PREV MED 3: SAMPLEX BASED RATIO

FAMILY HEALTH
Geriatric Care, Care of the Dying, Home Health Care Essentials, Family Meeting and Counseling, Motivational Counseling,
PREV MED 3

SHIFTING EXAM
Optimal Primary Care for LGBTQ+ Patients 01 DEC 2021

SHIFTING EXAMINATION 2021

QUESTION ANSWER RATIONALE
1. Mr. Sanchez, a 68 year-old with COPD, comes to the clinic Providing ongoing medical information and advice (Level 2)
due to progressive cough and occasional dyspnea. You • When we start asking a family member to give more information so
then ask his wife additional information about his we can better understand the bigger picture.
symptoms and how it is affecting his sleep. This is an • Respectful listening is the key skill needed yet no intervention is involved
example of what level of physician involvement with
• Skills in identifying gross family dysfunction that interferes with medical
families?
treatment.
A. Level 1 ® When there is an obvious detachment or overattachment of the
B accompanying family member to the patient
B. Level 2
C. Level 3 ® It is up to us to capitalize on these observations as we escalate
D. Level 4 to level 3 – physician involvement.

“…increase awareness, influence nutrition practice, modify behaviors and thereafter

improve the health conditions of Filipinos.”

Batch 2023 Family Meeting and Counseling 1.04

2. Advance Care Planning is about? ADVANCE CARE PLANNING
• Chance to make decisions about the care you want to receive at a
A. Getting your will and estate in order time when you might be unable to speak for yourself
B. Pre-planning your funeral • Process that involves you, your family, loved ones, and health care
C. Deciding who will make financial decisions for you providers
if you are unable to • Goal: maintain and maximize your health and independence as you face
D. Deciding who will make health care decisions for the end of your life
you if you are unable to D • Should be a compassionate process and with support and education as
your health changes
• Encourage patients to choose a surrogate decision-maker
® Important component of advance care planning
® Discuss values and preferences Immunization and Education

Batch 2023 Trans Care of the Dying 1.02

A-TG4 | Balilo | Alvarez, Amorsolo, Andaya, Ang E., Ang H.

3. It is defined as the cornerstone of health and wellness, a SELF-REGULATION
conscious willful, internally directed behavior that • Cornerstone of health and wellness
promotes health and homeostasis • Taking control of one’s lifestyle and health behaviors so that lifestyle is
the result of choice and not the result of chance and ignorance
A. Self regulation • Conscious, willful, internally directed behavior that promotes health and
B. Self Enhancement A homeostasis “…increase awareness, influence nutrition practice, modify
C. Self Awareness
D. Self Motivation behaviors and thereafter improve the health conditions of Filipinos.”

Batch 2023 Trans Motivational Counseling 1.05

4. The following describes the scope of hospice care HOSPICE CARE

• Consists of palliative and supportive services for dying persons and their
A. Care and services provided does not end with the families
death of the patient ® Usually those who have less than 6 months to live.
B. Benefits patients who are elderly and with chronic
• It highlights quality rather than length of life
illness
• Make the patient as comfortable as possible
C. Prolongs the dying process by any artificial
means of support • Provided by interdisciplinary team of professionals and volunteers (care
D. Offers comfort and focuses on helping the patient coordinator, nurse, physician, counselor, volunteer coordinator, and
become independent at home spiritual support)
A
• Provides continuity of care
• It provides family-centered care involving the patient and family in making
decisions
• Available 24/7
• Palliative care is also provided in hospice care
• Provides follow-up bereavement care for up to 1 year after the
patient’s death

Batch 2023 Trans Care of the Dying 1.02

5. Which of the following is an abnormal finding in older
persons?

A. Waist circumference of 42 inches in a 70 year old

male Answer 2
B. Mid arm circumference of 25 cm in a 60 year old
female
C. Calf circumference of 28 cm in a 65 year old
female
D. Muscle mass of 4.88 kg/m2 in a 68 year old D
female

Batch 2023 Trans Geriatric Care 1.01

A-TG4 | Balilo | Alvarez, Amorsolo, Andaya, Ang E., Ang H.

6. True about the Edmonton Symptom Assessment Scale ESAS
(ESAS):
A questionnaire used to rate the intensity of nine common symptoms experienced by
A. ESAS is routinely done to all patients on a daily cancer patients, including pain, tiredness, nausea, depression, anxiety,
basis drowsiness, appetite, well-being and shortness of breath. “wear masks or any
B. It is a ten-item patient-rated symptom visual D protective equipment…”
analogue scale
C. ESAS looks into well-being, depression, anxiety Source:
and spiritual distress http://cancercaresoutheast.ca/edmonton-symptom-assessment-system-esas
D. It evaluates tiredness, nausea, anxiety,
drowsiness, insomnia and appetite
7. Contemplative Stage Contemplation

A. Patient is ready but not prepared • “getting ready”

B. Patient is not ready • Has the intention to engage in the healthy behavior within the next few
C. Patient is defensive, doesn't like months but could remain in this stage for up to 2 years.
D. Patient has the thought but unlikely to act
• People in this stage appreciate the positives of change in their behavior
• However, they may still try to avoid action and continue to put the behavior
D off.
• Has the thought but is unlikely to act
• Person is beginning to think about changing theirbehavior
• Old trans:
® Aware of problem exists, no commitment to action
® Encourage and strengthen the motivation

