Rationale: Conditional referrals are important for safety netting purposes. Acute cough is defined as 3 weeks or less, so in this case giving 14 days as the referral point is correct as the person has had the cough for just 7 days.

Rationale: For all patients, regardless of age and gender, viral infection (d) is the most common presentation.

Rationale: Dyspnoea, difficulty in breathing, could be seen in all the listed conditions. However, in a community pharmacy context, people with conditions other than heart failure (c) will be less associated with dyspnoea. Other symptoms such as shortness of breath and fatigue will be more frequently seen.

Rationale: Based on evidence, topical sympathomimetics (d) have the strongest evidence of efficacy. The added problem here is can they be given to this patient group? Manufacturer data states no adverse effects recorded and states it to be used with caution.

Rationale: Based on evidence, topical sympathomimetics (d) have the strongest evidence of efficacy. The added problem here is can they be given to this patient group? Manufacturer data states no adverse effects recorded and states it to be used with caution.

Rationale: Guaifenesin (d) is for productive coughs; Pholcodine (a) and dextromethorphan (c) are suitable for nonproductive coughs but current advice is to avoid them where possible; likewise, although chemically inert, glycerine (e) is not advocated.

Rationale: Chronic bronchitis (c) tends not to have nasal congestion; pneumonia (d) after this time should present with productive cough; pneumothorax (e) is very sudden in onset and will not have this history. This leaves UACS (a) and acute bronchitis (b) as viable options. In this case, acute bronchitis is more likely to have shortness of breath as a symptom.

Rationale: Sputum colour can be useful in helping narrow down the differential diagnosis. Viral and bacterial infection can range from sputum with no colour to yellow, green or brown. Given that viral infection is much more prevalent than bacterial infection, this is the most likely condition in this scenario.

Rationale: Nasal congestion and sore throat are hallmark symptoms of the common cold. However, loss of smell in association with these symptoms can suggest sinusitis.

Rationale: The symptom cluster of rhinorrhoea, cough, malaise, fever, headache and hoarseness are suggestive of viral infection. Absence of cough can indicate a bacterial infection and is therefore worthy of referral.

Rationale: Options a, b, and c all suggest referral but the symptom cluster does sound like normal symptoms of a cold and could be treated. This leaves d and e as possible correct answers. Vitamin C (d) has no evidence of efficacy, so e is the most suitable answer.

Rationale: A bacterial cause is hard to establish but a symptom cluster of option b is the best descriptor.

Rationale: A viral cause (c) should always be considered most likely although because this person is middle aged and has a history of smoking, bronchitis (a or b) is also likely and should be considered as the next most likely cause.

Rationale: Most coughs are productive or nonproductive from the outset. Heart failure (B), TB (C) and chronic bronchitis (D) are productive; croup (E) is nonproductive. Only pneumonia (A) from the listed conditions tends to change from nonproductive to productive

Rationale: Croup (E) is a childhood condition; pneumonia (A) and TB (C) are infections; heart failure (B) is associated with old age. Chronic bronchitis (D) has a strong association with smoking.

Rationale: Fever tends to suggest infection. From the above, only two conditions are infectious in origin, pneumonia (A) and TB (C). Of these, pneumonia often presents with a high fever.

Rationale: Some coughs can exhibit worse symptoms at certain times of the day. From the listed conditions, this is true of chronic bronchitis (D) and croup (E). Croup shows worsening symptoms in the evening.

Rationale: The sound of the cough is not normally helpful in establishing a diagnosis. However, for croup (E) the noise of the cough is characteristic and helpful in establishing the diagnosis

Rationale: Antazoline (E) is only available via the ocular route; chlorphenamine (C) is a first-generation antihistamine and causes sedation; this leaves the three second-generation antihistamines as options. All are less sedating than first-generation antihistamines but none are truly nonsedating. Of the three, loratadine (B) appears, from trial data, to be the least sedating..

Rationale: As per the answer for question 2.22, chlorphenamine (C) is the correct option.

