Quiz 2: Cough and Cold - Past Paper PDF

**Quiz 2** is scheduled for **Tuesday, 8th October**.     - **Cough and Cold**    A cold is an acute (almost always) viral infection which effects the upper respiratory tract.   Symptoms:  *sniffling, rhinorrhoea, sneezing, sore throat, nasal congestion, chest congestion, cough*    **Commo...

**Quiz 2** is scheduled for **Tuesday, 8th October**.     - **Cough and Cold**    A cold is an acute (almost always) viral infection which effects the upper respiratory tract.   Symptoms:  *sniffling, rhinorrhoea, sneezing, sore throat, nasal congestion, chest congestion, cough*    **Common cold-causing viruses:**  Rhinoviruses **30-50%**  Coronaviruses **10-15%**  Influenza and parainfluenza viruses **10-15%**  Respiratory syncytial viruses **5%**  Adenoviruses **5%**    Four of the seven (4/7) coronaviruses most frequently cause symptoms of the common cold. Coronavirus types 229E, NL63 and HKU1 and OC43 have been associated with the common cold, rarely causing more severe symptom.  Three of the seven coronaviruses cause much more severe, and sometimes fatal, respiratory infections in humans than other coronaviruses and have caused major outbreaks of deadly pneumonia in the 21st century:  1. SARS-CoV was identified in 2002 as the cause of an outbreak of severe acute respiratory syndrome (SARS).  2. MERS-CoV was identified in 2012 as the cause of Middle East Respiratory Syndrome (MERS).  3. SARS-CoV-2 is a novel coronavirus identified as the cause of Coronavirus Disease 2019 (COVID-19) that began in Wuhan, China in late 2019 and spread worldwide.    **Bacterial pharyngitis**: \ Streptococcus pyogenes (Group A Strep) \ Possibly causing 5 to 15% of sore throats in adults, 20-30% in children    **Impact of the common cold** \ **Severity:** \ Although not considered as life-threatening, its symptoms still cause discomfort \ Symptoms usually clear up on their own by 7--10 days but some may last up to 3 weeks or more \ **Frequency:** \ Children can suffer up to 10 colds each year, \ Young adults between 2 and 5 times and people over 60 years just 1- 2 times    A cold -- sniffles, sneezes, sore throat, rhinorrhoea, nasal congestion, cough, fever, aches and pains, fatigue \ Covid-19 -- high temp/chills, persistent cough, loss of taste/smell, shortness of breath, sore throat, headaches, aches and pains    Individuals of all ages can get an RSV infection but those at highest risk for severe disease include:  premature infants and infants aged 6 months and younger  individuals with chronic heart or lung disease  individuals with compromised immune systems  older adults    RSV starts off with mild cold-like symptoms which may include slight fever, \ sore throat, headache, and a runny and stuffy nose. Bronchiolitis and \ pneumonia often follow in young children. \ Death in people under 16 years of age from RSV is rare in high income \ countries like Australia. \ People with RSV are generally contagious for three to eight days. Some \ infants and people with impaired immune systems may be contagious up to \ four weeks after symptoms subside. \ Most people recover from the infection within ten days.    Treating the most troublesome symptoms \ Rhinorrhoea -- decongestants, anticholinergics \ Sore throat -- anti-inflammatories, anaesthetics, demulcents, antibacterials  \ Nasal congestion -- decongestants \ Aches and pains -- analgesics \ Cough -- decongestants, expectorants, suppressants    Symptomatic therapy for sore throat: Analgesics/ Anti-inflammatories  Oral  Paracetamol  Ibuprofen  Diclofenac  Combo paracetamol/ibuprofen    Lozenges (and other topicals)-- how active are the "actives"?  Anti-inflammatories: \*benzydamine, \*flurbiprofen, turmeric  Antiseptics: amylmetacresol, dichlorobenzyl alcohol,  hexylresorcinol  Anaesthetics: \*lignocaine (lidocaine)  Menthol \*-- analgesic, cough suppressant and  decongestant properties -- often combined with other  actives  \*  in throat sprays \* in nasal sprays    Treatments for coughs  Cough mixtures: Decongestants, Expectorants, Suppressants, Demulcents  Solid dose and combination formulations: Pseudoephedrine issues      A blue and white chart with black text Description automatically generated    Antitussives- pharmacy only   Includes: dextromethorphan (S2), dihydrocodeine (S3), and codeine (S8) \ Short-term use only \ Symptomatic relief of non-productive coughs & to break the cough cycle \ Beneficial for people with: \ --unexplained coughs or cough hypersensitivity syndrome, \ --whose quality of life is significantly affected \ In Australia, centrally acting: \ --act directly on the medullary cough centre in the brain \ --decrease nerve impulse discharges to the muscles associated with \ cough \ ➜ suppress the cough reflex    What is available in your pharmacy for dry cough?  