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Minor ailments Flashcards

L15, 16, 17, 17A (164 cards)

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1
Q

L15

What is an allergy and What is an allergen?

A

An allergy is an immune system reaction to a harmless substance, classified as a hypersensitivity disorder.
An allergen is a substance that triggers an allergic reaction.

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2
Q

L15 Allergies

Name risk factors for allergies.

A

Heredity, gender, race, age, environmental factors (pollution, allergen levels, dietary changes).

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3
Q

L15 Allergies

Define atopy.

A

A genetic predisposition to produce IgE antibodies in response to allergens, affecting the nose, eyes, skin, and lungs.

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4
Q

L15 Allergies

List common allergens and examples.

A

Proteins (e.g., foreign serum, vaccines)

Plant pollens (e.g., rye grass, ragweed)

Foods (e.g., nuts, seafood)

Drugs (e.g., penicillin)

Insect products (e.g., bee venom)

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5
Q

L15 Allergies

What are the actions of histamine on H1 receptors?

A

Vasodilation (erythema)

Increased capillary permeability (oedema)

Smooth muscle contraction (bronchoconstriction, GI motility)

Stimulation of sensory nerves (itch)

Increased gland secretions (nasal, salivary)

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6
Q

L15 Allergies

What is allergic rhinitis?

A

Inflammation of the nasal lining causing sneezing, nasal discharge, and blockage, affecting 1 in 5 people in the UK

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7
Q

L15 Allergies

Differentiate between types of allergic rhinitis.

A

Seasonal (e.g., hay fever): Symptoms occur with outdoor allergens (e.g., pollen).

Perennial: Year-round symptoms caused by indoor allergens (e.g., dust mites).

Occupational: Work-related allergens (e.g., wood dust).

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8
Q

L15 Allergies

Name non-pharmacological strategies for managing allergic rhinitis.

A

Allergen avoidance (e.g., keeping windows closed)

Using wrap-around sunglasses

Regular cleaning to minimize allergens

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9
Q

L15 Allergies

What are pharmacological treatments for allergic rhinitis?

A

H1 receptor antagonists (antihistamines)

Mast cell stabilisers

Intranasal corticosteroids

Local vasoconstrictors

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10
Q

L15 Allergies

Differentiate between 1st and 2nd generation antihistamines.

A

1st Generation: Cross blood-brain barrier, cause sedation (e.g., chlorphenamine).

2nd Generation: More selective, less sedation (e.g., loratadine).

Q: What is the preferred generation for allergic rhinitis treatment?
A: 2nd generation due to reduced side effects and dosing frequency.

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11
Q

L15 Allergies

What are the roles of mast cell stabilisers in eye drops?

A

Prevent histamine release, used for itchy and runny eyes.

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12
Q

L15 Allergies

List examples of intranasal corticosteroids.

A

Beclometasone, budesonide, fluticasone, mometasone.

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13
Q

L15 Allergies

When should allergic rhinitis patients be referred?

A

Symptoms persist despite treatment

Sleep disruption

Nasal obstruction that doesn’t clear

Red flags (e.g., orbital cellulitis, recurrent nosebleeds)

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14
Q

L15: Allergies

What type of hypersensitivity reaction is responsible for most allergic responses?
a) Type I (Immediate)
b) Type II (Cytotoxic)
c) Type III (Immune complex-mediated)
d) Type IV (Delayed-type)

A

Answer: a) Type I (Immediate)

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15
Q

L15: Allergies

Which antibody is mainly involved in allergic reactions?
a) IgA
b) IgG
c) IgE
d) IgM

A

Answer: c) IgE

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16
Q

L15: Allergies

Which of the following is NOT a typical allergen?
a) Plant pollen
b) Bee venom
c) Animal dander
d) Insulin

A

Answer: d) Insulin

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17
Q

L15: Allergies

What is “Atopy”?
a) Acquired immunity to allergens
b) Genetic predisposition to produce IgE antibodies
c) Inflammatory response caused by viruses
d) A severe form of eczema

A

Answer: b) Genetic predisposition to produce IgE antibodies

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18
Q

L15: Allergies

Which symptom is MOST associated with allergic rhinitis?
a) Vomiting
b) Sneezing
c) Diarrhoea
d) Wheezing

A

Answer: b) Sneezing

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19
Q

L15: Allergies

The “Triple Response of Lewis” describes the skin’s reaction to:
a) Bacterial infection
b) Viral invasion
c) Mechanical injury and histamine release
d) Fungal infection

A

Answer: c) Mechanical injury and histamine release

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20
Q

L15: Allergies

Which is the correct order of the “Triple Response of Lewis”?
a) Flare → Red Line → Wheal
b) Wheal → Flare → Red Line
c) Red Line → Flare → Wheal
d) Flare → Wheal → Red Line

A

Answer: c) Red Line → Flare → Wheal

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21
Q

L15: Allergies

Which of the following is a 2nd generation antihistamine?
a) Chlorphenamine
b) Diphenhydramine
c) Cetirizine
d) Promethazine

A

Answer: c) Cetirizine

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22
Q

L15: Allergies

First-generation antihistamines are more likely to cause which side effect?
a) Hypertension
b) Drowsiness
c) Increased appetite
d) Liver damage

A

Answer: b) Drowsiness

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23
Q

L15: Allergies

What is rhinitis medicamentosa caused by?
a) Allergens
b) Prolonged use of nasal vasoconstrictors
c) Viral infections
d) Bacterial overgrowth in nasal mucosa

A

Answer: b) Prolonged use of nasal vasoconstrictors

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24
Q

L15: Allergies

Intranasal corticosteroids like fluticasone are used because they: a) Provide immediate relief within minutes
b) Reduce local inflammation with minimal systemic absorption
c) Cure the allergy permanently
d) Have strong antibacterial properties

