Part I.
Public Health, Preventive and Family Medicine Principles & Concepts
Family and Community Medicine
For Items 1 – 3: You will be reading excepts of doctor-patient conversations that portray skills
within the ACTIVE LISTENING SKILLS
Patient Irma: “I cannot understand why I am having this chest pains for 3 weeks now. My
grandmother also had the same thing last year and she died of it”
Physician: “So you are afraid that the same thing might happen to you”
1. From the above conversation, the active listening skill used by the physician is __
A. Probing
B. Bracketing
C. Reflecting thought
D. Reflecting feelings
Patient Froilan: “I have had this headache for 4 days now. It has become intolerable today. It’s
as if something is pressing on my right head. I tried ibuprofen but there was no relief. It usually
occurs when I am studying my difficult subject”
Physician: “Aside from studying, is there any other incident that could have provoked the
headache?”
2. From the above conversation, the active listening skill used by the physician is __
A. Probing
B. Focusing
C. Bracketing
D. Leading
Patient Angela: “My blood pressure is on the rise because I am bothered by a lot of things at
home. The kids are very noisy and my husband is always shouting even at little things. My
mother-in-law has a poker face”
Physician: “You mean you have a lot of problems right now. Am I right?”
3. From the above conversation, the active listening skill used by the physician is __
A. Attending
B. Confrontation
C. Reflecting content
D. Perception checking
For Items 4 – 5: Rover, 18, a high school is diagnosed with bronchial asthma four years ago.
Symptoms disrupt his school performance. He is rushed to the ER of a nearby primary care
facility at least 4 x a month. He has been on maintenance inhaled fixed combination LABA –
corticosteroids.
4. Based on the PAFP Clinical Pathways in 2017, a primary preventive measure that is
relevant and most helpful for this patient must be _
A. Regular follow-up with the care provider
B. Avoidance of tobacco smoke and other known irritants
C. Food supplements that enhance immune resistance
D. Counseling on the dangers of drug addiction
5. To start a complete and reliable history taking, a primary care’s essential first step is to _
A. Introduce self
B. Greet the patient
C. Decipher the reliability of data
D. Gather family
For Items 6 – 9: Yadav is a 45-year old male government employee who lives together with his
wife and 3 kids. His wife brings him to your clinic after falling from a 4th ladder staircase of their
home. His wife claimed that he was drunk when the incident happened.
Vital signs : Temp: 37.3°C, HR: 82, RR: 18, BP: 140/80 mmHg.
Physical examination was mostly unremarkable except for a 3cms laceration at the forehead.
Upon further questioning, Yadav disclosed _he is a regular drinker of all sorts of liquor, such as
beer, around 4-5 bottles almost everyday for the past 20 years that they were married.
Lately, Yadav has missed some days of work due to “hangovers”, and has been consuming
“more than usual” amounts of liquor. He had significant weight loss for the past 4 months. He
1
became forgetful and is easily irritated, especially when he had not taken any alcoholic
beverage for a single day.
6. Based on the continuum of risks of alcohol drinking , Yadav falls into this category _
A. Safe drinking
B. Low-risk drinking
C. Hazardous drinking
D. Destructive drinking
7. As to the wife’s statement, Yadav has been drinking “more than usual” for the recent past
few days. The need for increasing amounts of substance to obtain the same level of
pleasurable effect is called _
A. Alcohol abuse
B. Alcohol addiction
C. Tolerance
D. Withdrawal
8. You decide to screen Yadav’s alcohol use using the CAGE questionnaire. Which of the
following questions is not be included in the CAGE questionnaire?
A. Have you ever been in a clinic or hospital because of your drinking?
B. Have you ever had to drink first thing in the morning to get rid of a hangover?
C. Have people ever annoyed you by criticizing your drinking?
D. Have you ever felt you ought to cut down on your drinking?
9. Which of the following laboratory results would not be consistent in the above patient’s
case?
