CFM Grand Final Samplex

Psychodynamics _____1. Mr. and Mrs. Santos celebrated their golden wedding anniversary. Both are retired and living by themselves. They maintain a healthy relationship with their children. What can be the most pressing concern of the couple that you can anticipate considering their present status? A. Coping with physical and mental decline B. Dealing with loss of spouse C. Managing stress in dealing with children in-laws D. Maintaining couple functioning _____2. The couple thought of visiting their attending physician. What are the activities that can be done during the visit? A. Ask how they are preparing for future deaths B. Perform periodic health examination C. Counsel them on how to improve their relationship D. Explore possibility of family meeting

_____3. The social service of a hospital was asked to get in touch with the family of Lolo Jose who has not visited him since he was confined. Relationship in Lolo Jose’s family may be described as ___. A. Enmeshed C. Functional B. Disengaged D. Dysfunctional _____4. APGAR was administered to a couple which revealed a score of 6. Which of the following figures represents their family map? A. Husband ------------ wife B. Husband ___/___ wife C. Husband ………… wife D. Husband _______ wife _____5. The following are health family characteristic EXCEPT A. After typhoon “Pedring,” a family busied themselves in joining clean-up activities in their community B. Members of a family in the evacuation center was heard blaming each other for their losses C. At the height of the typhoon, a family was able to survive because they took time to talk and plan their strategy D. None of the above Psychosocial Typology Case (6 – 10) _____6. Maria, 30 y/o, single, suffers from abnormal vaginal bleeding due to myoma for the past six menses. Hysterectomy was recommended. Implication was discussed by the attending physician. She sought second and third opinion regarding treatment. She cannot decide on what to do. In what stage in the illness trajectory did Maria got stuck? A. Stage 2 – reaction to diagnosis B. Stage 3 – major therapeutic efforts C. Stage 4 – early adjustment to outcome D. Stage 5 – permanency of outcome _____7. What is the time phase of illness? A. Crisis C. Terminal B. Chronic D. A and B

_____8. How would you characterize the patient’s myoma (a non-cancerous tumor in the uterus) as to onset, course, incapacitation and outcome? A. Acute, progressive, incapacitating, potentially fatal B. Acute, constant, not debilitating, nonfatal C. Gradual, progressive, incapacitating, potentially fatal D. Gradual, constant, not debilitating, nonfatal _____9. Maria finally decided to undergo operation. She was given two weeks of sick leave before she goes back to work. What would be the main task in this stage so that she can start her period of recovery? A. Continue to stay in bed to avoid abdominal pain B. Start to walk and move around gradually C. Resume regular physical activity including exercise D. Get a caregiver to assist in activities of daily living _____10. For the past 6 months that Maria bore her illness, she suffered discomfort and anxiety. What did she went through? A. Crisis C. Mourning B. Stress D. None Family Health Care Process A. Assessing B. Analyzing C. Planning

D. Implementing E. Evaluating

_____11. Determines the existence of any actual or potential health problems. _____12. Identifies the problem as remedied, improved, unchanged or worsened. _____13. Use a variety of tools for recording history, health, and physical assessments. _____14. Involves providing comfort measures, giving physical care, or providing health teaching and counseling. _____15. Allows family to prioritize its identified needs. Case (16 – 30) Maria is a married, 32 y/o mother of three. She has been discharged from the hospital against medical advice after a 3-day stay with a medical diagnosis of hypertension, diabetes and fracture of the left proximal humerus. She had initially gone to the emergency room of the hospital for treatment of her “broken arm” after a “fall down the basement stairs.” During her stay in the hospital, Maria appeared depressed and sullen, avoided eye contact, and answered all questions with one or two words. It was also noted that she had not any visitors during her stay. It was decided that a home care follow-up was indicated because Maria seemed to be vague and insecure about her condition even though she verbalized a complete understanding of her diet and medications. During the first home visit by the FHC team (family health care) the house appeared cluttered but was relatively clean. Empty beer bottles were noted. Maria appeared tense and agitated. Maria told the FHC team, “Let’s get this over with fast before my husband arrives. He does not want strangers in the house.” Maria revealed that she has an 8-y/o daughter who is her biggest help. Her other children are a 6-y/o son and a 5-y/o daughter. She never mentioned her husband. When probed about it, she averted her eyes and looked fearful. Maria said, “He is a wonderful father and husband when he is not drunk. We just have to act better so he’ll love us enough to stop drinking.” DIRECTION: Write the letter of the BEST answer. _____16. In the assessment phase of the family health care process, what tools were used by the FHC team to gather data about the family?