A

Answer: b) Reduce local inflammation with minimal systemic absorption

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25
# L15: Allergies Which of the following is an example of non-pharmacological management for allergic rhinitis? a) Using antihistamines b) Using nasal decongestants c) Monitoring pollen counts and closing windows d) Taking corticosteroid tablets
Answer: c) Monitoring pollen counts and closing windows
26
When should a patient with allergic rhinitis be referred to a specialist? a) If symptoms are mild and occasional b) If there is sleep disruption despite treatment c) If there is improvement after antihistamines d) If they have itchy eyes alone
Answer: b) If there is sleep disruption despite treatment
27
# L15: Allergies Anaphylaxis involves: a) A mild, localized skin rash b) A delayed allergic response c) Life-threatening shock and airway constriction d) Only gastrointestinal symptoms
Answer: c) Life-threatening shock and airway constriction
28
# L15: Allergies Which local vasoconstrictor has the longest action (up to 8 hours)? a) Phenylephrine b) Oxymetazoline c) Epinephrine d) Salbutamol
Answer: b) Oxymetazoline
29
# L15: Allergies A 7-year-old child presents with persistent nasal congestion, sneezing, and itchy eyes throughout the year. His symptoms worsen around his pet cat. Which type of allergic rhinitis is MOST likely? a) Seasonal allergic rhinitis b) Perennial allergic rhinitis c) Occupational allergic rhinitis d) Viral rhinitis
Answer: b) Perennial allergic rhinitis
30
# L15: Allergies A 22-year-old woman with seasonal allergic rhinitis uses oxymetazoline nasal spray continuously for 4 weeks. She now complains of worsening nasal blockage. What is the most likely diagnosis? a) Allergic rhinitis exacerbation b) Rhinitis medicamentosa c) Sinusitis d) Nasal polyp formation
Answer: b) Rhinitis medicamentosa
31
# L15: Allergies A patient with a history of atopy experiences sudden hypotension, wheezing, and widespread urticaria after eating peanuts. Immediate management includes: a) Oral antihistamines b) Oral corticosteroids c) Intramuscular adrenaline d) Intravenous antibiotics
Answer: c) Intramuscular adrenaline
32
# L15: Allergies A 34-year-old man with allergic rhinitis uses cetirizine but still complains of nasal congestion and sneezing. What is the NEXT BEST step in management? a) Increase the dose of cetirizine b) Add a local vasoconstrictor c) Start intranasal corticosteroids d) Switch to a first-generation antihistamine
Answer: c) Start intranasal corticosteroids
33
# L15: Allergies A 28-year-old woman who works as a baker presents with nasal congestion and sneezing mainly while at work. Symptoms resolve when on holiday. What is the most probable diagnosis? a) Seasonal allergic rhinitis b) Viral rhinitis c) Occupational allergic rhinitis d) Perennial allergic rhinitis
Answer: c) Occupational allergic rhinitis
34
# L15: Allergies A 45-year-old man is started on chlorphenamine for allergic rhinitis. Shortly after starting therapy, he reports feeling extremely drowsy and has difficulty concentrating at work. What is the most appropriate action? a) Advise him to stop medication and avoid allergens b) Switch to a second-generation antihistamine c) Increase chlorphenamine dosage d) Add a corticosteroid spray
Answer: b) Switch to a second-generation antihistamine
35
# L15: Allergies A 10-year-old boy using sodium cromoglicate eye drops complains they are not helping his itchy eyes after one day of use. What is the BEST advice? a) Stop using the drops and switch to steroids b) Use drops regularly for better effect c) Use drops only when symptoms are severe d) Increase the number of drops per use
Answer: b) Use drops regularly for better effect
36
# L15: Allergies A 35-year-old man presents with unilateral nasal obstruction and no other allergic symptoms. Which is the most appropriate course of action? a) Start intranasal corticosteroids b) Refer to specialist for further investigation c) Recommend a saline nasal wash d) Prescribe an oral antihistamine
Answer: b) Refer to specialist for further investigation
37
# L15: Allergies A patient with severe allergic rhinitis and known anaphylaxis to bee stings asks about emergency preparedness. What is the MOST important advice? a) Carry antihistamine tablets at all times b) Wear a scarf during high pollen days c) Carry two adrenaline autoinjector pens d) Stay indoors at all times
Answer: c) Carry two adrenaline autoinjector pens
38
# L15: Allergies Which characteristic differentiates allergic rhinitis from the common cold? a) Nasal congestion b) Presence of fever c) Rapid onset of symptoms after allergen exposure d) Cough and sore throat predominance
Answer: c) Rapid onset of symptoms after allergen exposure
39
# L16: Coughs and Colds What are the classifications of cough by duration?
1. Acute (<3 weeks): Commonly due to cold/flu or asthma. 2. Subacute (3–8 weeks): Often post-infection or due to airway inflammation. 3. Chronic (>8 weeks): Caused by allergies, reflux, infection, or serious conditions like lung cancer.
40
# L16: Coughs and Colds What is the difference between a dry and a chesty cough?
* Dry Cough: Non-productive, with no mucus. * Chesty Cough: Productive, with mucus (clear, yellow, or green). | For chesty if you see this, refer to GP
41
# L16: Coughs and Colds How are coughs treated?
*Dry Cough: Suppressants (e.g., codeine, dextromethorphan). * Chesty Cough: Expectorants (e.g., guaifenesin). * Soothing agents: Demulcents like honey or glycerol.
42
# L16: Coughs and Colds What is rhinitis medicamentosa?
Rebound congestion caused by prolonged use of topical decongestants (>7 days). Recovery can take months for severe cases.
43
# L16: Coughs and Colds What are the treatment options for a cold?
1. Symptomatic remedies: - Painkillers (e.g., paracetamol). - Antihistamines for decongestion or sedation. - Steam inhalation (menthol, eucalyptus). 2. Decongestants: Pseudoephedrine, phenylephrine (available as nasal sprays, drops, or tablets).
44
# L16: Coughs and Colds What are the legal restrictions for pseudoephedrine in the UK?
Cannot sell more than 720 mg of pseudoephedrine or 180 mg of ephedrine without a prescription. Illegal to sell products containing both pseudoephedrine and ephedrine in one transaction.
45
# L16: Coughs and Colds What are some non-pharmacological treatments for children with a cough or cold?
* Rest and fluids. * Saline nasal drops for congestion. * Lemon and honey drinks (not for infants <1 year). * Vapour rubs and steam inhalation. *
46
# L16: Coughs and Colds What are the red flags for lung cancer linked to coughing?
* Cough >3 weeks. * Blood in phlegm (haemoptysis). * Persistent chest/shoulder pain. * Unexplained weight loss or fatigue * Persistent breathlessness or hoarseness.
47
