Welcome, PharmD students, to this MCQ quiz on Patient Assessment for Allergies, Cough, and Cold! As accessible healthcare professionals, pharmacists play a vital role in triaging patients and guiding them toward appropriate self-care or medical referral. Effective patient assessment, using structured questioning techniques like SCHOLAR-MAC or QuEST, is key to differentiating these common conditions and identifying any ‘red flag’ symptoms. This quiz will test your ability to gather pertinent information, identify exclusions for self-treatment, and make sound clinical judgments. Let’s sharpen your assessment skills!
1. When a patient presents with symptoms of a cold, which structured questioning technique can help a pharmacist gather comprehensive information?
- a) SOAP note format
- b) SCHOLAR-MAC or QuEST
- c) APGAR score
- d) The “Five Rights”
Answer: b) SCHOLAR-MAC or QuEST
2. In the SCHOLAR mnemonic for patient assessment, the “S” stands for:
- a) Severity
- b) Symptoms
- c) Source
- d) Solutions
Answer: b) Symptoms
3. A patient complains of a runny nose, sneezing, and itchy, watery eyes that occur every spring. These symptoms are most suggestive of:
- a) Common cold
- b) Influenza
- c) Seasonal allergic rhinitis
- d) Acute bacterial sinusitis
Answer: c) Seasonal allergic rhinitis
4. Which of the following symptoms is more characteristic of influenza than a common cold?
- a) Mild sore throat
- b) Gradual onset of symptoms
- c) Abrupt onset of high fever, significant myalgia, and profound fatigue
- d) Clear nasal discharge
Answer: c) Abrupt onset of high fever, significant myalgia, and profound fatigue
5. When assessing a patient’s cough, it is important to determine if it is:
- a) Only occurring at night.
- b) Productive (producing mucus) or non-productive (dry).
- c) Caused by a specific medication the patient enjoys.
- d) A new fashion trend.
Answer: b) Productive (producing mucus) or non-productive (dry).
6. A patient reports a cough that has persisted for 4 weeks with no improvement despite trying OTC medications. This would be classified as a(n) _______ cough and generally warrants _______.
- a) Acute; self-treatment with a stronger OTC product.
- b) Subacute or chronic; medical referral.
- c) Normal; no action.
- d) Productive; immediate antibiotics.
Answer: b) Subacute or chronic; medical referral. (Acute <3 weeks, Subacute 3-8 weeks, Chronic >8 weeks. 4 weeks falls into subacute and often warrants referral if not improving).
7. Which question is essential to ask when assessing a patient for self-treatment of allergies, cough, or cold?
- a) “What is your favorite television show?”
- b) “What medications, including prescription, OTC, and herbals, are you currently taking?”
- c) “Do you prefer tablets or liquids?” (Important for recommendation, but assessment comes first).
- d) “What is your favorite color?”
Answer: b) “What medications, including prescription, OTC, and herbals, are you currently taking?”
8. A “red flag” symptom during patient assessment for cold symptoms that indicates a need for medical referral is:
- a) A clear, runny nose.
- b) Shortness of breath or difficulty breathing.
- c) A mild cough.
- d) Symptoms present for only 24 hours.
Answer: b) Shortness of breath or difficulty breathing.
9. In the QuEST method, “E” stands for “Establish that the patient is an appropriate self-care candidate.” This involves:
- a) Evaluating the patient’s insurance coverage.
- b) Identifying any exclusions for self-treatment or “red flags.”
- c) Ensuring the patient can afford the medication.
- d) Determining if the patient likes the taste of liquid medications.
Answer: b) Identifying any exclusions for self-treatment or “red flags.”
10. A patient describes their nasal discharge as thick, purulent, and yellowish-green for the past 3 days, accompanied by a low-grade fever and mild sore throat. This is most consistent with:
- a) Typical progression of a viral common cold.
- b) Seasonal allergic rhinitis.
