Oet Materials PDF

READING TEST 83
READING SUB-TEST : PART A

 Look at the four texts, A-D, in the separate Text Booklet.
 For each question, 1-20, look through the texts, A-D, to find the relevant
information.
 Write your answers on the spaces provided in this Question Paper.
 Answer all the questions within the 15-minute time limit.
 Your answers should be correctly spelt.
PART A -TEXT BOOKLET - BENIGN PROSTATIC HYPERPLASIA
Text A
A 62-year-old man with a 4-year progressive history of :

 Increasing lower urinary tract symptoms (LUTS); American Urological
Association (AUA) symptom score: 21
 Flow rate: 11 m/s
 Post-void residual: 60 mL
 Prostate volume (on transrectal ultrasonography [ TRUS] ): 65 mL
 Prostate-specific antigen (PSA) level: 3.2ng/mL
 The patient states that he is not bothered significantly by
his symptoms and does not desire active therapy.
What is his risk of progression?

This patient is at significant risk for benign prostatic hyperplasia BPH)
progression:
 Deterioration of symptoms
 Deterioration of flow rate
 Risk of acute urinary retention (AUR)
 Risk of surgery
What is the most appropriate medical therapy?
5-∝-Reductase inhibitor therapy, combination 5-∝-reductase inhibitor and
∝ - blocker therapy, or very careful watchful waiting.

Treatment:
The patient declines theraphy.
Implications for management:
When deciding between watchful waiting and active treatment, this patient
should be aware of his increased risk of BPH progression and unfavorable
outcomes. Close follow up is required to detect Significant progression.
Text B
The high prevalence of histologic BPH, bothersome LUTS(Lower Urinary
Tract Symptoms), BPE(Benign Prostatic Enlargement), and BOO (Bladder
Outlet Obstruction) has been emphasized, and the number of patients
presenting with these symptoms to health care providers engaged in the
care of such patients will likely increase significantly over the next decades.
Estimates from the United Nations 9 demonstrate that the percentage of
the population aged 65 years or older increased significantly between
2000 and 2005, both in underdeveloped and more developed regions, and
from 7% to 11% worldwide (Figure 2A).
In addition, life expectancy has changed worldwide from 56 years for the
observation period 1965 to 1970 to 65 years for 2000 to 2005. Again, the
more developed regions have a longer life expectancy, but the incremental
increase is greater in Africa, Asia, and Latin America And the Caribbean
regions (Figure 2B)
25
2000 2025
A 21
20
15 14
11
10 10
10
7 7
6
5 4
3
0
WORLD AFRICA ASIA LATIN AMERICA / MORE DEVELOPED
CARRIBEAN REGIONS
80
76
1965 - 1970 2000 - 2005
71
70 B 67
70
65
59
60 56
54
49
50 47
40
30
20
10
0
AFRICA ASIA LATIN AMERICA / MORE DEVELOPED WORLD
CARIBBEAN REGIONS
Figure 2
Trends in aging and life expectancy (A) Percentage of population
aged 65 years and older, by world region (B) Trends in life
expectancy at birth ( in years), by world region. Data from United
Nations 9
Text C
For men who have BPH and have a large prostate or a high PSA at
baseline, combination therapy can prevent about 2 episodes of clinical
progression per 100 men per year over 4 years of treatment. There is no
additional benefit within the first year of treatment. Most men who take
combination therapy will have no additional benefit, and about 4 additional
patients per 100 will become impotent who would not have taking an alpha
blocker alone. Combination therapy can also be instituted after clinical
progression occurs, but this strategy, while used widely has not been
studied.
Text D
Despite the deceptively simple description of benign prostatic hyperplasia

(BPH), the actual relationship between BPH, lower urinary tract symptoms
(LUTS) benign prostatic enlargement, and bladder outlet obstruction is
complex and requires a solid understanding of the definitional issues
involved. The etiology of BPH and LUTS is still poorly understood, but the
hormonal hypothesis has many arguments in its favor. There are many
medical and minimally invasive treatment options available for affected
patients. In the intermediate and long term, minimally invasive treatment
options are superior to medical therapy in terms of symptom and flow rate
improvement tissue ablative surgical treatment options are superior to both
minimally invasive and medical therapy.
PART A -QUESTIONS
Questions 1-7
For each of the questions, 1-7, decide which text (A, B, C or D) the
information comes from. You may use any letter more than once
1. About combination therapy?