A. Increased GGT
B. Increased AST
C. Decreased CDT
D. Blood alcohol concentration of 100mgs/100 ml
For Items 10 – 15: Katriona, 47 y/o fashion designer complains of irritability at work, poor
concentration, hot flashes and insomnia: She is separated from her husband after she gave
birth to her son who is now 7 years old. After which, she devoted herself to personally taking
care of her son and manage their family business.
Dr FG, her family physician requested for labworks and coordinated the care with a
gynecology-friend. Katriona was having ‘menopausal syndrome’
10. Increased responsiveness to FSH and FSH by the aging ovaries A hormonal treatment
option that addresses both the vasomotor symptoms and genitourinary syndrome of
menopause __
A. Estradiol
B. Basidoxifene
C. Escitalopram
D. Pregabalin
11. HRT option for menopausal women presenting with vasomotor symptoms
A. Citalopram
B. Norethindrone
C. Clonidine
D. Ospemifene
12. From the systematic review done by Hill and Crider, a non-hormonal drug was found to
be significantly effective and safe alternate drug to relive hot flushes among menopausal
women is _
A. Gabapentin
B. Carbamazepine
C. Diphenhydramine
D. Ranitidine
2
13. One study cited by Dr Ashley Hill suggests modest improvement in vaginal dryness was
achieved by the use of this food supplement _
A. Green tea
B. Black cohosh
C. Soy products
D. Omega-3
14. The only non hormonal treatment approved by the US FDA for dyspareunia due to
menopausal atrophy
A. Estradiol
B. Ospemifene
C. Conjugated estrogen
D. Vagifem
15. After an average of 13 years follow-up, the high-dose Estrogen-Progesterone
combination therapy (Women’s Health Initiative Trial, 2014) had significantly increased
risk of the following conditions__
A. Venous Thromboembolism
B. Breast cancer
C. Hip fractures
D. A and B only
For items 16 – 18. Kardo, 55 y/o policemen consults his family doctor because he noticed some
bodily changes and some psychosocial issues with regard to his marital relations. He is told that
he is having ‘andropause’
16. Kardo was screened for his condition using the ADAM Questionnaire. Which of the
following is TRUE about the ADAM questionnaire?
A. Tool in the diagnosis of midlife crisis
B. Score of 10 confirms healthy midlife
C. Detects estrogen and androgen imbalance
D. Score of 4 and above merits HRT use
17. Andropause is generally manifested as __
A. Trouble in focusing attention to details
B. Loss of libido and erectile dysfunction
C. Increased bone and muscle mass
D. Transient memory loss
18. Systematic reviews (published in 2010 - 2015) about andropause and somatopause has
this one important conclusion
A. Androgens improve symptoms without regard to hormonal levels
B. Transdermal DHT helped the participants in psychological coping
C. Significant augmentation of androgens was noted among eugonadal young men
D. Female participants benefited from the relief of depression
For Items 19 – 23. Wilfredo and Emma, husband and wife will have their GOLDEN WEDDING
ANNIVERSARY in June 16 this year. The have 2 children and 7 grandchildren. They are
brought to a gerontologist for a general check-up in preparation for the forthcoming event.
19. . Their ages are 81 and 78 respectively. In the PSG category, Wilfredo and Emma are __
A. Wilfredo is oldest old, while Emma is old old
B. Wilfredo is old old, while Emma is young old
C. Both Wilfredo and Emma are oldest old
D. Both Wilfredo and Emma are old old
20. Dr Balatero, their geriatrician, utilized the Comprehensive Geriatric Assessment (CGA)
for a holistic care of the elderly. CGA domain/s include/s:
A. Socio-environmental Circumstances
B. Cognition and Mental Health
C. Functional Ability
D. All of the above
3
21. One of the following is NOT a routine component of the CGA
A. Katz ADL
B. Dix-Hallpike Test
C. Yesavage GDS
D. MMSE
22. One of the following CGA components involves the basic processes of perception,
attention, memory, reasoning, decision-making and problem-solving
A. Cognitive
B. Neurologic
C. Psychiatric
D. Mood
23. Older age is characterized by the emergence of several complex health states that tend
to occur only later in life and that do not fall into discrete disease categories. These are
__
A. Geriatric syndromes
B. Idiosyncrasies in the elderly
C. Illness of the senior citizens
D. Depression in the elderly
For Items24 – 30. Susana is a 31 y/o ICU nurse diagnosed to have stage 2 invasive intraductal
carcinoma of her left breast 2 years ago. Bilateral radical mastectomy was done followed by
series of chemotherapy sessions.6 months later, she manifests changes behavioral and
memory lapses and developed progressively worsening difficulty of breathing. UTZ of the liver
and brain CT disclosed metastatic lesions, while chest x-ray showed minimal pleural effusion.