. Interview . Direct observation . Ocular inspection . A and B . All of the above _____17. What is/are the sign/s that the family is dysfunctional? A. Alcohol abuse . Marital conflict . Family violence . A and B . All of the above For the medical problem of the patient, give (1) secondary level of prevention as part of your intervention. For the psychosocial problem, choose the problem that could have been responsible for the patient’s hospitalization and give one (1) tertiary level of prevention to address the problem. Problem Objectives Intervention/ Treatment Evaluation A. Medical 18. 19. 20.

21. B. Psychosocial 22. 23. 24. 25. *Can state goals instead of objectives if it is more appropriate _____26. In implementing your plans, what are the things you have to consider to ensure success? A. Periodic evaluation B. Work within limitations C. Modify intervention when needed D. All of the above _____27. In evaluating your casework with the family, the following methods can be used EXCEPT: A. Feedback from patient . Consultation with supervisors . Case audit . None of the above

_____28. In case it turned out in your evaluation that the plan is not working out well, what could be the probable reasons? A. Coordination of services neglected . Goals and objectives not mutually established . Family priorities not ascertained . All of the above _____29. What are the indications for terminating the patient, family and physician therapeutic relationship? . Objectives have been achieved . Patient wants to end relationship . Intervention not effective . A and B _____30. Which among the following should be done during the termination phase? A. Summarize findings and interventions B. Explore family’s feelings and perceptions on what has transpired in the therapeutic relationship C. Establish continuity of care by giving contact numbers D. All of the above Direction: Each question below contains four suggested answers of which one or more is correct. Choose the letter: A - if a), b), and c) are correct B - if a) and c) are correct C - if b) and d) are correct D - if d) is correct E - if a), b), c), and d) are correct _____ 31. True about palliative care: a) It is the active, total care of the patient whose disease is not responsive to curative treatment. b) Control of pain, of other symptoms, and of social, psychological and spiritual problems is paramount. c) It is interdisciplinary in its approach and encompasses the patient, the family and the community in its scope. d) It affirms life and regards dying as a normal process, neither hastening nor postponing death and it sets out to preserve the best possible quality of life until death. _____ 32. True about palliative care: a) The goal is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. b) Strictly speaking, it is the care for the person who is facing the end of life and for those who love them. c) Palliative care can be delivered concurrently with life-prolonging care or as the main focus of care d) It is synonymous to that part of oncological care which involves the prevention and management of the adverse effects of cancer and its treatment. _____ 33. Principles of palliative care:

a) provides relief from pain and other distressing symptoms b) affirms life and regards dying as process that needs to be prevented or delayed to the best of one’s ability c) intends neither to hasten nor to postpone death d) does not include the psychological aspects of patient care as this is a task proper of the psychiatrist _____ 34. Principles of palliative care: a) offers a support system to help patients live as actively as possible until death b) offers a support system to help the family cope during the patient’s illness and in their own bereavement c) uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated d) will enhance quality of life, and may also positively influence the course of illness _____ 35. Principles of palliative care: a) is applicable only towards the end of life b) is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy c) does away with diagnostic investigations as the disease is not responsive to curative treatment anyway d) includes the investigations needed to better understand and manage distressing clinical complications _____36. True about hospice care: a) It is care for the whole person who is facing the end of life, aiming to meet all needs – physical, emotional, social and spiritual, and for those who love them b) Strives to offer freedom from pain, dignity, peace and calm c) Can be given at home, in day care and in the hospice d) Provision of care based on individual need and personal choice, by staff and volunteers working in multi-professional teams _____37. True about End-of-life care: a) Can be understood as comprehensive care for patients in an extended period of one to two years during which the patient/family and health professionals become aware of the life-limiting nature of their illness b) May be understood as comprehensive care for dying patients in the last few hours or days of life c) May be understood as comprehensive care for dying patients in the restricted time frame of the last 48 or 72 hours of life, which is the goal of the Liverpool Care Pathway for the Dying Patient that transfers the hospice model of care to patients dying in non-specialized settings d) May be used synonymously with palliative care or hospice care _____38. True about the palliative care approach: a) It is a way to integrate palliative care methods and procedures in settings not specialized in palliative care b) This includes pharmacological and non-pharmacological measures for symptom control

c) This includes communication with patient and family as well as with other healthcare professionals, decision-making and goal-setting in accordance with the principles of palliative care d) Cannot be used by general practitioners and staff in general hospitals and in nursing homes since they don’t have specialized training in palliative care _____ 39. Patients seen by or referred for palliative care: a) patients and/or family living with, or at risk of developing, a life-threatening illness due to any diagnosis, with any prognosis, regardless of age, and at any time they have unmet expectations and/or needs and are prepared to accept care b) patients requiring support with psychosocial or spiritual problems with the progression of their life-threatening disease c) patients suffering from pain, dyspnea and other physical symptoms d) patients with predefined medical diagnoses only, such as cancer

