CFM Major Ex Prepromo Post Promo

Family Violence

Family Structure A. B. C. D. 1. 2. 3. 4. 5.

Single Parent Kin-Network Nuclear Family Dyad Institutional Married man and woman C Father as OCW in Australia, mother in Philippines with children A Mary delivered her son but her partner refused to acknowledge the child. A Grandparents living alone in their residence. C A family builds a condominium where each other member takes a room to live there. B

A. Physical D. Material B. Psychosocial E. Sexual C. Medical 15. Withholding of dentures to a grandmother so that she will not be able to eat well. A 16. Hitting of children’s buttocks with a belt as a means of discipline. A 17. A 16-year old girl consents amorous affair with a 32year old male. E 18. Husband spends the family finances inn gambling. D 19. Keeping a child away from memories of an estranged husband. B Long Term Care Services

Illness Trajectory A. B.

Onset of illness D. Early adjustment to outcome Reaction to diagnosis E. Adjustment to permanency of outcome C. Major therapeutic effort 5.

Maria started to diet, take her medicine and consult at health center after learning about her hypertension through health education. B Aling Pilar was given fit to work after1 month of sick leave due to PTB. D Bobby refused to talk to his doctor and his family regarding his illness. B Lola Marta decided not to undergo surgery for her cancer claiming that she had accepted her fate and early demise. C Naty thinks that her nape pain are due to hypertension. She takes the medicine that her hypertensive neighbor recommended to her. A

6. 7. 8.

9.

Health Beliefs A. B.

Natural Magical

C. Mystical D. Animistic

10. Belief in amulet or “anting-anting” as protectors from darkness. B 11. Reliance on Astrology and Feng-Shui as guidance for daily living. C 12. A patient is worried that her back pains are due to kidney problem because her mother had dialysis before she died. A 13. A family asks a faith healer to perform rituals to drive away the evil spirit which they believe to be the one causing the disease. D 14. A mother believes that her child’s hands look like that of a chicken because she was fond of chicken while she was pregnant. C

A. Hospice Care B. Bereavement Care C. Physical Therapy

D. Nursing Care E. Medical Social Service

20. A patient who suffered from stroke is prescribed passive exercises. C 21. A stroke patient with poor gag reflex needs to have new feeding tubes every 2 weeks. D 22. Families of patients who died within a year are called to meet every 2 weeks for group sharing. B 23. A poor patient who was referred to NGO’s for financial assistance. E 24. A home care patient is being seen by a cancer pain specialist. A Home Care Team A. B.

Crisis-oriented Client-oriented

C. Intervention-oriented D. Service-oriented

25. Organized around saving or prolonging lives. A 26. Organized around individual health care. B 27. Organized around the effort to reach specific populations at risk. C 28. More life improving than life-saving. B 29. Organized around the delivery of a group of health care services. D WRITE THE LETTER OF THE CORRECT ANSWER 30. The COMPREHENSIVE characteristic of care given by a family physician is seen in the ff. situation: D A. Home care following hospitalization B. Referral to other disciplines C. Acute care in the emergency room D. Psychosocial support to patient and family members

31. Provision of the basic necessities of a child needed for growth and development is an example of ________ family function. A A. Biologic C. Psychologic B. Socio-cultural D. Economic 32. The GENOGRAM would help the physician get data on the ff. A A. Family members important in the provision of health care B. Strength and weaknesses of the family C. Family ties and functions D. Available community resources 33. Which of the following is not a medical concern of a Family with Young Children? D A. Adequate nutrition and exercise B. Planning of pregnancy and birth C. Environmental safety D. Alcoholism and other vices QUESTIONS 35-36 34. Mr. and Mrs. Roxas celebrated their golden wedding anniversary. Both are retired and are 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 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 35. The couple thought of visiting their attending physician. What are the activities that can be done during the visit? B A. Ask how they are preparing for future deaths B. Perform periodic health examinations C. Counsel them on how to improve their relationship D. Explore possibility of a family meeting QUESTIONS 37-38 36. Mrs. Dy complains of difficulty of sleep and feeling low lately. Her husband revealed that it started when their only son decided to live on his own in preparation for marriage. What is the main difficulty of Mrs. Dy? C A. Worried about the financial cost of marriage B. Anxious about the future of his son C. Difficulty in accepting that her son is starting a life of his own D. Angry because of her son’s lack of concern for her health 37. Mrs. Dy, upon the advice of her husband decided to seek consult. What activities can be most helpful for the patient? C