# L16: Coughs and Colds How can influenza be differentiated from the common cold?
* Cold: Gradual onset, mild symptoms, nasal congestion. * Flu: Sudden onset, fever, severe malaise, aches, and potential complications in vulnerable populations.
48
# L16: Coughs and Colds What are the best practices for treating cough in children?
* Avoid antitussives, expectorants, and decongestants in children under 6. * Use glycerol, simple linctus, or warm clear fluids. * Refer to GP if symptoms persist or worsen.
49
# L16: Coughs and Colds What is the role of hydration in managing a chesty cough?
Hydration reduces mucus viscosity, making it easier to clear. Water acts as a natural expectorant.
50
# L16: Coughs and Colds Why is codeine not recommended for children under 18?
Due to safety concerns, including risks of respiratory depression.
51
# L16: Coughs and Colds What should be determined during OTC supply for coughs?
* Who: Patient’s age and underlying conditions. * What: Nature and history of symptoms. * How long: Exclude chronic conditions. * Any other symptoms? * Medication: Current or past treatments.
52
# L16: Coughs and Colds What are the limitations of OTC cough medicines?
Cochrane reviews show no strong evidence for their efficacy in acute cough.
53
# L16: Coughs and Colds What are some common side effects of decongestants?
* Increased blood pressure. * Avoid in diabetes, hypertension, heart disease, and pregnancy.
54
# L16: Coughs and Colds What is the main difference between a cold and flu in terms of contagion?
* Cold: Less contagious, mostly mild symptoms. * Flu: Highly contagious, especially in the first 3 days, spread via nasal secretions and airborne droplets.
55
# L16: Coughs and Colds A 45-year-old man with a history of hypertension presents with nasal congestion from a cold. Which decongestant should be avoided? a) Oxymetazoline nasal spray b) Pseudoephedrine tablets c) Saline nasal drops d) Steam inhalation with menthol
Answer: b) Pseudoephedrine tablets
56
# L16: Coughs and Colds Which of the following accurately differentiates influenza from the common cold? a) Nasal congestion is only seen in influenza b) Influenza is more often associated with a high fever and limb aches c) The cold has a more severe systemic illness d) Influenza typically causes green sputum production
Answer: b) Influenza is more often associated with a high fever and limb aches
57
# L16: Coughs and Colds A mother asks for a cough syrup for her 4-year-old son with a mild cough and runny nose. According to MHRA guidance, which is the BEST advice? a) Recommend pholcodine linctus b) Recommend guaifenesin syrup c) Recommend simple linctus (glycerol-based) or fluids d) Recommend codeine syrup
Answer: c) Recommend simple linctus (glycerol-based) or fluids
58
# L16: Coughs and Colds What is a major risk associated with long-term use (>7 days) of oxymetazoline nasal spray? a) Systemic hypertension b) Development of rhinitis medicamentosa c) Opportunistic fungal infection d) Acute bacterial sinusitis
Answer: b) Development of rhinitis medicamentosa
59
# L16: Coughs and Colds A 68-year-old man reports a chronic cough lasting 10 weeks, mild haemoptysis, and recent weight loss. What is the most important next step? a) Prescribe a cough suppressant b) Recommend steam inhalation c) Refer urgently for chest imaging d) Start antibiotics empirically
Answer: c) Refer urgently for chest imaging
60
# L16: Coughs and Colds Which mechanism best explains how decongestants like phenylephrine improve nasal symptoms? a) Beta-2 adrenergic stimulation b) Alpha-adrenergic vasodilation c) Alpha-adrenergic vasoconstriction d) Histamine receptor blockade
Answer: c) Alpha-adrenergic vasoconstriction
61
# L16: Coughs and Colds A patient has a dry, non-productive cough 2 weeks after recovering from a cold. Which option would be most suitable for symptom relief? a) Guaifenesin b) Steam inhalation c) Pholcodine linctus d) Amoxicillin
Answer: c) Pholcodine linctus
62
# L16: Coughs and Colds Which of the following is TRUE regarding guaifenesin? a) Strong clinical evidence shows it shortens the duration of coughs b) It acts as a direct alpha-agonist in nasal tissues c) It helps reduce mucus viscosity through hydration mechanisms d) It is contraindicated in children over 6 years old
Answer: c) It helps reduce mucus viscosity through hydration mechanisms
63
# L16: Coughs and Colds Why is pseudoephedrine sales restricted under MHRA guidelines? a) It causes severe allergic reactions b) It is used in the manufacture of methamphetamine c) It causes chronic liver damage d) It is highly addictive itself
Answer: b) It is used in the manufacture of methamphetamine
64
# L16: Coughs and Colds A patient comes in asking for "something stronger" for their 5-day cough after a viral cold. What red flag should prompt immediate referral instead of OTC treatment? a) Mild sore throat b) Fever that resolved after 24 hours c) Persistent hoarseness and weight loss d) Yellow nasal discharge
Answer: c) Persistent hoarseness and weight loss
65
# L16: Coughs and Colds A 30-year-old woman with asthma develops a chesty cough producing green sputum following a cold. No fever or breathlessness. Best initial advice? a) Start antibiotics immediately b) OTC expectorants and hydration c) High-dose corticosteroids d) Oral antihistamines
Answer: b) OTC expectorants and hydration
66
# L16: Coughs and Colds A 10-year-old boy presents with a dry cough, worsened by exercise and cold air exposure, lasting 6 weeks post-cold. Most likely diagnosis? a) Common cold b) Bacterial pneumonia c) Post-viral airway hyperreactivity (post-viral cough) d) Lung cancer
Answer: c) Post-viral airway hyperreactivity (post-viral cough)
67
# L16: Coughs and Colds Which cough suppressant is now generally AVOIDED in all children under 18 years old? a) Pholcodine b) Codeine c) Guaifenesin d) Dextromethorphan
Answer: b) Codeine
68
# L16: Coughs and Colds A 29-year-old man reports worsening breathlessness and a productive cough 10 days after a cold. He also develops pleuritic chest pain. What is the most appropriate next step? a) Recommend OTC steam inhalation b) Prescribe oral corticosteroids c) Refer for urgent chest X-ray d) Supply an OTC expectorant
Answer: c) Refer for urgent chest X-ray
69
# L17: Pain What are the factors influencing pain?
Biological, psychological, and social factors.
70
# L17: Pain What is nociception?
It refers to the activation of pain receptors (nociceptors) by noxious stimuli, such as tissue injury or extreme temperatures
71
# L17: Pain What are the classifications of pain?
1. By Type: Nociceptive, Neuropathic, and Pain with no apparent cause. 2. By Duration: Acute, Chronic (Persistent), Recurrent/Intermittent.
72
# L17: Pain What is the WHO three-step analgesic ladder?
1. Mild pain: Non-opioid (paracetamol) ± adjuvant. 2. Moderate pain: Weak opioid (codeine) ± non-opioid ± adjuvant. 3. Severe pain: Strong opioid (morphine) ± non-opioid ± adjuvant.
73
