CFM1 Final Exam

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March 30, 2014

1. A physician maintains professional relationship with other medical and paramedical providers. He refers to them for specific needs of the patient when the need arises. What characteristic of care is given by the physician?

A. Primary

B. Continuing

C. Comprehensive D. Preventive

CHARACTERISTIS OF CARE OF FAMILY MEDICINE

PRIMARY

First contact at the ambulatory, out – patient, emergency & home setting

CONTINUING

Chronologically (from womb to tomb), geographically (from clinic to hospital), interdisciplinary (coordinate with different disciplines in medicine and health and non – health agencies COMPREHENSIVE

Ecological, social, cultural economic, educational, etc PREVENTIVE

All levels of prevention with emphasis on health education CURATIVE

Relieve symptoms, early diagnosis, and treatment REHABILITATE

Assist patient to go back to society

2. Based on systems theory, which among the following defines a family

A. Strong affection

B. Biologically related C. Permanent membership D. Changes through time

SYSTEMS THEORY FRAMEWORK

The family is defined as a system, because its members are interrelated and interdependent. The patterns of interaction among its members affect each person

3. A child of middle – class couple is suffering from malnutrition. Upon examination of family function, the couple admits that they spend very little time with their child who is being cared of by their yaya. What area of family function is affected?

A. Biologic

B. Educational

C. Affection

D. Socio – cultural

BASIC AREAS OF FAMILY FUNCTION

BIOLOGIC

Reproduction, child – rearing , child caring, nutrition, health maintenance, recreation

ECONOMIC

Provision of adequate financial resources, resource allocation, ensure financial security of members EDUCATIONAL

Teach, skills, attitudes, and skills relating to other function PSYCHOLOGIC/ AFFECTION

Promote the natural development of personalities, offer optimum psychological protection, promotes ability to form relationship with people in the family circle

SOCIO – CULTURAL

Socialization of children, promotion of status and legitimacy 4. Ana, a widow lives with her children in a house located in her husband’s family compound. Her in – laws take care of her children while she is at work. They also help provide financial help that her husband fails to do often. What type of family structure? A. Nuclear B. Extended C. Single parent D. Kin network TYPES OF FAMILIES NUCLEAR

Consists of parents and their children occupying a separate dwelling not shared with members of the family of origin NUCLEAR DYAD

Consists of “empty nesters” whose children have grown and left home

EXENDED

Three or more generations living in a household either unilaterally or bilaterally

KIN NETWORK

Nuclear households or unmarried members living in a close geographical proximity, and operating within a reciprocal system of exchange of good and services

SINGLE PARENT

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Remarried men and women living in a common household with children from previous marriages

COMMUNAL / CORPORATE

Grouping of individuals which are formed for specific ideological societal purpose

5. Inah brought her 5-year-old son to the doctor for difficulty of hearing. She cannot answer when asked when she did notice the problem. She was very busy working as mother and father to her children. This situation is one disadvantage of what type of family?

A. Nuclear B. Blended C. Extended

D. Single – parent

Inah was very busy working as a mother and father to her children

6. Which particular function of the family does Inah have difficulty with specifically shown in this particularly case? A. Socialization of children

B. Character education C. Personality development

D. Health promotion

7. TRUE of Filipino child – rearing practices A. Learns to be egalitarian

B. Infant touched by different family member

C. Child learns and values to be alone D. Child consulted on what he or she likes

8. When an elder asks for the opinion of another person during deliberation of community issues is an example of

A. Respect – Paggalang

B. Companionship – Pakikisama C. Cooperation – Bayanihan D. Sympathy – Pakikiramay PAKIKIRAMAY

Going out of one’s way to assist without being asked. PAKIKISAMA

Going along with certain people whom one may like to displease for various reasons

BAYANIHAN

Being a hero by giving assistance without compensation PAGGALANG

Giving respect to the opinions of those are elders, in authority or of peers during deliberations of important matters

9. One unique characteristic of pakikisama – companionship is

A. Respecting the privacy of another person

B. Pleasing another person for a future favor

C. Giving assistance without compensation D. Going out of one’s way without being asked 10. Which of the following is very much related to the Relational Imperative of Filipinos

A. Familism B. Particularism

C. Personalism

D. Popularism

MAIN IMPERATIVES OF FILIPNO VALUE ORIENTATION

RELATIVE

Actual person to person encounters EMOTIONAL

Emotionally laden norms MORAL

Filipinos are more moralistic than ordinarily perceived – utang na loob o debt of gratitude, loyalty, commitment 11. Refers to how time, space, and money are shared and measures the members’ satisfaction with the commitment made by other members