- c) Acute bacterial sinusitis (though viral can also cause this; duration and other symptoms matter).
- d) Vasomotor rhinitis.
Answer: a) Typical progression of a viral common cold. (Purulent discharge can occur in viral colds; bacterial sinusitis usually has more specific features like facial pain/pressure, longer duration, or biphasic illness).
11. When assessing a patient for allergic rhinitis, asking about _______ is crucial.
- a) recent international travel
- b) known allergens and triggers, and timing/seasonality of symptoms
- c) dietary fiber intake
- d) their exercise routine
Answer: b) known allergens and triggers, and timing/seasonality of symptoms
12. A patient with a cough reports coughing up greenish-yellow phlegm and feeling feverish for 5 days. This patient should be:
- a) Recommended an OTC antitussive immediately.
- b) Advised to drink more water and rest.
- c) Referred to a physician for further evaluation, as this could indicate a bacterial infection.
- d) Told it is just a common cold.
Answer: c) Referred to a physician for further evaluation, as this could indicate a bacterial infection.
13. The “H” in the SCHOLAR mnemonic stands for:
- a) Habits (smoking, alcohol)
- b) History (of the present illness, past medical history related to it)
- c) Headache severity
- d) Hydration status
Answer: b) History (of the present illness, past medical history related to it)
14. An exclusion for self-treatment of allergic rhinitis includes:
- a) Mild, intermittent sneezing.
- b) Symptoms of otitis media, sinusitis, or other infection.
- c) Previously diagnosed seasonal allergies responding to OTCs.
- d) Itchy nose.
Answer: b) Symptoms of otitis media, sinusitis, or other infection.
15. A patient with a common cold is also taking warfarin. When assessing for appropriate self-care, the pharmacist must consider:
- a) That most cold remedies are safe with warfarin.
- b) Potential drug interactions between OTC cold/cough products (e.g., some analgesics, dextromethorphan in high doses, certain herbals) and warfarin.
- c) That warfarin cures the common cold.
- d) Recommending high-dose vitamin C to counteract warfarin.
Answer: b) Potential drug interactions between OTC cold/cough products (e.g., some analgesics, dextromethorphan in high doses, certain herbals) and warfarin.
16. Which symptom would help differentiate allergic rhinitis from a non-allergic (vasomotor) rhinitis?
- a) Nasal congestion.
- b) Rhinorrhea.
- c) Prominent itching of the eyes, nose, and palate, and frequent sneezing often associated with allergen exposure.
- d) Postnasal drip.
Answer: c) Prominent itching of the eyes, nose, and palate, and frequent sneezing often associated with allergen exposure.
17. If a child under 3 months of age presents with a fever (rectal temp ≥100.4°F or 38°C), the appropriate action is:
- a) Recommend OTC acetaminophen and follow up in 3 days.
- b) Immediate medical referral.
- c) Recommend OTC ibuprofen.
- d) Advise lukewarm sponge baths only.
Answer: b) Immediate medical referral.
18. A patient reports a dry, hacking cough that worsens at night and has been present for 2 days along with a runny nose and sore throat. This is most likely associated with:
- a) Chronic bronchitis
- b) A common cold (viral upper respiratory infection)
- c) Pneumonia
- d) Tuberculosis
Answer: b) A common cold (viral upper respiratory infection)
19. When using the “A” (Aggravating factors) part of SCHOLAR, a pharmacist is trying to determine:
- a) What medications the patient is allergic to.
- b) What makes the symptoms worse.
- c) What actions the patient has already taken.
- d) The age of the patient.
Answer: b) What makes the symptoms worse.
20. A key assessment question for a patient requesting a decongestant is to ask about a history of:
- a) Asthma
- b) Hypertension, heart disease, or thyroid disorders.
- c) Dermatitis
- d) Migraine headaches
Answer: b) Hypertension, heart disease, or thyroid disorders.
