Cough and cold are among the most common ailments for which individuals seek self-care advice and over-the-counter (OTC) products. As accessible healthcare professionals, pharmacists play a critical role in this “Health & Wellness” space. This involves accurately assessing symptoms, identifying exclusions for self-treatment that necessitate medical referral, and recommending appropriate pharmacological and non-pharmacological therapies. For PharmD students, mastering the principles of self-care for cough and cold is a foundational skill that reinforces knowledge from multiple domains including pharmacology, patient assessment, and communication. This MCQ quiz will test your knowledge on the key aspects of managing cough and cold through self-care.
1. The common cold is primarily caused by which type of pathogen?
- A. Bacteria
- B. Fungi
- C. Viruses (most commonly Rhinovirus)
- D. Parasites
Answer: C. Viruses (most commonly Rhinovirus)
2. A cough that expels mucus or phlegm from the respiratory tract is best described as a(n):
- A. Non-productive cough
- B. Productive or “wet” cough
- C. Refractory cough
- D. Acute cough
Answer: B. Productive or “wet” cough
3. Which of the following patients presenting with cold symptoms should be immediately referred for medical evaluation (i.e., is an exclusion for self-treatment)?
- A. A 30-year-old with a runny nose and sore throat for 2 days.
- B. A 68-year-old with COPD presenting with shortness of breath and wheezing.
- C. A 25-year-old with mild congestion and sneezing.
- D. A 40-year-old with a scratchy throat.
Answer: B. A 68-year-old with COPD presenting with shortness of breath and wheezing.
4. A patient reports their cough has persisted for 10 days and is now accompanied by thick, yellow-green phlegm and a fever of 101°F. What is the appropriate recommendation?
- A. Recommend an OTC antitussive like dextromethorphan.
- B. Recommend an OTC expectorant like guaifenesin.
- C. Advise the patient to see a physician, as these are exclusions for self-treatment.
- D. Suggest a first-generation antihistamine.
Answer: C. Advise the patient to see a physician, as these are exclusions for self-treatment.
5. Systemic decongestants like pseudoephedrine and phenylephrine work by:
- A. Blocking histamine H1 receptors.
- B. Acting as alpha-adrenergic agonists, causing vasoconstriction of nasal blood vessels.
- C. Inhibiting cyclooxygenase enzymes.
- D. Stimulating beta-2 adrenergic receptors.
Answer: B. Acting as alpha-adrenergic agonists, causing vasoconstriction of nasal blood vessels.
6. A patient with which of the following conditions should be counseled to use systemic decongestants with caution or avoid them altogether?
- A. Allergic rhinitis
- B. Uncontrolled hypertension and cardiovascular disease
- C. Migraine headaches
- D. Osteoporosis
Answer: B. Uncontrolled hypertension and cardiovascular disease
7. Topical decongestant nasal sprays (e.g., oxymetazoline) should not be used for more than 3-5 consecutive days due to the risk of:
- A. Systemic hypertension
- B. Rebound congestion (rhinitis medicamentosa)
- C. Nasal polyps
- D. Anosmia (loss of smell)
Answer: B. Rebound congestion (rhinitis medicamentosa)
8. First-generation antihistamines (e.g., diphenhydramine, chlorpheniramine) are often included in multi-symptom nighttime cold products due to their:
- A. Potent antiviral activity.
- B. Decongestant properties.
- C. Sedating and anticholinergic (drying) effects.
- D. Analgesic properties.
Answer: C. Sedating and anticholinergic (drying) effects.
9. Dextromethorphan is an OTC antitussive used to suppress a non-productive cough. Its mechanism of action involves:
- A. Acting as an opioid receptor agonist.
- B. Increasing the production of thin respiratory secretions.
- C. Acting on the cough center in the medulla oblongata, with some NMDA receptor antagonism.
- D. Anesthetizing the throat to reduce irritation.
Answer: C. Acting on the cough center in the medulla oblongata, with some NMDA receptor antagonism.
10. Guaifenesin is the only FDA-approved OTC expectorant (protussive). Its proposed mechanism of action is to:
- A. Suppress the cough reflex centrally.