A. Adaptation B. Growth C. Resolve D. Partnership APGAR ADAPATATION

Capability of the family to utilize and share inherent resources, which are either intra or extra familial PARTNERSHIP

Sharing of decision – making; measures the satisfaction attained in solving problems by communicating GROWTH

Refers to both physical and emotional growth; measures the satisfaction of the available freedom to change

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How emotions like love, anger, hatred are shared between members; measures the member’s satisfaction with the intimacy and emotional interaction that exist in the family RESOLVE

Refers to how time, space, money are shared; measures member’s satisfaction with the commitment made by other members of the family

12. Belief in life after death helps terminally ill patients in acceptance of their fate. This is considered a resource in what area? A. Educational resource B. Religious resource C. Medical resource D. Emotional resource SCREEM RESOURCES SOCIAL

Social interaction is evident; family members have well – balanced lines of communication with extra – familial groups CULTURAL

Cultural pride or satisfaction can be identified, especially in distinct ethnic groups

RELIGIOUS

Offers satisfying spiritual experiences as well as contacts with an extra – familial support group

ECONOMIC

Provide both reasonable satisfactions with financial status and an ability to meet economic demands of normative life events

EDUCATIONAL

Allow members to solve and comprehend most of the problems

MEDICAL

Available through channels that are easily established and have previously been experienced in satisfactory manner 13. A patient being seen on home – care setting was noticed to be developing bedsore. To caregiver complained of being tired. What tool can be used to help the caregiver in her responsibility?

A. APGAR B. SCREEM

C. Genogram

D. ECOMAP

Initially, genogram will be used to seek help from other family members. If no one is available to substitute the caregiver, ECOMAP will be used to find institutions within the community to ask for some help.

TOOLS IN FAMILY ASSESSMENT

GENOGRAM

Scheme or graphic chart representation of both the genetic pedigrees of the family and key psychosocial and interaction data using standardized symbols

APGAR

Assesses the family function or dysfunction

8-10 highly functional

4-7 moderately dysfunctional 0-3 severely dysfunctional

FAMILY CIRCLE

Includes the family, the patient, and the all the people important to the patient

SCREEM

Capable to participate in provision of health care or to cope with crisis

ECOMAP

Depicts family’s connection with other families, organizations, and institutions

Part of the strategy of network designed to bring as many people together as possible for therapeutic support and to foster change

14. Which of the following statements are TRUE of assessing areas of family function?

A. Tools for assessment should be routinely used in every clinic consult

B. Tools should be used when there is an indication

C. All the tools should be used when indicated D. B& C

ASSESSMENT OF THE FAMILY

Allows the identification of actual or potential health problems

Development of a pan to improve the level of wellness in the family

Help practitioner elicit data about certain aspects of family structure, function, and process

Aid the health professional in determining major family concerns, needs and strengths

Must be easily utilized by the practitioner, which takes minimal amount of time to complete

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15. TRUE of Filipino Normative environment

A. Values have reference to standards people use for evaluating what is right or wrong, good or evil

B. The Filipino has several paradoxical traits and pattern of relationship that are imbued by his culture

C. Since the family is of utmost importance to the Filipino, each member is consulted with equal bearing important family member

D. In the communitarian practice called Bayanihan, people with strong leadership skills play center – stage in motivating other members to participate

The Filipino cultural orientation is supported by shared values which function as the basis of shared behavior common to most Filipinos. Values have reference to standards people use

for evaluating what is right or wrong, good or evil. Values are

related to norms which are rules of conduct specific to given social situations.

The Filipinos have two sets of paradoxical traits and patterns of relationship that are imbued by his culture. The first set is

the highly structured and authoritarian familial set-up where roles are prescribed especially for younger members of the family. This is characterized by autocratic leadership of the

elder-members, submitting one’s self to the decision of the family elders, and almost one-way communication in the pecking order. The second set of social relationship that the

Filipino has, which ironically exists side by side with the highly structured set-up, is the strong communitarian practice called

"Bayanihan" which literally means "being a hero." This practice ignores social ranking, structures, leadership roles and authority relationships. The roles in the structured set-up

mentioned earlier cease to exist. Surprisingly, the Filipino is at home with both cultural practices in his social life. He shifts from one setting to another with unbelievable ease and grace. In the first set up, there is no way that a child can lead the elders in any form of decision-making. In the Bayanihan set-up, however, if a child proves that he has the right qualification needed for the task, he may lead the elders, not excluding his father and elder brother

.

16. Mr. and Mrs. Roxas celebrated their golden wedding anniversary. Both are retired and living by themselves. They maintain a healthy relationship with their children. What can be the most pressing concern of the couple that you can anticipate considering their present status?