21. If a patient reports that their cold symptoms started severely, improved, and then suddenly worsened again with fever and facial pain, this “double sickening” might suggest:
- a) A normal cold progression.
- b) Development of a secondary bacterial infection like sinusitis.
- c) Allergic rhinitis.
- d) That the initial virus was very weak.
Answer: b) Development of a secondary bacterial infection like sinusitis.
22. Which information is crucial to gather when a patient complains of a sore throat?
- a) Their favorite type of tea.
- b) Duration, severity, presence of fever, difficulty swallowing, or swollen glands.
- c) If they have travel plans next year.
- d) Their preferred brand of lozenges.
Answer: b) Duration, severity, presence of fever, difficulty swallowing, or swollen glands. (To rule out strep throat or other serious conditions).
23. A patient with asthma who develops a cough and cold symptoms should be advised to:
- a) Stop using their asthma inhalers.
- b) Monitor their asthma symptoms closely and consult their physician, as colds can trigger asthma exacerbations.
- c) Only use strong OTC cough suppressants.
- d) Assume it’s just a simple cold and not worry.
Answer: b) Monitor their asthma symptoms closely and consult their physician, as colds can trigger asthma exacerbations.
24. The “C” in SCHOLAR-MAC stands for Characteristics of the symptom. Which question best elicits this?
- a) “When did it start?”
- b) “What does the symptom feel like (e.g., sharp, dull, itchy, burning)?”
- c) “What makes it better?”
- d) “What medications are you taking?”
Answer: b) “What does the symptom feel like (e.g., sharp, dull, itchy, burning)?”
25. An appropriate assessment question for someone with nasal congestion is:
- a) “Is the congestion in one nostril or both?”
- b) “Do you also have a headache?”
- c) “Is the discharge clear, yellow, or green?”
- d) All of the above are relevant assessment questions.
Answer: d) All of the above are relevant assessment questions.
26. If a patient reports a cough lasting more than 7-10 days despite OTC treatment, or if it is associated with a fever that does not subside, the pharmacist should:
- a) Recommend a different OTC cough suppressant.
- b) Advise the patient to double the dose of their current medication.
- c) Refer the patient to a physician for further evaluation.
- d) Suggest an herbal remedy only.
Answer: c) Refer the patient to a physician for further evaluation.
27. The “M” in QuEST/WWHAM (Medication being taken) is critical because:
- a) It helps determine the cost of therapy.
- b) It can reveal potential drug-drug interactions or if current medications could be causing the symptoms.
- c) It is only for prescription medications.
- d) It is primarily for marketing purposes.
Answer: b) It can reveal potential drug-drug interactions or if current medications could be causing the symptoms.
28. Paroxysmal (sudden, recurrent) sneezing is a hallmark symptom often pointing towards:
- a) A bacterial infection.
- b) Allergic rhinitis.
- c) The common cold.
- d) Influenza.
Answer: b) Allergic rhinitis.
29. When assessing a cough, asking “Does anything come up when you cough?” helps to differentiate between:
- a) Viral and bacterial cough.
- b) Productive and non-productive cough.
- c) Acute and chronic cough.
- d) Drug-induced cough and infection-induced cough.
Answer: b) Productive and non-productive cough.
30. A patient who is pregnant presents with cold symptoms. The pharmacist’s assessment must particularly focus on:
- a) Recommending the strongest available OTC medications.
- b) Identifying safe self-care options and recognizing when referral is needed, due to potential risks of medications during pregnancy.
- c) Telling her no medications are safe.
- d) Suggesting she wait until after delivery to treat her symptoms.
Answer: b) Identifying safe self-care options and recognizing when referral is needed, due to potential risks of medications during pregnancy.
