Respiratory system Flashcards
Community Pharmacy - Symptoms, Diagnosis and Treatment (25 cards)
Which of the following conditions causing cough is most prevalent in the immigrant population?
a. chronic bronchitis
b. asthma
c. heart failure
d. pneumonia
e. tuberculosis
e. tuberculosis
only tuberculosis from the listed conditions is more associated with ethnicity
Which of the following conditions with cough as a major presenting symptom is least likely to produce a productive cough?
a. chronic bronchitis
b. asthma
c. heart failure
d. pneumonia
e. tuberculosis
b. asthma
chronic bronchitis, bronchiectasis and tuberculosis are associated with productive coughs; pneumonia can start with a non-productive cough but becomes productive; asthma invariably has a non-productive cough
Mrs Jones visits your pharmacy complaining of having a dry cough for the last 7 days. After questioning, you decide it is a simple viral infection and recommend simple linctus. If symptoms persist, after how many further days would referral to the physician be appropriate?
a. 3 days
b. 5 days
c. 7 days
d. 10 days
e. 14 days
e. 14 days
conditional referrals are important for safety netting purposes. acute cough is defined as 3 weeks or less, so in this case giving 14 days as the referral point is correct as the person has had the cough for just 7 days.
Mr Patel, who is 48 years old, presents with a non-productive cough. Based on epidemiology, what is the most likely cause of the cough?
a. acute bronchitis
b. upper airways cough syndrome (postnasal drip)
c. asthma
d. viral infection
e. pneumothorax
d. viral infection
for all patients, regardless of age and gender, viral infection is the most common presentation
Dyspnoea is a symptom most closely associated with which condition?
a. chronic bronchitis
b. asthma
c. heart failure
d. pneumonia
e. tuberculosis
c. heart failure
Dyspnoea, difficulty in breathing, could be seen in all the listed conditions. However, in a community pharmacy context, people with conditions other than heart failure will be less associated with dyspnoea. other symptoms such as shortness of breath and fatigue will be more frequently seen.
You are recommending treatment for a young woman to treat a common cold (primary symptom of nasal congestion). She tells you that she is breastfeeding. What would be the most suitable option?
a. vitamin C
b. steam inhalation
c. oral sympathomimetics
d. topical sympathomimetics
e. antihistamines
d. topical sympathomimetics
based on evidence, topical sympathomimetics have the strongest evidence of efficacy. the added problem here is can they be given to this patient group? manufacturer data states no adverse effects recorded and states it to be used with caution.
Simon, who is 32 years old, presents with a non-productive cough of 6 days’ duration. He has no other symptoms and takes no medication. What would be the most appropriate course of action to take?
a. give pholcodine, 5ml qds
b. advise only on drinking more fluids
c. give dextromethorphan, 10ml qds
d. give guafenesin, 10ml qds
e. give glycerine lemon and honey, 10ml qds
b. advise only on drinking more fluids
guaifenesin is for productive coughs; Pholcodine and dextromethorphan are suitable for non-productive coughs but current advice is to avoid them where possible; likewise, although chemically inert, glycerine is not advocated.
Steven Blake, who is 37 years old, visits the pharmacy wanting treatment for his cough. After questioning him, you find out he has had a non-productive cough for the last 7-10 days. He also states he has had some nasal congestion and been suffering from occasional shortness of breath. Based on the signs and symptoms listed, what is the most likely diagnosis?
a. upper airways cough syndrome (UACS)
b. acute bronchitis
c. chronic bronchitis
d. pneumonia
e. pneumothorax
b. acute bronchitis
chronic bronchitis tends not to have nasal congestion; pneumonia after this time should present with productive cough; pneumothorax is very sudden in onset and will not have this history. This leaves UACS and acute bronchitis is more likely to have shortness of breath as a symptom
Jane Thompson, a 19-year old woman, has a non-productive cough. You believe it to be a viral infection. Jane is asthmatic and suffers from type 1 diabetes. What would be the most appropriate treatment or course of action?
a. no treatment
b. a demulcent
c. a cough suppressant
d. an antihistamine
e. an expectorant
a. no treatment
viral infections are self-limiting and no treatment is necessary, so (a) would be a suitable recommendation. a demulcent could be tried. because they are diabetic, a sugar-free alternative would be useful, but it is unlikely that a few days’ treatment with a demulcent containing sugar will affect their diabetic control. If a demulcent containing sugar is recommended, the person could be told to monitor their blood sugar level more regularly. Cough suppressants and antihistamines have no evidence of efficacy and should not be recommended. An expectorant is only suitable for productive coughs.
Joanne Martin presents with a productive cough. She tells you that is yellow-green in colour. Given this information, what condition is most likely?
a. acute viral infection
b. heart failure
c. pneumonia
d. chronic bronchitis
e. acute bacterial infection
a. acute viral infection
sputum colour can be useful in helping narrow down the differential diagnosis. Viral and bacterial infection can range from sputum with no colour to yellow, green or brown. Given that viral infection is much more prevalent than bacterial infection, this is the most likely condition in this scenario.
David Daly, a 52 year old man, presents with symptoms of nasal congestion, slight sore throat, headache and loss of smell. The pharmacist decides to make a referral to the physician because the differential diagnosis suggests the following:
a. influenza
b. sinusitis
c. post nasal drip
d. rhinitis
e. glandular fever
b. sinusitis
nasal congestion and sore throat are hallmark symptoms of the common cold. however, loss of smell in association with these symptoms can suggest sinusitis.