A. Coping with physical and mental decline

B. Dealing with loss of spouse

C. Managing stress in dealing with children in-laws D. Maintaining couple functioning

Please refer to Table 1. The Stages of the Family Life Cycle and Related Health Concerns

17. What can the activities that can be done during the visit to their attending physician?

A. Ask how they are preparing for future deaths

B. Perform periodic health examination

C. Counsel them on how to improve the relationship D. Maintain couple functioning

18. Whenever there’s an issue in the family, two groups usually emerge with conflicting opinions and interests. This family organization reflects

A. Alliance B. Coalition C. Hierarchy D. Subsystem STRUCTURAL PARAMETERS HIERARCHY

Power or authority distributed in the family SUBSYSTEM

Family differentiates and carries out its function BOUNDARIES

Limits of the family and its members; rules defining who and how to participate

ROLES

Position in the family within a series of reciprocal expectations

(*) SCAPEGOAT / NOBLE SYMPTOM BEARER

Identified by the family as the source of its problems, accepts the family’s blame, and reflects the dysfunction of the family as a whole

(*) PARENTIFIED CHILD

Often the oldest; performs the parenteral functions, when one or both have abdicated the role

VALUES

Mental and emotional sets which aid persons in judging the relative worth or importance of things, ideas, or events ALLIANCE

Positive relationship between any two members of a system COALITION

Relationship between two persons in which 2 collide against a third

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19. The social service of a hospital was asked to get with the family of Lolo Jose who has not visited him since he was confined. Relationship in Lolo Jose’s family may be described as

A. Enmeshed

B. Disengaged

C. Functional D. Dysfunctional

20. APGAR was administered to a couple which revealed a score of 8. Which of the following figures represents their family map? A. Husband --- Wife B. Husband __/__ Wife C. Husband _____ Wife D. Husband ===== Wife --- Distant relationship __/__ Separated _____ Normal relationship ===== Close relationship

21. It is the body’s instinct to protect itself from emotional or physical pressure or in extreme situations, from danger A. Pressure

B. Catastrophe

C. Stress

D. Life event

Stress theory provides the foundation for identifying signs and symptoms of distress and for recognizing potential stressors

22. The stress of exhilarating, creative successful work is beneficial A. Eustress B. Distress C. Situational stress D. Maturational stress TYPES OF STRESS EUSTRESS

Good, pleasant, or curative stress DISTRESS

Unpleasant or disease – producing stress

TYPES OF CRISIS

MATURATIONAL

Normative; occur across the life spectrum; related to critical transition points in the course of normal human

development, which involve may physical, psychological, and social changes

SITUATIONAL

Non normative; occur across the life span, but usually not anticipated, and do not relate to normal maturational process; divorce, illness, relocation

23. A mother whose daughter has cerebral palsy deals with parents whose children calls her child abnormal. This is an example of ______ stressor. A. Intrafamilial B. Interfamilial C. Extrafamilial D. External TYPES OF STRESSORS INTERNAL (*) INTRAFAMILIAL

Within the unit itself; include allocation of roles and conflict among family members

EXTERNAL

(*) INTERFAMILIAL

Develop as the familial interacts with other systems in the environment that directly influence the family, such as schools, health care agencies, or work place

(*) EXTRAFAMILIAL

Occur as the family is influenced directly by the political, social, and cultural issues; limited – housing resources, depressed economy, cultural stigma

24. A graduating medical student with asthma had exacerbation during the final exam week. He crammed for make – up exams and for the submission of requirements for graduation. What type of crisis did he experience?

A. Maturational B. Situational

C. Both

D. None

25. A patient feels mixed emotions after a tragedy that struck her family. Which one of the following is correct in helping the patient initially?

A. A concerned woman telling the patient to stop crying and that everything would be all right with God’s help

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B. A doctor teaching the patient what to do so she can deal with the situation

C. A friend who patiently listened while patient was crying. talking, and at times shouting

D. A health volunteer who allowed the patient to be alone 26. Time phase of illness where the family proceed with a life of normalcy despite the presence of ta chronically ill family member

A. Crisis

B. Chronic

C. Terminal D. All of the above

27. Maria, 30 year-old, single, suffers from abnormal bleeding due to myoma. Hysterectomy was recommended. Implication was discussed by the attending physician. She sought second and third opinion regarding treatment. She cannot decide on what to do. In what stage in the illness trajectory did Maria got stuck?