31. “Allergic shiners” (dark circles under the eyes) and the “allergic salute” (upward rubbing of the nose) are physical signs sometimes seen in patients with:
- a) Influenza
- b) Chronic allergic rhinitis
- c) Acute bronchitis
- d) Pneumonia
Answer: b) Chronic allergic rhinitis
32. If a patient describes their cold symptoms as including significant body aches and a fever of 102°F (38.9°C) that started suddenly yesterday, the pharmacist should consider the possibility of:
- a) Allergic rhinitis
- b) A mild common cold
- c) Influenza, and assess for other flu symptoms and referral criteria.
- d) Vasomotor rhinitis
Answer: c) Influenza, and assess for other flu symptoms and referral criteria.
33. The “L” in SCHOLAR stands for Location. This is most relevant when assessing symptoms like:
- a) Fatigue
- b) Sore throat or sinus pain/pressure
- c) General malaise
- d) Fever
Answer: b) Sore throat or sinus pain/pressure
34. A key part of assessing “History” (in SCHOLAR) for a recurring problem like seasonal allergies would be to ask:
- a) “What did you eat for breakfast?”
- b) “Have you had these symptoms before, and if so, what time of year do they usually occur and what treatments were effective?”
- c) “Do you own any pets?” (Relevant for triggers, but the question is about history of the problem itself).
- d) “What is your current body weight?”
Answer: b) “Have you had these symptoms before, and if so, what time of year do they usually occur and what treatments were effective?”
35. A patient requests an OTC product for a cough that produces thick, green sputum. The pharmacist should:
- a) Recommend dextromethorphan.
- b) Recommend guaifenesin.
- c) Assess further and likely refer, as colored sputum can indicate a bacterial infection requiring medical evaluation.
- d) Tell them it will resolve on its own.
Answer: c) Assess further and likely refer, as colored sputum can indicate a bacterial infection requiring medical evaluation.
36. When a patient says they have “allergies,” an important clarifying question is:
- a) “What color are your eyes?”
- b) “What specific symptoms are you experiencing, and what do you think you are allergic to?”
- c) “How much do you weigh?”
- d) “Do you prefer brand name or generic?”
Answer: b) “What specific symptoms are you experiencing, and what do you think you are allergic to?”
37. Chest tightness or wheezing accompanying a cough and cold symptoms is a red flag because it may indicate:
- a) A very mild cold.
- b) Involvement of the lower respiratory tract (e.g., bronchitis, pneumonia) or an exacerbation of asthma/COPD.
- c) Typical allergic rhinitis.
- d) The patient is not drinking enough fluids.
Answer: b) Involvement of the lower respiratory tract (e.g., bronchitis, pneumonia) or an exacerbation of asthma/COPD.
38. The “R” in SCHOLAR stands for Remitting factors. This involves asking:
- a) “What makes your symptoms worse?”
- b) “What, if anything, makes your symptoms better or go away?”
- c) “What medications are you currently taking?”
- d) “When did your symptoms begin?”
Answer: b) “What, if anything, makes your symptoms better or go away?”
39. An elderly patient with multiple chronic conditions (e.g., heart failure, kidney disease) presents with cold symptoms. The pharmacist’s assessment should be particularly cautious regarding:
- a) The flavor of OTC products.
- b) Potential drug interactions, contraindications of OTCs due to comorbidities, and the higher risk of complications.
- c) Whether the patient can drive to the pharmacy.
- d) Recommending the newest products on the market.
Answer: b) Potential drug interactions, contraindications of OTCs due to comorbidities, and the higher risk of complications.
40. If a patient is seeking a product for “sinus congestion,” it is important to assess for symptoms of potential bacterial sinusitis, such as:
- a) Clear, watery rhinorrhea.
- b) Itchy eyes.
- c) Persistent (>10 days) purulent nasal discharge, facial pain/pressure, and possibly fever or “double sickening.”
- d) Sneezing.
Answer: c) Persistent (>10 days) purulent nasal discharge, facial pain/pressure, and possibly fever or “double sickening.”