2. Changes in the life expectancy?
3. Etiology of BPH is not clear
4. Patients with urinary Tract Infection will increase in the future
5. Patient denies active treatment?
6. Risk of BPH progression?
7. Lab investigation for BPH?
Questions 8-14
Answer each of the questions, 8-14, with a word or short phrase from one of the texts.
Each answer may include words, number of the both. Your answers should be correctly
spelled.
8. What are the treatment options for BPH?
9. List two risks BPH?
10. What treatment widely used after progression occurs, but has not been
studied?
11. What is BPH?
12. What's appropriate medical therapy?
13. As per 2005, what is the change in life expectancy since 1970?
14. What is the appropriate treatment for long term BPH patients?
Questions 15-20
Complete each of the sentences, 15- 20, with a word or short phrase from one of the
texts. Each answer may include words, number or both. Your answers should be
correctly spelled
15. regions have a longer life expectancy
16. treatment options are superior to both minimally
invasive and medical therapy options
17. Cause of BPH is not clear, but has many points in its
favor.
18. must be done in patients with BPH to rule out its
progression
19. Increase in percentage of population aged 68 years of older is
in 5 years.
20. can be used for patients with BPH progression.
END OF PART A THIS TEXT BOOKLET WILL BE COLLECTED
READING SUB-TEST : PART B
In this part of the test, there are six short extracts relating to the work of health
professionals .
For questions 1-6, choose the answer (A, B or C) which you think fits best
according to the text. Write your answers on the separate Answer Sheet
Questions 1-6
1. The manual states that the wheelchair should not be used
A. inside buildings.
B. without supervision
C. on any uneven surfaces,
Manual extract: Kuschall ultra-light wheelchair

Intended use
The active wheelchair is propelled manually and should only be used for
independent or assisted transport of a disabled patient with mobility
difficulties. In the absence of an assistant, it should only be operated by
patients who are physically and mentally able to do so safely (e.g., to
propel themselves, steer, brake, etc.). Even where restricted to indoor use,
the wheelchair is only suitable for use on level ground and accessible
terrain. This active wheelchair needs to be prescribed and fit to the
individual patient's specific health condition. Any other or incorrect use
could lead hazardous situations to arise.
2. These guidelines contain instructions for staff who
A. need to screen patients for MRSA

B. are likely to put patients at risk from MRSA.
C. intent to treat patients who are infected with MRSA.
MRSA Screening guidelines

It may be necessary to screen staff there is an outbreak of MRSA within a
ward or department. Results will normally be available within three days,
although occasionally additional tests need to be done in the laboratory.
Staff found to have MRSA will be given advice by the Department of
Occupational Health regarding treatment. Even minor skin sepsis or skin
diseases such as eczema, psoriasis or dermatitis amongst staff can result
in widespread dissemination of staphylococci. If a ward has an MRSA
problem, staff with any of these conditions (colonised or infected) must
contact Occupational Health promptly, so that they can be screened for
MRSA carriage. Small cuts and/or abrasions must always be covered with
a waterproof plaster. Staff with infected lesions must not have direct
contact with patients and must contact Occupational Health
3. The main point of the notice is that hospital staff
A. need to be aware of the relative risks of various bodily fluids.