A. Stage 2 – reaction to diagnosis

B. Stage 3 – major therapeutic efforts

C. Stage 4 – early adjustment to outcome D. Stage 5 – permanency of outcome

STAGES OF ILLNESS TRAJECTORY

STAGE 1 – ONSET OF ILLNESS Warning sign of malaise

Prior to contact with medical care providers

Medical beliefs and previous experiences provide influence to meaning of illness

Can be acute or chronic

STAGE 2 – REACTION TO DIAGNOSIS

Physician presents the diagnosis; disease and appropriate treatment can be described in terms the patient can understand

STAGE 3 – MAJOR THERAPEUTIC EFFORTS

Physician works in harmony with wishes of the patient and the family, and coordinates all aspects of therapy

STAGE 4 – EARLY ADJUSTMENT TO OUTCOME

Return from the hospital or major therapy initiates a period of gradual movement form the role of being sick to some form of recovery, or adaptation, with corresponding adjustments of relationship within the family STAGE 5 – PERMANENCY OF OUTCOME

family realizes that they must accept and adjust to a permanent disability and death

28. How would you characterize the patient’s myoma (a non – cancerous tumor in the uterus) as to onset, source, incapacitation, and outcome)

A. Acute, progressive, incapacitating, potentially fatal B. Acute, constant, not debilitating, non – fatal

C. Gradual, progressive, incapacitating, potentially fatal

D. Gradual, constant, not debilitating, non – fatal 29. Which of the following is TRUE of crisis points? A. Stage 2: patient cannot accept the prognosis B. Stage 3: family cannot buy the medicine

C. Stage 5: patient foresees permanent disability

D. All of the above

30. What makes stage 3 of illness trajectory particularly challenging?

A. Health beliefs and practices affects adherence of patient B. Financial constraint affects health prioritization

C. Family members have different opinion

D. A & B

31. A father needed a hearing aid however his children opted not to provide him with it so that he will not hear them when they talk about selling his properties. What type of violence? A. Material

B. Medical

C. Physical D. A & B

TYPES OF FAMILY VIOLENCE

PHYSICAL

Malnutrition and injuries such as bruises, welts, sprains, dislocation of extremities, and lacerations

PSYCHOLOGICAL

Verbal assault, threat, fear, or isolation MEDICAL

Withholding of medications or aids MATERIAL

Theft or misuse of money or property SEXUAL

Any sexual activity between a child and an adult or any significantly older that the child, whether by force or what may appear to be consent

INCEST

Sexual relations between blood relatives or members of the same socialization unit other than husband and wife

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32. A 3-year-old was brought to a doctor by a neighbor because of fever without the parents’ knowledge. The child’s weight was that of a 1-year-old. How would you assess the neighbor’s action?

A. Action is acceptable in the context possible of possible child neglect

B. Action is acceptable in the context of being a surrogate parent

C. Not acceptable, intrusion on family privacy D. Not acceptable, no consent from parents

33. A wife sought consult for difficulty of sleep. Upon probing, the patient admits of being beaten by her husband. How can a doctor do initially?

A. Report the case to women’s desk B. Refer to social worker

C. Individual counseling for the patient

D. Individual counseling for the husband

34. Aling Rosa shouted bad words and hit her daughter Rosal with a broomstick because she accidentally broke her precious vase. It was a form of discipline Which of the following is TRUE?

A. Norm among Filipino families

B. Form of child abuse

C. Both D. Neither

35. What factors bring about violence in the family? A. Dysfunctional family relationship

B. Substance abuse C. Mental health problem

D. All of the above

36. Which of the following best describes ayurvedic medicine?

A. The traditional practice originated from the Indians of West Coast, USA

B. The practice utilizes the concept of contrast and maintaining balance

C. As part of personalistic medicine, Ayurveda deals with the human senses and appeals to it

D. Contemporary jazz music may relax the mood of some but not others

TRADITIONAL MODEL

NATURALISTIC

Vitalistic – balance and harmony Humoral – body fluid changes Ayurvedic – appeals to sense Animistic – Spirits

Mystical – fate, dreams, omens PERSONALISTIC or MAGICAL

Causes result from the actions of people who have specific intent to harm the victim

Witchcraft, sorcery, usog, bati, kulam

37. Which of the following example/s can be traced to personalistic medicine?

A. After a heart break, Nelson consoles himself with wines and spirits

B. Christine delights herself by routinely looking at her boyfriend’s picture

C. Both is correct

D. Neither is correct

38. What is the importance of discovering the health illness belief system of a family?

A. It enables the physician to diagnose illnesses based on patient’s accounts

B. Health beliefs are part of the family practices and tradition C. The family poses a threat to medical management

especially in rural communities

D. The doctor is not always present and households act as support

39. While Chinese traditional medicine adapts harmony, the following may NOT TO BE TRUE with yin yang

A. The use of herbs like ginger is a sure way to cure sore throat

B. Getting caught in the rain is factor in developing rhinitis

C. Tinea pedis (athletes foot) is caused by waddling in flood waters

D. A glass of hot milk gives a goodnight’s rest

BIOMEDICAL MODEL

The mind and body dualism – everything is controlled by the mind, and the body just feels

