PATCHED: When the tonsils shows a membrane

Hello everyone.

I'm back with a simple mnemonic to deal with a questionably common but very important issue: The Patch On The Tonsil.

The Tonsils (Palatine) represents the most important part of Waldeyer's ring.
(Just how your engagement ring signifies a ring of safety from other hotter people hitting on you, the Waldeyer's ring makes sure no organisms hit your body. )

Here is a simple mnemonic to remember the Differential Diagnosis of A Patch on The Tonsils:

Membrane Kissed In My eVery PATCH

I've tried to keep this in the order of importance, where:

Membrane:
Membranous Tonsillitis
Kissed In:
Infectious Mononucleosis or the Kissing Disease 

My:
Malignancy of Tonsils / Leukemia

eVery:
Vincent Angina
P: -
A:
Agranulocytosis
Apthous Ulcer
T:
Traumatic
C:
Candida
Corynebacterium diphtheriae

H: -

1. Membranous Tonsillits:

- Caused by Streptococci, Hib

- Generally a form of Acute Tonsillitis. 

- Exudates from the crypts begin to join and form a patch over the tonsil . 

- Membrane can be easily wiped away with a swab. 

- Whitish Membrane 

2. Infectious Mononucleosis:

- Caused by Epstein Barr Virus 

- Exudates appear similar to that in Membranous Tonsillits. 

- Generally in young adults. 

- Non responsive to Antibiotic Therapy. 

- Atypical Lymphocytosis and positive Paul Bunnel or Monospot test 

- Lymphadenopathy very prominent 

3. Malignancies:

- Local carcinoma Tonsil. 

- Leukemias - Due to immunocompromised state produced by lack of mature competent cells 

4. Vincent Angina:

- Caused by Anaerobes like Fusobacterium and Borrelia Vincent (mixed infection)

- Fever and Discomfort are lesser 

- Membrane easily dislodged. 

- Culture / Microscopy  would show Spirocheteal Borrelia and Anaerobic bacteria 

5. Agranulocytosis:

- Due to immunocompromised state 

6. Apthous Ulcer:

- (duh.)

7. Trauma:
:P

8. Corynebacterium diphtheriae:

- Cause: Diphtheria.

- Membrane is extends beyond tonsils 

- Dirty grey in color 

- On removal it bleeds profusely 

- Albert's stain positive, Gram positive rods seen.

- Tellurite agar and Loeffer serum slope. Mnemonic: Tell-ur intern not to Loeffer around

9.Candida:

- Candida affects anything with a mucosa on it. So tonsils are no different. 

So your Management should be: 

1. Analgesics 

2. H2O2 gargles 

3. Antibiotics empirically 

4. A. If Membrane suggests a diptheria - "Tell-ur intern not to Loeffer around." 

4. B. If not , and there isn't good response : 

    5. Get a CBC - To rule out Agranulocytosis and Leukemias. Lymphocytosis can also suggest EBV. 

    6. Get a smear to distinguish Atypical Lymphocytosis. (EBV NA or Paul Bunnel to clinch diagnosis)  

   7. Get a membrane swab and culture. 

Hope this post took you out of a rough patch :')
Let me know how you like these. 

Happy-treating. 

Bye. :D 

~ A. P. Burkholderia