_____ 40. True of the disease stage and prognosis of patients referred for palliative care: a) Palliative care is appropriate for all patients from the time of diagnosis with a lifethreatening or debilitating illness --- a persistent or recurring condition that adversely affects daily functioning or will predictably reduce life expectancy b) Most patients will need palliative care only with far advanced disease, c) Some patients may require palliative care interventions for crisis management earlier in their disease trajectory d) The disease trajectory of palliative care patients can be a period of several years, months, weeks or days. _____ 41. Palliative treatment, care and support are provided: a) at home b) in nursing homes, and in residential homes for the elderly c) in hospitals d) in hospices _____ 42. Preferred place of care and place of death for palliative care patients: a) Determined mostly by patient and family preferences, but the place of death may be determined by other factors. b) The place of death for most patients is the hospital or nursing home. c) Most patients want to be cared for in their own homes, if possible until the time of death. d) In the final stage of the disease, the medical condition may deteriorate to the extent that it may necessitate admission to hospital or specialist inpatient unit for intensive medical and nursing care, which could not be provided in the home-care setting. _____ 43. True about grief and bereavement in palliative care: a) Palliative care offers support to family and other close carers during the patient’s illness, helping them prepare for loss b) Grief and bereavement risk assessment is routine, developmentally appropriate and ongoing for the patient and family throughout the illness trajectory, recognizing issues of loss and grief in living with a life-threatening illness.

c) Bereavement services and follow-up support are made available to the family after

the death of the patient.

d) Grief and bereavement service is not a core component, but rather an optional component, of palliative care service provision, since not everyone is trained to provide this and most health care professionals find this depressing. _____ 44. Staff for specialist palliative care services, in addition to nurses and physicians – should be available full-time, parttime or at regular times, and they should include: a) Physiotherapists, Occupational therapists, Speech therapists b) Chaplains, and Coordinators for spiritual care c) Wound management specialists, Lymphedema specialists d) Dietitians _____ 45. The following are specialist palliative care services: a) Inpatient hospice b) Palliative care unit (PCU) c) Home palliative care team d) Palliative outpatient clinic _____ 46. Position of palliative care towards life and death: a) Palliative care does not seek to postpone death b) The provision of euthanasia and physician-assisted suicide should not be part of the responsibility of palliative care. c) ‘The value of life, the natural process of death, and the fact that both provide opportunities for personal growth and selfactualization’ should be acknowledged. d) Palliative care seeks to hasten death so as to minimize the pain and suffering of the terminally-ill _____ 47. True about advance care planning in palliative care: a) Ideally, the patient, family and palliative care team discuss the planning and delivery of palliative care, taking into account the patient’s preferences, resources and best medical advice. b) Changes in the patient’s condition or performance status will lead to changes in the treatment regimen, and continuous discussion and adaptation will forge an individual plan of care throughout the disease trajectory. c) Advance directives allow patients to retain their personal autonomy and provide instructions for care in case the patients become incapacitated and cannot make decisions any more. d) Advance directives may be supplemented with, or substituted by, a healthcare proxy (or durable power of attorney) which allows the patient to designate a surrogate, a person who will make treatment decisions for the patient if the patient becomes too incapacitated to make such decisions. _____ 48. To adequately fulfill the role of a partner in the palliative care network, several prerequisites have to be met for one to be a volunteer for palliative care: a) Voluntary workers have to be trained, supervised and recognized by an association b) Training is indispensable and demands a diligent selection of voluntary workers c) Voluntary workers act within a team under the responsibility of a coordinator.

d) The volunteer coordinator is the link between the voluntary workers and the carers, between the hospital and the association _____ 49. True about long-term care: a) It is a variety of services that includes medical and non-medical care to people who have a chronic illness or disability.\ b) It helps meet health or personal needs of people who have a chronic illness or disability. c) Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. d) Long-term care can only be provided in nursing homes _____ 50. Types of Long-term Care Services: a) Community Based Services b) Home Health Care c) Housing for Aging and Disabled Individuals d) Continuing Care Retirement Communities COMPLEMENTARY & ALTERNATIVE HEALTH CARE Instructions: Write A if the statement is TRUE and B if the statement is FALSE. 51. Studies shows that most people used CAM to prolong their survival, palliate their symptoms, alleviate the side effects of conventional treatment. 52. CAM are proven therapies which are desperate measures over which patients can exert control when their disease is progressing. 53. CAM is the preferred terminology to describe therapies used in conjunction with conventional treatments. 54. Alternative Medicine is frequently grouped with Complementary Medicine or Integrative Medicine. 55. CAM maybe used improve a person’s well being. MULTIPLE CHOICE: CHOOSE THE BEST ANSWER. 56. Patients seek complementary and alternative therapies for the following reason/s. a. Self empowerment b. Dissatisfaction with conventional therapy c. Both d. Neither 57. The following are criticisms of Oncologists on CAM, EXCEPT: a. Medical Oncologists spend many years training in a scientific approach to cancer treatment b. They strive for the best possible outcome for their patients c. Ineffective therapy administered by practitioners with minimal training d. Practiced by doctors who have poor role model for health 58. According to Curt the distinguishing characteristic/s of unsound method of cancer treatment is/are: a. Promotion without sufficient preclinical data to justify use b. Unmethodological treatment that cannot detect meaningful responses c. Both

