COMMEDRecon_Evals7

COMMED EVALS 7 (December 16, 2010) Topics Covered: Traditional, Complementary and Alternative Medicine  Dr. Carnate  Violence Against Women and Elder Abuse  Dr. Carnat e   Health Emergency Management  Dr. Gonzaga  Hospice and Palliative Care  Dr. Hipol

1. The Traditional Medicine Program of the Philippines was replaced in 1997 by the: A. Philippine Institute of Traditional and Alternative Medicine B. Philippine Center for Traditional and Alternative Medicine C. Philippine Institute for Traditional and Alternative Health Care D. Philippine Institute for Traditional, Alternative and Complementary Health Philippine Philippine Institute for Traditional and Alternative Health Care (PITAHC) was established under RA No. 8423: Traditional and Alternative Medicine Act (TAMA) objectives: encourage scientific research y promote and advocate use y coordinate skills training courses y formulate standards, guidelines and codes of ethical practice y formulate policies for the protection (of practitioners and materials used) y formulate policies to strengthen the role of TAHC y promote TAHC y

2. The traditional and alternative modalities currently accepted in the Philippines include the following, except: A. Acupuncture B. Chiropractic C. Folk medicine D. Herbal medicine E. Massage 3. One of the objectives of the Phil ippine program for traditional medicine is to protect these from ex ploitation and patenting: A. Traditional healers B. Indigenous health resources C. Consumers of traditional medicine modalities D. All of the above 4. This is one of the characteristics that differentiates alternative medicine from traditional medicine: A. Holistic health care B. Handed down from another culture C. Not included in biomedicine D. Based on history, heritage and consciousness E. None of the above Traditional Medicine The sum total of knowledge, skills and practices on holistic health care which is recognized and accepted by the community  for its role in maintenance of health and treatment of diseases. It is based on the theory, belief and experiences that are indigenous to the different cultures, cultures , and that is developed and handed down from generation to generation .

Traditional and Alternative Health Care (TAHC) The sum total of knowledge, skills and practices on health care and and other than those embodied in biomedicine, used in the prevention, diagno diag nosis sis and elimination of physical or mental disorders. TRADITIONAL Medicine The sum total of knowledge, skills and practices on health care not necessarily explicable in the context of modern, scientific framework, but recognized by the people to help maintain and improve health towards the wholeness of  their being, the community and society, and other interrelations based on culture, history, heritage and  consciousness.  ALTERNATIVE Medicine Other forms of non-allopathic, occasionally non-indigenous or imported  healing methods, though not necessarily   practiced for centuries, nor handed down from one generation to another .

5. Traditional medicine is not part of mainstream medicine but is recognized for its contribution to health care. The form of political support: A. Neglect B. Exclusion C. Support D. Integration E. Recognition Integrated Part of mainstream/conventional medicine Supported** Not a part of mainstream medicine, but the government recognizes it and has efforts to bring it to mainstream Recognized The government announces its potential role in mainstream medicine Neglected Only conventional medicine is recognized **in

the Philippines, T/CAM is supported by the government 

6. Health systems that are non-allopathic and non-indigenous are considered by the Philippine Program on Traditional Medicine as: A. Complementary Medicine B. Traditional Medicine C. Biofield therapy D. Bioelectromagnetic modality E. C and D only 7. Reiki is an example of this type of alternative medicine form: A. Body-based therapy B. Body-mind intervention C. Biofield therapy D. Bioelectromagnetic modality E. C and D only 8. This form of alternative medical system uses small amounts of medicinal substances to cure diseases/symptoms. These same substances can cause the disease/symptoms when give in higher or more concentrated doses. A. Traditional Chinese Medicine B. Ayurveda C. Homeopathy D. Naturopathy E. None of the above 9. In the Philippines, these plants are still being screened for their medicinal properties, except: A. Tinospora crispa B. Lagerstroemia speciosa C. E hretia hretia microphylla entella asciatica D. C entella E. Euphorbia hirta The following are currently being screened for their medicinal properties: COMMON NAME SCIENTIFIC SCIENTIFI C NAME INDICATION INDICATIO N Makabuhay Tinospora crispa anti-malaria Banaba Lagerstroemia speciosa diuretic C entella Takip kuhol entella asiatica wound healing C yperus Mutha yperus rotondus intestinal motility Tawa-tawa/ anti-dengue (  platelet ct.) Euphorbia hirta Gatas-gatas anti-asthma