41. The “A” in SCHOLAR-MAC for Allergies refers to:
- a) Antihistamines used
- b) Associated symptoms
- c) Actions taken
- d) Allergies (to medications, foods, environment)
Answer: d) Allergies (to medications, foods, environment)
42. Before suggesting any self-care product, the most critical step a pharmacist performs is to:
- a) Check the price of all available products.
- b) Ensure the patient is an appropriate candidate for self-care by ruling out exclusions and red flags.
- c) Recommend their personal favorite product.
- d) Ask if the patient has insurance.
Answer: b) Ensure the patient is an appropriate candidate for self-care by ruling out exclusions and red flags.
43. A patient complains of a persistent sore throat for one week with a fever of 101°F and visible white spots on their tonsils. The pharmacist should:
- a) Recommend an OTC anesthetic lozenge and an antipyretic.
- b) Advise gargling with salt water.
- c) Strongly recommend medical referral to rule out streptococcal pharyngitis or other infections.
- d) Suggest they take a double dose of vitamin C.
Answer: c) Strongly recommend medical referral to rule out streptococcal pharyngitis or other infections.
44. When assessing a common cold, which symptom is generally NOT a primary indicator for immediate physician referral in an otherwise healthy adult?
- a) Shortness of breath.
- b) Chest pain.
- c) Clear rhinorrhea and mild malaise for 2 days.
- d) Fever above 103°F (39.4°C).
Answer: c) Clear rhinorrhea and mild malaise for 2 days.
45. Asking “Have you tried anything for these symptoms yet, and did it help?” falls under which part of patient assessment?
- a) Symptoms
- b) History (of current problem) or Actions taken (part of H or A in SCHOLAR)
- c) Location
- d) Remitting factors (if it helped)
Answer: b) History (of current problem) or Actions taken (part of H or A in SCHOLAR)
46. A patient describing “postnasal drip” as part of their cold or allergy symptoms helps the pharmacist understand:
- a) The severity of their fever.
- b) A specific characteristic of their rhinorrhea that might contribute to cough or sore throat.
- c) Their blood pressure.
- d) Their likelihood of developing pneumonia.
Answer: b) A specific characteristic of their rhinorrhea that might contribute to cough or sore throat.
47. The purpose of asking about “Co-existing conditions” (the second “C” in SCHOLAR-MAC) is primarily to:
- a) Make small talk with the patient.
- b) Identify conditions that may be contraindications for certain OTC products or increase the risk of complications.
- c) Determine the patient’s socioeconomic status.
- d) Decide on the flavor of the medication.
Answer: b) Identify conditions that may be contraindications for certain OTC products or increase the risk of complications.
48. Differentiating between viral and allergic conjunctivitis can be part of assessing allergy symptoms. Allergic conjunctivitis typically presents with:
- a) Purulent discharge and eyelid matting.
- b) Itching, redness, and watery discharge, often bilateral.
- c) Unilateral redness with severe pain.
- d) Foreign body sensation only.
Answer: b) Itching, redness, and watery discharge, often bilateral.
49. If a patient is unsure what is causing their symptoms (cold vs. allergy), the pharmacist can help by:
- a) Guessing based on the season.
- b) Asking targeted questions about symptom onset, nature of symptoms (e.g., itchiness, fever, body aches), timing, and potential triggers.
- c) Recommending a product that treats both.
- d) Telling them to take an antibiotic.
Answer: b) Asking targeted questions about symptom onset, nature of symptoms (e.g., itchiness, fever, body aches), timing, and potential triggers.
50. The final step in the QuEST process (“Talk with patient”) involves explaining the suggested strategies. For allergies, cough, and cold, this should include:
- a) Only the price of the product.
- b) How to use the product, what to expect, potential side effects, and when to follow up or see a doctor if symptoms don’t improve.
- c) A guarantee that the product will cure them instantly.
- d) A long list of all possible rare side effects to scare them.
Answer: b) How to use the product, what to expect, potential side effects, and when to follow up or see a doctor if symptoms don’t improve.