# L17: Pain What are the key characteristics of paracetamol? A:
Non-opioid, CNS-acting analgesic. Antipyretic, but no anti-inflammatory effects. Side effects are few and rare. Adult dose: 500-1000 mg every 4-6 hours (max 4 g/day).
74
# L17: Pain What are some examples of compound analgesics?
Co-codamol (paracetamol+codeine) Co-dydramol (paracetamol and Dihydrocodeine moderate dose) P Paramol (paracetamol and Dihydrocodeine low dose) OTC
75
# L17: Pain What is paracetamol hepatotoxicity?
Overdose leads to the accumulation of toxic metabolite NAPQI, causing liver damage. Risk factors include chronic alcohol use and malnutrition.
76
# L17: Pain What are the limitations on OTC paracetamol sales in pharmacies?
Max 100 non-effervescent tablets/capsules. Usually supplied in packs of 16 or 32 dose units. Professional judgment required for larger quantities.
77
# L17: Pain Name the common NSAIDs available OTC
Aspirin, ibuprofen, diclofenac, and naproxen.
78
# L17: Pain What are the contraindications for aspirin use?
Children under 16 (Reye's syndrome risk). Hypersensitivity, especially in asthma patients. Avoid in bleeding disorders.
79
# L17: Pain What are the potential side effects of NSAIDs?
GI issues: Gastritis, ulcers, bleeding. Renal effects: Reduced renal blood flow. Cardiovascular risks: Increased thrombotic events.
80
# L17: Pain What are the red flags for referral in pain management?
Severe headache onset. Neck stiffness and photophobia. Persistent weight loss. Visual disturbances. Neurological symptoms (seizures, numbness).
81
# L17: Pain What does the acronym "SOCRATES" in pain assessment stand for?
S: Site O: Onset C: Characteristics R: Radiates A: Associated symptoms T: Time course E: Exacerbating/relieving factors S: Severity
82
# L17: Pain What is temporal arteritis (giant cell arteritis), and why is it serious?
Cause: Inflammation of arteries in the temples. Symptoms: Severe continuous headaches (one or both sides), scalp tenderness, jaw pain, vision problems. Complication: If untreated, it can lead to blindness. Demographics: Affects individuals >50 years, incidence of 1 in 5000. Referral: Requires immediate medical attention.
83
# L17: Pain What are the characteristics of sinusitis-related headaches?
Cause: Inflammation of sinus mucosal lining due to allergies or viral/bacterial infection. Pain: Severe, with tenderness, worsens when bending forward or lying down. Referral: Necessary for treating secondary bacterial infections.
84
# L17: Pain What are the key features of migraines?
Pain: Unilateral, pulsing or throbbing, onset over minutes to hours. Aura: Visual disturbances (flashing lights, zigzag lines, or partial visual field loss) lasting up to 60 minutes. Associated symptoms: Nausea, vomiting, sensitivity to light, impaired daily activities. Duration: Up to 72 hours. Demographics: More common in women.
85
# L17: Pain What are the characteristics of cluster headaches?
Pain: Severe, unilateral (one side of the head), often around the eye and temporal area. Frequency: Occurs in clusters, can recur daily for months or years. Duration: Lasts 15 minutes to 3 hours. Associated symptoms: Lacrimation (tearing), rhinitis (nasal congestion). Trigger patterns: Often occur at similar times of the day. Note: Requires referral if frequent.
86
# L17: Pain What are the characteristics of tension-type headaches?
Pain: Mild to moderate, described as a tight band around the head. Features: Dull ache, constant pressure, bilateral, non-pulsating, no aura, no light sensitivity. Cause: Muscle spasms in the neck and scalp. Triggers: Stress, lack of sleep, alcohol, dehydration. Activity Impact: Not aggravated by physical activity.
87
# L17: Pain How are headaches classified?
1. Primary headaches: Standalone conditions (e.g., migraine, tension-type, cluster headaches). 2. Secondary headaches: Symptomatic of underlying issues (e.g., infections, neoplasms, vascular problems, intracranial bleeds, or drug-induced).
88
# L17: Pain Name red flags that require referral for pain.
Visual disturbances Neck stiffness with photophobia Sudden/severe headache Weight loss Fever Neurological symptoms (e.g., numbness, seizures)
89
# L17: Pain What is first-line OTC treatment for dysmenorrhoea?
Naproxen or ibuprofen.
90
# L17: Pain What are rubefacients and their mechanism?
Counter-irritants causing vasodilation to distract from pain.
91
# L17: Pain Which of the following best defines pain according to IASP? A. A physical response to injury B. The sensation of discomfort due to inflammation C. An unpleasant sensory and emotional experience associated with actual or potential tissue damage D. A reaction to temperature extremes
C. An unpleasant sensory and emotional experience associated with actual or potential tissue damage ✅ Explanation: The International Association for the Study of Pain (IASP) defines pain as more than just physical; it includes emotional experiences. It's subjective and can't be fully explained by physical findings alone.
92
# L17: Pain Which statement about pain is FALSE? A. Pain is a subjective experience B. Nociception and pain are the same C. Pain is influenced by psychological and social factors D. Respecting the patient's report of pain is essential
✅ Answer: B Explanation: Nociception is the detection of noxious stimuli by sensory neurons, while pain is the conscious experience of discomfort. The two are related but not the same.
93
# L17: Pain Which statement is TRUE regarding effervescent paracetamol sales? A. They are subject to a strict 32-tablet limit B. They can only be sold with a prescription C. There is no legal limit, but pharmacists should use professional judgment D. They are banned in children under 16
C. There is no legal limit, but pharmacists should use professional judgment ✅Explanation: Neuropathic pain stems from nerve damage and is often described with unusual sensations like burning, tingling, or electrical shocks.
94
# L17: Pain Which of the following is an example of acute nociceptive pain? A. Diabetic neuropathy B. Shingles C. Twisted ankle D. Chronic arthritis
C. Twisted ankle ✅ Explanation: A twisted ankle involves tissue damage activating nociceptors, making it a clear case of acute nociceptive pain.
95
# L17: Pain Which of the following is NOT a side effect commonly associated with NSAIDs? A. Gastric irritation B. Constipation C. Increased blood pressure D. Renal impairment
B. Constipation ✅🧠 Explanation: Constipation is more associated with opioid analgesics. NSAIDs are known for GI, renal, and cardiovascular risks.
96
# L17: Pain What is the maximum recommended daily dose of paracetamol for adults? A. 2 g B. 3 g C. 4 g D. 5 g
C. 4 g ✅
97
# L17: Pain Why is aspirin contraindicated in children under 16? A. It causes asthma B. Risk of gastrointestinal bleeding C. Causes Reye’s syndrome D. It is ineffective in children
C. Causes Reye’s syndrome ✅ 🧠 Explanation: Reye’s syndrome is a rare but serious condition that causes liver and brain swelling, associated with aspirin use in children.