- B. Loosen and thin lower respiratory tract secretions, making coughs more productive.
- C. Decrease inflammation in the airways.
- D. Dry up all respiratory secretions.
Answer: B. Loosen and thin lower respiratory tract secretions, making coughs more productive.
11. A patient asks for a recommendation for a hacking, dry (non-productive) cough that is keeping them up at night. The most appropriate single-ingredient OTC product to recommend would be:
- A. Guaifenesin
- B. Acetaminophen
- C. Dextromethorphan
- D. Pseudoephedrine
Answer: C. Dextromethorphan
12. A patient complains of a “chesty” cough with thick phlegm that is difficult to expectorate. The most appropriate single-ingredient OTC product to recommend would be:
- A. Dextromethorphan
- B. Guaifenesin
- C. Diphenhydramine
- D. Phenylephrine
Answer: B. Guaifenesin
13. A patient selects a combination cold product containing an analgesic, a decongestant, an antihistamine, and a cough suppressant. This product would be inappropriate if the patient’s only symptom is:
- A. A runny nose
- B. A headache and body aches
- C. A stuffy nose
- D. All of the above are appropriate uses.
Answer: B. A headache and body aches (The other ingredients would be unnecessary and add risk of side effects).
14. What is the primary concern with using “behind-the-counter” pseudoephedrine versus “front-of-counter” phenylephrine?
- A. Pseudoephedrine is significantly less effective than phenylephrine.
- B. Phenylephrine has a higher risk of causing rebound congestion.
- C. Pseudoephedrine can be illicitly used to manufacture methamphetamine, hence its restricted access.
- D. Phenylephrine has a much longer duration of action.
Answer: C. Pseudoephedrine can be illicitly used to manufacture methamphetamine, hence its restricted access.
15. Which of the following is an effective non-pharmacological recommendation for soothing a sore throat associated with a cold?
- A. Drinking caffeinated beverages.
- B. Gargling with salt water or using non-medicated lozenges/hard candies.
- C. Whispering instead of talking.
- D. Eating spicy foods.
Answer: B. Gargling with salt water or using non-medicated lozenges/hard candies.
16. For children under the age of 4, the FDA and product manufacturers generally recommend:
- A. Using adult doses of cough and cold products.
- B. Avoiding the use of most OTC cough and cold products due to lack of efficacy and risk of serious side effects.
- C. Using honey for cough in all children under 1 year of age.
- D. Preferring combination products over single-ingredient products.
Answer: B. Avoiding the use of most OTC cough and cold products due to lack of efficacy and risk of serious side effects.
17. Honey has shown some evidence for effectiveness in treating nocturnal cough in which patient population?
- A. Infants under 12 months of age
- B. Children over 1 year of age
- C. All adult patients with diabetes
- D. Pregnant women
Answer: B. Children over 1 year of age (Honey should NOT be given to infants <1 year due to risk of botulism).
18. Which of the following non-pharmacological measures can help relieve nasal congestion?
- A. Lying flat to sleep
- B. Using a cool-mist humidifier or vaporizer, and using saline nasal sprays or rinses
- C. Decreasing fluid intake
- D. Drinking alcohol
Answer: B. Using a cool-mist humidifier or vaporizer, and using saline nasal sprays or rinses
19. Zinc lozenges for the common cold, if used, should be initiated:
- A. After symptoms have persisted for 7 days.
- B. Only for prevention, not treatment.
- C. Within 24-48 hours of symptom onset to potentially reduce the duration of the cold.
- D. At bedtime only.
Answer: C. Within 24-48 hours of symptom onset to potentially reduce the duration of the cold.
20. A patient asks if Vitamin C is effective for treating their cold. The most evidence-based response is:
- A. High-dose IV Vitamin C is proven to cure the common cold.
- B. Regular supplementation with Vitamin C may slightly reduce the duration of a cold, but starting it after symptoms begin has little to no effect.
- C. Vitamin C prevents the common cold in all individuals.
- D. Vitamin C is primarily used as a decongestant.
Answer: B. Regular supplementation with Vitamin C may slightly reduce the duration of a cold, but starting it after symptoms begin has little to no effect.
