Symptoms In Pharmacy - Respiratory Conditions (w20)

Question 1

What is the common ailment scheme (CAS) ?

Answer 1

• The Common Ailment Service is a free NHS service
• Patients can access for advice and treatment of 26 conditions through CAS.

Question 2

What does the common ailment scheme (CAS) service involve ?

Answer 2

• Patient registration with the pharmacy
• Private consultation with the pharmacist
• Advice on management and treatment where needed OR referral if necessary

Question 3

Who can access the common ailment scheme (CAS) in Wales ?
What are the exclusions ?

Answer 3

1) Any patient who lives in Wales or who is registered to a Welsh GP is eligible to access the Choose Pharmacy Service.

The only exclusions are:
Temporary residents whose usual address is not in Wales
Care Home residents

Question 4

Are there any exclusions for specific conditions ?

Answer 4

• Age
• Pregnancy/breastfeeding
• If they have had the condition multiple times

Question 5

What are the 26 conditions that can be treated under the common ailment scheme ?

Answer 5

1) Acne
2) Athletes Foot
3) Backache (acute)
4) Chickenpox
5) Cold sores*
6) Colic*
7) Conjunctivitis (bacterial)
8) Constipation
9) Dermatitis (acute)
10) Diarrhoea*
11) Dry eyes
12) Haemorrhoids
13) Hayfever
14) Head Lice
15) Indigestion/reflux
16) Ingrowing toenail*
17) Intertrigo/ringworm
18) Mouth Ulcers
19) Nappy rash
20) Oral thrush
21) Scabies
22) Sore throat/tonsillitis
23) Teething
24) Threadworm
25) Vaginal thrush
26) Verruca

Question 6

What is choose pharmacy ?

Answer 6

Choose Pharmacy is a confidential NHS electronic records system, which community pharmacists use to record details of NHS services they provide to you.

Question 7

List the difference in symptoms between cold and flu and also list the shared symptoms …

Answer 7

Cold symptoms :
- congestion
- itchy/watery eyes
- feeling tired

Flu symptoms :
- fever
- body aches
- extreme fatigue

Shared symptoms:
- cough
- runny/ stuffy nose
- sore throat
- headache

Question 8

What is a common cold ?

Answer 8

Mild, self-limiting, viral (rhinovirus), upper respiratory tract infection

Question 9

How is common cold transmitted ?
How long can individuals remain infected ?

Answer 9

• Transmitted by either direct contact or aerosol transmission.
• People can remain infectious for several weeks.

Question 10

What are the most common complications from common cold ?

Answer 10

The most common complications aresinusitis, lower respiratory tract infections (LRTI), andacute otitis media.

Question 11

What is the onset of symptoms for common cold ?

Answer 11

Onset of symptoms after infection is sudden, reaching a peak at day 2–3, then decreasing in intensity.

Question 12

In adults and children, how long do symptoms tend to last for common cold ?

Answer 12

In adults and older children, symptoms tend to last about a week, although cough can persist for up to 3 weeks.

Question 13

How long do symptoms tend to last in younger children for common cold ?

Answer 13

In younger children, symptoms typically last 10–14 days.

Question 14

What can common cold in smokers cause ?

Answer 14

• prolonged infection
• tend to have more severe respiratory symptoms (including a cough)

Question 15

What are the common symptoms or signs in a progressive order in adults and older children for common cold ?

Answer 15

Common symptoms or signs in adults and older children include:
1) Sore or irritated throat.
2) Nasal irritation, congestion, nasal discharge (rhinorrhoea), and sneezing.
3) Nasal discharge is often profuse and clear at first but becomes thicker and darker as the infection progresses.
4) Cough, which typically develops after nasal symptoms clear.
5) Hoarse voice caused by associated laryngitis.
6) General malaise.

Question 16

What is seasonal influenza ?

Answer 16

Acute respiratory illness caused by RNA viruses of the family Orthomyxoviridae (influenza viruses).

Question 17

What are the complications of influenza in adults that are respiratory in nature ?

Answer 17

• Acute bronchitis.
• Pneumonia.
• Exacerbations of asthma and chronic obstructive pulmonary disease (COPD).
• Otitis media.
• Sinusitis.

Question 18

How long after exposure do influenza symptoms appear ?

Answer 18

• appear around 2 days after exposure

Question 19

What is uncomplicated influenza ?

Answer 19

Uncomplicated influenza: coryza (inflammation), nasal discharge,cough, fever,gastrointestinal (GI) symptoms, headache, malaise, myalgia, arthralgia,ocular symptoms, and sore throat.

Question 20

What is complicated influenza ?

Answer 20

Complicated influenza: require hospital admission, involve thelower respiratory tract,central nervous system (CNS), or cause significant exacerbation of an underlying medical condition.

Question 21

What are the ‘at risk’ groups for seasonal influenza ?

Answer 21

• Those with chronic respiratory, heart, kidney, liver, or neurological disease; diabetes mellitus (DM); or those who are obese orimmunosuppressed.
• Those > 65 years.
• Women who are pregnant (or women up to two weeks post partum).
• Children aged < 6 months.

Question 22

What is management for seasonal influenza ?