98
# L17: Pain Codeine is a prodrug of which analgesic? A. Paracetamol B. Morphine C. Aspirin D. Ibuprofen
B. Morphine ✅ Explanation: Codeine must be metabolised by the liver enzyme CYP2D6 into morphine to exert its analgesic effects.
99
# L17: Pain Which group is most at risk of opioid toxicity from codeine due to genetic variation? A. Poor metabolisers B. Ultra-rapid metabolisers C. Intermediate metabolisers D. Extensive metabolisers
B. Ultra-rapid metabolisers ✅ 🧠 Explanation: Ultra-rapid metabolisers convert codeine to morphine too quickly, which can lead to dangerous levels and toxicity.
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# L17: Pain What is a major counseling point for patients taking codeine? A. Avoid dairy products B. May cause drowsiness and constipation C. Only effective for migraines D. Take on an empty stomach
B. May cause drowsiness and constipation ✅ 🧠 Explanation: Codeine can cause opioid-related side effects like sedation and constipation, so patients need to be warned, especially for short-term use.
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# L17: Pain What does the "S" in the SOCRATES pain assessment acronym stand for? A. Severity B. Site C. Sensation D. Specificity
Answer. B. Site ✅ 🧠 Explanation: "S" stands for Site — asking where the pain is located helps identify potential causes and guide treatment options.
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# L17: Pain Which description is most typical of visceral nociceptive pain? A. Sharp and localized B. Burning and electrical C. Cramping and poorly localized D. Shooting and stabbing
Answer. C. Cramping and poorly localized ✅ 🧠 Explanation: Visceral pain arises from internal organs and is often described as dull, cramping, and hard to pinpoint.
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# L17: Pain Which of the following is a red flag symptom for referral in someone presenting with a headache? A. Headache relieved by paracetamol B. Gradual onset tension headache C. Headache with neck stiffness and photophobia D. Headache after caffeine withdrawal
Answer. C. Headache with neck stiffness and photophobia ✅ 🧠 Explanation: This combination can indicate meningitis, which is a medical emergency and requires immediate referral.
104
# L17: Pain Which OTC NSAID is specifically licensed for dysmenorrhoea (period pain)? A. Aspirin B. Naproxen C. Diclofenac D. Paracetamol
Answer. B. Naproxen ✅ 🧠 Explanation: Naproxen 250 mg (pack of 9) is P-licensed specifically for managing period pain. It's effective in reducing prostaglandin-induced cramps.
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# L17: Pain What is the main mechanism of action of rubefacients in pain relief? A. Central inhibition of COX enzymes B. Blocking opioid receptors C. Counter-irritation via skin vasodilation D. Local anaesthetic effects
Answer. C. Counter-irritation via skin vasodilation ✅ 🧠 Explanation: Rubefacients work by irritating the skin to create a warming sensation, distracting from deeper pain sensations.
106
# L17: Pain Which of the following is NOT considered a first-line strategy for managing acute soft tissue injuries? A. Rest B. Elevation C. Diclofenac cream D. Immediate antibiotic therapy
Answer. D. Immediate antibiotic therapy ✅ 🧠 Explanation: RICE (Rest, Ice, Compression, Elevation) and NSAIDs (topical/systemic) are standard. Antibiotics are not indicated unless there's infection.
107
# L17: Pain Which OTC analgesic combination includes both a sedative antihistamine and codeine? A. Panadol Extra B. Migraleve Pink C. Solpadeine Max D. Feminax
Answer. B. Migraleve Pink ✅ 🧠 Explanation: Migraleve Pink contains paracetamol, codeine, and a sedative antihistamine, making it useful for migraine management with associated nausea.
108
# L17: Pain What is the main risk associated with repeated high doses of paracetamol in underweight or malnourished patients? A. Asthma B. Kidney stones C. Hepatotoxicity D. Gastric bleeding
Answer. C. Hepatotoxicity ✅ 🧠 Explanation: Malnutrition reduces glutathione reserves, increasing vulnerability to NAPQI toxicity, even at therapeutic doses.
109
# L17: Pain Which patient group is at increased risk of NSAID-induced bronchospasm? A. Children under 5 B. People with diabetes C. People with asthma D. Obese patients
Answer. C. People with asthma ✅ 🧠 Explanation: NSAIDs can trigger bronchospasm in some asthmatics due to altered arachidonic acid metabolism.
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# L17: Pain Why was oral diclofenac withdrawn from OTC sale in the UK? A. Low demand B. High potential for addiction C. Increased cardiovascular risk D. Ineffective in pain relief
Answer. C. Increased cardiovascular risk ✅ 🧠 Explanation: Diclofenac was shown to carry a higher risk of thrombotic events compared to ibuprofen or naproxen, leading to its withdrawal.
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# L17: Pain Which Solpadeine product contains caffeine, codeine, and paracetamol? A. Solpadeine Plus B. Solpadeine Max C. Panadol Ultra D. Syndol
Answer. A. Solpadeine Plus ✅ 🧠 Explanation: Solpadeine Plus contains paracetamol, codeine, and caffeine. The caffeine slightly enhances the analgesic effect.
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# L17: Pain What is the main difference between Migraleve Pink and Migraleve Yellow? A. Yellow contains caffeine B. Pink contains a sedative antihistamine C. Pink has no paracetamol D. Yellow is for children only
Answer. B. Pink contains a sedative antihistamine ✅ 🧠 Explanation: Migraleve Pink = paracetamol + codeine + sedative antihistamine. Migraleve Yellow = just paracetamol + codeine.
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# L17: Pain Which drug can inhibit codeine’s conversion to morphine, reducing its analgesic effect? A. Caffeine B. Naproxen C. Fluoxetine D. Ibuprofen
Answer. C. Fluoxetine ✅ 🧠 Explanation: Fluoxetine is a CYP2D6 inhibitor. Codeine requires this enzyme to be converted to morphine, so inhibition reduces pain relief.
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# L17: Pain Which group is least likely to benefit from codeine due to genetic variation? A. Ultra-rapid metabolisers B. Poor metabolisers C. Intermediate metabolisers D. Extensive metabolisers
Answer. B. Poor metabolisers ✅ 🧠 Explanation: Poor metabolisers can’t convert codeine effectively into morphine, so they get little pain relief — but may still get side effects.
115
# L17: Pain Which of the following is considered an adjuvant in the WHO pain ladder? A. Caffeine B. Antidepressants C. Codeine D. Naproxen
Answer. B. Antidepressants ✅ 🧠 Explanation: Adjuvants (e.g., antidepressants, anticonvulsants) are used especially for neuropathic pain and to enhance analgesia.