21. A patient with a non-productive cough mentions they recently started a new blood pressure medication. Which medication class is famously associated with causing a dry, hacking cough?
- A. Beta-blockers
- B. ACE Inhibitors (e.g., lisinopril, enalapril)
- C. Calcium channel blockers
- D. Thiazide diuretics
Answer: B. ACE Inhibitors (e.g., lisinopril, enalapril)
22. A patient purchasing a multi-symptom cold product containing acetaminophen should be counseled to:
- A. Also take a separate acetaminophen product for fever.
- B. Be aware of the total daily dose of acetaminophen from all sources to avoid exceeding the maximum recommended dose (e.g., 3,000-4,000 mg/day for adults).
- C. Take the product with alcohol to enhance its effect.
- D. Only take the product for one day.
Answer: B. Be aware of the total daily dose of acetaminophen from all sources to avoid exceeding the maximum recommended dose (e.g., 3,000-4,000 mg/day for adults).
23. Why are second-generation antihistamines (e.g., loratadine, cetirizine) generally not effective or recommended for cold symptoms?
- A. They cause excessive sedation.
- B. Histamine is not a primary mediator of cold symptoms, and these agents lack the anticholinergic effects that provide some symptomatic relief with first-generation agents.
- C. They are less potent than first-generation antihistamines.
- D. They are only available by prescription.
Answer: B. Histamine is not a primary mediator of cold symptoms, and these agents lack the anticholinergic effects that provide some symptomatic relief with first-generation agents.
24. A patient with benign prostatic hyperplasia (BPH) should use which of the following OTC cold medications with caution due to the risk of worsening urinary symptoms?
- A. Guaifenesin
- B. Systemic decongestants (e.g., pseudoephedrine) and first-generation antihistamines
- C. Acetaminophen
- D. Saline nasal spray
Answer: B. Systemic decongestants (e.g., pseudoephedrine) and first-generation antihistamines
25. Local anesthetics for sore throat, such as benzocaine or dyclonine in lozenges and sprays, work by:
- A. Killing the virus causing the cold.
- B. Reducing inflammation systemically.
- C. Temporarily numbing the nerve endings in the throat to relieve pain.
- D. Suppressing the cough reflex.
Answer: C. Temporarily numbing the nerve endings in the throat to relieve pain.
26. Which of the following is an exclusion for self-treatment of cough?
- A. A cough that has lasted for 3 days.
- B. A dry, hacking cough.
- C. A cough accompanied by shortness of breath, chest pain, or hemoptysis (coughing up blood).
- D. A cough associated with a minor throat irritation.
Answer: C. A cough accompanied by shortness of breath, chest pain, or hemoptysis (coughing up blood).
27. The primary goal of using an expectorant like guaifenesin is to:
- A. Stop the patient from coughing completely.
- B. Make a non-productive cough productive, and a productive cough more effective at clearing mucus.
- C. Induce sleep.
- D. Relieve nasal congestion.
Answer: B. Make a non-productive cough productive, and a productive cough more effective at clearing mucus.
28. A patient is looking for a cold remedy and mentions they take a monoamine oxidase inhibitor (MAOI). Which two OTC ingredients should they be counseled to avoid due to risk of a serious hypertensive crisis?
- A. Guaifenesin and Acetaminophen
- B. Dextromethorphan and Systemic Decongestants (pseudoephedrine/phenylephrine)
- C. Loratadine and Ibuprofen
- D. Saline and Menthol
Answer: B. Dextromethorphan and Systemic Decongestants (pseudoephedrine/phenylephrine)
29. Which of the following is a key counseling point for any patient seeking self-care for cough or cold?
- A. Antibiotics are always necessary.
- B. The importance of hydration and rest.
- C. OTC products will cure the viral infection.
- D. Symptoms should resolve completely within 24 hours.
Answer: B. The importance of hydration and rest.
30. A patient with narrow-angle glaucoma should avoid which class of OTC cold medications?
- A. Expectorants
- B. Systemic decongestants and first-generation antihistamines (due to mydriatic/anticholinergic effects)
- C. Analgesics
- D. Vitamin C
Answer: B. Systemic decongestants and first-generation antihistamines (due to mydriatic/anticholinergic effects)
31. The term “post-nasal drip” often causes a chronic cough. Management can include:
- A. An OTC antitussive only.