Batch 2023 Motivational Counseling 1.05

8. If the physician has some compelling reason to think that PRINCIPLE OF INFORMED CONSENT AND PATIENT AUTONOMY
disclosure would create a predictable harmful effect on a
suicidal patient, it may be justified to withhold truthful • Clear ethical and legal obligations to provide patients with as much
information. information as they desire about their illness and its treatment.
• Physicians may not withhold medical information even if they
suspect it will have a negative effect on the patient. Yet a mandate to:
A. True
® Disclose the truth, with regard or concern for the sensitivity with
B. False
B which it is done
® Obligation to support the patients and assist them in decision-
making

Disclaimer: Trans did not specifically state that this applies even in patients with
suicidal tendencies but this is the closest lecture-based rationale we could find.

Batch 2023 Trans Health Promotion in Public Health: Triad and Interventions 1.03
9. Most patients who were aware of the diagnosis felt more BENEFITS OF DISCLOSURE (NTK) **Note: Labeled as NTK in trans but was asked
depressed and anxious than those who were kept in the in the Exam**
dark about their terminal illness. • For patients whose diagnoses were disclosed
• In a study by Centeno-Cortes et al., there was no increase in perceived
A. True B
symptoms of anxiety, despair, sadness, depression insomnia or fear in
B. False the group of informed patients compared to the uninformed patients
• 75% of informed patients were able to share their concerns about the
illness and its consequences with their relatives.
A-TG4 | Balilo | Alvarez, Amorsolo, Andaya, Ang E., Ang H.
 • Families of informed patients felt that they were in a better position to
care for the patient.
• Allows the patient to make practical (e.g. making a will, settling bank
accounts and mortgages) and emotional adjustments to the illness;
thereby providing closure to his or her life.
• Diagnosis disclosure in cancer is also correlated with improved symptom
control and patient satisfaction with care.
® Disadvantage: Gerle et al., found that patients who were
not informed of the diagnosis tended to be more anxious
and at times, felt desperate.

Batch 2023 Trans Health Care of the Dying 1.02

10. It is a patient centered framework designed to enhance Motivational Interviewing (MI)
intrinsic motivation, conduct consultation in manner that • Patient centered
the patient feels responsible ® Explore the patient’s reasons for and against change
® Technique to raise change issues without patient resistance
A. Health Belief Model ® Collaborative, not prescriptive
B. Motivational Interviewing B
• Designed to enhance intrinsic motivation
C. Trans Theoretical Model ® Conduct consultation in manner that patient feels responsible for
D. PFC Model the decision to change (enhances susceptibility of change)

Batch 2023 Trans Motivational Counseling 1.05

11. Trans Theoretical Stage Model defines behavior change as A. True
the ff. except B. “The stages of behavior change are unlikely to be linear and are more likely
to be cyclical” – True
A. Behavior Change is not always linear C. True
B. Cyclical, people move between stages D D. False – Next would be Preparation then Action then Maintenance
C. Just like a journey
D. Once contemplative stage is reached the end
goal stops Batch 2023 Trans Motivational Counseling 1.05

12. Acceptance, which refers to the intention to understand, Motivational Interviewing (MI)
includes these components except • Acceptance
• Respect for and approval of patient
A. Absolute Worth • Does not mean agreeing with patient every time
B. Accurate Sympathy • Demonstration of the intention to understand patient’s
C. Autonomic Support • POV and concerns is important
D. Affirmation B • 4 components of acceptance in motivational counseling
® Absolute worth
® Accurate empathy
® Autonomic support
® Affirmation

Batch 2023 Trans Motivational Counseling 1.05

13. Rejection Insensitivity is a psychological condition that
causes a person to feel oversensitive to rejection or
perceived rejection in relationship and social interaction
*should be Rejection Sensitivity instead of Insensitivity
Rejection Sensitivity
B
• A psychological condition that causes a person to feel oversensitive to rejection
or perceived rejection in relationships and social interactions.

A-TG4 | Balilo | Alvarez, Amorsolo, Andaya, Ang E., Ang H.

 A. True • Can result to chronic anxiety from expectations of rejection based on their
B. False sexuality
• Minor stress and rejection sensitivity are associated with higher rates of:
® Depression
® Anxiety
® Substance abuse
® Suicide
® Cardiovascular outcomes

Batch 2023 Trans Optimal Primary Care for LGBTQ+ Patients. 1.06

14. Genderqueer a term used by persons who may not entirely Gender Identity
identify as either male or female The person’s internal sense of their own gender

A. True • Cisgender: natal sex concordant with internal sense of gender

B. False • Transgender: natal sex discordant with internal sense of gender
• Genderqueer: a term used by persons who may not entirely identify as either
A
male or female
• Bigender: a person whose gender identity encompasses both male and female
genders.
• Some may feel that one identity is stronger, but both are present