10. Vitex negundo is also known as A. Ampalaya B. Lagundi C. Yerba-buena D. Tsaang-gubat E. Ulasimang bato

11. This medicinal plant is currently being investigated for its anti-malarial properties: A. Gatas-gatas B. Makabuhay C. Takip-kuhol D. Mutha E. None of the above HERBAL

COMMON NAME Akapulko Ampalaya Bawang Bayabas Lagundi Niyug-niyugan Sambong Tsaang-gubat Ulasimang bato Yerba Buena

MEDICINES SCIENTIFIC SCIENTIFI C NAME C assia assia alata Momordica charantia  Allium sativum Psidium guajava Vitex negundo Quisqualis indica Blumea balsamica Ehretia microphylla Peperomia pellucida Mentha cordifolia

INDICATION INDICATIO N fungal infection diabetes mellitus hypercholesterolemia antiseptic anti-asthma anti-helminthic anti-urolithiasis intestinal motility anti-hyperuricemia body pains

For # 12-16: 12-16: Match the herbal medicines medicines in Column A with the indications/diseases indications/diseases for which the DOH has approved their use in Column B. COLUMN A COLUMN B C 12. Sambong

A. Body pains

A 13. Yerba Buena

B. Intestinal motility problems

E 14. Bawang

C. Urolithiasis

B

15. Tsaang-gubat

D.

D 16. Ulasimang Bato

Hyperuricemia

E. Hypercholesterolemia

For # 17-20: 17-20: Match the items in Column Column A as to the form of Complemetary and Alternative Medicine in Column B. COLUMN A

COLUMN B

D 17. Reiki

A. Mind-body interventions

A 18. Prayer healing

B. Biologically-based therapies

C 19. Osteopathy

C. Manipulative and body-based methods

B

20. Aromatherapy

D.

Energy therapies

E. None of the above ote: N ote:

Most of the questions under VAW/Elderly Abuse are definitions and need no further explanation. Just absorb. 

21. This theory avers that violence against women is a result of the need of men to assert power and control over women: A. Caregiver stress B. Trans-generational violence C. Abuser psychopathology D. Sociological perspective E. Feminist perspective 22. That media has a role in the causation of el der abuse is a theory of: A. Caregiver Stress B. Trans-generational Abuse C. Abuser Psychopathology D. None of the above

23. This theory of causation of elder abuse avers that elder abuse is a learned behavior: A. Caregiver Stress B. Trans-generational Abuse C. Abuser Psychopathology D. None of the above 24. That women are inferior to men is a message of this (these) theory (theories) of causation of violence against women (VAW): A. Social Perspective B. Feminist Perspective C. Both 25. That violence is a learned behavior is a theory of: A. Sociological Perspective B. Trans-generational violence C. Caregiver Stress D. All of the above E. A and B only 26. This theory avers that elder abuse is a result of the pressures of looking after an elderly person: A. Caregiver Stress B. Trans-generational violence C. Abuser psychopathology D. Sociological perspective E. Feminist perspective 27. In this effect of VAW, the woman-victim/survivor feels depressed, incompetent and powerless to change her circumstances A. Post-traumatic stress disorder B. Battered wife syndrome C. Learned helplessness D. All of the above 28. In this effect of VAW, the woman-victim/survivor w oman-victim/survivor exhibits dissociation as a coping mechanism A. Post-traumatic stress disorder B. Battered wife syndrome C. Learned helplessness D. All of the above 29. Physical effects of VAW include the following: A. Sexually-transmitted diseases B. Suicide C. Miscarriages D. Maternal mortality E. All of the above 30. Hypervigilance, sleeplessness and exaggerated startle response are symptoms of this psychological effect of  VAW: A. Learned helplessness B. Battered wife syndrome C. Post-traumatic stress disorder D. Depression 31. A male prison guard committed lascivious acts against a female prisoner. The form of VAW committed is: A. Sexual violence B. Custodial abuse C. Deprivation of liberty D. A and B only E. All of the above