A. B. C. D.

Request a battery of laboratory test Get a thorough history and physical examination Perform primary care counseling Refer to psychiatrist

38. Identification of problems results from the analysis of data gathered in the assessment phase of the family health care. Which conceptual framework serves as a valuable method for anticipating a family’s need for assistance or anticipatory guidance? A A. Life-span perspective B. Systems framework C. Ethnomedical model D. Biopsychosocial approach 39. A patient on home care progressively developed bed sores, function reveals caregiver fatigue. What could account for the pathology based on family systems theory? B A. Enmeshment C. Triangulation B. Disengagement D. Coalition 40. This type of outcome in the family illness trajectory maintains a constant sense of vulnerability. B A. Return to full health C. Permanent disability B. Partial recovery D. Death 41. Which among the following statements is not true? D A. For every disease, there is a corresponding impact of illness B. For illness with acute onset, the family is more prone to crisis situation C. For stages 2 & 5 of the illness trajectory, the family will go through the same process of denial, anger, and depression D. For chronic illness, the family is less prone to stress due to coping through time 42. Evaluation of a family in crisis needs data on family development stage in order to ____. B A. Determine degree of disruption in the function of the family B. Assess timelines of the illness problem C. Identify nature of the crisis D. Predict how well the family can handle crisis 43. Assessment of family in crisis requires evaluation of the degree of disruption in the family. This pertains to __. C A. Family developmental stage C. Family Role B. Family Resources D. Family Stressor 44. In assessing a family, a physician needs to gather database. Which of the ff. is not a part of the process? C A. Medical history-taking and physical assessments B. Use standards of care to focus the interviewing process C. Identify when data are insufficient to make a clinical diagnosis D. Use tools to asses all parameters of family functioning

45. After collecting data, the physician’s next step is to C/D A. Make a plan for intervention B. Identify problem needs C. Consult with peers D. Get feedback from index family 46. In implementing a family health care plan, physician’s actions include the ff. EXCEPT B A. Set time parameters for frequency and length of home visits B. Make differential conclusion about family needs C. Identify alternative intervention strategies D. Involves providing comfort measures, giving physical care, or providing health teaching and counseling 47. An elderly patient was noted to have hematoma in the legs. Upon probing, the patient claimed he fell from the bed. Caregiver was hesitant to bring him to the hospital for medical management. What will you do? D A. Report to authorities B. Perform home safety assessment C. Expand social services D. Assess family functioning 48. Tertiary prevention for those who are victims of violence includes D A. Screen for possible violence B. Provide appropriate medical care C. Inform women of their rights D. Refer to local support group and shelter 49. Provides evaluation of the patient’s health status taking into consideration genetic and lifestyle attributes in the context of the most common causes of mortality. D A. Health risk appraisal C. Health maintenance B. Physical examination D. Periodic screening 50. To achieve maximum benefit from exercise, an individual must maintain this: D A. Basal metabolic rate C. Max O2 consumption B. Body mass index D. Target heart rate 51. For males age 50 yrs and older, this screening procedure is important for early detection of urogenital abnormality A A. Digital rectal examination C. Urinalysis B. Stool examination D. Ultrasound 52. Pap smear screening is recommended at: C A. 20 yr old, not sexually active B. 35 yr old, not sexually active C. 18 yr old, sexually active D. 60 yr old, sexually active 53. The Filipino food pyramid has ____ as its basic requirement. A A. Water C. Vegetables B. Rice and root crops D. Fish 54. Which of the ff. is a reason for routinely convening a family meeting? A

A.

55.

56.

57.

58.

59.

60.

61.

62.

Admission and discharge of patient from the hospital B. Transfer of patient care from doctor to the family C. Establish rapport by getting to know the family D. High utilization of medical services by the family Which among the ff. patients would need home care? A A. An elderly patient with severe pain caused by arthritis B. A patient with dehydration caused by diarrhea and vomiting C. A carpenter who cannot ambulate with suspected leg fracture D. A child with high grade fever diagnosed with pneumonia A patient with bone metastasis in hospice care inquired about complementary medicine to relieve him of pain. What option would be safe for the patient? D A. Acupuncture C. Osteopathic manipulation B. Chiropractic D. Therapeutic touch Caregiver of the patient went to the clinic for wellness consult. She asked for relaxation techniques that can help her cope with her daily tasks. What would be an inexpensive, easy way of relaxing? A A. Mind-body technique C. Massage B. Aromatherapy D. Dietary supplementation Which among the ff. patients would need home care? A A. An elderly patient with severe pain caused by arthritis B. A patient with dehydration caused by diarrhea and vomiting C. A carpenter who cannot ambulate with suspected leg fracture D. A child with high grade fever diagnosed with pneumonia This aspect of care emphasizes symptom control and Quality of life A A. Hospice care C. Terminal care B. Palliative care D. Respite care Family meeting and counseling needed for the ff. reasons EXCEPT. D A. Give prognosis B. Preparation for the eventuality of death C. Assess candidate for bereavement D. None of the above Learning and application of techniques to manage interdependence to do job in the best possible way: C A. Progress notes B. Interdisciplinary approach to health car C. Teamwork D. Cross referral This involves 1 physician requesting the services of another for a particular purpose & for a limited time: B A. Consultation C. Transfer of service B. Referral D. Teamwork

