Welcome, PharmD students, to this MCQ quiz focusing on Self-Care for Pain and Fever! These are two of the most common symptoms for which patients seek assistance and non-prescription treatments from pharmacists. A solid understanding of assessing different types of pain and fever, selecting appropriate OTC analgesics and antipyretics, counseling on their safe and effective use (especially in pediatric and elderly populations), and recognizing crucial exclusions for self-treatment is paramount. This quiz will test your knowledge in these key areas, preparing you to provide sound advice and care. Let’s get started!
1. Which non-prescription analgesic is generally preferred for a patient with a history of gastric ulcers?
- a) Aspirin
- b) Ibuprofen
- c) Acetaminophen
- d) Naproxen sodium
Answer: c) Acetaminophen
2. What is the primary mechanism of action of NSAIDs like ibuprofen and naproxen in reducing pain and inflammation?
- a) They selectively block COX-2 enzymes only.
- b) They inhibit prostaglandin synthesis by blocking COX-1 and COX-2 enzymes.
- c) They act as opioid receptor agonists.
- d) They increase the production of endorphins.
Answer: b) They inhibit prostaglandin synthesis by blocking COX-1 and COX-2 enzymes.
3. A parent asks for a fever-reducing medication for their 6-month-old infant. Which of the following is generally considered a safe and effective option for this age group when dosed appropriately?
- a) Aspirin
- b) Acetaminophen or Ibuprofen
- c) Naproxen sodium
- d) Codeine
Answer: b) Acetaminophen or Ibuprofen (Ibuprofen is typically for 6 months and older, acetaminophen can be used younger but for self-care in a 6-month-old, both are common considerations if appropriate.)
4. What is the maximum recommended daily dose of acetaminophen for an adult without liver disease, when using OTC products for self-care?
- a) 1000 mg
- b) 2000 mg
- c) 3000-4000 mg (varies by product labeling, typically 3000mg or 3250mg, but some older labels might state 4000mg. For self-care, sticking to package limits is crucial).
- d) 5000 mg
Answer: c) 3000-4000 mg (Pharmacists usually recommend staying at 3000mg or lower for safety in self-care)
5. Reye’s syndrome is a rare but serious condition associated with the use of which medication in children and teenagers recovering from viral infections like influenza or chickenpox?
- a) Acetaminophen
- b) Ibuprofen
- c) Aspirin
- d) Naproxen
Answer: c) Aspirin
6. Which of the following best describes the RICE therapy for acute musculoskeletal injuries?
- a) Rehydrate, Ibuprofen, Compression, Elevate
- b) Rest, Ice, Compression, Elevate
- c) Run, Ice, Call physician, Exercise
- d) Rub, Inject, Cast, Examine
Answer: b) Rest, Ice, Compression, Elevate
7. Topical counterirritants like menthol or camphor provide pain relief primarily by:
- a) Systemically inhibiting prostaglandin synthesis.
- b) Producing a cooling or warming sensation that distracts from the underlying pain (gate control theory).
- c) Directly numbing nerve endings like local anesthetics.
- d) Reducing inflammation through a steroidal mechanism.
Answer: b) Producing a cooling or warming sensation that distracts from the underlying pain (gate control theory).
8. What is a key counseling point when recommending an OTC topical NSAID like diclofenac gel?
- a) Apply liberally to the entire body.
- b) It provides immediate pain relief within seconds.
- c) Apply a thin layer to the affected area and avoid occlusive dressings unless directed.
- d) It is safe to use with oral NSAIDs without any increased risk.
Answer: c) Apply a thin layer to the affected area and avoid occlusive dressings unless directed.
9. A temperature of 100.4°F (38°C) taken orally is generally considered:
- a) Hypothermia
- b) A normal body temperature
- c) A fever
- d) A critically high fever requiring immediate hospitalization
Answer: c) A fever
10. Non-pharmacological measures for reducing fever include:
- a) Dressing the person in heavy clothing to induce sweating.
- b) Administering an ice bath.
- c) Ensuring adequate fluid intake and wearing light clothing.
- d) Applying alcohol rubs to the skin.
Answer: c) Ensuring adequate fluid intake and wearing light clothing.
11. An exclusion for self-treatment of headache is:
- a) Mild tension-type headache.
- b) Headache associated with a common cold.
- c) A severe headache described as “the worst headache of my life,” especially if sudden onset.
- d) Headache lasting less than 2 hours.
Answer: c) A severe headache described as “the worst headache of my life,” especially if sudden onset.
12. The primary concern with acetaminophen overdose is:
- a) Severe kidney damage
- b) Severe liver damage (hepatotoxicity)
- c) Cardiovascular collapse
- d) Respiratory depression
Answer: b) Severe liver damage (hepatotoxicity)
13. When alternating acetaminophen and ibuprofen for fever in children, parents should be counseled to:
- a) Administer both medications at the same time for better effect.
