Quinsy

Quinsy

Q. 1 In which of  the following locations there is collection of pus in the quinsy:
 A Peritonsillar space
 B Parapharyngeal space
 C Retropharyngeal space
 D Within the tonsil
Q. 1 In which of  the following locations there is collection of pus in the quinsy:
 A Peritonsillar space
 B Parapharyngeal space
 C Retropharyngeal space
 D Within the tonsil
Ans. A

Explanation:

Peritonsillar space

Quinsy (Peritonsillar abscess) usually unilateral and most commonly affected adult males

i) This consists of suppuration outside the tonsillar capsule, and the swelling can extends to the soft palate and the tonsil may also be pushed medially.

ii) It is a complication of acute or chronic tonsillitis, There occurs accumulation of pus between the tonsil capsule and tonsil bed. In most cases pus collection occurs antero-superior to tonsil, but may sometimes occur lateral or superior to tonsil

iii) Quinsy is the collection of pus in the peritonsillar space which lies between the capsule of tonsil and the superior constrictor muscle

Para-pharyngeal labscess-infection from tonsil or peritonsillar tissue may involve parapharyngeal space with

abscess formation.

The tonsil should be removed 6-8 weeks following a quinsy

Complication of peritonsillar abscess

Aspiration and asphyxia

Para pharyngeal abscess

Thrombosis of internal jugular vein or even a carotid artery rupture can occurs because of extension of this abscess to para pharyngeal space   Laryngeal oedema with resultant asphyxia

Septicaemia and multiple abscesses mayo cure


Q. 2

Quinsy is also known as

 A

Peritosillar abscess

 B

Retropharyngeal abscess

 C

Parapharyngeal abscess

 D

Paraepiglottic abscess

Q. 2

Quinsy is also known as

 A

Peritosillar abscess

 B

Retropharyngeal abscess

 C

Parapharyngeal abscess

 D

Paraepiglottic abscess

Ans. A

Explanation:

Q. 3

Swelling between tonsillar area and superior constrictor muscle is known as:

 A

Quinsy

 B

Dental abscess

 C

Par apharyngeal abscess

 D

Retroparyngeal abscess

Q. 3

Swelling between tonsillar area and superior constrictor muscle is known as:

 A

Quinsy

 B

Dental abscess

 C

Par apharyngeal abscess

 D

Retroparyngeal abscess

Ans. A

Explanation:

Q. 4

Quinsy is also known as:

 A

Peritosillar abscess

 B

Retropharyngeal abscess

 C

Parapharyngeal abscess

 D

Paraepiglottic abscess

Q. 4

Quinsy is also known as:

 A

Peritosillar abscess

 B

Retropharyngeal abscess

 C

Parapharyngeal abscess

 D

Paraepiglottic abscess

Ans. A

Explanation:

Quinsy is also known as peritonsillar abcess, it is a collection of pus in the peritonsillar space which lies between the capsule of palatine tonsil and pharyngeal muscle.

Peritonsillar abcess is the most common deep space infection of head and neck in the adult.

It is characterized by pain, difficulty swallowing, trismus, hot potato voice, fever, malaise, dehydration and rancid breath.

Examination shows erythematous oropharyngeal mucosa, purulent tonsillar exudates, inferomedial displacement of tonsil on the involved side with contralateral deviation of the uvula.


Q. 5

A child with high fever, severe sore throat presented with painful swallowing. Her voice was abnormal. Quinsy was diagnosed. What is referred to as Quinsy?

 A

Peritonsillar abscess

 B

Retropharyngeal abscess

 C

Parapharyngeal abscess

 D

Any of the above

Q. 5

A child with high fever, severe sore throat presented with painful swallowing. Her voice was abnormal. Quinsy was diagnosed. What is referred to as Quinsy?