CASE 64-67 A 24 year old male medical student was seen for periodic health exam. He smokes around 3 sticks per day and consumes 1-2 bottles of beer a day. He sleeps 6 hours on most days of the week. No regular exercise. Physical examination revealed the following: height=5’10, weight=200 lbs., waist=36inches, BP=140/90 63. What is the ideal body weight? A A. 150-160 lbs. B. 160-170 lbs. C. 170-180 lbs. D. 180-190 lbs. 64. What would be his BMI if he is classified to be obese class I? C A. >/= 18.5-22.9 C. 25-29.9 B. 23-24.9 D. >/= 30 65. What will his risk for co-morbidities based on his BMI and waist circumference? C A. Increased C. Severe B. Moderate D. Very Severe 66. If you give an exercise prescription, what would be the target heart rate? B A. 98-108 C. 137-147 B. 118-127 D. 157-170 FAMILY CASE 68-79 A 42 yr old woman, married with 2 daughters from Masbate revealed a 2 yr history of breast mass. Physical examination showed a cachectic patient with unilateral multiple breast mass with foul smelling discharge. The patient sought consult from faith healers in their hometown. Her family relatives firmly believe that it was due to “barang” (witchcraft). She was brought to Manila to consult with another faith healer. She refused to see a doctor, as it would render ineffective the treatment being done to her by the faith healer. Deep in her heart she has given up hope for cure. 67. For a doctor to understand the health benefits and practices of the family and the index patient, what tool in family assessment should be used? D A. Clinical biographies C. Ecomap B. Family circle D. SCREEM 68. What is the stage in the illness trajectory? D A. Stage 1 C. Stage 3 B. Stage 2 D. Stage 5 Describe the patient’s condition as to: 69. ONSET ____ 70. COURSE ____ 71. OUTCOME ____ 72. In evaluating the potential crisis once the patient dies, which among the ff. would help evaluate the degree of distribution in the function of the family? C A. Family stressor C. Family role B. Family developmental stage D. Family coping history

73. How does the family explain the etiology of illness? D A. Natural C. Animistic B. Mystical D. Magical 74. What is the patient’s locus of control? B A. Internal C. Intrafamilial B. External D. Extrafamilial 75. What would consist primary level of prevention for the two daughters? C A. Hospice care C. Health education B. Counselling D. Breast examination 76. What would consist tertiary level of prevention for the patient? A A. Hospice care C. Health education B. Counseling D. Breast examination 77. In exploring the health belief of the family, which among the ff. statements would be appropriate to determine the emotionally critical misperception? A A. What made you think that your condition is caused by “barang”? B. Can you tell me what “barang” is all about? C. How come you believe in “barang”? D. Why do you believe that “barang” has caused your sickness? 78. In responding to the patient’s decision to accept her fate without resorting to medical management, which among the ff. would be an emphatic response? B A. It’s your decision. You are solely responsible to any consequences B. It’s sad that both of us cannot do anything anymore to relieve you of your condition C. I understand your decision. I hope you will be at peace with it D. Although I respect your decision, I still would like to say that we could have done more to help you FAMILY CASE 80-85 Mr. So, a 64 yr old man with of advanced cancer of the prostate, was referred to a hospice program. He complains of excruciating pain, anorexia and inability to get out of bed. He lived with his wife and daughter. Both women work and believe that for financial reasons, they cannot give up their positions. The home care team explains that Mr. So’s eligibility to the hospice program depends on the availability of someone at home to assist with his care at all times. 79. In the assessment phase of a family health care process, what specific tool are you going to use to identify possible caregivers? B A. APGAR C. SCREEM B. Genogram D. Family map 80. After data were collected, the family health care team proceeded to data analysis. One of the findings is an APGAR score of 6. What does this mean? C A. Highly functional C. Moderately dysfunctional B. Moderately functional D. Severely dysfunctional