Mechanical metaphor – human beings are the machine, doctors cure them

Specific etiology – bacterial, fungal, parasitic, & viral causes of diseases

40. The development of keloids from a BCG injection site is an evolution from

A. Humoral medicine

B. Traditional medicine C. Ayurvedic medicine D. Chinese medicine

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41. The state of well-being physically, emotionally, and socially, and NOT merely the absence of disease A. Wellness

B. Health education

C. Health

D. Biopsychosocial approach HEALTH

A state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity WELLNESS

An integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable of

Requires that the individual maintains a continuum of balance and purposeful direction within the environment where he is functioning

HEALTH EDUCATION

Involves communicating information, imparting, and interpreting technical knowledge, reinforcing positive lifestyles, and exploding myths

Essential first step to health promotion HEALTH PROMOTION

Combines the objective of disease prevention with techniques of health education

Combination of simple and complex strategies that encourage physical, mental, social, economic, or general wellness

42. Level of prevention where there are no symptoms but there is presence of risk factors

A. Primary prevention

B. Secondary prevention

C. Tertiary prevention D. All of the above

43. Health education includes the following except: A. Imparting knowledge

B. Interpreting technical data C. Reinforcing lifestyle

D. Encouraging myths

44. As wellness advocates, physicians must do any of the following:

A. Apply principles of preventive medicine B. Delay initiation of disease progression C. Provide appropriate advice on lifestyle change

D. All of the above

45. Example of aerobic exercise A. Weight lifting

B. Brisk walking

C. Dumbells D. Stretching

RECOMMENDED AEROBIC EXERCISES

Brisk walking Ballroom dancing Biking

Swimming

46. Practical way of determining if patient is ready for prescribed physical activity

A. Ask the patient directly if she is ready B. Stress test prior to exercise regimen

C. Talk test

D. Warm up and cooling down exercises cannot be tolerated 47. One basis for the recommendation for moderate alcohol intake

A. French paradox

B. European connection C. Medical Treaty of Geneva D. World Health Organization 48. Body mass index is measured by A. mL/L

B. kg/m2

C. mmHg D. mmol/L

BMI= weight in kg / height in m2

49. Rubella vaccination is given to prevent

A. Congenital cataract

B. Fungal infection of newborn C. Tetanus neonatorum D. Infant diabetes

50. Screening for cervical cancer A. Direct rectal examination B. Self - breast examination

C. Pap Smear

D. Ultrasound of the uterus

51. The Filipino pyramid food guide is different from all other food pyramids in that

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A. It has increased recommendation for carbohydrates B. It divides the protein group to two

C. It includes increased fluid intake

D. It emphasizes on low fat content of foods

Philippines is a humid country. Increased fluid intake prevents us from dehydration. In extra hot day, fluid intake must be 1.5 to 2 L

52. Increased risk of osteoporosis

A. Increased caffeine intake

B. Increased calcium and vitamin D intake C. Adequate physical activity

D. Smoking cessation

53. Stress awareness is important because of its effect on A. Bone metabolism

B. Immune system

C. Intelligence D. Vision acuity

54. Environmental sensitivity is an integral dimension of wellness and includes

A. Chemical contamination

B. Advocacy for environmental consciousness C. Improvement of living conditions

D. A & C

E. B & C

ENVIRONMENTAL SENSITIVITY

Integral dimension of wellness

Advocate environmental consciousness and improvement of living condition:

Chemical contamination Air pollution

Noise pollution

Waste clumps to include toxic wastes

55. To prevent neural tube defects, folic acid must be taken A. At every pregnancy

B. Before pregnancy

C. Not critical to development of the neural tube D. Must be started at birth till adolescence

Spina bifida may occur 25 to 29 days after a woman gets pregnant; therefore, supplementation should begin before conception and continue for at least 10 to 12 weeks of pregnancy.

