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CFM Final Exam

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?

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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 husbands 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
Consists of one parent with one or more children

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

Giving respect to the opinions of those are elders, in


authority or of peers during deliberations of important
matters

COMMUNAL / CORPORATE
Grouping of individuals which are formed for specific
ideological societal purpose

9. One unique characteristic of pakikisama companionship


is

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

A. Respecting the privacy of another person


B. Pleasing another person for a future favor
C. Giving assistance without compensation
D. Going out of ones 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

6. Which particular function of the family does Inah have


difficulty with specifically shown in this particularly case?

RELATIVE
Actual person to person encounters

A. Socialization of children
B. Character education
C. Personality development
D. Health promotion

EMOTIONAL
Emotionally laden norms

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 ones 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

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
AFFECTION

PAGGALANG

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How emotions like love, anger, hatred are shared between


members; measures the members satisfaction with the
intimacy and emotional interaction that exist in the family
RESOLVE
Refers to how time, space, money are shared; measures
members 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

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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
4-7
0-3

highly functional
moderately dysfunctional
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 familys 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
Provides a composite picture of family strength and need

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 ones 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

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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 theres 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 familys 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

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 Joses 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 bodys 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

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

22. The stress of exhilarating, creative successful work is


beneficial

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

A. Eustress
B. Distress
C. Situational stress
D. Maturational stress

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?

TYPES OF STRESS
EUSTRESS
Good, pleasant, or curative stress

A. Maturational
B. Situational
C. Both
D. None

DISTRESS
Unpleasant or disease producing stress

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 Gods 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

28. How would you characterize the patients 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. 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

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?

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

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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

32. A 3-year-old was brought to a doctor by a neighbor


because of fever without the parents knowledge. The childs
weight was that of a 1-year-old. How would you assess the
neighbors 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 womens desk
B. Refer to social worker
C. Individual counseling for the patient
D. Individual counseling for the husband

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
boyfriends picture
C. Both is correct
D. Neither is correct
38. What is the importance of discovering the health illness
belief system of a family?

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. It enables the physician to diagnose illnesses based on


patients 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

A. Norm among Filipino families


B. Form of child abuse
C. Both
D. Neither

39. While Chinese traditional medicine adapts harmony, the


following may NOT TO BE TRUE with yin yang

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

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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 goodnights 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

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

45. Example of aerobic exercise


A. Weight lifting
B. Brisk walking
C. Dumbells
D. Stretching

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

RECOMMENDED AEROBIC EXERCISES


Brisk walking
Ballroom dancing
Biking
Swimming

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

46. Practical way of determining if patient is ready for


prescribed physical activity

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

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

42. Level of prevention where there are no symptoms but


there is presence of risk factors

A. mL/L
B. kg/m2
C. mmHg
D. mmol/L

A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. All of the above

BMI= weight in kg / height in m2

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

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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

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

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 = 510
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

53. Stress awareness is important because of its effect on


A. Bone metabolism
B. Immune system
C. Intelligence
D. Vision acuity

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

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

Patient - MALE
Lower limit
5 feet, 10 inches
5 feet = 105 lbs
10 inches x 5 lbs = 50 lbs
Total: 155lbs

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

Upper limit
5feet, 10 inches
5 feet = 106 lbs
10 inches x 6 lbs = 60 lbs
Total: 166 lbs

55. To prevent neural tube defects, folic acid must be taken

57. What is the BMI?

A. At every pregnancy
B. Before pregnancy
C. Not critical to development of the neural tube
D. Must be started at birth till adolescence

A. 25
B. 26
C. 27
D. 28

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.

BMI= weight in kg/ height in m2

Answer: 155 lbs to 166 lbs

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


A. Normal
B. Overweight
C. Obese I
D. Obese II

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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

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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
D. Neither

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

11 | P a g e J L U 2 0 1 4 - 1 C

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 patients medical and personal needs the
patient for what lies ahead
C. Provide subspecialist with data relevant to patients 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 physicians 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
B. Teamwork

C. Hierarchy of management roles


D. A & C
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 patients 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

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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 patients 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
Reiki, magnets, qigong

A Principle of Palliative Care


B Not a principle of Palliative Care
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
PATIENTS 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 lifethreatening 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

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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 3day 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

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, Lets 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 hell 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

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

119. In the evaluation of the chosen treatment plan for the


medical problem, what are you going to look for?

Recognize social, cultural, economic, and environmental


barriers, and wok, within these limitations

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
patients hospitalization?

Carry through with planned intervention

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Base intervention activities on scientific principles and


knowledge

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
D. A & B

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