Batch 2023 Trans Optimal Primary Care for LGBTQ+ Patients. 1.06
15. Terminal breathlessness can be best managed with Morphine
• 2-10mg sublingual or 2-4mg SQ q 2-4H
A. Intubation • Reduces tachypnea and breathlessness decreased anxiety
B. Oxygen at all times • Low dose morphine; blunts medullary response to CO2 retention or oxygen
C. Bi-level positive airway pressure (BiPAP) D decline
D. Low-dose morphine with or without Midazolam
Benzodiazepines (Midazolam)
• For anxiety associated with dyspnea

Batch 2023 Trans Care of the Dying. 1.02

16. A patient admitted in the wards was referred for a family Who should attend (a family meeting)?
meeting due to unresponsiveness to the current treatment • The patient (if able to participate)
regimen. Under optimal situations, who among the • The patient's primary health care proxy/surrogate decision maker
following is not obligated to attend?
• The patient's primary caregiver
A. Hired caregiver • Any other family or friends to the patient wants present
B. Patient’s primary caregiver • Representatives from the primary medical team
C. Patient’s surrogate decision maker → Does not mean that the entire team need to be there per se, but if at all
D. Social worker possible, the patient’s intern should be
A
Highly relevant consultants
• If the situation is that a patient is terminally ill from a particular disease and
some end-of-life decisions to be made (example, turning off an ICD in a
patient with advanced heart failure or stopping chemotherapy)
Patient’s primary care physician
• This is usually not logistically possible but great if can attend, particularly for
end-of-life discussions
Non-physician members of the medical team

A-TG4 | Balilo | Alvarez, Amorsolo, Andaya, Ang E., Ang H.


17. Mrs. Calma, a 46-year-old woman presented to you with a
cervical biopsy result showing cervical cancer. Select the
correct SPIKES model component when you ask "How
would you like me to give the information about the test
result?'"
A. Setting up the interview
B. Assessing the patient’s perception
C. Getting the patient’s invitation
D. Strategy and summary
18. Which of the following does not apply to terminally-ill
patients who are taking opioids
A. Drug tolerance later results in drug addiction
B. Opioids are dangerous especially to patients at
the end-of-life
C. Opioids keep them comfortable but may require
increased doses
D. Increased doses leads to drug tolerance as the
body adjusts to the medication
A-TG4 | Balilo | Alvarez, Amorsolo, Andaya, Ang E., Ang H.
• If relevant to the discussion
• Include social workers or case managers if it’s a situation involving a
complicated discharge plan but may also include: Nurses, PTs, and even
speech pathologists
Batch 2023 Trans Family Meeting and Counseling. 1.04
Obtaining the Patient’s INVITATION
• Some patients desire full information about their condition, but some do not
• Some want to be straightforward to the diagnosis and move on to the plan of
treatment.
Discussing information at a time of ordering tests can cue the physician to
plan the next discussion with the patient.
C • “How would you like me to give the information about the test results? Would
you like me to give you all the information or sketch out the results and
spend more time discussing the treatment plan?”
Batch 2023 Trans Care of the Dying. 1.02
“Will I become addicted if I’m prescribed strong opioids like morphine?”
• Pain specialists view addiction as a series of specific behaviors involving:
→ Compulsive use of medication
→ Loss of control over medications
→ Insistence on taking meds despite deterioration in the quality of life (QOL)
• Physical dependence on opioids occurs when they are taken for more than
A twenty-four hours.
→ But physical dependence is a normal, expected part of proper pain
treatment
→ Meds are slowly tapered over time to ensure that patients do not
experience severe withdrawal symptoms due to physical dependence
Batch 2023 Trans Care of the Dying. 1.02
19. A 75 year old female, finished Grade 5 has a Montreal
Cognitive Assessment score of 23. Interpret the score

A. Normal cognitive status

B. Mild cognitive impairment
C. Mild dementia
D. Moderate dementia

*A score of 23 is pathological already (since less than or equal to 23)

MMSE Interpretation via SEVERITY:

*Normal (24-30)
*Mild cognitive impairment (18-23)
*Severe cognitive impairment (0-17)

Batch 2023 Trans Geriatric Care. 1.01

A-TG4 | Balilo | Alvarez, Amorsolo, Andaya, Ang E., Ang H.

20. Based on the International Prostate Symptom Score (IPSS)
of an elderly patient, what is the severity of his symptoms?

Incomplete emptying-1
Frequency - 2
Intermittency-1
Urgency- 1
Weak stream - 0
Straining-0
Nocturia- 1
Quality of life-2

A. Mild
B. Moderate
C. Severe
D. Bothersome

International Prostate Symptom Score (I-PSS)

*Mild (1-7)
*Moderate (8-19)
*Severe (20-35)

*Patient’s total is 8, therefore his symptoms classifies as moderate

Batch 2023 Trans Geriatric Care. 1.01

A-TG4 | Balilo | Alvarez, Amorsolo, Andaya, Ang E., Ang H.