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# L17: Pain Why might soluble paracetamol be preferred over regular tablets? A. It lasts longer B. It has fewer side effects C. It acts faster and is easier to swallow D. It is more potent
Answer. C. It acts faster and is easier to swallow ✅ 🧠 Explanation: Soluble tablets dissolve before ingestion, speeding up absorption — ideal if the patient has nausea or difficulty swallowing.
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# L17: Pain Which of the following statements about caffeine in analgesics is TRUE? A. It reduces paracetamol’s effectiveness B. It is only used in prescription products C. It can slightly enhance analgesia when used ≥100 mg D. It increases constipation risk
Answer. C. It can slightly enhance analgesia when used ≥100 mg ✅ 🧠 Explanation: Cochrane reviews show caffeine at or above 100 mg can give a small but statistically significant boost in pain relief.
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# L17: Pain A patient requests two 32-packs of co-codamol effervescent. What’s the correct action? A. Sell without issue — effervescent forms are unlimited B. Sell only if patient is under 16 C. Refuse — packs over 32 count as prescription-only D. Refer to GP
Answer. C. Refuse — packs over 32 count as prescription-only ✅ 🧠 Explanation: Any codeine product pack >32 tablets (even effervescent) is classed as a POM (Prescription Only Medicine).
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# L17: Pain A customer wants 2 x 100 dispersible aspirin 75 mg packs. What should the pharmacist consider? A. No limits apply B. Warn that this is an unsafe dose C. Confirm that it’s for cardiovascular prevention D. Deny sale — aspirin 75 mg is POM
Answer. C. Confirm that it’s for cardiovascular prevention ✅ 🧠 Explanation: Aspirin 75 mg is used as an antiplatelet, not analgesic. Though legal to sell, best practice is to confirm it's for long-term prevention use.
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# L17A: Eye and ear health Describe the anatomy of the eye.
Sclera: White part, protects the eye and maintains shape. Cornea: Transparent dome, refracts light onto the lens. Lens: Focuses light onto the retina. Retina: Contains light-sensitive cells that convert light to electrical signals sent to the brain. Iris: Colored part; controls light entering the pupil. Pupil: Central circular opening for light passage. Macula: Provides vision for fine work and reading.
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# L17A: Eye and ear health What are the key symptoms of ophthalmic health issues?
Affected eyes. Discharge. Pain, discomfort, itchiness. Photophobia. Visual changes. Associated systemic symptoms. Duration and previous treatments tried.
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# L17A: Eye and ear health What are the common causes and management of red eye?
Causes: Inflammation of the conjunctiva due to bacterial, viral, or allergic reactions. Symptoms: Pain, discharge, altered vision. Management: Take a detailed history for diagnosis. Treat based on the cause (e.g., bacterial or allergic conjunctivitis).
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# L17A: Eye and ear health What are the symptoms and treatment of bacterial conjunctivitis?
Symptoms: Redness, purulent discharge. Gritty or burning feeling. Eyelids stuck together in the morning. Management: Self-limiting (5-10 days). Clean discharge with boiled water and cotton wool. Severe cases: Chloramphenicol drops (2-hourly for 2 days, then 4-hourly) or ointment (4 times daily).
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# L17A: Eye and ear health How do you manage allergic conjunctivitis?
Avoid triggers: Pollen, animal fur, etc. Medications: Sodium cromoglicate drops (mast cell stabilizers). Oral antihistamines (e.g., loratadine, cetirizine). Self-care: Avoid allergens, do not rub eyes.
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# L17A: Eye and ear health What are the causes, symptoms, and management of dry eyes?
Causes: Aging, medications (antihistamines, diuretics), increased tear evaporation. Symptoms: Gritty, burning sensation; vision unaffected. Management: Use artificial tears (e.g., Hypromellose). Avoid prolonged screen use. Reduce contact lens wear.
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# L17A: Eye and ear health What is a subconjunctival hemorrhage, and how is it managed?
Definition: Ruptured blood vessel under the conjunctiva, causing redness. Symptoms: Bright red patch on the sclera, no pain or vision issues. Management: Reassure patient. Resolves in 10-14 days. Check blood pressure.
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# L17A: Eye and ear health Describe otic health anatomy and common issues.
Ear Anatomy: Outer ear: Pinna, ear canal, tympanic membrane. Middle ear: Eustachian tube, ossicles (malleus, incus, stapes). Inner ear: Cochlea. Symptoms of Issues: Discharge, hearing changes, pain, and duration of symptoms.
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# L17A: Eye and ear health What are the causes, symptoms, and management of impacted ear wax?
Causes: Use of cotton buds, hearing aids. Symptoms: Gradual hearing loss, blocked feeling. Management: Use cerumenolytic agents (e.g., olive oil). Avoid cotton buds or ear candles. In severe cases, microsuction or syringing by a professional.
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# L17A: Eye and ear health How is otitis externa treated?
Definition: Inflammation of the external ear canal. Causes: Bacteria (e.g., Pseudomonas aeruginosa), swimming, trauma. Symptoms: Pain, itch, discharge, worsened by moving the pinna. Management: Mild: Acetic acid ear drops (EarCalm). Moderate/severe: Topical antibiotics with/without corticosteroids (e.g., Gentisone HC).
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# L17A: Eye and ear health What are the steps for administering ear drops?
1. Wash hands. 2. Warm drops by holding the bottle in your hand. 3. Lie on your side with the affected ear facing upward. 4. Pull the ear upward and back to straighten the canal. 5. Insert the required drops. 6. Remain in position for 5-10 minutes. 7. Replace the lid and discard after 4 weeks of opening.
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# L17A: Eye and ear health What is a stye, and how is it managed?
Definition: Infection of an eyelash root (Staphylococcus bacteria). Symptoms: Painful, red lump on the eyelid. Sensitive to touch. Management: Self-limiting (resolves in a few days to weeks). Warm compresses 3-4 times daily to release pus. Avoid puncturing the stye. Refrain from using makeup or contact lenses.
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# L17A: Eye and ear health What is blepharitis, and how is it managed?