B. should regard all bodily fluids as potentially infectious
C. must review procedures for handling bodily fluids
Infection prevention
Infection control measures are intended to protect patients, hospital
workers and others in the healthcare setting. While infection prevention is
most commonly associated with preventing HIV transmission, these
procedures also guard against other blood borne pathogens, such as
hepatitis B and C, syphilis and Chagas disease. They should be considered
standard practice since an outbreak of enteric illness can easily occur in a
crowded hospital.
Infection prevention depends upon a system of practices in which all blood

and bodily fluids, including cerebrospinal fluid, sputum and semen, are
considered to be infectious. All such fluids from all people are treated with
the same degree of caution, so no judgement is required about the
potential infectivity of a particular specimen. Hand washing, the use of
barrier protection such as gloves and aprons, the safe handling and
disposal of 'sharps and medical waste and proper disinfection, cleaning
and sterilisation are all part of creating a safe hospital.
4. What do nursing staff have to do?
A. train the patient how to control their condition with the use of an insulin
pump
B. determine whether the patient is capable of using an insulin pump
appropriately
C. evaluate the effectiveness of an insulin pump as a long-term means of
treatment
Extract from staff guidelines: Insulin pumps
Many patients with diabetes self-medicate using an insulin pump. If you're
caring for a hospitalised patient with an insulin pump, assess their ability to
manage self-care while in the hospital. Patients using pump therapy must
possess good diabetes self-management skills. They must also have a
willingness to monitor their blood glucose frequently and record blood
glucose readings, carbohydrate intake, insulin boluses, and exercise.
Besides assessing the patient's physical and mental status, review and
record pump-specific information, such as the pump's make and model.
Also assess the type of insulin being delivered and the date when the
infusion site was changed last Assess the patient's level of consciousness
and cognitive status. If the patient doesn't seem competent to operate the
device, notify the healthcare provider and document your findings.
5. The extract states that abnormalities in babies born to mothers who took
salbutamol are
A. relatively infrequent
B. clearly unrelated to its use.
C. caused by a combination of drugs
Extract from a monograph: Salbutamol Sulphate Inhalation Aerosol

Pregnant women
Salbutamol has been in widespread use for many years in humans without
apparent ill consequence. However, there are no adequate and well
controlled studies in pregnant women and there is little published evidence
of its safety in the early stages of human pregnancy. Administration of any
drug to pregnant women should only be considered if the anticipated
benefits to the expectant women are greater than any possible risks to the
foetus.
During worldwide marketing experience, rare cases of various congenital

anomalies, including cleft palate and limb defects, have been reported in
the offspring of patients being treated with salbutamol. Some of the
mothers were taking multiple medications during their pregnancies
Because no consistent pattern of defects can be discerned, a relationship
with salbutamol use cannot be established.
6. What is the purpose of this extract?

A. to present the advantages and disadvantages of particular procedures
B. to question the effectiveness of certain ways of removing non-viable
tissue
C. to explain which methods are appropriate for dealing with which types
of wounds
Extract from a textbook: debridement

Debridement is the removal of non-viable tissue from the wound bed to
encourage wound healing. Sharp debridement is a very quick method, but
should only be carried out by a competent practitioner, and may not be
appropriate for all patients. Autolytic debridement is often used before other
methods of debridement. Products that can be used to facilitate autolytic
debridement include hydrogels hydrocolloids, cadexomer iodine and honey.
Hydrosurgery systems combine lavage with sharp debridement and provide
a safe and effective technique, which can be used in the ward environment.
This has been shown to precisely target damaged and necrotic tissue and
is associated with reduced procedure time. Ultrasonic assisted
debridement is a relatively painless method of removing non-viable tissue
and has been shown to be effective in reducing bacterial burden, with
earlier transition to secondary procedures. However, these last two
methods are potentially expensive and equipment may not always be
available.
READING SUB-TEST : PART C
In this part of the test, there are two texts about different aspects of healthcare.
For questions 7-22, choose the answer (A, B, C or D) which you think fits best
Part C -Text 1
Cardiovascular benefits of exercise
Cardiovascular disease (CVD) is the leading cause of death for both men
and women in the United States. According to the American Heart
Association (AHA), by the year 2030, the prevalence of cardiovascular
disease in the USA is expected to increase by 9.9% , the prevalence of
both heart failure and stroke is expected to increase by approximately 25%.
Worldwide, it is projected that CVD will be responsible for over 25 million
deaths per year by 2025. And yet, although several risk factors are non-
modifiable (age, male gender, race, and family history). the majority of
contributing factors are amenable to intervention. These include elevated
blood pressure, high cholesterol, smoking, obesity, diet and excess stress.
Aspirin taken in low doses among high risk groups is also recommended
for its cardiovascular benefits.
One modifiable behaviour with major therapeutic implications for CVD is