d. Neither 59. TRUE about scientific methods: a. Testing relies heavily on epidemiology and statistical analysis b. Old treatments are discarded if they are proven less safe or effective than the new method c. Both d. Neither 60. Role of health care professionals in helping patients to make decisions. a. Finding information and asking questions b. Navigate the “information overload” c. Both d. Neither MATCHING TYPE: MATCH COLUMN A WITH COLUMN B. Choose the best answer. . ACUPUNCTURE . MIND/BODY TECHNIQUE . MASSAGE THERAPY . MUSIC THERAPY . AROMATHERAPY/HERBAL MEDICINE 61. Helps reduce stress, increase mobility, enhance respirations, stabilize vital signs, and assist the body’s natural ability to heal. 62. Controlled trials show that this modality produces emotional and physiological benefits and reduces anxiety, stress, depression and pain. 63. Helps reduce the symptoms such as nausea and pain and strengthen the body’s immune system by unblocking the “universal life force”. 64. Reduces stress, symptom management and control of some physiologic reactions as exemplified by Yoga. 65. Should be discontinued prior to chemotherapy or surgery because of possible effect on coagulation and interaction. 66. Use of Meridians 67. Cascara and Psyllium 68. Biofeedback 69. Tai Chi 70. St. John’s wort IMPACT OF ILLNESS MATCHING TYPE: . STAGE I D. STAGE IV . STAGE II E. STAGE V . STAGE III 71. A 23 year old lady came in with a history of nose bleeding. Platelet count shows decreased. Doctor is considering DHF. 72. 45 year old female died due to chronic renal failure. 73. A 69 year old male stroke patient referred to Rehabilitation service for therapy. 74. A 58 years old female with Invasive Ductal Carcinoma of the breast for Modified Radical Mastectomy.

75. Rita is suffering from severe headache and she self medicated with paracetamol. 76. 69 year old male stroke patient referred to Rehabilitation service for therapy. 77. This phase has three possible outcome, a return to full health, partial recovery and a permanent disability. 78. First crisis occurs. 79. Second crisis occurs. 80. Disease maybe acute or chronic. WRITE A IF THE STATEMENT IS TRUE AND B IF THE STATEMENT IS FALSE. 81. Family’s reaction to illness and death occurs in stages with the following order denial, anger, bargaining, depression and acceptance. 82. Lifestyle and cultural characteristics of the family are important consideration in making a treatment plan. 83 Severe illness may lead to financial catastrophe thus cost of therapy should be according to the family’s ability to afford it. 84. Sudden change in behavior can be considered as red flag. 85. Other people may take the responsibility of the family in taking care of the patient for them to become empowered and self-reliant. WELLNESS I. Choose the best answer:

__D___ 86. Primary prevention means: . Treatment of diseases in the uncomplicated state . Treatment of diseases in the complicated state . Bringing the patient to as normal function as possible . Preventive measures even before disease occurs __A___87. Chest x-ray done prior to admission to medical school to check for the presence of tuberculosis is what level of prevention? . Primary . Secondary . Tertiary . All of the above

__B___88. Screening for cancer of the cervix . Gram stain of vaginal discharge . Pap smear . Colposcopy . A & B only __A___ 89. Recommended screening for breast cancer: . Breast self-examination . Biopsy