A 22-year-old first year medical student was seen for periodic health exam. He does not complain of any symptom. He smokes around 3 sticks per day usually after meals and drinks alcohol on weekends. He sleeps 6 hours on most days of the week. Physical activity is limited to playing basketball twice per week. Family history for diabetes and hypertension. Physical examination revealed:

Height = 5’10 Weight = 185 lbs

56. What is the ideal body weight? A. 155-165 lbs

B. 156-166 lbs

C. Both A & B

Neither A nor B

IBW – MALE

105 – 106 lbs for first 5 feet plus 5 – 6 lbs per inch thereafter

IBW – FEMALE

100 lbs for first 5 feet plus 5 lbs per inch thereafter Patient - MALE Lower limit 5 feet, 10 inches 5 feet = 105 lbs 10 inches x 5 lbs = 50 lbs Total: 155lbs Upper limit 5feet, 10 inches 5 feet = 106 lbs 10 inches x 6 lbs = 60 lbs Total: 166 lbs Answer: 155 lbs to 166 lbs

57. What is the BMI? A. 25

B. 26 C. 27

D. 28

BMI= weight in kg/ height in m2

58. What is the classification of BMI according to WHO? A. Normal

B. Overweight

C. Obese I

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CLASSIFICATION OF BMI (kg/m2)

UNDERWEIGHT <18.5 Low Average

NORMAL >18.5 – 22.9 Average Increased

OVERWEIGHT >23 Increased Moderate

AT RISK 23 – 24.9

OBESE I 25 – 29.9 Moderate Severe

OBESE II >30 Severe Very severe

59. If you give an exercise prescription, what would be the target heart rate?

A. 135-145 B. 136-146 C. 137-147 D .138-148 THR = (220 - age) x (% activity) % ACTIVITY NO PREVIOUS EXERCISE 60 – 65 %

MINIMAL TO SOME PREVIOUS EXERCISE 70 – 75 %

PREVIOUS REGULAR EXERCISE 80 %

60. if you will recommend aerobic exercise that the student can easily integrate in his daily activities, which one would you recommend?

A. Biking

B. Ballroom dancing C. Swimming

D. A & C

61. As far as proper diet is concerned, what would you recommend?

A. Increase fluid intake (water, milk, soda) B. Low fat dairy (low content of unsaturated fats) C. Low sodium (5grams sodium)

D. Increase fiber intake (fruits and vegetables)

62. Aside from diet and exercise, what other intervention would you recommend that can prevent diabetes and hypertension?

A. Stress management

B. Sleep minimum of 8 hours a day

C. Social networking most days of the week

D. All of the above

63. What procedures would you recommend to screen for heredo-familial diseases?

A. Blood pressure monitoring B. Blood sugar determination C. Chest x-ray

D. A & B

64. Primary level of intervention in this case would generally consist of

A. Immunization B. Low fat, low salt diet C. Smoking cessation

D. All of the above

65. Health promotion activities that the student can engage in are the following

A. Membership in fitness center B. Joining a travel club

C. Consulting a dietician

D. A & C

66. Patient seek complementary and alternative therapies for the following reason/s

A. Self-empowerment

B. Dissatisfaction with conventional

C. Both

D. Neither

67. The following are criticism of Oncologists on CAM, EXCEPT A. Medical Oncologists spend many years training in a scientific approach to cancer

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 CRITICISM OF ALTERNATIVE CANCER TREATMENTS

An Oncological Perspective

Medical oncologists spend many years training in a scientific approach to cancer treatment.

They strive for the best possible outcome for their patients. It is therefore not surprising that they may be particularly critical of what they regard as ineffective therapy

administered by practitioners with minimal training. 68. 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

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CHARACTERISTICS OF UNSOUND METHODS OF CANCER TREATMENT

Promotion without sufficient preclinical data to justify use in patient

Unmethodological treatment of patients that cannot detect either meaningful responses or therapy-related side effect 69. 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

THE SCIENTIFIC METHOD A Pillar of Modern Medicine

Modern medical practice is founded on scientific inquiry. Because of this, there are no final answers. Old treatments are discarded if they are proved less safe or effective than a newer method.

Testing the effectiveness of treatments relies heavily on epidemiology and statistical analysis.

70. 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

ROLE OF HEALTH CARE PROFESSIONALS

In helping patients to make decisions as health professionals our roles are to help them to make their own decisions. This involves listening to the patient, finding information and asking questions.

We may often be called upon to help navigate the “information overload” of very variable quality that is out there on the internet.

71. A transfer of responsibility to another physician for the care of a specific problem

A. Referral B. Consultation

C. Transfer of service

D. Discharge

72. This involves one physician requesting the services of another for a particular purpose and for a limited time A. Transfer of service

B. Parallel consultation

C. Referral

D. Substitution

73. Virtues upon which referrals are based

A. Courage and humility

B. Patience and loyalty C. Vigilance and trust D. Honesty and love

74. When is a referral considered?

A. When a patient is dissatisfied with his progress B. When diagnosis is uncertain

C. When patient or his family show s lack of confidence

D. All of the above

75. Concerns on referrals affecting the physician EXCEPT

A. Anxiety on the part of the patient

B. Referring physician risks losing a patient C. Embarrassment if a mistake is discovered in the management

D. Power struggle

76. The following is/are observed in making a successful referral

A. Educate the patient on reason for referral

B. Recommend a subspecialist or treatment center best suited to the patient’s medical and personal needs the patient for what lies ahead