- b) Strictly follow dosing intervals for each individual medication and keep careful records to avoid overdose.
- c) Use this strategy for more than 3 days without consulting a doctor.
- d) Give higher doses of each medication.
Answer: b) Strictly follow dosing intervals for each individual medication and keep careful records to avoid overdose.
14. Capsaicin cream is used topically for pain. How does it work?
- a) It causes vasoconstriction, reducing blood flow to the painful area.
- b) It initially stimulates and then desensitizes sensory nerves by depleting substance P.
- c) It directly cools the skin surface.
- d) It blocks prostaglandin synthesis.
Answer: b) It initially stimulates and then desensitizes sensory nerves by depleting substance P.
15. Exclusions for self-treatment of fever include:
- a) Fever in an adult lasting less than 24 hours.
- b) A child < 2 years of age with a fever lasting > 24 hours without physician consultation.
- c) A temperature of 99.5°F (37.5°C) orally.
- d) Fever responding well to antipyretics.
Answer: b) A child < 2 years of age with a fever lasting > 24 hours without physician consultation. (Specific age/duration cutoffs for referral vary slightly, but prolonged fever in young children is a key exclusion).
16. Which type of thermometer is generally considered the most accurate for infants under 3 months?
- a) Oral
- b) Axillary
- c) Rectal
- d) Temporal artery (forehead)
Answer: c) Rectal
17. What is a common side effect associated with oral NSAIDs that limits their use in some patients?
- a) Hepatotoxicity (more common with APAP)
- b) Gastrointestinal irritation, ulceration, or bleeding
- c) Sedation
- d) Bronchodilation
Answer: b) Gastrointestinal irritation, ulceration, or bleeding
18. For self-treatment of pain, non-prescription analgesics should generally not be used for more than:
- a) 1-2 days without improvement.
- b) 7-10 days (depending on the type of pain and product label) without consulting a doctor.
- c) 1 month.
- d) Indefinitely, as long as they provide relief.
Answer: b) 7-10 days (depending on the type of pain and product label) without consulting a doctor.
19. Which type of headache is often described as a bilateral, pressing, or tightening sensation of mild to moderate intensity?
- a) Migraine headache
- b) Cluster headache
- c) Tension-type headache
- d) Sinus headache
Answer: c) Tension-type headache
20. Patients with which condition should use NSAIDs cautiously or avoid them due to potential worsening of their condition or increased risk of adverse events?
- a) Osteoarthritis
- b) Heart failure, uncontrolled hypertension, or kidney disease
- c) Common cold
- d) Muscle strain
Answer: b) Heart failure, uncontrolled hypertension, or kidney disease
21. Febrile seizures in children:
- a) Always result in epilepsy.
- b) Are seizures that occur with fever, are generally brief, and most children outgrow them without long-term consequences.
- c) Should always be self-treated with higher doses of antipyretics.
- d) Only occur if the fever is above 105°F (40.5°C).
Answer: b) Are seizures that occur with fever, are generally brief, and most children outgrow them without long-term consequences. (However, a first-time febrile seizure always warrants medical evaluation).
22. What is an important counseling point for applying heat therapy for muscle pain?
- a) Apply directly to broken skin.
- b) Use for at least 1 hour continuously at the highest setting.
- c) Protect the skin from direct contact with very hot sources to prevent burns; apply for 15-20 minutes at a time.
- d) Heat should be used immediately after an acute injury instead of ice.
Answer: c) Protect the skin from direct contact with very hot sources to prevent burns; apply for 15-20 minutes at a time.
23. A patient complaining of pain localized over the sinuses, often accompanied by nasal congestion, may be experiencing a:
- a) Tension-type headache
- b) Migraine headache
- c) Sinus headache
- d) Cluster headache
Answer: c) Sinus headache (Though many “sinus headaches” are actually migraines).
24. Which dietary supplement is sometimes used for osteoarthritis pain, although evidence for significant benefit is mixed?
- a) Vitamin C
- b) Melatonin
- c) Glucosamine and chondroitin
- d) St. John’s Wort
Answer: c) Glucosamine and chondroitin
25. The primary goal of fever treatment is to:
- a) Cure the underlying illness.
- b) Lower the temperature to below normal.
- c) Improve patient comfort and reduce associated symptoms like malaise.
- d) Prevent febrile seizures in all children.
Answer: c) Improve patient comfort and reduce associated symptoms like malaise.
26. When should ice be applied to an acute musculoskeletal injury?
- a) Only after 24 hours.
- b) As soon as possible after the injury, typically for 15-20 minutes at a time, several times a day for the first 24-48 hours.
- c) Continuously for several hours.