81. The family map would appear as _______. B A. Mr. So ______ Wife, Daughter B. Mr. So _____//_____ Wife, Daughter C. Mr. So ======= Wife, Daughter D. Mr. So _____//______Wife_____//____Daughter 82. The management of the physiological changes associated with the advanced prostate cancer of Mr. So would fall under __________ level of prevention. C A. Primary C. Tertiary B. Secondary D. Both B & C 83. For Mr. So’s daughter who is a 24 yr old, asymptomatic, wellness at primary level intervention would include: A A. Health education B. Annual physical examination C. Self-breast examination D. Counseling 84. In the event that Mr. So reaches the terminal phase of his illness, which among the ff. is NOT a condition to stop treatment in a dying patient? A A. Life is preserved by ordinary means B. Patient and/or family consents C. Irrefutable evidence that biological death is imminent D. Treatment will not prolong life for any significant time FAMILY CASE 86-100 Mrs. D began having difficulty remembering things, missing at time of work, and appearing in public in an untidy state at age of 64 yrs. Mrs. D was brought to a doctor for consult and was diagnosed to have Alzheimer’s disease. Because Mrs. D’s condition seemed to progress rapidly, the attending physicians did a home visit. When he arrived, he found Mrs. D unkempt, bedridden and has lost weight. The daughter who lives with her complained of exhaustion and of getting very little help from her siblings. 85. In assessing the condition of the index patient and the family, the doctor made use of several tools. Which among the ff. tools and their corresponding indication for use is NOT CORRECT? A/C A. APGAR-assess familial resources B. Genogram-identify alternate caregivers C. SCREEM-assess capacity of family to participate in health care D. Family map-describe family dynamics 86. Upon analysis of data, the doctor identified several factors that might have led to caregiver fatigue. Which among the ff. is the most probable cause? A A. APGAR score of 6 B. Financial constraints C. Nuclear family D. Cultural stigma of the disease

87. The doctor decided to draw a visual representation of what’s going on in the family. How would it appear? D A.

B.

C.

D. 88. How would you explain the psychodynamics of the family that would account for the caregiver fatigue? A A. Disengagement of sibling B. Enmeshment if caregiver with the patient C. Conflict avoidance D. Enabling Complete the table below:

A. B.

Problem Medical Bedridden Psychosocial Dysfunctional relationship

Objectives 90

Plan 91

Evaluation 92

93

94

95

96. Which type of health team is in charge of the needs of the patient? B A. Crisis-oriented C. Intervention-oriented B. Client-oriented D. Service-oriented 97. What type of referral would the attending physician be undertaking if he refer to a psychologist for the psychological assessment of the caregiver? B A. Internal referral C. Cross-referral B. Collateral referral D. Split-referral 98. Who can be part of the health care team to address the needs of the family? D A. Nurse C. Physical therapist B. Nutritionist D. All of the above 99. What activities can be done as part of evaluation? D A. Home visit C. Family meeting B. Team management meeting D. All of the above 100. What would be the criteria for terminating the health plan for the family? C A. Objectives achieved C. Both B. Family refused D. Neither

FEU-NRMF INSTITUTE OF MEDICINE DEPARTMENT OF COMMUNITY AND FAMILY MEDICINE Community and Family Medicine I

Exam No._____

Pre-Promo Removal Examination – October 13, 2011 NAME: _______________________________________________________SECTION: ___________ INSTRUCTIONS: 1. Sign the attendance sheet twice, the first for attendance and the second as you submit your papers. 2. Check your papers for completeness and legibility. If necessary, request for a replacement soon after distribution. 3. Read, understand and follow all instructions very carefully. Write legibly. Ambiguously written answers will not be considered correct. Strictly NO ERASURES. 4. Absolutely NO CHEATING. Cheaters will be dealt with severely. 5. Raise your hand if you have any question and the proctor shall attend to you. >>>> DIRECTION: Choose the best answer. Psychodynamics __B___1. Retired couple on their 60th year together proud of their children’s accomplishments and enjoying their grandchildren. What do you anticipate will be the most pressing concern of this couple? A. Managing differences with spouses of their chilren B. Coping with physical and mental decline C. Dealing with death of spouse 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 __D___3. C.L. an 80 year old woman stayed in the nursing home since 2 months ago. Since then none of her children has visited her. The family relationship may be described as: A. Enmeshed B. Functional C. Dysfunctional D. Disengaged __B___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) __B___6. A patient was advised surgery for a bleeding ulcer. Necessary information was discussed by the surgeon; however, patient cannot decide what to do. She is afraid of any complications. 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 __A___10. Ten months prior to the definitive surgery a patient went through anxiety as manifested by loss of appetite, loss of weight and sleepless nights. This phase/state is: A. Stress B. Crisis C. Mourning D. Recovery Family Health Care Process A. Assessing B. Analyzing C. Planning