FORMS OF VAW Physical Violence Sexual Violence Psychological Violence Economic Abuse Deprivation of Liberty Restricting a womans freedom of movement Depriving a woman of her legal rights Medical Abuse Abuse by medical personnel Custodial Abuse Abuse by caretakers

32. Forcing an elderly person to sign a document giving another person the power-of-attorney is a form of: A. Physical abuse B. Financial abuse C. Neglect D. None of the above 33. Not taking an elderly person to the doctor to have his/her bedsores managed is an example of this form of elder abuse: A. Physical abuse B. Psychological abuse C. Physical neglect D. A and B only E. B and C only 34. Fiduciary abuse: A. The refusal or failure to fulfill a care-giving obligation or to provide for basic needs B. Acts intended to make a women financially dependent C. The illegal or improper exploitation or use of funds or resources of the older person p erson D. Depriving a woman of her legal rights or F or

# 35-37 

MEASURES THAT PROTECT VS. VAW/ELDE R ABUSE International Policies/Instruments Policies/Instruments Universal Declaration of Human Rights (1948) UN Declaration on the Elimination of VAW (1993) UN Declaration on the Prevention of Elder Abuse (2002) Philippine Philippine Policies and Laws  Revised Penal Code (1932) Article 246: Parricide Article 737: Qualified Seduction 

Philippine Constitution (1987) Gender equality Prevention and elimination of violence -



RA

7877: Anti-Sexual Harassment Act (1995) Definition and punishment



RA

8353: Anti-Rape Law (1997) Definition and punishment Marital rape -



RA

8551

-

Creation of Womens Desks in Precincts



RA

9208: Anti-Trafficking in Persons Act (2003) Definition and punishment



RA

9262: Anti-VAW and their Children Act (2004) Definition and punishment

Non-Government and Community Response Establishment of Counseling and Crisis Centers Policy advocacy for Womens Rights

35. That employers, teachers, supervisors and persons in authority should act with care towards women in their employ, guidance and care is embodied in this law: A. Anti-Trafficking in Persons Act B. Anti-Sexual Harassment Act C. Anti-Rape Law D. Anti-VAW and their Children and Act E. All of the above 36. Recruitment of women to be sexual workers is a punishable crime according to this law: A. Anti-Trafficking in Persons Act B. Anti-Sexual Harassment Act C. Anti-Rape Law D. Anti-VAW and their Children and Act E. All of the above 37. Republic Act 8551 is the Philippine Law that: A. Defined what behavior constitutes sexual harassment B. Prescribes appropriate punishment for acts of violence against women C. Defined trafficking D. Created womens desks in precincts 38. The following is(are) true of VAW: A. Usually a one-time occurrence B. Occurrence is usually sporadic C. A single form of abuse is usually committed D. The abuser is usually known 39. The following is(are) true of VAW: A. Elderly women are unlikely to be victims of VAW B. Most incidents of VAW get reported to authorities C. The most commonly reported form of VAW is sexual abuse D. Making a woman watch the abuse of her pet is a form of VAW E. None of the above 40. This form of VAW is present in the Philippine definition of VAW (Republic Act 9262: Anti-VAW Act) but is not specified in the VAW definition of the United Nations: A. Public violence B. Intra-family violence C. Economic violence D. Gender-based violence DEFINITIONS OF VAW UN General Assembly, 1993 gender-based violence that results in, or is likely to result to, physical, sexual, or psychological harm or suffering any act of  act of gender-based to women, including threats of such acts, coercion, or arbitrary deprivation of liberty  whether occurring in public or private life. life. RA

9262, 2004 any act or series of acts committed by any person against his wife, former wife, or against a woman with whom the person has or had a sexual or dating relationship, or with whom he has a common child, or against her child, whether legitimate or illegitimate, within or without the family abode, which result in or is likely to result in physical, sexual, and psychological harm or suffering or economic abuse, abuse , including threats of such acts, battery, assault, coercion, harassment, or arbitrary deprivation of liberty.