21. The following can be done during catharsis, EXCEPT: Catharsis
• This phase seeks to define the clinical problem from the family’s point of view
by:
A. Explore the patient's understanding of his illness ® Exploring the patient and family’s understanding of health
B. Recognize the family's understanding of the patient's ® We allow the patient to open up and ventilate, and we explore
illness the patient’s and their family’s understanding of health, the
C. Reflect on or probe the feeling illness, and the circumstances surrounding this medical
D. Correct the emotionally critical misperception D condition
® Identify the emotionally critical misperceptions that influence
the behavior of both patient and family members
® Reflect on/probe their feelings

*We identify the emotionally critical misperceptions, we do not correct them

Batch 2023 Trans Family Meeting and Counseling. 1.04

22. A 68 year old female consulted after sustaining a fall. She Clinical Syndrome (of Frailty) includes 3 or more of the following:
has had three falls this year. She also complains of • Unintentional weight loss of >10lbs in the previous year
increased lethargy over the last six months with difficulty • Self-reported exhaustion
going out of her house to even do grocery shopping. She • Weakness (as measured by grip strength in the lowest 20% by gender and
lives on the second floor and used to be able to go up the BMI)
stairs to reach her room. However, in the last six months,
• Slow walking speed (lowest 20% by gender & height)
she has been unable to climb up and has to take the lift
daily. She has also lost 6 kg over the last year from her • Low physical activity (as measured by kcal; lowest 20%
usual weight of 46kg to 40kg now. What is the possible B
Warning Signs (for frailty):
reason why this patient is falling?
• Low level of activity
A. Depression • Exhaustion
B. Frailty • Unintentional weight loss
C. Hypothyroidism • Atypical mood swings
D. Malignancy
Batch 2023 Trans Geriatric Care. 1.01

23. The following makes documentation in Home Care Documentation in Home Care is essential in order to ensure that treatment decisions
essential EXCEPT: are correct and effective, and that only necessary diagnostic tests are done.
Documentation is basically monitoring the progress and response of the patient in his
treatment regimen while at home.
A. It is used to communicate the patients' progress
with other members of the home health care team D
B. It is essential to ensure reimbursement from payer
sources
C. It provides evidence of your patient outcomes along
with the quality of care and improvement
D. It leads to incorrect treatment decisions and
expensive and unnecessary diagnostic studies *Not in Trans or previous SBRs
24. The top three (3) wishes of dying patients To be conscious and able to communicate, to be surrounded by the people he/she
loves and to be free from pain are the top 3 wishes of dying patients since they are
i. To be conscious and able to communicate more focused on being at ease or comfort in their last moments and that they are able
ii. To be surrounded by the people he/she loves C to direct their final wishes or messages to their loved ones.
iii. To be able to eat and drink
iv. To be free from pain
v. To be kept clean and well kempt

A-TG4 | Balilo | Alvarez, Amorsolo, Andaya, Ang E., Ang H.

 A. i, ii, iii
B. ii, iii, iv
C. i, ii, iv
D. i, ii, v *Not in Trans or previous SBRs
25. Mrs. Calma, a 46-year-old woman presented to you with a Assessing the patient’s perception
cervical biopsy result showing cervical cancer. Select the • The dictum here is: “before you tell, ask.”
correct SPIKES model component when you ask / say "What is ® Before discussing medical information, the clinician uses open-
your understanding of the biopsy result?" ended questions to create a reasonably accurate picture of how
the patient perceives the medical situation.
A. Setting up the interview • First, find out how much the patient actually knows.
B. Assessing the patient's perception ® In particular, how serious does he/she think the
C. Giving knowledge and information to patient ® illness is? How much will this affect his/her future?
D. Strategy and Summary • e.g. “What have you been told about your medical situation so far?” or
“What is your understanding of the reasons we did the MRI?”
B ® Based on this, you can gauge how close to reality is the patient’s
understanding
• Guide you on the pacing of the disclosure
• Correct any misinformation and tailor the bad news to what the patient
understands
• It can also accomplish the important task in determining if the patient
is engaged in any variation of illness denial like:
® Wishful thinking → Omission of the essential but
unfavorable medical details of the illness → Unrealistic
expectations of treatment

Care of the Dying 2023 Trans 1.02 p (Reference)

26. Minority Stress Model is a theory that can be applied to Minority Stress Model
various types of stigmatized population. Characterized by the
experience of violence, harassment and discrimination. It is social research and a public health model that is designed in understanding the
lived experiences of oppressed communities
A
A. True
B. False It is a theory that can be applied to various types of stigmatized population.

Optimal Primary Care for LGBT+Q Patients 2023 Trans 1.06 p 1

A-TG4 | Balilo | Alvarez, Amorsolo, Andaya, Ang E., Ang H.

27. Based on the fall risk assessment tool, the score of the
patient is as follows: Recent fall-4, Medications- 2 Psychological-
3 cognitive status - 2. What is the degree of the risk for fall?