Rationale: Manufacturers advise against the use of second-generation antihistamines (options A, B and D). Antazoline (E) would not be used in nasal congestion.

Rationale: Acrivastine (A) and antazoline (E) are licensed for use in those from 12 years of age and loratadine (B) and cetirizine (D) from 2 years.

Rationale: Shortness of breath is rarely seen in acute bronchitis (a). All other options can show breathlessness but chronic bronchitis (c), heart failure (d) and pneumonia (e) do not normally exhibit bronchoconstriction.

Rationale: Traditionally people advocated putting the child in a steamy room (c) but this is now not recommended. Treatment with cough remedies (a) and (b) will be ineffective. Symptoms, although distressing, rarely warrant direct referral to an emergency department (e).

Rationale: Epidemiological data show that young men (d)are more prone to pneumothorax but it is unknown why.

Rationale: Sympathomimetics are known to have this effect (options d and e) but it only occurs with topical formulations d.

Rationale: All options will have a beneficial effect on symptoms; however, nasal decongestants (e) should be only used short-term. Antihistamines are effective but less so than corticosteroids in treating nasal symptoms.

Rationale: Glandular fever is most commonly seen in young adults as transmission is primarily through saliva (e.g. kissing).

Rationale: Pain is dull, thus eliminating option e. It starts as unilateral pain (generally when someone would present to the pharmacy) and so options a and b can also be eliminated. Pain is worsened on bending down so option c is correct.

Rationale: All possibilities can be seen in children. Croup (c) is specific to children but relatively uncommon. Asthma (a) has higher prevalence rates in children than adults but again is not very common. Postnasal drip (d) is usually a consequence of infection, of which viral (e) is by far the most common cause of cough.

Rationale: Dyspnoea (laboured breathing) is a relatively uncommon symptom associated with cough. Breathlessness can be seen in pneumonia, heart failure, chronic bronchitis and asthma. Although shortness of breath as well is most seen with asthma and heart failure, but cough would be expected to be a presenting symptom in asthma.

Rationale: Antihistamines have an anticholinergic effect and therefore need to be used with caution in glaucoma more than the other conditions listed.

Rationale: Smoking history will mean that chronic bronchitis (c) is a possibility in this age group but viral cough will still be the commonest cause of cough.

Rationale: Dosing adjustments are required in severe renal and liver impairment only and severe heart failure as well as in patients with active or history of recurrent peptic ulceration.

Rationale: Nasal steroids (b and e) need to be used regularly as does cromoglicate (c) to have any beneficial effect. Acrivastine (a) can be given intermittently or long term, but naphazoline (d), because of rebound effects, is limited to short-term use only.

Rationale: Associated headaches with cough (a) is a relatively common symptom; duration (b) is classed as acute until 3 weeks has elapsed; failure to respond to treatment (c) doesn’t necessarily require referral, but reassessment of symptoms would be advisable; sputum colour (e) unless suggestive of haemoptysis is not a referral point. However, shortness of breath (d) needs further evaluation.

Rationale: Heart failure is insidious in onset and does not usually present with cough as the first symptom if identified whilst still mild. The other conditions will generally present with cough as a major presenting symptom.

Rationale: Pneumonia (d) and tuberculosis (e) are bacterial in origin; heart failure (c) is due to left ventricular failure; acute bronchitis (a) is usually viral in origin. Chronic bronchitis (b) is associated strongly with a smoking history.

Rationale: Ethnicity does not usually effect prevalence of conditions associated with cough although a notable exception is tuberculosis with the majority of cases seen in people from the Indian subcontinent.

Rationale: Pseudoephedrine has direct and indirect sympathomimetic activity and can increase systolic blood pressure but is much less potent than ephedrine.

Rationale: Pseudoephedrine is structurally related to methamphetamine (crystal meth) and has been used as a base to manufacture it.

Rationale: None of the medicines listed in their respective SmPCs state they cause a reduction in breast milk, but there are a number of reports and research papers that have linked sympathomimetics to causing a reduction in breast milk production.