C. Provide subspecialist with data relevant to patient’s illness

D. All of the above

77. Responsibilities of the consultant to whom the patient is referred to

A. Give the referring physician prompt feedback

B. Referrals to other consultants he deems necessary should be done only with the referring physician’s permission C. Recommends (not carry out) therapeutic suggestions unless pre-arranged with referring physician

D. All of the above

78. Responsibilities of the referring physician

A. Do not provide complete assessment to avoid bias in the completion of the referral

B. Preparation and compliance of patient C. Selection of consultant

D. A & C

E. B & C

79. Interdisciplinary approach is synonymous to A. Individualized approach

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Teamwork is essential if the family physician to provide comprehensive medical car to his patients. Such teamwork would consist of interdisciplinary approach to health care. 80. Organized around health care aimed more at life improving than life –saving

A. Service oriented team B. Intervention oriented team

C. Client oriented team

D. Crisis oriented team Matching Type A. Crisis oriented B. Client oriented C. Intervention oriented D. Service oriented

81. Dialysis center – INTERVENTION ORIENTED

82. Private ambulatory care facilities – CLIENT ORIENTED 83. The likes of 9 11 – CRISIS ORIENTED

84. Disaster teams during calamities – CRISIS ORIENTED 85. Medical technologist to extract blood in patient’s home (home service) – SERVICE ORIENTED

KINDS OF TEAM

CRISIS ORIENTED

Organized around saving or prolonging lives

Highly sophisticated, technologically equipped, roles are clear Ex cardiac arrest team

CLIENT ORIENTED

Organized around individual health care

Problem solving, more life improving than life saving Ex comprehensive health care, family health care INTERVENTION ORIENTED

Organized around the effort to reach certain population at risk

Ex health team for the aged, alcoholics, STD SERVICE ORIENTED

Organized around the delivery of a group of health care services

Ex maternal or child care, family planning

A. Interval referral B. Collateral referral C. Cross referral D. Split referral

86. A family medicine specialist consults a cardiologist for opinion on a case of increased blood pressure not responding to present anti-hypertensive drugs – COLLATERAL REFERRAL 87. A family medicine specialist refers to a dermatologist regarding itchy vesicles on the skin. While examining the patient, the dermatologist finds that the patient is also suffering from diabetes and refers the patient to an endocrinologist – CROSS REFERRAL

88. A family medicine specialist manages the bronchial asthma while the surgeon operates on a patient’s appendix –

INTERVAL REFERRAL

89. A patient with multiplicity of medical conditions is seen by a team of doctors; however, the family physician to whom the patient initially consulted remains the team leader of the medical team – COLLATERAL REFERRAL

90. The family medicine specialist transfers service to a patient to a transplant surgeon for kidney transplant in patient with renal failure – INTERVAL REFERRAL

A. Biologically based approach B. Manipulative therapies C. Mind and body interventions D. Alternative medical systems E. Energy therapies

91. Massage – MANIPULATIVE THERAPIES 92. Herbs – BIOLOGICALLY BASED APPROACH 93. Homeopathy – ALTERNATIVE MEDICAL SYSTEMS 94. Magnets – ENERGY THERAPIES

95. Meditation – MIND AND BODY INTERVENTIONS 96. Chiropractic – MANIPULATIVE THERAPIES 97. Spirituality – MIND AND BODY INTERVENTIONS 98. Qigong – ENERGY THERAPIES

99. Neuropathy – ALTERNATIVE MEDICAL SYTEMS 100. Vitamins – BIOLOGICALLY BASED APPROACH

COMPLEMENTARY AND ALTERNATIVE MEDICINE

BIOLOGICALLY BASED APPROACH Diets, herbs, vitamins

MANIPULATIVE THERAPIES Massage, chiropractic, osteopathy MIND AND BODY INTERVENTIONS Yoga, spirituality, relaxation ALTERNATIVE MEDICAL SYSTEMS Homeopathy, neuropathy, Ayurveda ENERGY THERAPIES

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101. Provides relief of physical and psychosocial pain

102. It is only for patients who have no hope

103. Includes investigations needed to better understand and manage distressing clinical complications

104. Provides support for the patient and his family all throughout the sickness and support for the family after the patient has passed away

105. Offers a support system to help patients live as actively as possible until death

106. Provides only pain and symptom control for patients with life threatening illnesses

107. Affirms life and death as a normal process

108. Intends to hasten death or postpone death 109. Does not involve a team approach to care

110. Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy

PRINCIPLES OF PALLATIVE CARE

Provides RELIEF FROM PAIN and other distressing symptoms Affirms LIFE and regards DYING as NORMAL PROCESS Intends NEITHER HASTEN nor POSTPONE DEATH