- d) Never, heat is always preferred.
Answer: b) As soon as possible after the injury, typically for 15-20 minutes at a time, several times a day for the first 24-48 hours.
27. Which is an important consideration when recommending acetaminophen to a patient who consumes alcohol regularly?
- a) Alcohol increases acetaminophen’s effectiveness.
- b) There is an increased risk of liver damage if daily acetaminophen limits are exceeded or if there is underlying liver disease; alcohol can exacerbate this.
- c) Acetaminophen will prevent hangovers.
- d) No special precautions are needed.
Answer: b) There is an increased risk of liver damage if daily acetaminophen limits are exceeded or if there is underlying liver disease; alcohol can exacerbate this.
28. For menstrual pain (dysmenorrhea), which class of OTC analgesics is often most effective due to its anti-prostaglandin activity?
- a) Acetaminophen
- b) NSAIDs (e.g., ibuprofen, naproxen)
- c) Opioid analgesics
- d) Topical counterirritants
Answer: b) NSAIDs (e.g., ibuprofen, naproxen)
29. An exclusion for self-treatment of musculoskeletal pain is:
- a) Mild muscle soreness after exercise.
- b) Pain that persists for more than 7-10 days or worsens.
- c) Pain associated with a minor ankle sprain.
- d) Pain rated as 2 out of 10 on a pain scale.
Answer: b) Pain that persists for more than 7-10 days or worsens.
30. “Water-based” or “greaseless” topical analgesic formulations are generally preferred over “oil-based” ones because they:
- a) Are more potent.
- b) Are less likely to stain clothing and may be easier to apply and remove.
- c) Provide longer-lasting pain relief.
- d) Can be applied to open wounds.
Answer: b) Are less likely to stain clothing and may be easier to apply and remove.
31. What is an appropriate way to measure a liquid pediatric antipyretic?
- a) Using a household teaspoon.
- b) Using the calibrated dosing device (syringe or cup) that comes with the product.
- c) Estimating the dose.
- d) Using a tablespoon.
Answer: b) Using the calibrated dosing device (syringe or cup) that comes with the product.
32. A patient asks if they can take two different OTC pain relievers at the same time (e.g., acetaminophen and ibuprofen). What is important to counsel?
- a) This is always recommended for better pain relief.
- b) They should be aware of the active ingredients in all products to avoid exceeding maximum daily doses of either drug and to understand the potential risks of combination.
- c) It will reduce the side effects of both drugs.
- d) This combination is never permissible.
Answer: b) They should be aware of the active ingredients in all products to avoid exceeding maximum daily doses of either drug and to understand the potential risks of combination. (While sometimes done under medical advice, for self-care, caution is key.)
33. Which symptom associated with a headache would necessitate immediate medical referral?
- a) Mild photophobia
- b) Headache accompanied by stiff neck, fever, and altered mental status
- c) Gradual onset over several hours
- d) History of similar headaches
Answer: b) Headache accompanied by stiff neck, fever, and altered mental status (Suggests meningitis).
34. The term “analgesic” refers to a medication that:
- a) Reduces fever
- b) Relieves pain
- c) Reduces inflammation
- d) Fights infection
Answer: b) Relieves pain
35. When is it generally appropriate to self-treat a fever in an adult?
- a) If the fever is above 104°F (40°C).
- b) If the fever lasts for more than 3 days without improvement or is associated with severe symptoms.
- c) If the fever is mild to moderate, associated with minor illness, and the patient is otherwise healthy.
- d) Never, all fevers require a doctor’s visit.
Answer: c) If the fever is mild to moderate, associated with minor illness, and the patient is otherwise healthy. (With the caveat that if it persists >3 days or worsens, see MD).
36. A patient has a strain from lifting a heavy object. Besides RICE, what type of OTC medication might be helpful for the pain and inflammation in the first few days?
- a) An oral NSAID like ibuprofen.
- b) Acetaminophen (for pain, but less for inflammation).
- c) A decongestant.
- d) An antidiarrheal.
Answer: a) An oral NSAID like ibuprofen.
37. Methyl salicylate is a common ingredient in topical analgesic rubs. Patients with an allergy to which medication should use it cautiously or avoid it?
- a) Acetaminophen
- b) Penicillin
- c) Aspirin or other salicylates
- d) Sulfonamides
Answer: c) Aspirin or other salicylates
38. For a patient with mild osteoarthritis pain in the knee, which self-care approach might be recommended in addition to or before systemic analgesics?
- a) Complete bed rest.
- b) Weight loss (if overweight), exercise (low-impact), and potentially topical analgesics.
- c) High-dose opioid therapy.
- d) Avoiding all physical activity.
Answer: b) Weight loss (if overweight), exercise (low-impact), and potentially topical analgesics.