24. Susana is labeled by the cancer team as _ “terminally ill” patient because _
A. She has chronic incurable illness
B. She has approximately 12 months to live
C. She has a remaining life of 6 months or less
D. She has already metastatic lesions
25. Which of these statements is TRUE about care of the dying?
A. Abandonment is a major fear of a dying patient
B. Giving hope unconditionally can be comforting to patients
C. Patient and her family’s desire is addressed at all costs
D. Touch and sitting with the patient enhances self-pity
26. A dying patient spend an average of ___ awake hours alone per day
A. 15
B. 12
C. 10
D. 08
27. The principal complaint of most terminally ill patients (Rakel’s Textbook of Family
Medicine, 2017) is __
A. Depression
B. Intractable pain
C. Sleep disturbances
D. Vomiting
28. Which of the following is TRUE about advance directives?
A. A variety of case-specific advance care planning must be hidden to protect
patient’s confidentiality
B. Made legally to express preferences in the event the patient is unable to make
decisions
C. The appointment of health care surrogate as patient’s proxy is an optional part of
the document
D. All of the above
29. Death with dignity in the medical perspective
A. Let the patient die peacefully without any form of medications
B. Allow the patient to spend all her resources to have comfortable remaining days
C. Bring the patient to the surroundings that give meaning to her life
D. Put an unconscious dying patient to artificial ventilation
4
30. The hospice care team is to support the patient’s family and should provide a follow-up
bereavement care for up to ___ months after the patient dies.
A. 18
B. 15
C. 12
D. 10
For items 31 – 39 _Refer to the Family Case of Mrs Reyes
Mr and Mrs Nicanor Reyes, both of their late fifties, have two children: Ed, a 19-year-old
male in his sophomore year of college, and Ciara, a 12-year-old female in her first year at a
public science high school. The family lives in Pasay City, Metro Manila
Two weeks ago, Inang Dada, 77 y/o mother of Mrs. Reyes and who lives in Batangas
(four hours away from the city), had CVA with right-sided residuals. She was admitted for a
week in a provincial hospital. On discharge, the doctor advised close follow-up monitoring of the
patient. Since Mrs. Reyes’ father _Amang Tony in his early eighties is not capable of taking care
of the patient, Mrs. Reyes decided to stay in the province for a while. She would make it a point
to travel twice a week to Pasay to check on her family’s needs.
Mrs. Reyes started to experience frequent back pains, headaches, and muscle pains.
Although she knew that her husband and two children could understand, she felt sad that she
could not personally attend to their needs as before, and she would also feel guilty if she did not
attend to her aging parents.
She sought several consultations for the different symptoms that she had. However, all
diagnostics tests revealed normal results. She decided to visit a family physician.