inactivity. Inactive or sedentary behaviour has been associated with
numerous health conditions and review of several studies has confirmed
that prolonged total sedentary time (measured objectively via an
accelerometer) has a particularly adverse relationship with cardiovascular
risk factors, disease, and mortality outcomes. The cardiovascular effects of
leisure time physical activity are compelling and well documented.
Adequate physical leisure activities like walking, swimming, cycling, or stair
climbing done regularly have been shown to reduce type 2 diabetes, some
cancers, falls, fractures, and depression. Improvements in physical function
and weight management have also been shown along with increases in
cognitive function, quality of life, and life expectancy.
Several occupational studies have shown adequate physical activity in the

workplace also provides benefits. Seat-bound bus drivers in London
experienced more coronary heart disease than mobile conductors working
on the same buses, as do office-based postal workers compared to their
colleagues delivering mail on foot. The AHA recommends that all
Americans invest in at least 30 minutes a day of physical activity on most
days of the week. In the face of such unambiguous evidence, however,
most healthy adults, apparently by choice it must be assumed, remain
sedentary.
The cardiovascular beneficial effects of regular exercise for patients with a

high risk of coronary disease have also been well documented. Leisure
time exercise reduced cardiovascular mortality during a 16-year follow-up
study of men in the high risk category. In the Honolulu Heart Study, elderly
men walking more than 1.5 miles per day similarly reduced their risk of
coronary disease. Such people engaging in regular exercise have also
demo other CVD benefits including decreased rate of strokes and
improvement in erectile dysfunction. There is also evidence of an up to 3-
year increase in lifespan in these groups
Among patients with experience of heart failure, regular physical activity

has also been found to help improve angina-free activity, prevent heart
attacks, and result in decreased death rates. It also improves physical
endurance in patients with peripheral artery disease. Exercise programs
carried out under supervision such as cardiac rehabilitation in patients who
have undergone percutaneous coronary interventions or heart valve
surgery, who are transplantation candidates or recipients, or who have
peripheral arterial disease result in significant short and long-term CVD
benefits.
Since data indicate that cardiovascular disease begins early in life, physical
interventions such as regular exercise should be started early for optimum
effect. The US Department of Health and Human Services for Young
People wisely recommends that high school students achieve a minimum
target of 60 minutes of daily exercise. This may be best achieved via a
mandated curriculum. Subsequent transition from high school to college is
associated with a steep decline in physical activity. Provision of convenient
and adequate exercise time as well as free or inexpensive college credits
for documented workout periods could potentially enhance participation.
Time spent on leisure time physical activity decreases further with entry
into the workforce. Free health club memberships and paid supervised
exercise time could help promote a continuing exercise regimen.
Government sponsored subsidies to employers incorporating such exercise
programs can help decrease the anticipated future cardiovascular disease
burden in this population.
General physicians can play an important role in counselling patients and

promoting exercise. Although barriers such as lack of time and patient non-
compliance exist, medical reviews support the effectiveness of physician
counselling, both in the short term and long term. The good news is that the
percentage of adults engaging in exercise regimes on the advice of US
physicians has increased from 22.6% to 32.4 % in the last decade. The
empowerment of physicians, with training sessions and adequate
reimbursement for their services, will further increase this percentage and
ensure long-term adherence to such programmes. Given that risk factors
for CVD are consistent throughout the world, reducing its burden will not
only improve the quality of life, but will increase the lifespan for millions of
humans worldwide, not to mention saving billions of health-related dollars.
Part C -Text 1: Questions 7-14
7. In the first paragraph, what point does the writer make about CVD?
A. Measures to treat CVD have failed to contain its spread.

B. There is potential for reducing overall incidence of CVD.
C. Effective CVD treatment depends on patient co-operation.
D. Genetic factors are likely to play a greater role in controlling CVD.
8. In the second paragraph, what does the writer say about inactivity?
A. Its role in the development of CVD varies greatly from person to person.
B. Its level of risk lies mainly in the overall amount of time spent inactive.
C. Its true impact has only become known with advances in technology
D. Its long-term effects are exacerbated by certain medical conditions.
9. The writer mentions London bus drivers in order to
A. demonstrate the value of a certain piece of medical advice.