. Excision biopsy . Chest x-ray __B___90. Ideal body weight for women is computed as follows: . 100 lbs for first 5 feet plus 5 lbs per cm. . 100 lbs for first 5 years plus 5 lbs per in. . 106 lbs for first 5 feet plus 6 lbs per in. . 105 lbs for first 5 feet plus 5 lbs per cm. __B ___ 91. Formula for basal body temperature: . BMI = weight in lbs ÷ height in m2 . BMI = weight in kg ÷ height in m2 . BMI = height in m2 ÷ weight in kg . BMI = height m2 x weight in kg __C___ 92. Treatment of a post-stroke patient in rehabilitation is: . Primary prevention . Secondary prevention . Tertiary prevention . None of the above __A___ 93. Precaution to giving Rubella vaccination: . Pregnancy within 28 days of the administration . Diarrhea 3 days before administration . Only for women in the reproductive age group . Fever __B___ 94. Hepatitis B vaccination is important for Filipinos because: . Hepatitis B is hereditary . Hepatitis B is endemic in the Philippines . Hepatitis B is permanent . Hepatitis B is a sexually transmitted disease __C___ 95. Infants who received oral polio vaccine must be isolated from pregnant women because: A . oral polio virus is airborne B. oral polio virus may create polio disease in the recipient C. oral polio virus is excreted in the stool soon after vaccination D. oral polio virus is unable to protect pregnant women from the disease IDA __D___ 96. The SOAP in the problem-oriented format of the POMR means: . Symptoms, Objectives, Assessment. Plans

. Subjective, Objective, Assessment, Perspective . Symptoms, Objections, Asessment, Prognosis . Subjective, Objective, Assessment, Plan __C___ 97. The ____ is a specialized but brief summary of the patient’s case and course in the hospital: . The admitting summary . The progress notes . The discharge summary . The plan chart ___A__ 98. The following best describes a crisis-oriented team: . Organized and technologically equipped aimed at saving or prolonging Organized around the effort to reach specific populations at risk . Organized around the delivery of a group of health care services . Organized around individual health care with emphasis on life improvement than life-saving . Organized around the effort to reach specific populations at risk __B___ 99. The problem oriented medical record (POMR) includes the following: . Narrative description of the patient’s medical history . A listing of his medical problems, medications and progress notes . A genogram to indicate hierarchy of diseases occurring in the family . All of the above __D___ 100. Objective (s) of medical records or write-ups: . To convey information to the consultant . To document & clarify the progression & approaches of the medical team . To quantify & organize impressions on the case . All of the above

Matching type: COLUMN ACOLUMN B 96. Diabetes clinic A. Crisis-oriented team 97. Stroke unitB. Client-oriented team 98. Unit for reproductive healthC. Intervention-oriented team services 99. Unit for health educationD. Service-oriented team Services 100. Well-baby clinic Matching type: A. Internal referralC. Cross-referral B. Collateral referralD. Split referral 101. A family physician referring a pulmonary embolism case to a pulmonologist. 102. A case of renal failure with ischemic disease being managed by a nephrologist and a

cardiologist. 103. A surgeon referring a case of appendicitis to a diabetologist. 104. A general practitioner referring a case of an anxiety reaction with depressed mode to a psychiatrist 105. A family physician referring a high risk pregnancy to a perinatologist. Multiple choice. 106. The following is/are indication/s for referral EXCEPT. A. The physician is not certain about the diagnosis of Systemic Lupus Erythematosus (SLE) B. The patient doubts the physician’s diagnosis of Systemic Lupus Erythematosus (SLE) C. The physician consulted by the patient with SLE-like symptoms is a general practitioner. D. The attending physician of the patient suffering from SLE is a trained rheumatologist. 107. The following is/are responsibility/ies of the referring physician. A. Referral must be done to a consultant whose personality is compatible with that of the referring physician. B. Adequate transfer of information by the referring physician through telephone is acceptable for non-urgent requests. C. Referring physician gives the patient control over the time of appointment with the consultant. D. The amount of information to be given is to the patient is left all together to the consultant by the referring physician 108. The following is/are disadvantage/s of team approach: A. Care is cost-effective B. Solution to shortage of physician C. Recognizes non-physiologic aspects of patient’s needs. D. None of the above. 109. One of the concepts of interdisciplinary approach to care is the recognition that medical problem can be separated from the other aspects of patient care. A. TrueB. False 110. The following is/are included in the problem list: A. SocialC. Economic B. PsychiatricD. All of the above END OF EXAMINATION

CFM: Stress and Crisis __B___ 1. Developed the now-famous theory of the influence of stress on people's ability to cope with and adapt to the pressures of injury and disease (1926): . Hans Christian Andersen . Hans Selye . Howard Selye . Hans Dawson __A___ 2. A person is stimulated and able to manage with this type of stress: . Eustress . Distress