A. Low
B. Medium
C. High
D. Very high

Fall Risk Assessment Tool

5-11: Low Risk

12-15: Medium Risk
16-20: High Risk

Geriatric Care 2023 Trans 1.01 p. 5

28. Who among the following patients is at risk for fall? Functional Reach Test
(70-87 years old)
A. 75 year old male with functional reach test score Male 13.6
of 12 inches Female 10.47
B. 65 year old female with Timed up and go test Timed up and Go test Score should be less than 12 sec
score of 10 seconds
C. 60 year old who stagger for more than 3 steps in
Frailty
180 degrees turn
D. 80 years old taking Losartan Atorvastatin and
• Including 3 or more of the following:
Vitamin D
• Unintentional weight loss of >10lbs in the previous year
• Self-reported exhaustion
• Weakness (as measured by grip strength in the lowest 20%
C • by gender and BMI)
• Slow walking speed (lowest 20% by gender & height)
• Low physical activity (as measured by kcal; lowest 20%)

D - Polypharmacy

• 4 or more prescription medications or 3 or more newprescription medications

in 24 hours
• 4 meds increase the risk of fall
• 5 meds increase the risk of adverse events

Geriatric Care 2023 Trans 1.01 p. 8-9

A-TG4 | Balilo | Alvarez, Amorsolo, Andaya, Ang E., Ang H.

29. Which of the following is true of the recommended protocol CHOICE A – false because measure gait speed is the initial parameter to be measured,
for sarcopenia? not handgrip strength. Handgrip strength would be measured after gait speed was
assessed to be > 0.8 m/s
A. Test handgrip strength or usual gait speed before
CHOICE B – false because low grip strength for women is less than 20 kg
assessing muscle mass
B. Low handgrip strength is less than 26 kg for CHOICE C – false because a low gait speed is less than 0.8 m/s
female CHOICE D – best answer. The cut-off for appendicular skeletal mass is 7.23 kg/m2 in
D
C. Low gait speed is less than 1m/sec men, lower than that would be considered low appendicular skeletal mass. The value in
D. Low appendicular skeletal mass is less than 5.4 the question 5.4 kg/m2 is still within the actual range that would be assessed to be low
Kg/m2 in men appendicular skeletal mass, thus, all elderly patients that would have appendicular
skeletal mass less than 5.4 kg/m2 would still accurately be assessed to have low
appendicular skeletal mass as the cut-off is actually 7.23 kg/m2 and lower.

2023 Trans PREV MED 1.01 - GERIATRIC CARE p8

30. True regarding Tramadol in pain management: According to severity of pain from mild, moderate then moderate to severe:
Step 1: Mild Pain
A. It is strong opioid. • Non-opioid +/- adjuvant therapy
B. A common side effect of constipation Step 2: Moderate Pain
C. It is a medication used for WHO STEP 2 pain C • ‘Weak’ opioid or fixed dose opioids +/- non-opioid +/- adjuvant therapy
management • Example of fixed-dose opioid: acetaminophen with tramadol
D. The IV route is the preferred route of Step 3: Severe Pain
administration • Strong opioids

Care of the Dying 2023 Trans 1.02p. 6

31. The Modified Caregiver Strain Index of a family member is Ask the caregiver all the questions listed in the index and categorize whether s/he
22. This is considered as: experiences it whether madalas, paminsan-minsan or halos hindi. Total the score.

A. Normal MCSI scoring

B. Predisposition to strain ≤ 23 – normal
A
C. Mild strain 24-28 – predisposition to strain
D. Severe strain ≥ 29 – severe caregiver strain

Geriatric Care 2023 Trans 1.02 p. 9

32. A 75 year old has difficulty initiating and maintaining sleep For people with primary insomnia (not related to other conditions), can sleep restriction
accompanied by daytime sleepiness. Which of the following is a therapy (SRT) improve outcomes?
correct recommendation? • SRT improves time to fall asleep by 12 mins and time asleep while in bed by
C 5-10%
A. May give a glass of wine before sleeping • SRT improves sleep for 1 in 2-6 patients compared to sleep hygiene alone
B. Give benzodiazepines
C. Do sleep restriction therapy Geriatric Care 2023 Trans 1.01 p. 7
D. Give melatonin for 1 month
33. Improvement of quality of life among patients with life- Quality-of-life assessment can be a helpful tool in ensuring optimal palliative care.
limiting illness
To adequately assess quality of life, it must be first defined and subsequently measured.
A. Can be mostly achieved by engaging a C This article outlines several of the instruments available to measure quality of life,
multidisciplinary team including the Karnofsky Score, Edmonton Symptom Assessment, Memorial
B. Is dependent on the premorbid state and Symptoms Assessment Scale, European Organization for Research and
social determinants of health Treatment of Cancer Questionnaire, Quality and Quantity of Life Short
Questionnaire, and Cambridge Palliative Assessment Schedule. Use of these

A-TG4 | Balilo | Alvarez, Amorsolo, Andaya, Ang E., Ang H.