Integrates psychological and spiritual aspects of patient care Offers a support system to help patients LIVE AS ACTIVELY AS POSSIBLE UNTIL DEATH

Offers a support system to help the family COPE DURING PATIENT’S ILLNESS and in their own bereavement

Uses a team approach to address the needs of the patients and their families, including bereavement counseling, if indicated

Will ENHANCE QUALITY OF LIFE, and may also positively INFLUENCE the course of illness

Applicable EARLY in the course of life, IN CONJUCTION with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy

Includes investigations needed to better understand and manage distressing clinical symptoms

A – True

B – False

111. Palliative care is appropriate for any patient and his or her family living with or at risk of developing a

life-threatening illness due to any diagnosis or any prognosis

112. Palliative care is only for patients with cancer

113. Palliative care is offered only to patients who have no hope and are no longer seeking cure

114. Palliative care is only useful when the family of a patient with a life threatening disorder is faced with a medical crisis

115. Palliative care can be provided in the setting of choice of the patient or the family be it at home, in the hospital, or in a health care facility

PALLIATIVE CARE

Approach that improves the quality of life of patients and their families facing problems associated with life – threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual

Both a philosophy of care and an organized highly structured system for delivering care to persons with life – threatening or debilitating illness

Patient and family centered that focuses upon effective management of pain and other distressing symptoms, while incorporating psychosocial and spiritual care according to patient or family needs, values, beliefs, and cultures GOAL OF PALLATIVE CARE

Prevent and relieve suffering

Support the possible quality life for patients and their families regardless of the stage of the disease of the need for other therapies

Can be delivered concurrently with LIFE – PROLONGING CARE as the main focus of care

Active, total care of the patient whose disease is not responsive to curative treatment

Control of pain, other symptoms, social, psychological, and spiritual problems is paramount

Interdisciplinary in its approach and encompasses the patient, the family, and the community in its scope

Offer the most basic concept of care

Providing for the needs of the patient whenever he or she is care for, either at home or in the hospital

Affirms life and regards dying as normal process Neither hastens nor postpones death

Sets out to preserve the best possible quality of life until death

CASE

Maria is married, 32 year-old mother of three. She has been discharged from the hospital against medical advice after a 3-day stay with a medical diagnosis of diabetes mellitus 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

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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 family health care team, 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-year-old daughter who is her biggest help. Her other children are a 6-year-old son and a 5-year-old 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.”

116. 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. All of the above

117. Which one of the following medical problems and objectives is/are correct?

A. Depression – to improve mood and well-being

B. Fracture – to improve motor function of the injured arm

C. Diabetes – to maintain blood sugar to normal level of <100mg/dl

D. B & C

118. Which one of the following is the appropriate secondary level of intervention for the identified medical problems? A. Fracture – x – ray of the injured arm and physical therapy B. Depression – antidepressant and counselling

C. Diabetes – diabetic diet and anti- diabetic counseling

D. All of the above

119. In the evaluation of the chosen treatment plan for the medical problem, what are you going to look for?

A. Diabetes – blood sugar level of <100mg/dl B. Fracture – improved motor function

C. Depression – improved mood and well-being

D. A & B

120. What is the psychosocial problem that led to the patient’s hospitalization?

A. Dysfunctional marital relationship

B. Family violence

C. Substance abuse D. Mental health problem

121. Which among the following level of intervention for the psychosocial problem is correct?

A. Secondary: mental health assessment of family members B. Secondary: family and individual counseling

C. Tertiary: rehabilitation of husband D. A & B

E. A, B, & C

LEVELS OF PREVENTION

PRIMARY

Prevention of occurrence of any clinical manifestation Personal health services: Immunization, Lifestyle change, Counseling, Genetic counseling, Public health services SECONDARY

Early intervention to detect and treat asymptomatic disease Colorectal screening, Cervical cytological testing, Blood pressure screening, Self – breast examination, Medical and surgical therapy

TERTIARY

Settles established disease to avoid complications and disability

Assist in rehabilitation

122. 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

SYSTEMATIC APPROACH TO ACTION

Demonstrate awareness of proper timing when carrying out intervention activities

Adapt or modify of intervention strategies when client situation changes

Recognize social, cultural, economic, and environmental barriers, and wok, within these limitations

Carry through with planned intervention

Base intervention activities on scientific principles and knowledge

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123. In evaluating your casework within 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

METHODS IN EVALUATING PHASE

Feedback from the patient and family

Consult with peers, supervisors, and other health care professionals

Summarize records Conduct case audit

124. 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