Definition: Chronic inflammation of the eyelid margins. Causes: Staphylococcus bacteria, seborrhoeic dermatitis, rosacea. Symptoms: Stickiness, yellow scales on eyelashes. Worse in the morning. Associated with dry eyes. Management: Long-term lid hygiene (Blephaclean, Blephasol). Warm compresses daily. Chloramphenicol ointment if hygiene is insufficient.
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# L17A: Eye and ear health When should eye-related symptoms be referred to a specialist?
Visual disturbances. Photophobia. True eye pain. Trauma or foreign body in the eye. Red eye in infants under 4 weeks. Irregular/non-reactive pupils. Previous serious eye diseases.
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# L17A: Eye and ear health What are the steps for administering eye ointment?
1. Wash hands thoroughly. 2. Tilt the head backward and look upward. 3. Pull down the lower eyelid to form a pocket. 4. Apply a 1 cm strip of ointment along the lower eyelid, from the nose outward. 5. Close the eye and blink to spread the ointment. 6. Wipe away any excess ointment. 7. Vision may be blurry temporarily but clears upon blinking.
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# L17A: Eye and ear health What is mastoiditis, and why is it a red flag in otic health?
Definition: Infection of the mastoid bone, typically a complication of untreated middle ear infections. Symptoms: Redness, tenderness, and pain behind the ear. Swelling or ear displacement. Referral: Requires urgent medical attention to prevent complications such as hearing loss or systemic infections.
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# L17A: Eye and ear health What are the common symptoms and management of subconjunctival hemorrhage?
Symptoms: Bright red patch on the sclera due to ruptured blood vessel. No pain, no vision loss. Management: Reassure the patient. Typically resolves without treatment in 10-14 days. Measure blood pressure if recurrent.
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# L17A: Eye and ear health What are the contraindications for using certain ophthalmic and otic treatments
Chloramphenicol: Not licensed OTC for children under 2 years. Ear syringing: No longer provided by GP surgeries, must be performed by trained professionals. Cotton buds: Should not be used to remove earwax, as they can worsen impaction. Ear candles: Lack scientific evidence and may pose risks.
138
What is the most common cause of bacterial conjunctivitis? A. Pseudomonas aeruginosa B. Staphylococcus aureus C. Streptococcus pneumoniae D. Both B and C
Answer. D. Both B and C ✅ 🧠 Explanation: Bacterial conjunctivitis is most commonly caused by Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae.
139
Which of the following symptoms is MOST suggestive of allergic conjunctivitis? A. Gritty sensation and purulent discharge B. Red eye in only one eye C. Itchy, watery eyes with bilateral redness D. Blurred vision and eye pain
Answer. C. Itchy, watery eyes with bilateral redness ✅ 🧠 Explanation: Allergic conjunctivitis typically affects both eyes and presents with itching, watery discharge, and generalised redness — not pain or purulent discharge.
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# L15: Allergies Which statement about dry eyes is TRUE? A. They commonly affect one eye only B. They cause severe vision loss C. They are often associated with blepharitis D. They are best treated with antihistamines
Answer. C. They are often associated with blepharitis ✅ 🧠 Explanation: Dry eyes frequently occur alongside blepharitis. Antihistamines actually worsen dry eyes and should be avoided if possible.
141
What is the first-line OTC treatment for mild bacterial conjunctivitis in adults? A. Acetic acid spray B. Sodium cromoglicate drops C. Chloramphenicol 0.5% eye drops D. Gentisone HC
Answer. C. Chloramphenicol 0.5% eye drops ✅ 🧠 Explanation: For moderate/severe cases or persistent symptoms, chloramphenicol drops are the go-to OTC treatment (not licensed under age 2).
142
A subconjunctival haemorrhage requires: A. Immediate antibiotics B. Urgent eye irrigation C. Reassurance and blood pressure check D. Antihistamine therapy
Answer. C. Reassurance and blood pressure check ✅ 🧠 Explanation: Though it may look dramatic, it’s usually harmless and self-resolves in 1–2 weeks. High blood pressure may be a trigger.
143
What is the recommended treatment for a stye? A. Acetic acid spray B. Chloramphenicol ointment C. Warm compresses 3–4 times daily D. Puncturing the stye with a sterile needle
Answer. C. Warm compresses 3–4 times daily ✅ 🧠 Explanation: Styes are self-limiting. Warm compresses help drain the pus. Antibiotics are not typically necessary.
144
Which of the following is a red flag requiring referral in an eye condition? A. Mild bilateral redness B. Watery eyes C. Photophobia D. Grittiness
Answer. C. Photophobia ✅ 🧠 Explanation: Photophobia (light sensitivity), especially with other symptoms like visual changes or eye pain, can indicate serious issues like uveitis or keratitis.
145
What is the key difference between the ear canal’s outer 2/3 and inner 1/3? A. Outer 2/3 has smooth skin B. Inner 1/3 produces earwax C. Outer 2/3 has hairs and glands D. Inner 1/3 has cartilage
Answer. C. Outer 2/3 has hairs and glands ✅ 🧠 Explanation: The outer 2/3 of the ear canal is hairy and contains glands that produce cerumen (wax). The inner third has smooth skin.
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Which of the following earwax treatments is a GSL product? A. Olive oil B. Sodium bicarbonate 5% C. Urea hydrogen peroxide 5% D. Chloramphenicol
Answer. A. Olive oil ✅ 🧠 Explanation: Olive oil is a General Sale List (GSL) item used to soften earwax. Sodium bicarbonate and urea hydrogen peroxide are Pharmacy (P) medicines.
147
Otitis externa is commonly caused by: A. Fungal infection B. Skin trauma, water exposure, and bacteria C. Middle ear pressure imbalance D. Viral sinusitis
Answer. B. Skin trauma, water exposure, and bacteria ✅ 🧠 Explanation: Swimmer’s ear (otitis externa) results from bacterial infection in the outer ear canal, especially when skin is broken or moist.
148
What is the first-line OTC treatment for mild otitis externa? A. Gentisone HC B. Acetic acid spray (EarCalm) C. Olive oil D. Oral antibiotics
Answer. B. Acetic acid spray (EarCalm) ✅ 🧠 Explanation: EarCalm is a pharmacy-only product containing acetic acid — an effective antimicrobial for mild otitis externa.
149
Which of the following is a red flag for otic referral? A. Itchy ears B. Wax impaction C. Pain on ear movement D. Mastoiditis (redness/tenderness behind ear)
Answer. D. Mastoiditis (redness/tenderness behind ear) ✅ 🧠 Explanation: Mastoiditis is a serious condition affecting the bone behind the ear and requires urgent medical referral.
150
Which symptom is LEAST likely to be present in bacterial conjunctivitis? A. Purulent discharge B. One eye affected before the other C. Itching and sneezing D. Eyelids stuck together in the morning