. Bad stress . All of the above __A___ 3. The type of response to a stress is determined by: . Perception of change . Sex of the patient . Time of day . B & C only __D___ 4. Perception of change is modified by the following: . Past experiences in handling stressors . Biopsychosocial status prior to stressor . Duration of exposure to stress . All of the above __D___ 5. Factors affecting outcome of crisis: A. Perception of the event B. Situational support C. Adequate coping mechanism D. All of the above __A___ 6. Role of a physician in stress management of patients: . Helps patients and their families handle stressful life events . Solve the patient’s problems . Must leave patient alone to solve his problems so he will learn to be self-reliant . Stress is a normal occurrence not needing distinct medical attention __C___ 7. A healthy way to manage stress includes the following: . Exhaust yourself by physical activity . Keep the schedule tight and full . Have enough sleep . Increase carbohydrate intake __A___ 8. In problem-solving in times of stress and crisis the following must be considered: . The patient must learn to accept help . Doctor must be reassurance even if the future looks nil . Better to bring out the blame now before it is too late . Patient need not volunteer cooperation during the intervention __A___ 9. M.B. is 34 year old female, a newly diagnosed tuberculosis (TB) patient. She knows nothing of the disease and is so afraid she will die soon. As the attending physician how may you help her? . Educative approach, increase understanding and healthy functioning by acquisition of knowledge . Reassure her tuberculosis is really “nothing” so she should not worry about it too much . She needs to be reprimanded for worrying without reading for herself about the disease

. She must be given a prescription for tuberculosis __C___ 10. T.M. is a 54 year old woman recently coming from a breast mass biopsy. Now she is seated in the doctor’s office waiting her results. She is very anxious. As the attending physician part of your responsibility is: . Help confront conflict by telling her to subdue her feelings . Help confront crisis in megadoses so the problem is resolved immediately . Help find facts because truth is less frightening than the unknown . Help review her previous experiences so she can feel sorry about bad habits and not do them again __A___ 11. J.T. is a medical student. The upcoming exam is causing a lot of tension even when he thinks he has studied enough. You may recommend regular exercise because: . Exercise has a tendency to make people feel better than those who do not . Exercise will help him have better grades . Exercise increases perspiration . Exercise should not be recommended because it can cause other diseases __A___ 12. Included in basic stress relief techniques are relaxation techniques including: . Yoga . Day-dreaming . Arnis . Karate __D___ 13. Pedro 54 years old has a wife and 7 children ages ranging from 3 to 15 years old. He and his wife are unemployed for the past year so life has been extremely difficult. He is at this moment on top of a commercial billboard along Quezon Avenue shouting and crying that he will commit suicide and five minutes later, did so. According to Smilktein’s cycle of family function, Pedro is now in this stage: . Family in equilibrium . Family in disequilibrium . Family is in pathologic equilibrium . Family is in terminal disequilibrium

__B___ 14. Kris Aquino’s recent annulment of marriage may be classified: . Maturational development . Situational development . Both . Neither II. Write A if the statement is TRUE and B if the statement is FALSE: __A___ 15. Stress causes higher levels of the hormone cortisol and that increases the amount of fat deposited in the abdomen resulting in obesity. __A___ 16. Stress causes higher levels of adrenaline and that increases risk for heart disease.

__B___ 17. Stress seems to lower the blood sugar levels of people with type 2 diabetes directly. __A___ 18. Stress can affect how you age accelerating by 9-17 additional years. __A___ 19. stress is considered one of the most common triggers for headaches like tension headaches and migraine. __B___ 20. Stress can improve asthma. CFM 1: Family as a Unit of Care Instructions: Match the lettered items to the numbered items. . NUCLEAR . NUCLEAR DYAD . SINGLE PARENT . BLENDED _____ 1. Cita and her husband don’t have a child. _____ 2. Ramon takes care of the daily needs of his children because Luisa is working as a caregiver in the US. _____ 3. Two years after, Luisa finished her contract and returned to the Philippines. She and Ramon took turns in taking care of their children. _____ 4. Their eldest daughter, Maria bore a son out of wedlock. She met Cesar a father of two from his previous marriage. They decided to get married and lived together. _____ 5. After all the children got married they left Luisa and Ramon and lived with their spouses. . EXTENDED . KIN NETWORK . CORPORATE . INSTITUTIONAL _____ 1. Home for the aged _____ 2. Danny’s mom lived with them after her husband died _____ 3. Amish Community _____ 4. Dela Cruz brothers and their families live in one compound _____ 5. Boarding school . AUTHORITARIAN . DEMOCRATIC _____ 1. In this type of family set-up, the parents respect the decision and ideas of the children. _____ 2. Results to low self-reliance. _____ 3. Permissiveness prevail. . UPPER CLASS . MIDDLE CLASS . LOWER CLASS _____ 1. This social class pattern sees life as a continuous struggle for survival _____ 2. They are very much closely knit. _____ 3. They believe in self-improvement through education . PERMANENT . ENDURING . AFFECTIVE

