A 6-year-old has clockwork episodes of fever, aphthous ulcers, pharyngitis and cervical adenitis. Growth is normal and the child is completely well between attacks. Which statement about tonsillectomy is most accurate?
PFAPA should be confirmed clinically and mimics excluded. Tonsillectomy may reduce episodes in selected children, so frequency, burden, medical alternatives, uncertainty and operative risks should be discussed rather than applying infection-count criteria alone.
A. PFAPA is a modifying factor that can justify discussing tonsillectomy after diagnostic review: PFAPA should be confirmed clinically and mimics excluded. Tonsillectomy may reduce episodes in selected children, so frequency, burden, medical alternatives, uncertainty and operative risks should be discussed rather than applying infection-count criteria alone.
B. Tonsillectomy is contraindicated because cultures are negative: PFAPA is autoinflammatory rather than recurrent bacterial tonsillitis.
C. Every child with recurrent fever requires immediate tonsillectomy: The syndrome must be established and treatment individualised.
D. Long-term antibiotics are mandatory: Antibiotics do not treat the underlying periodic fever syndrome.
E. Adenoidectomy alone is proven equivalent: The evidence and guideline modifying factor concern tonsillectomy, not isolated adenoidectomy.
If fever occurred with persistent inflammation, poor growth or symptoms between attacks, immunological, haematological or infectious alternatives would need renewed investigation.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
Back to the Section 1 bank