D. Implementing E. Evaluating

_____11. _____12. _____13. _____14.

Determines the existence of any actual or potential health problems. Identifies the problem as remedied, improved, unchanged or worsened. Use a variety of tools for recording history, health, and physical assessments. 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? A. Interview B. Direct observation C. Ocular inspection D. A and B E. All of the above _____17. What is/are the sign/s that the family is dysfunctional? A. Alcohol abuse B. Marital conflict C. Family violence D. A and B E. 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 B. Consultation with supervisors C. Case audit D. 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 B. Goals and objectives not mutually established C. Family priorities not ascertained D. All of the above _____29. What are the indications for terminating the patient, family and physician therapeutic relationship? A. Objectives have been achieved B. Patient wants to end relationship C. Intervention not effective D. 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 Palliative Care Write A if the statement is “True” and B if the statement is “False” __A___ 31. Palliative care is ______________: a) 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 multiprofessional 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, decisionmaking 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 life-threatening 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 lifethreatening 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, part-time 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 self-actualization’ 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. A. B. C. D. E.

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 A. STAGE I B. STAGE II C. STAGE III

D. STAGE IV E. STAGE V

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 apermanent 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 selfreliant. WELLNESS I. Choose the best answer: __D___ 86. Primary prevention means: A. Treatment of diseases in the uncomplicated state B. Treatment of diseases in the complicated state C. Bringing the patient to as normal function as possible D. 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? A. Primary B. Secondary C. Tertiary D. All of the above __B___88. Screening for cancer of the cervix A. Gram stain of vaginal discharge B. Pap smear C. Colposcopy D. A & B only __A___ 89. Recommended screening for breast cancer: A. Breast self-examination B. Biopsy C. Excision biopsy D. Chest x-ray __B___90. Ideal body weight for women is computed as follows: A. 100 lbs for first 5 feet plus 5 lbs per cm. B. 100 lbs for first 5 years plus 5 lbs per in. C. 106 lbs for first 5 feet plus 6 lbs per in. D. 105 lbs for first 5 feet plus 5 lbs per cm. __B ___ 91. Formula for basal body temperature: A. BMI = weight in lbs ÷ height in m 2 B. BMI = weight in kg ÷ height in m2 C. BMI = height in m2 ÷ weight in kg D. BMI = height m2 x weight in kg __C___ 92. Treatment of a post-stroke patient in rehabilitation is: A. Primary prevention B. Secondary prevention C. Tertiary prevention D. None of the above

__A___ 93. Precaution to giving Rubella vaccination: A. Pregnancy within 28 days of the administration B. Diarrhea 3 days before administration C. Only for women in the reproductive age group D. Fever __B___ 94. Hepatitis B vaccination is important for Filipinos because: A. Hepatitis B is hereditary B. Hepatitis B is endemic in the Philippines C. Hepatitis B is permanent D. 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: A. Symptoms, Objectives, Assessment. Plans B. Subjective, Objective, Assessment, Perspective C. Symptoms, Objections, Assessment, Prognosis D. Subjective, Objective, Assessment, Plan __C___ 97. The ___ is a specialized but brief summary of the patient’s case and course in the hospital: A. The admitting summary B. The progress notes C. The discharge summary D. The plan chart ___A__ 98. The following best describes a crisis-oriented team: A. Organized and technologically equipped aimed at saving or prolonging Organized around the effort to reach specific populations at risk B. Organized around the delivery of a group of health care services C. Organized around individual health care with emphasis on life improvement than life-saving D. Organized around the effort to reach specific populations at risk __B___ 99. The problem oriented medical record (POMR) includes the following: A. Narrative description of the patient’s medical history B. A listing of his medical problems, medications and progress notes C. A genogram to indicate hierarchy of diseases occurring in the family D. All of the above __D___ 100. Objective (s) of medical records or write-ups: A. To convey information to the consultant B. To document & clarify the progression & approaches of the medical team C. To quantify & organize impressions on the case D. All of the above

