poor Immunization Status of

Patient esp. of DTaP

• May complain of Abdominal • Travel History where

Distension Diphtheria is endemic

• Patient complains of
Nasopharyngeal Discharge

• Patient could be around a

person who had already
these symptoms
EXAMINATON:

• Membrane on medial surface • Membrane on tonsils and

of tonsils surrounding area

• Membrane localized to • Membrane extends beyond

tonsils tonsils

• Membrane could or couldn’t • Membrane always present

be present.

• Membrane could be easily • Membrane is adherent and

wiped off couldn’t be removed easily.

• Removing does not lead to • Removing membrane leads to

bleeding bleeding

• Neurological Signs

In throat, where poor nerve

conduction may cause difficulty
swallowing.
Nerves to the arms and legs also
may become inflamed, causing
muscle weakness.
If the diphtheria toxin damages the
nerves that help control muscles
used in breathing, these muscles
may become paralyzed.
 • Cutaneous Signs

Ulcers covered by a gray

membrane also may be skin
diphtheria.

SOURCES:

• https://www.mayoclinic.org/diseases-conditions/diphtheria/symptoms-causes/syc-
20351897
• Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, Shruti
Dhingra (Chapters 42, 51)
• Last's Anatomy: Regional and Applied
Book by Chummy S. Sinnatamby

THANKYOU!!!