 C. Starts with routine symptom assessment as
the cornerstone of symptom management
D. Can be achieved in the presence of family
members who are proactive in the care of the
patient
instruments in the context of goal-setting and family meetings as well as common pitfalls
in quality-of-life assessment are outlined.
Not in trans or SBRs of higher batches
https://doi.org/10.1177/1049909107301778

34. Physicians are guided by this principle when prescribing On Addiction: Will I become addicted if I’m prescribed strong opioids like morphine?
opioids for palliative care patients:
Pain specialists view addiction as a series of specific behaviors involving:
A. IV route is the preferred route for all cancer • Compulsive use of medication
patients • Loss of control over medications
B. Using long-acting opioids are best for • Insistence on taking meds despite deterioration in the quality of life (QOL)
breakthrough pain C
C. Withdraw drug slowly to minimize effects of Physical dependence on opioids occurs when they are taken for more than twenty-four
physical dependence hours.
D. Addiction is a valid excuse to withhold • But physical dependence is a normal, expected part of proper pain treatment
prescribing morphine • Meds are slowly tapered over time to ensure that patients do not experience
severe withdrawal symptoms due to physical dependence

Care of the Dying 2023 Trans 1.02 p. 6

35 Which among the following is LEAST likely to be an objective Objectives of counseling
of family counseling? • Symptom relief
• Leads to insight
A. Symptom relief C • Behavioral change
B. Behavioral change
C. Solve family conflicts Trans 2023 Family Counselling p. 3
D. Leads to insight

36. Family counseling in caring for an elderly presents an Initial patient encounter, hospitalization/confinement, caring for an elderly, pregnancy
opportunity for physicians to engage that patient's family more and well-child visits
proactively.
A
• Present an opportunity for physicians to engage the patient’s family more
A. True proactively
B. False
Trans 2023 Family Counselling p.2
37. Palliative care and hospice care are similar in these aspects Hospice Care
• In Family Medicine, Hospice and Palliative Medicine is one of the
A. Both attends to patients and families subspecialties
B. Care is dependent on the nature of prognosis • Consists of palliative and supportive service for dying persons and their
C. The two are aimed at best possible treatment families
D. Both can be provided at any point in the
illness trajectory A Palliative 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 the patient’s illness
and in the bereavement

Care of the Dying 2023 Trans 1.02 (page 9)

A-TG4 | Balilo | Alvarez, Amorsolo, Andaya, Ang E., Ang H.

38. Studies show that the early integration of palliative care in “The 3 highlighted studies demonstrate early integration of PC improves QOL,
the course of illness results to: depression, prognostic understanding, and health service use in patients... These
remarkable outcomes provide a critical foundation for continued early integration of PC
A. Better quality of relationships, improved pain into oncology care…”
control
B. Improved treatment outcomes, better quality of
D
relationships
C. Longer survival, better quality of relationships, Bauman, J. R., & Temel, J. S. (2014). The integration of early palliative care with
better quality of life oncology care: the time has come for a new tradition. Journal of the National
D. Improved quality of life, improved survival, better Comprehensive Cancer Network : JNCCN, 12(12), 1763–1771.
treatment outcomes https://doi.org/10.6004/jnccn.2014.0177

39. In choosing an activity for a person in later stages of Fundamental Practice to Change Outcomes
dementia, family or professional carers should consider: • Focused on guidelines, feedback and role changes can improve processes
• Address more than one area have more impact
A. The strengths and preferences of the person • Focus on patient-centered change outcomes
involved
B. Maximizing opportunities for using short-term A
memory
C. Recreating activities the person enjoyed in the
past
D. Stretching the body and having fun
Geriatrics 2023 Trans 1.01 (page 1)
40. Checking if the patient is in denial is a part of in conduction Assessing the Patient’s Perception
the SPIKES protocol. • It can also accomplish the important task in determining if the patient is
engaged in any variation of illness denial
A. Setting up the interview and getting the physical
context right
B
B. Assessing the patient’s perception
C. Obtaining the patient’s invitation
D. Exploring the patient’s emotions and giving
empathy
Care of the Dying 2023 Trans 1.02 (page 3)
41. The timing for Hospice care is best provided when: Giving Knowledge and Information to the Patient
• Even if curative care is no longer an option, there are still things we can do
A. The patient requests for it for the patient like providing hospice and palliative care
B. The curative treatment is no longer an option • Hospice Care
C. The family is ready to discuss death and dying • Consists of palliative and supportive services for dying persons and their
D. The patient has accepted the forthcoming of families
death ® Usually those who have less than 6 months to live
® Goal: not to unnecessary prolong the life of the patient but more of
B improve the quality of life or to allow the patient have dignity even if
they are dying
• It highlights quality rather than length of life

Care of the Dying 2023 Trans 1.02 (page 3 and 9)

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42. Pain is always a part of dying. Pain Control - central component for the care of most patients in palliative care and
the assessment is the critical part of this management.
A. TRUE B
B. FALSE
Care of the dying 2023 Trans 1.02 (page 5)
43. In which of the following scenarios would family meeting be When is the Family Meeting Potentially Indicated?
absolutely necessary?
• A serious diagnosis will be disclosed (Rationale for the question: COVID-19
A. An adolescent with chronic sinusitis
is an infectious and communicable disease with interventions still bordering on
B. A teacher seeking pre-employment medical
experimental today, thus, because of all these risks and possible lapses in
clearance
treatment, a family meeting is necessary to ensure that isolation would be
C. A multipara who delivered a healthy baby boy
done and to educate them on the signs that would warrant medical attention)
D. A newly-diagnosed nurse with mild COVID-19 D
• Current treatment plan not working
• A decision needs to be made regarding the patient’s discharge
• There is discordance between either the patient’s goals, current treatment,
prognosis, or code status
• There is interpersonal conflict between the patient, family, and medical team