Matching type: COLUMN A 96. Diabetes clinic 97. Stroke unit 98. Unit for reproductive health services 99. Unit for health education services 100. Well-baby clinic

COLUMN B A. Crisis-oriented team B. Client-oriented team C. Intervention-oriented team D. Service-oriented team

Matching type: A. Internal referral C. Cross-referral B. Collateral referral D. 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. True B. False 110. The following is/are included in the problem list: A. Social C. Economic B. Psychiatric D. All of the above

END OF EXAMINATION

FEU-NRMF INSTITUTE OF MEDICINE DEPARTMENT OF COMMUNITY AND FAMILY MEDICINE Community and Family Medicine I

Exam No._____

Post-Promo Removal Examination – October 24, 2011 NAME: _______________________________________________________SECTION: ___________ INSTRUCTIONS: 1. Sign the attendance sheet twice, the first for attendance and the second as you submit your papers. 2. Check your papers for completeness and legibility. If necessary, request for a replacement soon after distribution. 3. Read, understand and follow all instructions very carefully. Write legibly. Ambiguously written answers will not be considered correct. Strictly NO ERASURES. 4. Absolutely NO CHEATING. Cheaters will be dealt with severely. 5. Raise your hand if you have any question and the proctor shall attend to you. >>>> Palliative Care In reference to the principles of palliative care: Write A if the statement is “True” and B if the statement is “False” __B___ 1. Palliative care is for active patients whose disease is responsive to curative treatment. __A___ 2. Neither hastens nor postpones death but preserves the best possible quality of life until death. __B___ 3. Strictly speaking, it is the care for the person who is facing the end of life and for those who love them. __B___ 4. It is synonymous to that part of oncological care which involves the prevention and management of the adverse effects of cancer and its treatment. __A___ 5. Provides relief from pain and other distressing symptoms __B___ 6. Affirms life and regards dying as process that needs to be prevented or delayed to the best of one’s ability __A___ 7. Includes the psychological aspects of patient care apart from the medical needs __A___ 8. Utilizes a team approach to address the needs of patients and their families, including bereavement counseling, if indicated __B___ 9. Is applicable only towards the end of life In reference to hospice care: Write A if the statement is “True” and B if the statement is “False” Hospice care is ________: __A___10. 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 __A___11. Strives to offer freedom from pain, dignity, peace and calm End-of-Life care __A___ 12. 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___ 13. 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 Patients seen by or referred for palliative care: __A___ 14. 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. __A___ 15. Patients requiring support with psychosocial or spiritual problems with the progression of their life-threatening disease. __B___ 16. Patients with pre-defined medical diagnoses only, such as cancer. __A___ 17.The disease trajectory of palliative care patients can be a period of several years, months, weeks or days. __A___18. Preferred place of care and place of death for palliative care patients: Determined mostly by patient and family preferences, but the place of death may be determined by other factors. __B___19. True about grief and bereavement in palliative care: 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. __A___20. True about advance care planning in palliative care: 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. __A___21. 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. __B___22. Palliative care seeks to hasten death so as to minimize the pain and suffering of the terminally-ill. __A___ 23. Types of Long-term Care Services: community based services, home health care, housing for aging and disabled individuals, and continuing care retirement communities. Write A if the statement is “True” and B if the statement is “False” __B___ 24. Long-term care can only be provided in nursing homes. __B___ 25. Position of palliative care towards life and death: Palliative care seeks to hasten death so as to minimize the pain and suffering of the terminally-ill. __A___ 26. The value of life, the natural process of death, and the fact that both provide opportunities for personal growth and self-actualization’ should be acknowledged. __A___ 27. Palliative care does not seek to postpone death.

Interdisciplinary Approach Matching type: COLUMN A __C___ 28. Tuberculosis (TB) clinic __A___ 29. Burn and Trauma unit __D___ 30. Unit for reproductive health services __B___ 31. Unit for health education services __D___ 32. Well-baby clinic

COLUMN B A. Crisis-oriented team B. Client-oriented team C. Intervention-oriented team D. Service-oriented team