Answer. C. Itching and sneezing ✅ 🧠 Explanation: Itching and sneezing suggest allergic conjunctivitis, not bacterial. Bacterial infections typically start in one eye and involve sticky discharge.
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Eye Drop vs Eye Ointment – Patient Counseling What is a key counseling point for patients using eye ointments? A. Always use ointment before drops B. Vision may blur temporarily C. Apply it directly to the iris D. Wash off excess ointment immediately
Answer. B. Vision may blur temporarily ✅ 🧠 Explanation: Eye ointments may cause blurred vision — important for patient safety (e.g., driving).
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Otic Red Flag Nuances A parent reports a 3-year-old with ear pain and fever. What should the pharmacist do? A. Recommend EarCalm B. Supply olive oil C. Refer to GP D. Suggest oral antihistamines
Answer. C. Refer to GP ✅ 🧠 Explanation: Ear pain in young children (especially with systemic symptoms like fever) is a red flag for referral — may be otitis media or serious infection.
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Admin Technique: Eye Drops vs Ear Drops Why is it important to press the inner corner of the eye after eye drop administration? A. It makes the medication more potent B. It reduces reflex tearing C. It prevents the drops from entering the tear duct D. It helps spread the drop across the retina
Answer. C. It prevents the drops from entering the tear duct ✅ 🧠 Explanation: Applying pressure to the nasolacrimal duct helps limit systemic absorption and keeps more of the drug in the eye.
154
"Medical Device" Eye Drops Concept Which statement about artificial tears for dry eyes is TRUE? A. All are licensed medicines B. They should be used only at bedtime C. Some are classified as medical devices D. They contain antibiotics
Answer. C. Some are classified as medical devices ✅ 🧠 Explanation: Many lubricating eye drops are not technically medicines but medical devices — they bear CE/UKCA marks.
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Ear Wax Management Scenarios Which advice is best for a patient with impacted earwax who uses cotton buds daily? A. Continue using buds, but gently B. Insert ear candles C. Use olive oil drops and avoid buds D. Use sodium bicarbonate and rinse with water
Answer. C. Use olive oil drops and avoid buds ✅ 🧠 Explanation: Cotton buds push wax deeper. Olive oil is safe and softens wax. Ear candles are ineffective and unsafe.
156
Which of the following may worsen dry eye symptoms? A. Oral antihistamines B. Paracetamol C. Acetic acid ear spray D. Eye lubricants
Answer. A. Oral antihistamines ✅ 🧠 Explanation: Antihistamines can reduce tear production and worsen dry eye symptoms.
157
What is the role of combination ear drops like Gentisone HC in otitis externa? A. Anti-fungal only B. Cerumen softening C. Anti-inflammatory and antibacterial D. Just for wax removal
Answer. C. Anti-inflammatory and antibacterial ✅ 🧠 Explanation: Gentisone HC contains a steroid and an antibiotic — used in more severe cases of otitis externa.
158
A 34-year-old man presents with a red, gritty feeling in his right eye. He woke up with his eyelids stuck together and yellow discharge. No visual changes or pain. He doesn’t wear contact lenses. What’s the most appropriate management? A. Refer to GP immediately B. Recommend chloramphenicol 0.5% eye drops C. Recommend sodium cromoglicate 2% drops D. Suggest warm compress and monitor
Answer. B. Recommend chloramphenicol 0.5% eye drops ✅ 🧠 Explanation: Signs point to bacterial conjunctivitis. Chloramphenicol drops are effective unless red flags are present (e.g., visual disturbance or contact lens use).
159
An elderly woman is concerned about a bright red patch in the white of her left eye. There is no pain, discharge, or change in vision. It appeared suddenly this morning after coughing heavily. What’s the correct advice? A. Supply chloramphenicol drops B. Reassure and advise it will resolve on its own C. Refer urgently to GP D. Recommend antihistamines
Answer. B. Reassure and advise it will resolve on its own ✅ 🧠 Explanation: This is likely a subconjunctival haemorrhage, often caused by minor trauma (e.g., coughing). It looks dramatic but is harmless and self-resolving.
160
A 22-year-old hay fever sufferer asks for help with itchy, red, watery eyes affecting both eyes. He also has sneezing and a runny nose. What is the most appropriate OTC treatment? A. Chloramphenicol drops B. Sodium cromoglicate eye drops C. Gentisone HC ear drops D. Olive oil drops
Answer. B. Sodium cromoglicate eye drops ✅ 🧠 Explanation: These are classic allergic conjunctivitis symptoms. Mast cell stabilisers like sodium cromoglicate treat the cause (histamine release), not just the symptoms.
161
A 76-year-old woman complains of reduced hearing and fullness in her right ear. She uses cotton buds daily. There is no pain, discharge, or fever. What is your recommendation? A. Suggest olive oil ear drops B. Prescribe antibiotics C. Recommend antihistamines D. Refer urgently to GP
Answer. A. Suggest olive oil ear drops ✅ 🧠 Explanation: Symptoms suggest earwax impaction. Olive oil softens the wax, and the patient should avoid using cotton buds.
162
A woman in her 30s presents with right ear pain and discharge after a swimming trip. Pulling on her outer ear worsens the pain. What’s the best course of action? A. Recommend chloramphenicol B. Suggest EarCalm spray C. Refer urgently to ENT D. Recommend sodium bicarbonate drops
Answer. B. Suggest EarCalm spray ✅ 🧠 Explanation: This is typical otitis externa (swimmer’s ear). First-line OTC is acetic acid spray (EarCalm). Advise to avoid water and trauma to the ear.
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A mother comes in with her 3-week-old baby who has a red, watery eye. There is no discharge, but the eye looks irritated. What should you do? A. Supply chloramphenicol ointment B. Suggest warm compress C. Refer to GP D. Recommend allergy drops
Answer. C. Refer to GP ✅ 🧠 Explanation: Any red eye in a baby under 4 weeks is a red flag and needs immediate referral to rule out serious infection (e.g., neonatal conjunctivitis).
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A patient is prescribed both chloramphenicol eye drops and ointment. She asks how to use them together. What do you advise? A. Use them at the same time B. Use drops first, wait 5–10 minutes, then ointment C. Use ointment first, then drops D. Only use one or the other
Answer. B. Use drops first, wait 5–10 minutes, then ointment ✅ 🧠 Explanation: Always apply eye drops before ointments to allow proper absorption. The ointment creates a barrier that could block drop penetration.

Applied Pharmacy Practice (6 decks)

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