39. How should a parent respond if their child has a fever but is otherwise playful and comfortable?
- a) Immediately administer an antipyretic to bring the temperature down to normal.
- b) Focus on comfort measures and hydration; an antipyretic may not be necessary unless the child is uncomfortable or the fever is very high.
- c) Rush the child to the emergency room.
- d) Give alternating doses of acetaminophen and ibuprofen every 2 hours.
Answer: b) Focus on comfort measures and hydration; an antipyretic may not be necessary unless the child is uncomfortable or the fever is very high.
40. A common cause of tension-type headaches is:
- a) Food allergies
- b) Sinus infection
- c) Muscle tension in the neck, shoulders, or scalp, often related to stress or posture
- d) Vascular changes in the brain
Answer: c) Muscle tension in the neck, shoulders, or scalp, often related to stress or posture
41. What is a significant risk if NSAIDs are used during the third trimester of pregnancy?
- a) Neural tube defects
- b) Premature closure of the ductus arteriosus in the fetus
- c) Cleft palate
- d) Enhanced fetal growth
Answer: b) Premature closure of the ductus arteriosus in the fetus
42. If a patient complains of a headache that is unilateral, throbbing, and associated with nausea and photophobia, this is suggestive of:
- a) Tension-type headache
- b) Migraine headache
- c) Cluster headache
- d) Medication-overuse headache
Answer: b) Migraine headache (Self-care is limited to mild/infrequent, previously diagnosed migraines).
43. Why is it important to ask about the “P” (Provocative/Palliative factors) when assessing a patient’s pain using the PQRST or similar mnemonic?
- a) To determine the patient’s preferred pharmacy.
- b) To understand what makes the pain better or worse, which can guide treatment and identify triggers.
- c) To assess their psychological state.
- d) To prescribe the correct medication.
Answer: b) To understand what makes the pain better or worse, which can guide treatment and identify triggers.
44. Lukewarm (tepid) sponge baths are sometimes recommended for fever reduction in children, but what is a crucial caution?
- a) The water should be ice cold for best effect.
- b) Alcohol should be added to the water.
- c) Stop if the child starts shivering, as shivering can increase body temperature.
- d) They are more effective than antipyretic medications.
Answer: c) Stop if the child starts shivering, as shivering can increase body temperature.
45. Patients taking anticoagulants (e.g., warfarin) should be advised that concomitant use of which OTC analgesics increases the risk of bleeding?
- a) Acetaminophen only
- b) NSAIDs and Aspirin
- c) Opioids
- d) Topical capsaicin
Answer: b) NSAIDs and Aspirin
46. A “medication-overuse headache” can occur when:
- a) A patient rarely takes pain medication.
- b) A patient frequently uses acute pain relievers (e.g., >2-3 times per week) for headaches, leading to more frequent headaches.
- c) A prescribed pain medication is taken exactly as directed.
- d) A patient uses only topical analgesics.
Answer: b) A patient frequently uses acute pain relievers (e.g., >2-3 times per week) for headaches, leading to more frequent headaches.
47. One of the benefits of naproxen sodium compared to ibuprofen for OTC pain relief is:
- a) It has a much faster onset of action.
- b) It generally has fewer GI side effects.
- c) It has a longer duration of action, allowing for less frequent dosing (e.g., every 8-12 hours).
- d) It is the only NSAID safe for infants.
Answer: c) It has a longer duration of action, allowing for less frequent dosing (e.g., every 8-12 hours).
48. When assessing a patient’s fever, it’s important to ask about:
- a) Their favorite color.
- b) The method used to take the temperature, the actual reading, and any associated symptoms.
- c) How many pain relievers they have at home.
- d) Their annual income.
Answer: b) The method used to take the temperature, the actual reading, and any associated symptoms.
49. Which statement is TRUE regarding the self-treatment of osteoarthritis pain?
- a) OTC analgesics can cure osteoarthritis.
- b) Self-care focuses on symptomatic relief of mild to moderate pain, often involving oral analgesics, topical products, and non-pharmacologic measures.
- c) High-impact exercise is always recommended.
- d) Weight management has no role in osteoarthritis of the knee.
Answer: b) Self-care focuses on symptomatic relief of mild to moderate pain, often involving oral analgesics, topical products, and non-pharmacologic measures.
50. The pharmacist’s primary role in self-care for pain and fever is to:
- a) Diagnose the underlying cause of all pain and fever.
- b) Ensure safe and effective use of OTC products, counsel on non-pharmacological measures, and identify situations requiring medical referral.
- c) Always recommend the strongest available OTC product.
- d) Discourage patients from seeking physician advice.
Answer: b) Ensure safe and effective use of OTC products, counsel on non-pharmacological measures, and identify situations requiring medical referral.