Answer 22

Management:
- Drink adequate fluid
- Take paracetamol or ibuprofen to relieve symptoms, rest
- Stay off work or school until the worst symptoms have resolved (usually ~1 week)

Question 23

Urgent admission to hospital for seasonal fluency should be considered if …

Answer 23

• A complication such as pneumonia occurs.
• The person has a concomitant disease that may be affected by influenza (for example, type 1 diabetes).
• There is suspicion of a serious illness other than influenza (for example,meningitis).

Question 24

What is a cough and how is it triggered ?

Answer 24

• It is a reflex response to airway irritation.
• It is triggered by stimulation of airway cough receptors, either by irritants or by conditions that cause airway distortion.

Question 25

What is an acute cough ?

Answer 25

Lasting <3 weeks

Question 26

What is a sub-acute cough ?

Answer 26

Lasting 3-8 weeks

Question 27

What is a chronic cough ?

Answer 27

Lasting >8 weeks

Question 28

What is a cough commonly caused by ?

Answer 28

Commonly caused by a viral upper respiratory tract infection (URTI).

Question 29

What are the other causes of a cough ?

Answer 29

• Acute bronchitis.
• Pneumonia.
• Acute exacerbations of asthma
• Environmental or occupational causes.
• Foreign body aspiration.

Question 30

What is a management for a cough ?

Answer 30

Management of people with cough should be based on treating the underlying cause where it has been identified, or sequential trials of treatment to confirm or refute common causes.

Offer self care (e.g. paracetamol or ibuprofen for pain and inflammation, if appropriate), and refer to smoking cessation if relevant.

Question 31

When should you refer a patient with a cough to a respiratory physician ?

Answer 31

Referral to a respiratory physician should be arranged for people with a cough that does NOT respond to trials of treatment, if the diagnosis is uncertain, or if systemically unwell.

Question 32

When should emergency referral be given ?

Answer 32

Should be arranged for people with clinical features of foreign body aspiration

Question 33

What is croup ?

Answer 33

Croup (laryngotracheobronchitis) is a common childhood disease usually caused by a virus.

Question 34

What are the symptoms of croup ?

Answer 34

Symptoms:
- sudden onset of a seal-like barking cough usually accompanied by stridor (predominantly inspiratory),
- hoarse voice,
- respiratory distress due to upper-airwayobstruction.
- Symptoms are usually worse at night.
- There may be a fever.

Question 35

What is the group commonly affected by croup ?

Answer 35

Croup most commonly affects children between 6 months and 6years of age, with a peak incidence during the second year of life.

Question 36

What do mild croup symptoms include ?

Answer 36

Mild croup symptomsincludeseal-like barkingcough but no stridor or sternal/intercostal recession at rest.

Question 37

What are moderate croup symptoms ?

Answer 37

Moderate croup symptoms includeseal-like barkingcough with stridor and sternal recession at rest; no agitation or lethargy.

Question 38

What Rae the severe croup symptoms ?

Answer 38

Severe croup symptoms includeseal-like barkingcough with stridor and sternal/intercostal recession associated with agitation or lethargy.

Question 39

When should a child with croup be immediately admitted ?

Answer 39

A child should be immediately admitted when presenting with moderate or severe croup, or impending respiratory failure.

Question 40

What is the management for croup ?
What happens if the child is too unwell to receive medication ?

Answer 40

Management: All children with mild, moderate, or severe croup should receive a single dose of oral dexamethasone (0.15 mg per kg body weight).

• If the child is too unwell to receive medication, inhaled budesonide (2 mg nebulised as a single dose) or intramuscular (IM) dexamethasome (0.6 mg/kg as a single dose) are possible alternatives.

Question 41

Croup is usually self limiting, how one does it usually take four symptoms to resolve ?

Answer 41

Within 48hours

Question 42

What should you recommend for a child who has croup and is being managed at home ?

Answer 42

Paracetamol and ibuprofen to control the fever and pain, but parents should be advised to seek urgent medical advice if there is any deterioration.

Question 43

What is whooping cough - also known as pertussis ?
And what is the incubation period ?

Answer 43

• It is a highly infectious disease caused by the bacteriumBordetella pertussis.
• It is spread by aerosol droplets released during coughing, and disproportionately affects infants and young children.
• The incubation period is usually about 7 days, and the person is infectious for 3weeks after the onset of symptoms.

Question 44

What are the three phases of symptoms of whooping cough ?

Answer 44

Whooping cough has 3 phases of symptoms:
1) The catarrhal phase lasts ~ a week and is characterised by the development of a dry, unproductive cough.

2) The paroxysmal phase may last for a month or more and is characterised by coughing fits, whooping, and post-tussive vomiting. The person may be relatively well between paroxysms.

3) The convalescent phase may last an additional 2 months or more, and is characterised by gradual improvement in the frequency and severity of symptoms.

Question 45

What antibiotics do you usually give patients with whooping cough ?

Answer 45

An antibiotic (usually a macrolide, such as erythromycin or clarithromycin) should be prescribed to all people with suspected or confirmed whooping cough with onset of cough within the previous 21 days.

Question 46

What advice should you give patients with whooping cough ?

Answer 46

• Advice should be given on rest, adequate fluid intake, and the use of paracetamol or ibuprofen for symptomatic relief.
• Children and healthcare workers should be advised to stay off nursery, school, or work until 48 hours of appropriate antibiotic treatment has been completed, or 21 days after onset of symptoms if not treated.
• Close contacts may require antibiotic prophylaxis.