Matching type: A. Internal referral C. Cross-referral B. Collateral referral D. Split referral __A___ 33. A family physician referring a pulmonary embolism case to a pulmonologist. __D___ 34. A case of renal failure with ischemic disease being managed by a nephrologist and a cardiologist. __D____35. A surgeon referring a case of appendicitis to a diabetologist. __B____36. A general practitioner referring a case of an anxiety reaction with depressed mode to a psychiatrist __C____37. A family physician referring a high risk pregnancy to a perinatologist. Choose the best answer __A___ 38. The SOAP in the problem-oriented format of the POMR means: A. Subjective, Objective, Assessment, Plan B. Symptoms, Objectives, Assessment. Plans C. Subjective, Objective, Assessment, Perspective D. Symptoms, Objections, Assessment, Prognosis __C___ 39. The ____ is a specialized but brief summary of the patient’s case and course in the hospital: A. The admitting summary B. The progress notes C. The discharge summary D. The plan chart ___A__ 40. The following best describes a crisis-oriented team: A. Organized and technologically equipped aimed at saving or prolonging Organized around the effort to reach specific populations at risk B. Organized around the delivery of a group of health care services C. Organized around individual health care with emphasis on life improvement than life-saving D. Organized around the effort to reach specific populations at risk __B___ 41. The problem oriented medical record (POMR) includes the following: A. Narrative description of the patient’s medical history B. A listing of his medical problems, medications and progress notes C. A genogram to indicate hierarchy of diseases occurring in the family D. All of the above __D___ 42. Objective (s) of medical records or write-ups: A. To convey information to the consultant B. To document & clarify the progression & approaches of the medical team C. To quantify & organize impressions on the case D. All of the above WELLNESS I. Choose the best answer: __D___ 43. Primary prevention means: A. Treatment of diseases in the uncomplicated state B. Treatment of diseases in the complicated state C. Bringing the patient to as normal function as possible D. Preventive measures even before disease occurs __B___44. Pap smear done to screen for cervical cancer in patients who are sexually active. What level of prevention is this? A. Primary B. Secondary C. Tertiary D. All of the above __B___45. Screening for urinary tract infection A. Gram stain of vaginal discharge B. Urinalysis C. Cystoscopy D. A & B only __A___ 46. Recommended screening for breast cancer: A. Breast self-examination B. Biopsy C. Excision biopsy D. Chest x-ray __B___47. Ideal body weight for women is computed as follows: A. 100 lbs for first 5 feet plus 5 lbs per cm. thereafter B. 100 lbs for first 5 feet plus 5 lbs per in. thereafter C. 106 lbs for first 5 feet plus 6 lbs per in. thereafter D. 105 lbs for first 5 feet plus 5 lbs per cm. thereafter

__B ___ 48. Formula for BMI: A. BMI = weight in lbs ÷ height in m 2 B. BMI = weight in kg ÷ height in m2 C. BMI = height in m2 ÷ weight in kg D. BMI = height m2 x weight in kg __C___ 49. Treatment of a post-stroke patient includes bringing him back to as normal function as possible. This is what level of prevention? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. None of the above __A___ 50. Precaution to giving Rubella vaccination: A. Pregnancy within 28 days of the administration B. Diarrhea 3 days before administration C. Only for women in the reproductive age group D. Fever __B___ 51. Hepatitis B vaccination is important for Filipinos because: A. Hepatitis B is hereditary B. Hepatitis B is endemic in the Philippines C. Hepatitis B is permanent D. Hepatitis B is a sexually transmitted disease __C___ 52. 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 Psychodynamics __B___53. Retired couple on their 60th year together proud of their children’s accomplishments and enjoying their grandchildren. What do you anticipate will be the most pressing concern of this couple? A. Managing differences with spouses of their children B. Coping with physical and mental decline C. Dealing with death of spouse D. Maintaining couple functioning __D___54. C.L. an 80 year old woman stayed in the nursing home since 2 months ago. Since then none of her children has visited her. The family relationship may be described as: A. Enmeshed B. Functional C. Dysfunctional D. Disengaged __B___55. 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 __C___56. The following is/are healthy family characteristic(s): A. After typhoon “Pedring,” a family busied themselves in joining looting activities in the evacuation center 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. The members positioned themselves strategically to ensure receipt of relief goods even before the others find out about it Psychosocial Typology __B___57. A patient was advised surgery for a bleeding ulcer. Necessary information was discussed by the surgeon; however, patient cannot decide what to do. She is afraid of any complications. 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 __A___58. Ten months prior to the definitive surgery a patient went through anxiety as manifested by loss of appetite, loss of weight and sleepless nights. This phase/state is: A. Stress B. Crisis C. Mourning D. Recovery Family Health Care Process A. Assessing D. Implementing B. Analyzing E. Evaluating C. Planning __B___59. Determines the existence of any actual or potential health problems. __E___60. Identifies the problem as remedied, improved, unchanged or worsened. __A___61. Use a variety of tools for recording history, health, and physical assessments. __D___62. Involves providing comfort measures, giving physical care, or providing health teaching and counseling. __C___63. Allows family to prioritize its identified needs.