41. Epidemics and plagues are inevitable after every disaster. Your best counter-argument is: A. Affected population is too shocked/helpless to take responsibility for their own survival B. Local population almost always cover immediate life saving needs C. Dead bodies will not lead to catastrophic outbreak of exotic diseases 42. The National Health Policy Framework on Health Emergencies and disasters has the following features EXCEPT: A. 3-phase coverage B. Risk Reduction Focused C. Selected Hazard Approach D. Integrated in Health Programs

For # 43-51:

Choose the appropriate answer from the following A. Hazard B. Disaster C. Vulnerability D. Capacity E. Risk

HAZARD

-

 potential for causing injuries to life and damaging A natural or human generated event or occurrence that has the  potential for property and environment

DISASTER Any occurrence that causes damage, economic disruption, loss of human lives and deterioration in health and  health services On a scale sufficient to warrant an extraordinary response from outside the affected community areas Any actual threat to public safety and/or public health where local government and the emergency services are unable to meet the immediate needs of the community VULNERABILITY A set of   of   prevailing or consequential conditions which adversely affect peoples ability to prevent, mitigate, prepare for and respond to hazardous events CAPACITY esource  , means, and strength which exist in households and communities and which enable them to cope with, Resource  withstand, prepare for, prevent, mitigate or quickly recover from a disaster. RISK

-

  Anticipated consequences of a specific hazard affecting a specific community at a specific time Level of loss of damage that can be predicted to result from a particular hazard affecting a particular place at a particular time

43. Endosulfan cargo in Princess of Stars A  Hazard 44. Typhoon Ondoy A/B  Hazard/Disaster 45. First floor location of x-rays in hospitals C  Vulnerability 46. Floating foundations for buildings D  Capacity 47. Any occurrence that causes damage, economic disruption, loss of human lives and deterioration in health and health services on a scale sufficient to warrant an extraordinary response from OUTSI DE the affected community areas B  Disaster 48. Resource, means and strength which exist in households and communities and which enable them to cope with, withstand, prepare for, prevent, mitigate or quickly recover from a disaster D  Capacity 49. A natural or human generated event or occurrence that has the potential for causing injuries to life and damaging property and environment A  Hazard 50. Anticipated consequences of a specific hazard affecting a specific community at a specific time E - Risk 51. A set of prevailing or consequential conditions which adversely affect peoples ability to prevent, mitigate, prepare for and respond to hazardous events C - Vulnerability

52. A comprehensive strategy for reducing threats and consequences to public health and safety of the community by preventing exposure to hazards, reducing vulnerabilities and developing response and recovery is known as: A. Disaster Management B. Vulnerability Reduction C. Risk Management D. Mitigation E. Disaster Preparedness 53. Principles involved in health emergency/disaster management EXCEPT: A. Sustainable Development B. Integrated Approach C. Millennium Development D. Primary Health Care 54. The roles of the Health Sector during the Pre-event Phase are the following EXCEPT: A. Assess Risks B. Reduce Risks C. Prepare for Emergencies D. Responding to Emergencies

For 55-58: 55-58: A. B. C. D.

Choose from the list below the appropriate Phase Phase to which the health activity belongs Preparedness (Pre-Event) Response (Event) Rehabilitation and Reconstruction (Post-Event) All phases

HEALTH

ACTIVITIES FOR EACH PHASE

PRE-EVENT PHASE: PREPAREDNESS Development of policies, guidelines, procedures Development of Health Emergency Preparedness, Response, Recovery/Reconstruction Plans (HEPRR) Development of organization Physical infrastructure development Systems development Early warning and alert systems Stockpile/Preposition  food, drugs, medical supplies, cadaver bags Training of health staff  Public health information Exercises  Drills (Test/Update plan)

EVENT PHASE: RESPONSE Mass casualty management On-site management  triage y Hospital management  definitive treatment y Public health services Environmental health  water, excreta disposal, vector control y Food and nutrition y Control of communicable diseases  immunizations, treatment y Shelters (evacuation camps) y Mental Health and Psychosocial Support Services y Management of  Dead and Missing y Risk communication The purposeful exchange of information about the existence, nature, form, severity or acceptability of  y health risks between policy makers, health care providers and public media aimed at changing behavior and inducing action to minimize risks

POST-EVENT PHASE: RECOVE RY/RECONST RUCTION Restore to normal basic health services Repair damages to equipment and buildings Psychosocial support

55. Public Health Services B  Response 56. Food/water survey and stockpiling A - Preparedness

57.