Marshmallow + herbal agents  S2 -- dextromethorphan (in some stores)  S3 -- dihydrocodeine  S8 -- Codeine linctus (POM)    Demulcents   Soothe & protect irritated tissue by forming a protective film over the throat and pharynx \ Demulcents have a physical mechanism of action (local): \ -- Rapid onset of effect/action \ -- Duration of action is dependent on the mucilaginous medicine used \ For dry cough helps reduce the urge to cough by protecting cough receptors against noxious stimuli \ Common demulcents include Sugar, Honey, Glycerol \ Herbal demulcents, e.g. Althaea officinalis -- Marshmallow root, are made up of polysaccharides (mucilage) \ Mucilage molecules are long-strand polysaccharides too large to be systemically = absorbed \ They have a 'slippery', mild taste and swell in water, producing a gel- like mass that can be used to soothe and protect irritated mucous membranes    A diagram of a molecule Description automatically generated      - Cohort Studies    **Key Characteristics of Cohort Studies:**  - **Study Design**: Cohort studies are observational and typically follow a group of individuals (the cohort) over time. Participants are classified into groups based on exposure to a risk factor or intervention.  - **Exposure and Outcome**: Participants are observed to see if they develop a particular outcome, such as a disease or health event, based on their exposure status.  - **Time Frame**: Prospective (moving forward in time) or retrospective (looking back at past data).  - **Comparison**: Cohort studies compare rates of outcomes between exposed and unexposed groups.  **Strengths of Cohort Designs:**  - **Temporal Sequence**: Clearly establishes a timeline between exposure and outcome, which is useful for studying causality.  - **Multiple Outcomes**: Can assess multiple outcomes for the same exposure.  - **Direct Measurement**: Cohort studies can directly measure the incidence (new cases) of outcomes.  - **Reduced Recall Bias**: Especially in prospective studies, information is collected before the outcome occurs, reducing bias.  **Weaknesses of Cohort Designs:**  - **Time and Cost**: Can be expensive and take a long time to follow up with participants.  - **Loss to Follow-Up**: If participants drop out, this can introduce bias and affect validity.  - **Confounding Variables**: Difficult to fully control for all confounders, which can affect the association between exposure and outcome.  - **Not Ideal for Rare Outcomes**: Because large sample sizes may be needed to capture enough cases, cohort studies are less efficient for rare diseases.  **Key Elements and Issues in Case-Control Designs:**  - **Research Aim**: To determine the relationship between an exposure and an outcome by comparing individuals with the outcome (cases) to those without (controls).  - **Study Population**: Individuals with the condition (cases) and a comparable group without the condition (controls).  - **Cases**: Individuals who have the disease or outcome of interest.  - **Controls**: Individuals who do not have the disease but are otherwise similar to the cases.  - **Covariates**: Variables (e.g., age, gender, socioeconomic status) that may affect the relationship between exposure and outcome.  - **Study Period**: The time over which cases and controls are identified; may be retrospective.  - **Follow-Up**: Typically, not needed since the outcome has already occurred.  - **Measure of Association**: Odds ratio (OR), comparing the odds of exposure in cases vs. controls.  **Factors Affecting Risk of Bias in Cohort Studies:**  - **Selection Bias**: If the cohort is not representative of the general population or if the exposed/unexposed groups differ systematically.  - **Loss to Follow-Up**: If too many participants drop out, this can bias results.  - **Confounding**: Confounders, or variables that affect both the exposure and the outcome, can distort the true association. Controlling for these in the study design or analysis is essential.  - **Measurement Bias**: If exposure or outcomes are measured inaccurately, this can introduce bias.  **Calculating and Interpreting Relative and Absolute Risk:**  - **Relative Risk (RR)**: Measures the risk of an outcome in the exposed group relative to the unexposed group.  - **Absolute Risk (AR)**: The difference in risk between the exposed and unexposed groups.  - Interpretation: This provides the actual difference in risk, which can help quantify the clinical significance.  - **Confidence Intervals (CIs)**: Provide a range of values within which the true measure of association is likely to fall. A CI that does not cross 1.0 for RR indicates statistical significance.  **Use of Cohort Study Results in Clinical Practice:**  - **Risk Assessment**: Understanding the risks associated with exposures (e.g., medications, lifestyle factors) helps clinicians weigh the benefits and harms of treatment options.  - **Guideline Development**: Results from cohort studies contribute to evidence-based clinical guidelines for managing conditions, particularly for long-term health outcomes.  - **Patient Education**: Cohort studies can inform patients about the relative risks of certain behaviours or treatments, helping in shared decision-making.      Cohort studies  Participants enrolled based on their exposure status, then followed up to determine the development of new cases of the outcome  Provide information about the causation of the disease and the most direct measurement of the risk of developing the outcome  May be either concurrent / prospective or historical / retrospective    Selection of Participants  Unexposed participants should be sampled from the same (or comparable) source population as the exposed group  Both groups should be free of the outcome and equally susceptible to its development  Baseline characteristics should be similar between the two groups, except for the exposure of interest    Cohort study design  Equivalent information on exposure and outcome status should be available for the two groups  Both groups should be accessible and available for follow up  Multiple comparison control groups selected in different ways may enforce the validity of results  Nonparticipation:  not all subjects eligible to participate do so  participants may differ from those nonparticipants    Follow Up  Major source of potential bias is the failure to obtain outcome information on all subjects - Attrition bias  Other source of bias - collecting follow-up on a greater proportion of one of the two groups -- Sampling bias  Duration of follow up depends on the exposure and the outcome of interest    Cohort study considerations  Interviewers / observers should be blinded to the exposure status of the patient -- measurement bias  Standardised clearly defined protocols should be utilised -- measurement bias  Long periods of follow up may be required  Subjects lost to follow up are inevitable, and may be important -- attrition bias  Possible for exposure status to change during the study  -- Retest may be expensive and difficult, but need to acknowledge this    Advantages  Direct calculation of relative risk  May provide information on incidence of disease  Temporal relationship between exposure and outcome is clear  Efficient for studies of rare exposures  Can provide information on multiple outcomes  Minimises bias (particularly selection bias)  Strongest observational design for establishing a cause-and- effect relationship    Disadvantages  Time consuming  Often requires a large sample size  Expensive  Not useful for studies of rare outcomes  Losses to follow up may affect validity    - Headache and Migraine    **1. Clinical Presentation and Differential Diagnosis:**  - **Headaches**: Typically include tension-type, cluster, and secondary headaches. Patients may present with symptoms such as dull, aching pain (tension-type) or sharp, one-sided pain (cluster). Secondary headaches are due to underlying conditions like infections or head trauma.  - **Migraines**: Often involve moderate to severe throbbing pain, typically unilateral, accompanied by nausea, vomiting, sensitivity to light and sound, and sometimes an aura (visual disturbances or tingling).  - **Differential Diagnosis**: Involves distinguishing between primary headache disorders (like migraine and tension headaches) and secondary headaches (those caused by underlying medical conditions). Key factors include onset, pattern, associated symptoms, and neurological signs.  **2. Risk Factors and Triggers:**  - **Common Risk Factors**: Includes family history, hormonal changes (especially in women), stress, lack of sleep, and dietary factors.  - **Common Triggers**: Bright lights, loud noises, strong smells, specific foods (e.g., chocolate, caffeine), dehydration, and changes in sleep patterns. Risk assessment and screening focus on identifying these factors to minimize exposure.  - **Avoidance Strategies**: Involve educating patients to avoid known triggers (e.g., diet, lifestyle adjustments) and stress management techniques.  **3. Principles of Management:**  - **Acute Management**: Early intervention with medications like NSAIDs, triptans, and antiemetics.  - **Preventive Management**: May involve beta-blockers, anticonvulsants, and antidepressants for chronic migraines.  - **Non-Pharmacological**: Includes lifestyle changes, stress reduction, and cognitive behavioural therapy.  **4. Non-Pharmacological Therapy Options:**  - **Stress Management**: Techniques like relaxation therapy, meditation, and biofeedback.  - **Dietary Adjustments**: Avoidance of foods known to trigger migraines.  - **Lifestyle Modifications**: Maintaining regular sleep schedules, staying hydrated, and practicing good posture to reduce tension-type headaches.  **5. Complementary and Alternative Medicines (CAMs):**  - **Popular CAMs**: Include acupuncture, massage therapy, chiropractic care, and certain herbal supplements (e.g., feverfew, butterbur, magnesium).  - **Evidence**: CAMs like magnesium and riboflavin may have some efficacy in reducing migraine frequency, though they should be used cautiously in conjunction with conventional treatments.  **6. Non-Prescription Analgesics and Other Medications:**  - **Common Medications**: Non-prescription options include acetaminophen, ibuprofen, and aspirin.  - **Mechanism of Action**: Most non-prescription analgesics work by inhibiting the production of prostaglandins, thereby reducing inflammation and pain.  - **Contraindications**: Contraindicated in patients with certain gastrointestinal issues, kidney disease, or hypersensitivity to NSAIDs.  - **Adverse Effects**: Long-term use can lead to gastrointestinal bleeding, kidney damage, or medication-overuse headache (rebound headache).  - **Drug Interactions**: NSAIDs interact with anticoagulants, corticosteroids, and some antihypertensives.  **7. Non-Prescription Management:**  - For mild to moderate headaches and migraines, start with simple analgesics like acetaminophen or NSAIDs. Triptans are recommended for more severe migraines but are prescription-only.  - Educate patients on the appropriate use of these medications, including dosing limits to avoid overuse.  **8. Counselling Patients:**  - **Medication Instructions**: Provide clear instructions on how to take over-the-counter analgesics, including maximum daily doses and the importance of not exceeding recommended use to avoid medication-overuse headaches.  - **Lifestyle Advice**: Offer guidance on lifestyle adjustments, trigger avoidance, and the importance of early treatment.  - **Written Information**: Provide patients with educational materials, such as headache diaries, to track triggers, medications used, and headache frequency.  **9. Using Scientific Literature:**  - Rely on up-to-date clinical guidelines and research findings from cohort studies, randomized controlled trials, and systematic reviews to guide treatment decisions.  - Utilize evidence to recommend therapies with proven efficacy and safety profiles, particularly for non-prescription management.    Migraine with Aura- Aura Symptoms  \- Visual disturbances (eg. zigzag lines, blind spots in the visual field)  \- Numbness/weakness on one side of the body  \- Pins and needles  \- Speech disturbance  \- Dizziness    A screenshot of a medical information Description automatically generated    A screenshot of a medical information Description automatically generated      A screenshot of a medical survey Description automatically generated      Migraine:  \- Rest in a quiet, darkened room  \- Avoid movement and activity  \- Maintain fluid intake  \- Cold pack on forehead and heat pack on shoulders  \- Headache diary  \- Stress management, CBT, relaxation therapy    Avoid triggers:  \- Tyramine-containing foods/drinks such as red wine and aged cheese  \- Ice cream or citrus fruit  \- Food additives such as nitrites and monosodium glutamine (MSG)  \- Eye strain  \- Nicotine  \- Teeth grinding    - Cross-Sectional Studies      **Cross-Sectional Studies:**  1. **Key Characteristics**:  - **Design**: A cross-sectional study observes a population at a single point in time to examine the relationship between exposure and outcome. It captures a "snapshot" of a population.  - **Variables**: Measures exposure and outcome simultaneously in individuals, without establishing temporal sequence.  2. **Strengths and Weaknesses**:  - **Strengths**:  - Efficient and quick since data is collected at one time point.  - Useful for assessing prevalence of conditions in a population.  - Can explore multiple exposures and outcomes.  - **Weaknesses**:  - Cannot establish causality or determine the temporal relationship between exposure and outcome.  - Prone to bias, particularly selection and information bias.  - Confounding can affect associations if not properly controlled.  3. **Key Elements and Issues**:  - **Research Aim**: Often used to assess prevalence and relationships between risk factors and outcomes at a specific time.  - **Study Population**: The population should be representative of the group being studied.  - **Exposure**: Measured at the same time as the outcome, making it difficult to determine cause and effect.  - **Outcome**: The health-related state or event being studied.  - **Measure of Association**: Often presented as prevalence ratios or odds ratios, which describe the relationship between exposure and outcome.  4. **Factors Affecting Bias**:  - **Bias**: Selection bias (non-representative sample) and recall bias (inaccurate recollection of past exposures).  - **Confounding**: Confounding variables can distort the association between exposure and outcome, such as age or socioeconomic factors.  5. **Interpreting Results**:  - Cross-sectional studies are useful for generating hypotheses, but the lack of temporal information limits conclusions about causality. Interpretation of the association must consider potential confounders and biases.  6. **Applying Results to Clinical Practice**:  - Cross-sectional studies can inform practice by providing insight into the prevalence of conditions or risk factors in a population, allowing for tailored public health interventions or patient care strategies.              **Pain Management:**  1. **Clinical Presentation and Differential Diagnosis**:  - **Types of Pain**: Acute vs. chronic pain, neuropathic vs. nociceptive pain, and specific conditions like osteoarthritis or fibromyalgia.  - **Differential Diagnosis**: Based on history, physical exam, and patient-reported symptoms, differentiating between types of pain requires understanding its source (e.g., tissue damage vs. nerve injury).  2. **Risk Factors and Triggers**:  - **Common Risk Factors**: Injury, surgery, chronic diseases like diabetes or arthritis.  - **Triggers**: Activity, posture, stress, and specific environmental or lifestyle factors.  - **Management Strategies**: Avoidance of known triggers, lifestyle adjustments, and early intervention to prevent chronic pain development.  3. **Principles of Pain Management**:  - **Multimodal Approach**: Combines pharmacological and non-pharmacological strategies, targeting pain through different mechanisms.  - **Acute vs. Chronic**: Acute pain is managed with short-term analgesics, while chronic pain often requires long-term strategies including physical therapy, counselling, and preventive medications.  4. **Non-Pharmacological Therapy**:  - **Options**: Physical therapy, cognitive behavioural therapy (CBT), mindfulness, heat/cold therapy, and acupuncture.  - **Application**: Patients should be educated about lifestyle modifications, exercises, and stress management to reduce pain severity.  5. **Complementary and Alternative Medicines (CAMs)**:  - **CAMs in Pain**: Acupuncture, yoga, meditation, and herbal supplements (e.g., capsaicin cream, glucosamine).  - **Evidence**: Some CAMs have limited evidence for efficacy but can complement traditional pain management when used appropriately.  6. **Mechanisms of Action of Non-Prescription Analgesics**:  - **Common Analgesics**: Acetaminophen, NSAIDs (ibuprofen, aspirin), and topical agents (e.g., lidocaine).  - **Mechanism**: NSAIDs reduce inflammation by inhibiting COX enzymes, while acetaminophen acts on central pain pathways.  - **Adverse Effects**: Gastrointestinal issues (NSAIDs), liver toxicity (acetaminophen), and potential medication-overuse headaches.  - **Contraindications**: NSAIDs are contraindicated in patients with gastrointestinal ulcers, kidney disease, or cardiovascular risk.  7. **Non-Prescription Management**:  - **For Mild-Moderate Pain**: NSAIDs or acetaminophen are first-line options.  - **Education**: Provide patients with clear dosing guidelines to prevent overuse or adverse effects.  8. **Patient Counselling**:  - **Proper Use of Analgesics**: Explain when to take medications, appropriate dosing intervals, and the importance of not exceeding recommended doses.  - **Lifestyle Modifications**: Counselling on posture, exercise, and stress management can complement medication use.  - **Written Information**: Providing pain management plans or educational pamphlets to reinforce instructions.  9. **Use of Scientific Literature**:  - Stay updated on the latest clinical trials, systematic reviews, and cohort studies to ensure evidence-based recommendations for managing pain and choosing the most appropriate treatments.