- B. An intranasal corticosteroid and/or a first-generation antihistamine/decongestant combination.
- C. An OTC expectorant only.
- D. High doses of Vitamin C.
Answer: B. An intranasal corticosteroid and/or a first-generation antihistamine/decongestant combination.
32. For a patient with a cold, the best recommendation to manage body aches and fever would be:
- A. An oral decongestant like pseudoephedrine.
- B. A systemic analgesic/antipyretic like acetaminophen or ibuprofen.
- C. A cough suppressant like dextromethorphan.
- D. A topical nasal spray like oxymetazoline.
Answer: B. A systemic analgesic/antipyretic like acetaminophen or ibuprofen.
33. What is the most common adverse effect of first-generation antihistamines like diphenhydramine?
- A. Insomnia
- B. Hypertension
- C. Drowsiness and sedation
- D. Tachycardia
Answer: C. Drowsiness and sedation
34. A patient asks why phenylephrine seems less effective than the pseudoephedrine they used to buy. The pharmacist can explain that:
- A. This is just the patient’s perception.
- B. Phenylephrine has lower oral bioavailability and may be less effective as a decongestant at standard OTC doses compared to pseudoephedrine.
- C. Phenylephrine is actually a more potent decongestant.
- D. The FDA has banned pseudoephedrine for being ineffective.
Answer: B. Phenylephrine has lower oral bioavailability and may be less effective as a decongestant at standard OTC doses compared to pseudoephedrine.
35. A key principle of recommending OTC combination products for cough and cold is to:
- A. Always choose the product with the most ingredients.
- B. Choose a product that only treats the specific symptoms the patient is experiencing.
- C. Recommend nighttime formulas for daytime use to ensure rest.
- D. Avoid all combination products.
Answer: B. Choose a product that only treats the specific symptoms the patient is experiencing.
36. A patient with a productive cough asks if they should take dextromethorphan. What is the most appropriate advice?
- A. Yes, suppressing a productive cough is always recommended.
- B. It is generally not recommended to suppress a productive cough, as coughing is helping to clear mucus from the lungs. An expectorant like guaifenesin may be more appropriate.
- C. Dextromethorphan is only for dry cough and has no effect on a productive cough.
- D. They should take both dextromethorphan and guaifenesin together.
Answer: B. It is generally not recommended to suppress a productive cough, as coughing is helping to clear mucus from the lungs. An expectorant like guaifenesin may be more appropriate.
37. Which of the following is a non-pharmacological method to soothe a cough?
- A. Dry air environments
- B. Using a humidifier or taking a steamy shower; using non-medicated lozenges
- C. Deep, forceful coughing to clear the throat
- D. Drinking cold, caffeinated beverages
Answer: B. Using a humidifier or taking a steamy shower; using non-medicated lozenges
38. The “common cold” is a self-limiting illness. This means:
- A. It requires aggressive antibiotic treatment.
- B. It will generally resolve on its own, and self-care is aimed at symptomatic relief.
- C. It will last for at least 4 weeks.
- D. It is a chronic condition.
Answer: B. It will generally resolve on its own, and self-care is aimed at symptomatic relief.
39. Why is it important to ask about a patient’s existing medical conditions before recommending an OTC cough/cold product?
- A. To determine their insurance coverage.
- B. To identify potential contraindications or precautions (e.g., decongestants in hypertension, antihistamines in BPH/glaucoma).
- C. To suggest the most expensive product.
- D. This is not necessary for OTC products.
Answer: B. To identify potential contraindications or precautions (e.g., decongestants in hypertension, antihistamines in BPH/glaucoma).
40. The term “vasomotor rhinitis” can be mimicked by the overuse of which product?
- A. Oral pseudoephedrine
- B. Topical decongestant nasal sprays (causing rhinitis medicamentosa)
- C. Saline nasal spray
- D. Guaifenesin
Answer: B. Topical decongestant nasal sprays (causing rhinitis medicamentosa)
41. A patient complains of a sore, scratchy throat and wants a recommendation. A local anesthetic spray containing ________ would be an appropriate suggestion for temporary relief.