Damage

repair of buildings and equipment C  Rehabilitation and Reconstruction

58. Mass Casualty Management B - Response 59. Mental Health and Psychosocial Support now EXC LUDES this activity: A. Critical Incident Stress Debriefing B. Provision of Basic Needs C. Provision of Appropriate Medical Care D. Gender Sensitive Health Care 60. The New Republic Act 10121 changes the names of the Coordinating Councils at different administrative levels to: A. Risk and Disaster Reduction B. Risk Management and Disaster Reduction C. Disaster Risk Reduction and Management D. Disaster Risk Management

For # 61-64: Who among the patient/s would merit/s Palliative Care? A. Yes B. No 61. Carlos, 21 y/o male was brought in for the chief complaint of severe right leg pain and swelling. X-Ray showed fracture of both his tibia and fibula. NO He needs definitive treatment for his fractured tibia and fibula.

62. Carla is a 34 y/o teacher who was diagnosed to suffering from breast CA 1 year ago. She was able to finish six cycles of chemotherapy with very minimal side effects. Last week she complained of severe right upper arm pain. An X-ray of her right arm showed positive for metastasis. She was prescribed pain relievers and was told that she would have to undergo again several cycles of chemotherapy. YES 63. Mario is a 42 y/o male diagnosed to be suffering from pulmonary CA with brain metastasis a month ago. Patient is complaining of severe headache and cough. He was prescribed several oral analgesics which gave temporary relief. He refused to receive any chemotherapy. He is also complaining of dizziness and inability to sleep and on and off difficulty of breathing. YES 64. Marvin, 45 y/o carpenter started to have on and off productive cough and fever 1 year ago associated with anorexia and weight loss. Signs and symptoms persisted until consult. One day prior to consult patient had DOB which prompted consult. YES 65. True of Palliative Care: A. Aims to cure B. Relieves suffering C. Supports the best possible quality of life for patients and their families fa milies D. Specifically at the terminal stage of the disease E. B and C only PALLIATIVE CARE A philosophy of care An organized, highly structured system for delivering care Aims to prevent to prevent and relieve suffering 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

66. True of the medications for palliative care: A. Modify the disease B. Relieve the pain C. Prolong life D. Hasten life

67. The disease where patients reported the highest % of pain: A. COPD B. Lung cancer C. CHF D. Colon cancer 68. The disease where patients reported the lowest % of pain: A. COPD B. Lung cancer C. CHF D. Colon cancer or F or

# 67-68 

Pain Data from SUPPORT COLON CANCE R Liver failure Lung cancer MOSF + Cancer MOSF + Sepsis COPD CHF

60% 60% 57% 53% 52% 44% 43%

69. The most frequent self-reported symptom Experience of Critically I ll Cancer Patients Receiving Intensive C are A. Pain B. Discomfort C. Taste D. Anxiety Self-Reported Symptom Experience of Critically Ill Cancer Patients Receiving Intensive Care F requency requency

of self-reported symptoms, in descending order:

Discomfort

Thirst Sleeping Anxiety Pain Hunger Depression SOB

70. What do family members want 1-2 years after bereavement? A. To be listened to B. Privacy C. To be remembered and contacted after the death D. A and B E. All of the above What Family Members Want 1-2 Years After Bereavement Loved ones wishes honored Inclusion in decision processes Support/assistance at home Practical help (transportation, medicines, equipment) Personal care needs (bathing, feeding, toileting) Honest information 24/7 access To be listened to Privacy To be remembered and contacted after the death