B. stress the need for more research into health and safety issues.
C. show how important free-time activities may be to particular groups,
D. emphasise the importance of working environment to long-term health
10. The phrase 'apparently by choice’ in the third paragraph suggests the
writer
A. believes that health education has failed the public.

B. remains unsure of the motivations of certain people.
C. thinks that people resent interference with their lifestyles
D. recognises that the rights of individuals take priority in health issues.
11. In the fourth paragraph, what does the writer suggest about taking up
regular exercise?
A. Its benefits are most dramatic amongst patients with pre-existing

conditions
B. It has more significant effects when combined with other behavioural
changes.
C. Its value in reducing the risks of CVD is restricted to one particular age
group.
D. It is always possible for a patient to benefit from making such alterations
to lifestyle.
12. The writer says ‘short- and long-term CVD benefits’ derive from
A. long distance walking
B. better cardiac procedures.
C. organised physical activity.
D. treatment of arterial diseases.
13. The writer supports official exercise guidelines for US high school
students because.
A. it is likely to have more than just health benefits for them.

B. they are rarely self-motivated in terms of physical activity.
C. it is improbable they will take up exercise as they get older
D. they will gain the maximum long-term benefits from such exercise.
14. What does the writer suggest about general physicians promoting
exercise?
A. Patients are more likely to adopt effective methods under their guidance.
B. They are generally seen as positive role models by patients.
C. There are insufficient incentives for further development
D. It may not be the best use of their time.
Part C -Text 2
Power of Placebo
Ted Kaptchuk is a Professor of Medicine at Harvard Medical School. For
the last 15 years, he and fellow researchers have been studying the
placebo effect - something that, before the 1990s, was seen simply as a
thorn in medicine's side. To prove a medicine is effective, pharmaceutical
companies must show not only that their drug has the desired effects, but
that the effects are significantly greater than those of a placebo control
group. However, both groups often show healing results. Kaptchuk's
innovative studies were among the first to study the placebo effect in
clinical trials and tease apart its separate components. He identified such
variables as patients reporting bias (a conscious or unconscious desire to
please researchers), patients simply responding to doctors attention, the
different methods of placebo delivery and symptoms subsiding without
treatment-the inevitable trajectory of most chronic ailments.
Kaptchuk's first randomised clinical drug trial involved 270 participants who
were hoping to alleviate severe arm pain such as carpal tunnel syndrome
or tendonitis. Half the subjects were instructed to take pain-reducing pills
while the other half were told they'd be receiving acupuncture treatment.
But just two weeks into the trial, about a third of participants - regardless of
whether they'd had pills or acupuncture started to complain of terrible side
effects. They reported things like extreme fatigue and nightmarish levels of
pain. Curiously though, these side effects were exactly what the
researchers had warned patients about before they started treatment. But
more astounding was that the majority of participants in other words the
remaining two-thirds - reported real relief. particularly those in the
acupuncture group This seemed amazing, as no-one had ever proved the
superior effect of acupuncture over standard painkillers. But Kaptchuk's
team hadn't proved it either. The acupuncture needles were in fact
retractable shams that never pierced the skin and the painkillers were
actually pills made of corn starch. This study wasn't aimed at comparing
two treatments. It was deliberately designed to compare two fakes.
Kaptchuk needle/pill experiment shows that the methods of placebo

administration are as important as the administration itself. It's a valuable
insight for any health professional: patients' feelings and beliefs matter, and
the ways physicians present treatments to patients can significantly affect
their health. This is the one finding from placebo research that doctors can
apply to their practice immediately. Others such as sham acupuncture, pills
or other fake interventions are nowhere near ready for clinical application.
Using placebo in this way requires deceit, which falls foul of several major
pillars medical ethics, including patient autonomy and informed consent.
Years of considering this problem led Kaptchuk to his next clinical