Anna is a married, 38 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, type 2 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, Anna appeared depressed and sullen, avoided eye contact, and answered all questions with one or two words. It was also noted that she did not have any visitors during her stay. A home care follow-up was recommended because Anna 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. Anna appeared stressed out. Anna told the FHC team, “Let’s get this over with fast before my husband arrives. He does not want strangers in the house.” Anna 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. Anna 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. __E___64. In the assessment phase of the family health care process, what tools were used by the FHC team to gather data about the family? A. Interview B. Direct observation C. Ocular inspection D. A and B E. All of the above __E___65. What is/are the sign/s that the family is dysfunctional? A. Alcohol abuse B. Marital conflict C. Family violence D. A and B E. All of the above COMPLEMENTARY & ALTERNATIVE HEALTH CARE (CAM) Instructions: Write A if the statement is TRUE and B if the statement is FALSE. __A___ 66.Studies shows that most people used CAM to prolong their survival, palliate their symptoms, and alleviate the side effects of conventional treatment. __B___ 67. CAM are proven therapies which are desperate measures over which patients can exert control when their disease is progressing. __A___ 68. CAM is the preferred terminology to describe therapies used in conjunction with conventional treatments. __A___ 69. Alternative Medicine is frequently grouped with Complementary Medicine or Integrative Medicine. __A___70. CAM maybe used to improve a person’s well being. MULTIPLE CHOICE: CHOOSE THE BEST ANSWER. __C___ 71. Patients seek complementary and alternative therapies for the following reason/s. A. Self empowerment B. Dissatisfaction with conventional therapy C. Both D. Neither __D___ 72. 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 __C___ 73. 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 __C___ 74. 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 __C___ 75. 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. A. ACUPUNCTURE B. MIND/BODY TECHNIQUE C. MASSAGE THERAPY D. MUSIC THERAPY E. AROMATHERAPY/HERBAL MEDICINE __C___ 76. Helps reduce stress, increase mobility, enhance respirations, stabilize vital signs, and assist the body’s natural ability to heal. __D___ 77. Controlled trials show that this modality produces emotional and physiological benefits and reduces anxiety, stress, depression and pain. __A___ 78. Helps reduce the symptoms such as nausea and pain and strengthen the body’s immune system by unblocking the “universal life force”. __B___ 79. Reduces stress, symptom management and control of some physiologic reactions as exemplified by Yoga. __E___ 80. Should be discontinued prior to chemotherapy or surgery because of possible effect on coagulation and interaction. __A___ 81. Use of Meridians __B___ 82. Cascara and Psyllium __B___ 83. Biofeedback __E___ 84. Tai Chi __E___ 85. St. John’s Wort IMPACT OF ILLNESS MATCHING TYPE: A. STAGE I B. STAGE II C. STAGE III

D. STAGE IV E. STAGE V

__B___ 86. A 23 year old lady came in with a history of nose bleeding. Platelet count is decreased. Doctor is considering Dengue fever. __E___ 87. 45 year old female died due to chronic renal failure. __D___88. A 69 year old male stroke patient referred to rehabilitation service for therapy. __A___ 89. Rita is suffering from severe headache and she self medicated with paracetamol. __C___90. A 58 year old female with breast cancer (Invasive Ductal Carcinoma) will undergo surgery involving removal of the breast (Modified Radical Mastectomy) __D___ 91. 69 year old male stroke patient referred to Rehabilitation service for therapy. __D___ 92. This phase has three possible outcome, a return to full health, partial recovery and a permanent disability. __B___93. First crisis occurs. __D___94. Second crisis occurs. __B___95. Disease maybe acute or chronic. WRITE A IF THE STATEMENT IS TRUE AND B IF THE STATEMENT IS FALSE. __B___ 96. Family’s reaction to illness & death occurs in stages with the following order denial, anger, bargaining, depression and acceptance. __A___ 97. Lifestyle and cultural characteristics of the family are important consideration in making a treatment plan. __B___ 98 Severe illness may lead to financial catastrophe thus cost of therapy should be according to the family’s ability to afford it. __A___ 99. Sudden change in behavior can be considered as red flag. __B___100. Other people may take the responsibility of the family in taking care of the patient for them to become empowered and self-reliant.

END OF EXAMINATION