. COMMONALITY _____ 1. The sense of belonging draw the family together despite conflicts _____ 2. Characteristic of the family that is a fundamental part of each individual’s identity _____ 3. Members are not expelled because of decrease in function _____ 4. Children may share the same attributes as their parents which they can develop. Instructions: Match the lettered items to the numbered items. . Wellness . Primary health care . History taking . Works harmoniously with organizations . Medical records _____1. Health care provider _____2. Researcher _____3. Education _____4. Social mobilizer _____5. Manager . Ecological factors . Symptom relief . From “womb to tomb” . First contact care . Immunization _____ 11. Primary _____ 12. Continuing _____ 13. Comprehensive _____ 14. Prevention _____ 15. Curative Instructions: Write A if the statement is True and B if it is False. _____ 16. The WHO expert committee states that every hospital should have a service for the personal physician who has a staff appointment in one or more accredited hospitals. _____17. Folson committee report states that every medical student’s training should include exposure to family practice. _____18. Millis commission reports that there should be a specialty board for family physicians. _____19. The Michelson committee report also stated that opportunity for specialty board certification is essential and a necessity.

Questions on Family Dynamics Family Life Cycle . Newly married couple . Family with young children . Family with adolescent . Launching family . Family in Later Years _____ 1. Health concerns primarily focused on accident prevention, growth and development of children under 6 yrs. old. _____ 2. Heightened concern on issues of peer influence on drugs, alcohol and risky behavior. _____ 3. Problems of infertility or unplanned pregnancy are important health considerations.

_____ 4. Deals with signs and symptoms of depression related to multiple losses like death of spouse. _____ 5. Concerned with health issues aggravated by difficulty of “letting go” on the part of the parents. Family Systems Concepts . Family stability . Family change . Circular causality . Relational context of symptoms _____ 6. A mother was chided for giving in to her husband’s request every time he asked money for a drink. She was told that her husband will not be able to change. _____ 7. The older children of a couple started to leave home. Although very much saddened, the couple started planning for the time where they would be alone by themselves. Living in a condominium seems to be an interesting option. _____ 8. A father who despite having health problems continues to function as the provider of the family so as not to disrupt the established family set-up especially since his children are not yet financially stable. _____ 9. A first year medical student was brought by his parents to a doctor for frequent headache which has been causing absences in school. Physical examination was essentially normal. When confronted with it, the student asked if it is better to drop from medical school. He would rather do something else. _____ 10. A couple who had separated continues to be friends and care of each other to the delight of their children. Family Structure A. Alliance B. Coalition C. Hierarchy D. Subsystem

_____ 11. The Reyes family had a family meeting at the start of the year. They have agreed to put up a family business by the end of the second quarter. Everyone was involved and performed assigned tasks. _____ 12. As parents, the couple works to provide for the needs of their children. _____ 13. In the Ramos family where both parents are unemployed, the son who works abroad is sought for major decisions concerning the family. _____ 14. The only doctor in the family is burdened by the increasing reliance on him by his family. _____ 15. Whenever there’s an issue in the family, the eldest child gravitates toward the father and the youngest toward the mother. The situation becomes more complicated when the in-laws start to meddle. Family Process A. Enmeshment B. Disengagement C. Triangulation D. Transactional pattern _____ 16. An infant was noted to have skin problems. When mother was asked, the doctor was told that she does not bathe the child everyday as instructed by her grandmother. _____ 17. A husband comes home after being yelled at by his boss and shouts at his wife. The wife, in turn, shouts at their child. When her husband asked her about it, she says, “The child is being stubborn.” _____ 18. The social service of a hospital was asked to get in touch with the family of Lolo Jose who cannot be discharged because the family had not come to the hospital to bring home the patient. Failure to locate the family would mean institutionalization for Lolo Jose. _____ 19. Dr. Elsa does home care for her patient with cancer. She visits the patient as often as she can. When her patient