 A

Peritonsillar abscess

 B

Retropharyngeal abscess

 C

Parapharyngeal abscess

 D

Any of the above

Ans. A

Explanation:

  • When infection penetrates the tonsillar capsule and involves the surrounding tissues, peritonsillar cellulitis results.
  • Peritonsillar abscess otherwise known as ‘quinsy’ and cellulitis present with severe sore throat, odynophagia, trismus, medial deviation of the soft palate and peritonsillar fold, and an abnormal muffled (“hot potato”) voice.
 

Q. 6

Pus collection in “quinsy” usually gets collected in which location?

 A

Peritonsillar space

 B

Within the tonsil

 C

Parapharyngeal space

 D

Retropharyngeal space

Q. 6

Pus collection in “quinsy” usually gets collected in which location?

 A

Peritonsillar space

 B

Within the tonsil

 C

Parapharyngeal space

 D

Retropharyngeal space

Ans. A

Explanation:

Quinsy usually follows an episode of acute tonsillitis.

Parapharyngeal abscess is a complication of quinsy.


Q. 7

Quincy tonsillectomy is done in:

 A

Tonsilolith

 B

Tonsillar malignancy

 C

Tonsillitis

 D

None of the above

Q. 7

Quincy tonsillectomy is done in:

 A

Tonsilolith

 B

Tonsillar malignancy

 C

Tonsillitis

 D

None of the above

Ans. C

Explanation:

Q. 8

Tonsillectomy following peritonsillar abscess is done after weeks:

 A

1-3 weeks

 B

6-8 weeks

 C

4-6 weeks

 D

8-12 weeks

Q. 8

Tonsillectomy following peritonsillar abscess is done after weeks:

 A

1-3 weeks

 B

6-8 weeks

 C

4-6 weeks

 D

8-12 weeks

Ans. B

Explanation:

 

 

The tonsils should be removed 6-8 weeks following a Quinsy. – Turner 10th/ed p 86

Tonsils are removed 4-6 weeks following an attack of Quinsy. – Dhingra 6th/ed 

Most people would practise interval tonsillectomy for these patients, deferring surgery for 6 weeks following resolution of an attack. – Head and Neck Surgery by Chris de Souza  


Q. 9

Contraindication of adenotonsillectomy:

 A

Age < 4 yr

 B

Poliomyelitis

 C

Haemophilus infection

 D

b and c

Q. 9

Contraindication of adenotonsillectomy:

 A

Age < 4 yr

 B

Poliomyelitis

 C

Haemophilus infection

 D

b and c

Ans. D

Explanation:

 

Tonsillectomy should not be performed during epidemics of poliomyelitis.This is because there are evidences that the virus may gain access to the exposed nerve sheaths and give rise to the fatal bulbar form of the disease.

It should not be undertaken in the presence of respiratory tract infections or during the period of incubation of after contact with one of the infectious disease (i.e. Haemophilus) or if there is tonsillar inflammation.

It is safer to wait for 3 weeks after an acute inflammatory disease, before performing tonsillectomy

According of Turner – Tonsillectomy can be performed at any age, if there are sufficient indications for their removal.

According to Dhingra –  Children < 3 years (Not < 4 years as given in the options) are poor candidates for surgery. So tonsillectomy should not be done in them.

According to Head and Neck Surgery de Souza ‑ As tonsillar tissue has a role in the development of the immune system, it is advisable that surgery should be delayed until the age of 3 whenever possible.


Q. 10

In which of the following locations, there is collection of pus in the quinsy:

 A

Peritonsillar space

 B

Parapharyngeal space

 C

Retropharyngeal space

 D

Within the tonsil

Q. 10

In which of the following locations, there is collection of pus in the quinsy:

 A

Peritonsillar space

 B

Parapharyngeal space

 C

Retropharyngeal space

 D

Within the tonsil

Ans. A

Explanation:

 

Quinsy is collection of pus in the peritonsillar space which lies between the capsule of tonsil and superior constrictor muscle i.e. peritonsillar abscess.