- A. Pseudoephedrine
- B. Guaifenesin
- C. Benzocaine or Dyclonine
- D. Oxymetazoline
Answer: C. Benzocaine or Dyclonine
42. Which of the following is an important counseling point for dextromethorphan due to its potential for abuse at high doses?
- A. It should only be used as directed and not taken in larger amounts than recommended.
- B. It can be safely mixed with alcohol.
- C. It has no potential for causing CNS effects.
- D. It should be stored in an easily accessible location for children.
Answer: A. It should only be used as directed and not taken in larger amounts than recommended.
43. A patient is looking for a product to help with nasal congestion AND a runny nose at bedtime. A suitable choice could be a combination product containing:
- A. Guaifenesin and dextromethorphan
- B. A decongestant (e.g., pseudoephedrine) and a first-generation antihistamine (e.g., diphenhydramine)
- C. A LAMA and a LABA
- D. Only acetaminophen
Answer: B. A decongestant (e.g., pseudoephedrine) and a first-generation antihistamine (e.g., diphenhydramine)
44. What is the primary reason for avoiding the use of codeine as an antitussive in children?
- A. It is ineffective as a cough suppressant.
- B. Genetic variability in CYP2D6 metabolism can lead to unpredictable conversion to morphine, causing a risk of severe respiratory depression.
- C. It is only available as an injection.
- D. It causes severe hypertension in children.
Answer: B. Genetic variability in CYP2D6 metabolism can lead to unpredictable conversion to morphine, causing a risk of severe respiratory depression.
45. A patient with well-controlled type 1 diabetes asks for a recommendation for a cough syrup. The pharmacist should recommend:
- A. The product with the highest sugar and alcohol content.
- B. A sugar-free and/or alcohol-free formulation if possible, and counsel on potential impacts on blood glucose.
- C. That all cough syrups are contraindicated in diabetes.
- D. A product containing a high dose of pseudoephedrine.
Answer: B. A sugar-free and/or alcohol-free formulation if possible, and counsel on potential impacts on blood glucose.
46. The main role of the pharmacist in self-care for cough and cold is to:
- A. Diagnose the specific virus causing the cold.
- B. Ensure the patient is properly assessed for self-care appropriateness, and help them select a safe and effective product for their specific symptoms.
- C. Prescribe antibiotics for all viral infections.
- D. Sell the largest quantity of product possible.
Answer: B. Ensure the patient is properly assessed for self-care appropriateness, and help them select a safe and effective product for their specific symptoms.
47. A “tussive” agent is another word for a drug that __________, while an “antitussive” is a drug that __________.
- A. Suppresses cough; promotes cough
- B. Promotes cough; suppresses cough
- C. Treats nasal congestion; treats cough
- D. Treats cough; treats nasal congestion
Answer: B. Promotes cough; suppresses cough (A protussive or expectorant promotes coughing up of phlegm).
48. Why is it important for a patient taking guaifenesin to maintain adequate hydration?
- A. To prevent dehydration caused by the drug.
- B. Adequate fluid intake may help the drug work more effectively by thinning mucus.
- C. To prevent the metabolism of guaifenesin.
- D. To reduce the risk of CNS side effects.
Answer: B. Adequate fluid intake may help the drug work more effectively by thinning mucus.
49. A patient wants an OTC product for a cough. They mention they also have very high, uncontrolled blood pressure. Which ingredient should they be advised to avoid?
- A. Guaifenesin
- B. Dextromethorphan
- C. Systemic decongestants like pseudoephedrine
- D. Menthol
Answer: C. Systemic decongestants like pseudoephedrine (often found in cough/cold combo products).
50. The ultimate goal of self-care for the common cold is to:
- A. Shorten the duration of the illness by 50%.
- B. Prevent all future colds.
- C. Provide symptomatic relief while the body’s immune system clears the self-limiting viral infection.
- D. Eliminate the need to ever see a physician.
Answer: C. Provide symptomatic relief while the body’s immune system clears the self-limiting viral infection.
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