died, she felt very sad. She filed for a leave of absence. _____ 20. In the Reyes household, the mother’s “TO DO” notes for the week are posted in the kitchen’s white board. The family talks about it over dinner at the start of the week. Dysfunctional Behavior . Enmeshment . Disengagement . Rigidity . Enabling . Conflict avoidance _____ 21. An adolescent was warned by his friends to be careful with his adventures like drugs, drag racing, etc. He said not to worry because his parents would surely mobilize their connections to protect him. _____ 22. A 70-y/o patient often comes to the clinic alone by himself. The doctor advised him that it is better if somebody accompanies him. The patient tearfully shook his head and said, “My children are very busy.” _____ 23. Hypertension in a patient with married children remains uncontrolled despite medications. She complains that she has to take care of a lot of things including the lives of her married children. _____24. An adolescent would stay out at night or pretend that he is already asleep so his father can’t ask him about what he’s doing. _____ 25. A father said to his son, “Our family has always been like this. We have survived through the years. I am not going to change my position no matter what happens.” Family Case The Santos family lives in a middle-class subdivision in Quezon City. Cesar Santos, 50 y/o, and Shirley Santos, 48 y/o are apparently healthy. However, their only child, Tony, has diabetes diagnosed at the age of 13. His diabetes was stable until his senior high school. His blood sugar was often elevated. Tony claimed to be taking his insulin and sticking to his diet. His condition worsened until he was finally admitted in the hospital. Psychosocial history revealed that Tony has a very close relationship with his mother. Prior to the worsening of Tony’s condition, his 80- y/o maternal grandmother died due to complications of diabetes and his father has been travelling more since his promotion. Tony was also preparing to leave home for college. His mother’s need for closeness increased with the loss of her mother and her husband’s frequent absences. His father communicates as often as possible. His mother, though, wants his father to be by her side more often, but was silent about it. It was during this time that Tony developed symptoms. The two younger sisters of his mother live in the provinces and cannot come to lend support to them. _____ 26. What is the type of family structure? A. Nuclear B. Extended C. Nuclear dyad D. Single-parent _____ 27. Considering the family’s life cycle, the following developmental tasks contributed to the family’s current crisis EXCEPT . Tony’s difficulty in moving out to start college life . Failure of Tony’s parents to align marital and career issues . Difficulty in dealing with the death of Tony’s grandmother . Increased need for closeness of Tony’s mother _____ 28. Which of the following tools is practical to use in order to evaluate family function? A. APGAR B. Genogram C. Ecomap

D. Draw a Family Test _____ 29. Which among the following best represents Tony’s family map? . Tony ____/_____ Mother ____/_____ Father _________ . Tony _________ Mother ____/_____ Father _________ . Tony ____/_____ Mother _________ Father . Tony

Mother ____/_____ Father

_____ 30. Describe the psychodynamics underlying family dysfunction that triggered the family’s current crisis. . Enmeshment of Tony with his mother . Disengagement of Tony’s father from the family . Enabling shown by Tony’s tolerance of his parents’ behavior . Triangulation wherein Tony became a symptom-bearer Tools for Family Assessment Instructions: Match the lettered items to the numbered items. . Genogram . SCREEM . APGAR . Ecomap . Life Chart _____ 1. Family assessment tool used mainly to determine whether the family relationships are functional or dysfunctional. _____ 2. Spirituality as a resource can be identified by this tool. _____ 3. This tool must reflect at least three generations for better reference. ____ 4. Maps out relationship of patient with the barangay, the church, and the neighbors. ____ 5. Indicates significant dates in the life of a patient and later relating this to his condition.

II. Choose the best answer: _____ 1. Qualities of a good family assessment tool: . Easily available . Not time consuming . Provide composite financial capacity of the family . Must be acceptable to patient _____ 2. Refers to how time, space, money are shared and measures the members’ satisfaction with the commitment made by other members: . Adapatation . Growth

. Resolve . Partnership _____ 3. An APGAR score of ‘7’ means the family is: . Highly functional . Highly dysfunctional . Moderately functional . Moderately dysfunctional

_____ 4. Which area of the SCREEM addresses this: the family is unable to utilize health care resources: . Social . Educational . Medical . Economic _____ 5. Belief in life after death helps terminally ill patients in acceptance of their fate. This is considered a resource in what area? . Educational resource . Religious resource . Medical resource . Emotional resource

III. Identify the index patient and make his basic genogram indicating the following: the generations with members of each generation showing sex, age and names and diagnosis. (12 points) Cesar 49 years old came in because of type 2 diabetes. Diabetes being a heredo-familial disease the attending physician looked for risk factors one of which is family history. It was found that his father Andrew 73 y/o and two younger brothers Mar 42 y/o and Alex 45 y/o tested positive for diabetes but his elder sister Anna 51 y/o was negative. His reported that their son Nelson, now 20 y/o tested negative too. PARENTS of CES IV. ECOMAP CHURCH BOB PARENTS of BOB NEIGHBORS ED mos AL CESes BOB’S SIBLINGS OFFICE WORK

DAY CARE Instructions: Write A if the statement is True and B if it is False. __ ___ 1. Ces has very close relationship with bob’s parents and siblings. _____ 2. Bob and Ces appear to be religious persons. _____ 3. The neighbors are potential source of assistance in time of need. _____ 4. Bob has a profitable work and he is favored in the office. _____ 5. Ces seems to have difficulty with her work schedule. _____ 6. Seems to show Ces feels older son’s presence causes the difficulties in balancing work & home. _____ 7. Relationship of Bob and Ces are strained.