31. At present time, the family category of Mr and Mrs Reyes as to structure is __
A. Nuclear
B. Blended
C. Extended
D. Communal
32. Which of the following points in the history supports the _Family Systems Theory?
A. Mrs Reyes experiences ‘burn-out syndrome’ because of complex family issues
B. Mrs Reyes attempts to achieve balance between her mother and her own family
C. The somatic symptoms _back pains, headache and myalgias being felt by Mrs
Reyes can be directly related to the guilt within her
D. All of the above
33. Mr and Mrs Reyes family belongs to what stage in the Family Life Cycle?
A. Family with Young Children
B. Family with Adolescents
C. Launching Family
D. Family in Retirement Family in Later Years
34. The hallmark of the family’s emotional transition
A. Marked shifts in the intensity of relationships
B. Surge of exchange with the community at large
C. Changes in balance of responsibilities and functioning
D. Shift of priorities towards personal achievements
35. A Family Life Cycle first order change (need to do) in the above case is __
A. Mrs Reyes attends to her duties as wife and mother
B. Mrs Reyes takes care of her parents at the expense of her children and husband
C. Mr Reyes makes room for his wife to attend to her personal priorities
D. Mr Reyes gives up his job to take care of the children and household
36. A tenet of family practice that implies full service health care to people of both sexes and
all ages _“from conception to resurrection”
A. Primary
B. Coordinated
C. Comprehensive
D. Family-focused
5
37. In the Family Illness Trajectory, the most difficult stage for the patient is __
A. Onset of Illness to Diagnosis
B. Impact Phase – Reaction to Diagnosis
C. Major Therapeutic Efforts
D. Adjustment to Permanency of Outcome
38. The hospitalization of a specific family member will have the greatest impact on the entire
system (Leopando’s Textbook of Family Medicine, 2014). This family member is _
A. Father
B. Mother
C. Children
D. Grandfather
39. This type of family is composed of individuals formed for specific societal purposes
A. Extended
B. Blended
C. Communal
D. Ideological
Public Health
40. A 28-day-old infant died of congenital atresia. This is classified as _
A. Post-neonatal Mortality
B. Neonatal Mortality
C. Fetal Mortality
D. Perinatal Mortality
41. The following is a TRUE STATEMENT about childhood immunization
A. Vaccines can not be given to children with minor febrile illness or malnutrition
B. Periodic administration of booster may not maintain the level of immunity
C. Giving multiple vaccines at the same time and with caution promotes adherence
D. Fever is always an absolute contraindication to all childhood vaccination
42. Which of the following indices is sensitive in describing the health status of a community?
A. Crude death rate
B. Infant mortality rate
C. Maternal mortality rate
D. Proportionate mortality rate
43. One of the following is NOT a primary level of disease prevention
A. Deworming of school children
B. Proper waste disposal in homes and school
C. Encouraging the regular use of toothbrushes
D. Building fences around the house
44. A population pyramid that has broad base, indicating a high proportion of children, rapid rate of
population growth, and a low proportion of older people is called:
A. Stationary pyramid
B. Expanding pyramid
C. Constrictive pyramid
D. Regressive pyramid
45. The largest source of non-ionizing radiation in the environment _
A. Sunlight
B. Cosmic rays
C. Gamma rays
D. Radon
46. The physician as a social mobilizer _
A. Updates knowledge and skills and upgrades his competencies
B. Affiliates himself in the academe aside from manning his clinical practice
C. Improves the quality of care by responding to the patient’s total health needs
D. Effects change by promoting healthy lifestyles, reconciling health requirements,
and initiating activities for health developments
6
47. Which of the following is NOT a characteristic of a continuous measurement data?
A. Fractional portions are possible
B. Measurement scales based on discrete data
C. Obtained through varying degrees of precision
D. Acquired by use of measuring instruments
48. In the life cycle of malarial parasites, the sporogonic cycle covers the period of time
between _
A. Injection of sporozoites to oocyst formation
B. Ingestion of gametocyte to formation of ookinete
C. Injection of sporozoites to the rupture of schizonts
D. Ingestion of gametocyte to the release of sporozoites
49. One of the following is a TRUE statement about the ecologic concept of a disease
A. Behind every disease is the phenomenon of unchanging alteration
B. Disease results from an imbalance between disease agent and host
C. The host-agent interaction are not directly related to external environment
D. Any health problem starts from an individual’s behavior towards nature
50. The interval between the entry of a pathogenic bacteria and the manifestations of clinical
signs and symptoms in affected patients
A. Asymptomatic stage
B. Incubation period
C. Prodromal stage
D. Pre-clinical phase
51. Incidence rate is a health indicator of _
A. Disease occurrence at an unexpected rate
B. Diseases occurring within an interval
C. New cases of disease in a population
D. Old cases of a disease under study
52. In the statistical analysis of investigations, which of the following statements is TRUE?
A. Indirect association results from biases in the study
B. Associations between variables are measured by inferential statistics
C. Statistical association implicates causal relationship among all variables
D. The finding of statistical association supports a hypothesis of relationship
53. The best index utilized in making field studies about energy nutrient malnutrition is __
A. Dietary survey
B. Calorie counting
C. Biochemical test
D. Anthropometric measurement
54. This type of latrine is considered unsanitary
A. Hand flush water-seal
B. Aqua privy
C. Pit privy
D. Septic tank
55. As you work with an MHO, the DOH authorities inform about the influenza outbreak. The
people had been vaccinated with the culture strain that is the same as that incorporated
into the trivalent vaccine administered worldwide. If the same strain causes a high case
fatality rate in previously immunized population, this phenomenon is called __
A. Antigenic shift
B. Antigenic drift
C. Herd immunity
D. Vaccine reaction
7
Part II. Research Methods, Clinical Epidemiology, and EBM Principles
56. A diagnostic test has an overall sensitivity of 48.9 and specificity of 89.8. With these
results, the better usefulness of this test will be as __
A. Ancillary test
B. Screening test
C. Confirmatory test
D. Gold standard test
57. If a research outcome provides ‘the true answer’ to the question raised at the beginning
of the study, it is said to be __
A. Relevant
B. Reliable
C. Precise
D. Valid
58. The _______ of a test depends on the proportion of patients with the disease or health
condition in whom the test is positive
A. Accuracy
B. Specificity
C. Likelihood Ratio
D. Sensitivity
59. ____ refers to the total number of individuals who have the risk factor or the disease of
interest at a particular time in a specified population
A. Incidence
B. Prevalence
C. Morbidity
D. Risk ratio
60. The difference in event rates between two intervention or treatment groups is __
A. Absolute Risk Reduction
B. Relative Risk Reduction
C. Likelihood Ratio
D. Risk Ratio
61. A statistically derived range of values around a trial result in which the probability is that
the true result will be within that range is __
A. Probability (p) value
B. Confidence interval
C. Standard range
D. Normal value
62. The number of people who must be treated over a given period of time with the
experimental therapy to achieve one outcome or to prevent an adverse effect is called __
A. Number Needed To Treat
B. Intention To Treat
C. Therapeutic Range
D. Therapeutic Trial
63. The proportional reduction of adverse events between the treatment group over the
events affecting the control group in a clinical trial is __
A. Absolute Risk Reduction
B. Relative Risk Reduction
C. Risks Difference
D. Odds Ratio
64. The likelihood of a statistically significant difference between two groups in an
experimental study can be known by __
A. Probability (p) value
B. Confidence interval
C. Likelihood ratio
D. A and B only
8
65. Dr Chauhary is doing an investigation about his patients with mesothelioma and their
exposure to asbestos. He started with the outcomes and he reviewed the quantity of
asbestos number or years of exposure. The BEST research design to use is __
A. Cohort
B. Case control
C. Cross sectional
D. Case series
66. In a study done by Professor Helki, she was able to find the correlates of the LNU
DrFQDMF medical students’ class attendance with their academic rank, enrolled in the
year 2016 – 2017. This study is __
A. True experimental
B. Quasi-experimental
C. Observational, Analytic study
D. Descriptive, Qualitative study
67. Dr Mohammed enrolls 1000 patients with Type 2 Diabetes (females, ages = 50-60 with
no previous MI) on the same DPP4 inhibitors. He intends to divide them into regimen
compliant and non-compliant groups, then follow them up over the next 2 years to
determine who among these patients will develop autonomic neuropathy. He must use
this design __
A. Cohort
B. Case control
C. Cross-sectional
D. Case studies
68. A Survey on PTB patients enrolled in DOTS therapy, Barangay Caoayan Kiling and
Barangay Abanon, San Carlos City, Pangasinan, Phil in 2016-2017 is an example of __
A. Prevalence Study
B. Cohort Study
C. Case Series
D. Case Report
For items 69 – 70: Dr Bhutta conducts a research about a new drug for medical renal stone
expulsion. He gathered participants with similar characteristics, divided them into treatment
(new drug) and control arms (standard therapy) respectively
69. The research methodology is
A. Primary, Descriptive
B. Primary, Experimental
C. Secondary, Experimental
D. Secondary, Descriptive
70. The pre-selected study participants are chosen based on the inclusion criteria; _are being
distributed to the group where they are supposed to be analyzed. This is known as _
A. Blinding
B. Randomization
C. Purposive Sampling
D. Convenient Sampling
For Items 71 – 80: Consider the Case Vignette below_
Portia is a 31-year-old primigravid who regularly goes to the health center for prenatal
check-up, has a fetus in frank breech presentation at 36 5/7 weeks age of gestation. The
clinical estimated weight of the fetus is 3200 grams, compatible with sonologic fetal weight
estimate. Portia complains of irregular uterine contractions occurring every 2-3 hours.