Q. 11

True about quinsy is:

 A

Penicillin is used in treatment

 B

Abscess is located in capsule

 C

Commonly occurs bilaterally

 D

Immediate tonsillectomy should be done

Q. 11

True about quinsy is:

 A

Penicillin is used in treatment

 B

Abscess is located in capsule

 C

Commonly occurs bilaterally

 D

Immediate tonsillectomy should be done

Ans. A

Explanation:

 

  • Quinsy is collection of pus outside the capsule (not in capsule) in peritonsillar area
  • It is usually unilateral
  • Patient presents with toxic symptoms due to septicemia as well as local symptoms (e.g. dribbling of saliva from mouth)
  • Antibiotics: High-dose penicillin. (IV benzipenicillin) is the DOC. In patients allergic to penicillin, erythromycin is the DOC. If antibiotics fail to relieve the condition within 48 hours, then the abscess must be opened and drained.



Q. 12

7-year-old child has peritonsillar abscess and presents with trismus, the best treatment is:

 A

Immediate abscess drainage orally

 B

Drainage externally

 C

Systemic antibiotics up to 48 hours then drainage

 D

Tracheostomy

Q. 12

7-year-old child has peritonsillar abscess and presents with trismus, the best treatment is:

 A

Immediate abscess drainage orally

 B

Drainage externally

 C

Systemic antibiotics up to 48 hours then drainage

 D

Tracheostomy

Ans. C

Explanation:

Q. 13

Quinsy refers to ‑

 A

Intra-tonsillar abscess

 B

Peritonsillar abscess

 C

Submandibular abscess

 D

Retropharyngeal abscess

Q. 13

Quinsy refers to ‑

 A

Intra-tonsillar abscess

 B

Peritonsillar abscess

 C

Submandibular abscess

 D

Retropharyngeal abscess

Ans. B

Explanation:

Ans. is ‘b’ i.e., Peritonsillar abscess

Ouinsv (Peritonsillar abscess)

Quinsy consists of suppuration outside the capsule in the area around the capsule. There is collection of pus between the capsule of tonsil and the superior constrictor muscle, i.e. in the peritonsillar area. Peritonsillar abscess is a complication of tonsillitis and is most commonly caused by group A beta – hemolytic streptococcus. Clinical features of Quinsy

Clinical features are divided into :‑

1) General : They are due to septicaemia and resemble any acute infection. They include fever (up to 104°F), chills and rigors, general malaise, body aches, headache, nausea and constipation.

2) Local :

  1. Severe pain in throat. Usually unilateral.
  2. Odynophagia. It is so marked that the patient cannot even swallow his own saliva which dribbles from the angle of his mouth. Patient is usually dehydrated.
  3. Muffled and thick speech, often called “Hot potato voice”.
  4. Foul breath due to sepsis in the oral cavity and poor hygiene.
  5. Ipsilateral earache. This is referred pain via CN IX which supplies both the tonsil and the ear.
  6. Trismus due to spasm of pterygoid muscles which are in close proximity to the superior constrictor.

Examination findings

  1. The tonsil, pillars and soft palate on the involved side are congested and swollen. Tonsil itself may not appear enlarged as it gets buried in the oedematous pillars.
  2. Uvula is swollen and oedematous and pushed to the opposite side.
  3. Bulging of the soft palate and anterior pillar above the tonsil.
  4. Mucopus may be seen covering the tonsillar region.
  5. Cervical lymphadenopathy is commonly seen. This involves jugulodigastric lymph nodes.
  6. Torticollis : Patient keeps the neck tilted to the side of abscess.

Treatment of peritonsillar abscess

  • IV fluids
  • Antibiotics : High dose penicllin. (iv benzipenicillin) is the DOC. In patients allergic to penicillin erythromycin is the DOC.
  • Incision and drainage per orally, if the abscess does not resolve depite high dose of iv antibiotics.
  • Tonsillectomy is done 6 weeks following an attack of quinsy (interval tonsillectomy).


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