71. Palliative Care will NOT respond to the following imperatives: A. Clinical B. Fiscal C. Demographic D. Physical

IMPERATIVES OF PALLIATIVE CA RE CLINICAL Imperative Numerous studies document patient suffering: pain, nausea, breathlessness, anxiety, depression, fatigue Poor to non-existent communication in the hospital Physicians typically elicit fewer than half of patients concerns and dont discuss values, goals of care, and y treatment decisions FISCAL Imperative Exponentially rising costs with effective new technologies, aging population In the Philippines, limited money and resources Hospital and Health Care Delivery System for the future will have to effectively treat chronically and seriously ill in order to survive DEMOGRAPHIC Imperative The progressive and chronically ill patient, the elderly ill patient, and the patient with a severe illness accounts for much of medical spending The number of sick elderly patients is increasing DEMAND Imperative EDUCATIONAL EDUCATIONAL Imperative

72. Establishing attainable goal/s in palliative care i nclude/s A. Facilitate understanding of scope of illness and likely p rogression of patients and families B. Choose only the acceptable quality of life C. Solely determines what should be done to the patients and their families D. A and B E. All of the above Establishing realistic, attainable goals of care Help patients and families understand the scope of the illness and likely progression Identify relevant values and goals Define acceptable and unacceptable quality of life Define choices to be made and their benefits and burdens Help with decision-making Develop care plans that maximize chances that goals will be achieved.

73. Families provide _____ of long term care A. 40% B. 50% C. 60% D. >70% 74.  ______ of the illness and its care occurs at home A. 65% B. 75% C. 85% D. 95% 75. Palliative care can be applied: A. To any life-threatening diagnosis B. Whenever the patient/family is prepared to accept it C. May be focus of care D. A and B E. All of the above 76. 7-step protocol to negotiate goals of care (in order): 1. Create the right setting; determine what the patient and family know 2. explore what they are expecting or hoping for; suggest realistic goals 3. Respond empathically; make a plan and follow-through 4. Review and revise periodically, as appropriate

A. B. C. D.

1,2,3,4 2,3,4,1 1,3,2,4 2,1,3,4

7 STEP PROTOCOL TO NEGOTIATE GOALS OF LIFE 1. 2. 3. 4. 5. 6. 7.

Create the right setting what the patient and family know Explore what they are expecting or hoping for Suggest realistic goals Respond empathically Make a plan and follow-through Review and revise periodically, as appropriate Determine

77. The following should be considered in planning for palliative care: A. Availability of caregivers at home B. Financial capability of the patient C. Course of the illness D. A and B E. All of the above

For # 78-80: Refer to the case below Maria is a 40y/o female admitted at the DLSUMC with breast CA stage 4 and is undergoing chemotherapy. Presently she is having on and off vomiting secondary to the chemotherapy. Last month, she started to have moderate to severe left upper arm pain which could only be relieved by a very potent injectable pain reliever. Two weeks ago she started to have dyspnea and easy fatigability. She used to be the principal of the government high school in their place. She is being seen by a psychologist for her sleepless nights. Her husband is employed but his income is not enough to cover for the hospitalization of Maria. They have 3 sons who are all in high school. A Sr. of St. Pauls who is also a nurse visits her regularly for her spiritual needs. 78. Palliative care includes the following to A. Giving of the potent oral pain reliever B. Psychological support C. Spiritual support from the Sister of St. Pauls D. A and B E. All of the above 79. Other palliative care service/s which can be provided include/s: A. Modify the chemotherapy to lessen the vomiting B. Radiate the arm to lessen the pain C. Refer the family to a psychiatrist for counseling D. A and B E. All of the above 80. If this patient decides to go home, she can still be given palliative care service/s which include/s: A. Teach the relative on how to give the injectable pain reliever B. Train one of the relatives on how to take care of the patient C. Increase chemotherapeutic drugs to prolong life (A) is not the answer because pain is not her only symptom that needs to be addressed. (C) is not the answer because palliative care does not aim to prolong life.

Hope these help! Thank you Mau for the initiative.  kJana