The attending MHO decided to coordinate care with Dr Reyes, the consultant-on-duty
in Obstetrics-Gynecology Department of Region I Medical Center. Upon PE, the cervix is
closed and uneffaced, with a soft consistency. At an AOG close to 37 weeks, and with some
uterine contractions, the obstetrician would have to make decision on how and when to
deliver the baby in breech presentation in the safest possible manner.
9
71. The essential first step in the EBM cycle
A. Identify the clinical dilemma
B. Search for the evidence
C. Appraise the literature
D. Making decisions
72. A systematic assessment of validity and usefulness of a scientific literature is called__
A. Critical appraisal
B. Research process
C. Literature search
D. Meta-analysis
73. The ‘triad’ in EBM _
A. Documents, Patient’s decision, Meta-analysis
B. Medical updates, Physician’s Merit, Journals
C. Experts opinions, Patient’s benefits, Valid articles
D. Patient’s predicaments, Doctor’s merit, Updates
74. In an initial tease-out of a scientific article, one must find positive answer to one the following
questions if the paper is to be considered quality:
A. Are there differences between the two groups in terms of selection?
B. Was the assignment of study participants randomized?
C. Were the groups treated differently at the start of the trial?
D. How large was the treatment effect?
75. Which of the following criteria is included in the user’s secondary validity guide questions?
A. Blinding
B. Randomization
C. Treatment effect
D. Important outcome
76. According to EBM principles, the above case vignette must be categorized as a clinical question
that concerns about __
A. Diagnosis
B. Therapy
C. Causation
D. Prognosis
77. The most appropriate research methodology to be utilized in answering the clinical dilemma must
be ____
A. Cohort
B. Case-control
C. RCT
D. CPG
78. Doing the first step in the EBM cycle, the clinical question should be formulated as_
A. Among patients in labor, should the physician allow a trial of labor or deliver the baby
immediately by outright CS?
B. Among primigravid in labor, will x-ray pelvimetry helps the physician and his patient make
a decision on the mode of delivery?
C. Among primigravid in labor, will x-ray pelvimetry facilitates the baby’s delivery?
D. Among primigravid with fetal malpresentation will CS vs vaginal delivery reduce maternal
and neonatal morbidity and mortality?
79. As to recent studies by Commarasamy, Lathe, et al _the weakest link in the utilization of critical
appraisal in clinical practice is _
A. Formulation of focused clinical question
B. Clinical application of appraised paper
C. Selection of articles as the evidence
D. Identifying the article’s validity and reliability
80. The framed clinical question in the critical appraisal done was “_Among primigravids with
singleton, live, term breech, will cesarean delivery reduce the risk of perinatal/neonatal mortality
and/or serious neonatal morbidity?”.
All of the following are basic components of the clinical question, EXCEPT
A. Patient
B. Variable
C. Intervention
D. Outcome
10