A middle-aged man presents with sore throat. He has had the symptoms for 3 days. From the list of other symptoms, which would warrant referral to the physician?
a. rhinorrhoea, cough, malaise, fever, headache and hoarseness
b. rhinorrhoea, malaise, fever, headache and hoarseness
c. rhinorrhoea, cough, malaise, headache and hoarseness
d. rhinorrhoea, cough, malaise and fever
e. rhinorrhoea, cough, malaise, fever and hoarseness
b. rhinorrhoea, malaise, fever, headache and hoarseness
The symptom cluster of rhinorrhoea, cough, malaise, fever, headache and hoarseness are suggestive of viral infection. absence of cough can indicate a bacterial infection and is therefore worthy of referral.
A 28 year old patient presents with a cold and tells you the following: ‘I developed a sore throat a few days ago and now, as you can hear, my voice is very hoarse. My nose is all bunged up and I have a headache. I have taken paracetamol, which has not helped that much’. Which of the following is the most appropriate advice to give?
a. See a GP; the paracetamol should have helped ease the symptoms
b. See a GP; it sounds like you may now have sinusitis
c. See a GP; the symptoms sound more like a bacterial infection than a viral infection
d. It sounds like a typical cold; try some vitamin C and keep taking the paracetamol
e. It sounds like a typical cold; keep taking the paracetamol and try pseudoephedrine to ease the nasal congestion
e. It sounds like a typical cold; keep taking the paracetamol and try pseudoephedrine to ease the nasal congestion
options a, b, and c all suggest referral but the symptom cluster does sound like normal symptoms of a cold and could be treated. this leaves d and e as possible correct answers. vitamin C has no evidence of efficacy, so e is the most suitable answer
From the list below, what symptom(s) would best describe a bacterial sore throat?
a. tonsillar exudate, cough, headache
b. substantial tonsillar exudate, swollen cervical glands and high-grade fever
c. tonsillar exudate, swollen cervical glands, cough and headache
d. substantial tonsillar exudate and swollen cervical glands
e. tonsillar exudate, swollen cervical glands and high-grade fever
b. substantial tonsillar exudate, swollen cervical glands and high-grade fever
a bacterial cause is hard to establish but a symptom cluster of option b is the best descriptor
Based on epidemiology, what would be the most likely condition for a 55 year old man with a productive cough and a history of smoking?
a. acute bronchitis
b. chronic bronchitis
c. viral cough
d. asthma
e. postnasal drip
c. viral cough
A viral cause should always be considered most likely although because this person is middle aged and has a history of smoking, bronchitis is also likely and should be considered as the next most likely cause.
Which of the conditions is characterised by night sweats?
a. pneumonia
b. heart failure
c. tuberculosis (TB)
d. chronic bronchitis
e. laryngotracheobronchitis
c. tuberculosis
Associated symptoms with cough are useful in formulating a differential diagnosis. Pneumonia shows signs of infection, heart failure, shortness of breath, chronic, wheeze and breathlessness and croup breathless ness. None show night sweats.
Which of the conditions has initially a non-productive painful cough that progresses to a productive cough?
a. pneumonia
b. heart failure
c. tuberculosis (TB)
d. chronic bronchitis
e. laryngotracheobronchitis
a. pneumonia
Most cough are productive or non-productive from the outset. Heart failure, TB and chronic bronchitis are productive; croup is non-productive. Only pneumonia from the listed conditions tends to change from non productive to productive.
Which of the conditions is closely associated with a history of smoking?
a. pneumonia
b. heart failure
c. tuberculosis (TB)
d. chronic bronchitis
e. laryngotracheobronchitis
d. chronic bronchitis
croup is a childhood condition; pneumonia and TB are infections; heart failure is associated with old age. Chronic bronchitis has a strong association with smoking.
Which of the conditions is associated with a high-grade fever?
a. pneumonia
b. heart failure
c. tuberculosis (TB)
d. chronic bronchitis
e. laryngotracheobronchitis
a. pneumonia
fever tends to suggest infection. From the above, only two conditions are infections in origin, pneumonia and TB. Of these, pneumonia often presents with a high fever.
Which of the conditions has a cough that is worst in the morning?
a. pneumonia
b. heart failure
c. tuberculosis (TB)
d. chronic bronchitis
e. laryngotracheobronchitis
d. chronic bronchitis
Some coughs can exhibit worse symptoms at certain times of the day. From the listed conditions, this is true of chronic bronchitis and croup. Croup shows worsening symptoms in the evening.
Which of the conditions has a cough that has a bark-like quality?
a. pneumonia
b. heart failure
c. tuberculosis (TB)
d. chronic bronchitis
e. laryngotracheobronchitis
e. laryngotracheobronchitis
The sound of the cough is not normally helpful in establishing a diagnosis. However, for croup the noise of the cough is characteristic and helpful in establishing the diagnosis.
Which medicine causes least sedation when orally administered?
a. acrivastine
b. loratadine
c. chlorphenamine
d. cetirizine
e. antazoline
b. loratadine
Antazoline is only available via the ocular route; chlorphenamine is a first-generation antihistamine and causes sedation; this leaves the three second-generation antihistamines as options. All are less sedating than first-generation antihistamines but none are truly non-sedating. Of the three, loratadine appears, from trial data, to be the least sedating.
Which medicine is most likely to cause sedation?
a. acrivastine
b. loratadine
c. chlorphenamine
d. cetirizine
e. antazoline
c. chlorphenamine
Which medicine is most suitable for a pregnant woman with nasal congestion?
a. acrivastine
b. loratadine
c. chlorphenamine
d. cetirizine
e. antazoline
c. chlorphenamine
manufacturers advise against the use of second-generation antihistamines (options a, b and d). Antazoline would not be used in nasal congestion.