Family Meeting and Counseling 2023 Trans 1.04 (page 1)

44. Mr. A, was recently diagnosed with Lung Cancer and is Action
referred for counselling. Using CEA method, what question will • Action is the way forward. The “what now” after this.
be asked during action? • In action phase: we
® Share the findings with the patient and the family
A. How do you feel about your family’s reaction? ® Involve the patient and the family in the management plan up to the
B. What consequences of your illness makes you appropriate extent (goal-setting)
feel this way most? C ® Further discuss the treatment to correcting remaining misperception
C. What might make healing difficult for you? • Sample Questions to Elucidate this Step:
D. What do you want to know about your illness
® What type of treatment do you think would be most helpful?
right now?
® What important results do you expect from this treatment?
® What might make healing difficult for you?

Family Meeting and Counseling 2023 Trans 1.04 (page 3)

45. Mrs. Calma, a 46-year-old woman presented to you with a Setting Up the interview
cervical biopsy result showing cervical cancer. Select the • Arrange for some privacy
correct SPIKES model component when you ask/say “I noticed • Involve significant others
you have your husband with you. Would you like him to join us • Sit down
or would you rather have this discussion with you alone?” • Make a connection with the patient
A • Maintain eye contact
A. Setting up the interview • Touching the patient on the arm or hold a hand are other way to accomplish
B. Assessing the patient’s perception this
C. Giving knowledge and information to patient • Manage time constraints and interruptions
D. Strategy and Summary
Care of the Dying 2023 Trans 1.02 (Page 2)
46. A 70 year old patient has an MMSE score of 16. He has MMSE Interpretation via Severity
agitations at night. Which of the following is recommended • Severe Cognitive Impairment (0-17)
management?
B
Interventions: Pharmacologic
A. Donepezil + Memantine • Cholinesterase Inhibitors (Donepezil, Rivastigmine, and Galantamine)
B. Donepezil + Memantine + Quetiapine ® Can be used for all the stages of Dementia d/t Alzheimer’s Disease
A-TG4 | Balilo | Alvarez, Amorsolo, Andaya, Ang E., Ang H.
 C. Carbamazepine and Rivastigmine • Memantine
D. Memantine + Aripiprazole + Carbamazepine ® Used in moderate to severe Dementia d/t AD
• Low dose Atypical Antipsychotics (Risperidone, Aripiprazole, Quetiapine)
® Used for severe agitation, aggression, and psychotic symptoms

Geriatrics 2023 Trans 1.01 (page 3)

47. The goal of this statement is to encourage the patient to talk Open-ended questions
more • Goal: encourage the patient to talk more
A. Open Ended Question • Ex. “How do you feel you are doing in managing diabetes?”
A
B. Affirmative Statement
C. Reflective Statement
D. Summary Statement Motivational Counseling 2023 Trans (page 2)
48. Almer was diagnosed with lung cancer. He has been Dyspnea
experiencing difficulty of breathing due to pleural effusion. The • Pharmacologic Treatment
most appropriate management is: ® Antibiotics: Pneumonia
® Thoracentesis: Pleural Effusion
A. Low dose morphine ® Oxygen: hypoxemia
B. IV antibiotic regimen C
® Morphine: decrease anxiety; reduce tachypnea and breathlessness
C. Thoracentesis if effusion is significant ® Diuretics: treat congestion
D. O2 inhalataion by nasal cannula
® Benzodiazepines: anxiety

Care of the Dying 2023 Trans 1.02 (page 8)

49. Communities with higher levels of approval for same sex In communities with higher levels of approval for same sex relationships, there was a
relationships has higher prevalence of smoking. lower prevalence of smoking among LGBTQ individuals.
• Supportive of the hypothesis that structural stigma contributes to smoking
B
A. True and alcohol use
B. False
Optical Primary Care for LGBTQ+ Patients 2023 Trans 1.06 (page 1)
50. Which of the following is a correct provision of RA 9994? RA 9994 Expanded Senior Citizen Act of 2010
20% discount and VAT exemption for:
A. 20% discount on funeral services • Purchase of medicine including the flu and pneumococcal vaccines and
B. 5% discount on milk formula other essential medical supplies (ex. Pulse oximeter), accessories and
C. 10% discount on flu vaccine equipment
D. 15% discount on electricity • Professional fees of MD in all private hospitals, medical facilities, OPD and
home health care
A
• Medical and dental services, diagnostic and laboratory fees
• Actual transportation fare for land travel and domestic air transport and sea
shipping levels
• Funeral and burial services
• Admissions to cinema

Geriatric Care 2023 Trans 1.01 (page 9)

51. What is the limit for water consumption in order to get a RA 9994 Expanded Senior Citizen Act of 2010
discount?
A. 20 cumm • 5% on water and electricity registered on their name not exceeding 100kwh
B. 30 cumm B and 30 mm3
C. 40 cumm
D. 50 cumm
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52. Which of the following is not a basic principle in pain control In patients with ongoing pain, analgesics should be administered on a regular
for cancer patients? basis (around the clock) at intervals adjusted to the pharmacokinetics of a specific
agent. Regular dosing provides more consistent pain control than intermittent (as-
A. Establish diagnosis by history and PE needed) dosing.
B. Treat pain according to etiology C
C. Prescribe pain relief on as needed basis
D. Not all pain is due to cancer itself Legassie J, Marshall D. Pain Management: Basic Principles. McMaster Textbook of
Internal Medicine. Kraków: Medycyna Praktyczna.
https://empendium.com/mcmtextbook/chapter/B31.II.22.1.
53. Which of the following is NOT a correct recommendation for Interventions in elderly with Sarcopenia
prevention of sarcopenia in an older person?
• Diet, exercise
A. Protein 0.8 g/kg/day • Protein Requirement: 1 g/kg/day
B. Testosterone combined with diet and exercise • Ingested amino acids stimulate muscle protein synthesis and maintain
C. Amino acids muscle mass in elderly
D. Resistance exercises B • Testosterone supplementation:
® In older men, testosterone increases some muscle strength by 7%
® Moderate improvements in erectile function and libido
® Adverse events: cardiovascular in those with higher risk
® Many results are inconsistent, at high risk of bias, and difficult to
quantify in real world application
Geriatric Care 2023 Trans 1.01 (page 8)
54. Most patients prefer that physicians do not involve their The presence of family constitutes an important source of psychological stability
families in medical care for the patient, as well as a source of support for better recovery, since it helps him to
maintain a contact with his house and his friends. Moreover, the role of family, friends,
A. True and relatives is of vital importance for the maintenance of quality of life in hospitalized
B. False patients with chronic problems. Family can satisfy basic needs of the patient in the
hospital to a large extent.

The role of family, relatives and friends is vital to maintaining the quality of life of
B
hospitalized patients. During hospitalization, constant interaction between family and
nurses is necessary to achieve comprehensive care. The family greatly helps to reduce
the stress caused by disease and hospitalization

Radan, A., & Ivelić, R. (2021). The impact and contribution of family in the care of
patient in the hospital. Cardiologia Croatica, 16(11–12), 330.
https://doi.org/10.15836/ccar2021.330
55. The best drug that can address both pain and shortness of Commonly Used Analgesics
breath in dying patients is
• Morphine
A. Celecoxib ® Most commonly used opioid
B. Fentanyl ® If respiratory depression develops = 2x stable dose
C. Morphine C ® Reestablishing pain control requires not less than 1.5x previous
D. Oxycodone dose

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56. Rizza, a 17-year-old student came to you for counseling. She OARS
claims that she is so tired and can’t sleep anymore because of
the upcoming exams. She repeatedly tells you that she doesn’t O: Open-ended Questions
want to fail in the exams. How will you process reflection of A: Affirmative Statements
meaning in this student? R: Reflective Statements
• Goal: “Mini-summaries” – let the patient know you are listening
A. Use the patient’s own words that describe the most A • TIP: Helpful to repeat using the patient’s own words
important aspect of meaning • You can also use different types of advanced reflective listening: Shifting
B. Demand a transparency focus, Reframing
C. Let the patient choose what is important to her S: Summary Statements
D. Begin questions with “what, how, or why?”

Motivational Counseling 2023 Trans 1.05 (page 2)

57. Facing prejudice/judgement is common within the LGBT Minority Stress
population and can be characterized by the concept of Majority • It is a social research and a public health model that is designed in
Stress understanding the lived experiences of oppressed communities
B • It is a theory that can be applied to various types of stigmatized population
A. True
B. False
Optical Primary Care for LGBTQ+ Patients 2023 Trans 1.06 (page 1)
58. Advance Directive is legally binding while the Advance Care Advance Directive
Planning (ACP) is not • Written statement on what type of medical treatment you want at the end of
life
A. True • Confirms that your wishes are carried out if you are not able to communicate
B. False them to a healthcare professional
• Ongoing process that can change over time
• E.g. “The Living Will”

Care of the Drying 2023 Trans 1.02 (page 9)

A
-----------------------

Health care advance directives are legal documents that communicate a person's
wishes about health care decisions in the event the person becomes incapable of
making health care decisions.

An Advance Care Plan isn't legally binding. However, if you're near the end of life it's a
good idea to make one so that people involved in your care know what's important to
you.
59. Which among the following pertains to level 5 family Level 5: Family Therapy
involvement? • Entails extensive training and supervision
• Entails planning an organized therapeutic approach to bring about major
A. Providing ongoing medical information and advice changes in the family system
B. Eliciting feelings and providing emotional support
D
C. Systematic family assessment and planned
intervention
D. Therapeutic approach to being about major
changes in the family system

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 Family Meeting and Counseling 2023 Trans 1.04 (page 2-3)
60. A 74-year-old male consults because of his constipation. He Senna is given at 15-30 mg/day
explains that it “comes and goes” but he was hoping to “speed
it along this time”. Which of the following is NOT a correct
recommendation?

A. Eat fewer processed food, dairy products and meat

B. Water supplementation of 2 liters per day
C. Senna 45mg/day at bedtime
D. Consume whole grains 35g/day
C

Geriatric Care 2023 Trans 1.01 (page 7)

˙

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