experiment what if he simply told people they were taking placebos? This
time his team compared two groups of IBS sufferers. One group received
no treatment. The other patients were told they'd be taking fake, inert drugs
(from botties labelled placebo pills) and told also, at some length, that
placebos often have healing effects. The study's results shocked the
investigators themselves: even patients who knew they were taking
placebos described real improvement, reporting twice as much symptom
relief as the no-treatment group. It hints at a possible future in which
clinicians cajole the mind into healing itself and the body-without the drugs
that can be more of a problem than those they purport to solve.
But to really change minds in mainstream medicine, researchers have to

show biological evidence-a feat achieved only in the last decade through
imaging technology such as positron emission tomography (PET) scans
and functional magnetic resonance imaging (MRI). Kaptchuk's team has
shown with these technologies that placebo treatments affect the areas of
the brain that modulate pain reception. It's those advances in "hard
science, said one of Kaptchuk researchers, that have given placebo
research a legitimacy it never enjoyed before. This new visibility has
encouraged not only research funds but also interest from healthcare
organisations and pharmaceutical companies. As private hospitals in the
US run by healthcare companies increasingly reward doctors for
maintaining patients health (rather than for the number of procedures they
perform), research like Kaptchuk's becomes increasingly attractive and the
funding follows.
Another biological study showed that patients with a certain variation of a

gene linked to the release of dopamine were more likely to respond to
sham acupuncture than patients with a different variation findings that could
change the way pharmaceutical companies conduct drug trials. Companies
spend millions of dollars and often decades testing drugs, every drug must
outperform placebos if it is to be marketed. If drug companies could
preselect people who have a low predisposition for placebo response, this
could seriously reduce the size, cost and duration of clinical trials, bringing
cheaper drugs to the market years earlier than before.
15. The phrase 'a thorn in medicine's side’ highlights the way that the
placebo effect
A. varies from one trial to another.

B. affects certain patients more than others.
C. increases when researchers begin to study it.
D. complicates the process of testing new drugs
16. In the first paragraph, it's suggested that part of the placebo effect in
trials is due to
A. the way health problems often improve naturally.
B. researchers unintentionally amplifying small effects
C. patients responses sometimes being misinterpreted.
D. doctors treating patients in the control group differently.
17. The results of the trial described in the second paragraph suggest that
A. surprising findings are often overturned by further studies

B. simulated acupuncture is just as effective as the real thing.
C. patients' expectations may influence their response to treatment
D. it's easy to underestimate the negative effect of most treatments
18. According to the writer, what should health professionals learn from
Kaptchuk's studies?
A. The use of placebos is justifiable in some settings.

B. The more information patients are given the better.
C. Patients value clarity and honesty above clinical skill.
D. Dealing with patients perceptions can improve outcomes.
19. What is suggested about conventional treatments in the fourth

paragraph?
A. Patients would sometimes be better off without them,

B. They often relieve symptoms without curing the disease.
C. They may not work if patients do not know what they are
D. Insufficient attention is given to developing effective ones.
20. What does the phrase ‘This new visibility’ refer to?
A. improvements in the design of placebo studies

B. the increasing acceptance of placebo research
C. innovations in the technology used in placebo studies
D. the willingness of placebo researchers to admit mistakes
21. In the fifth paragraph, it is suggested that Kaptchuk's research may

ultimately benefit from
A. the financial success of drug companies.

B. a change in the way that doctors are paid.
C. the increasing number of patients being treated
D. improved monitoring of patients by healthcare providers.
22. According to the final paragraph, it would be advantageous for

companies to be able to use genetic testing to
A. understand why some patients dont respond to a particular drug.

B. choose participants for trials who will benefit most from them.
C. find out which placebos induce the greatest response.
D. exclude certain individuals from their drug trials.
END OF READING TEST, THIS BOOKLET WILL BE COLLECTED
Reading test 83 : Answer Key
Part A - Answer key 1 – 7

1. C
2. B
3. D
4. B
5. A
6. A
7. A
8. Medical and surgical
9. LUTS and BOO
10.
11. combination therapy
Old age disease
12. 5 ∝ reductase inhibitor therapy

13. Increased to 65 years
14. Minimum invasive treatment
15. Caribbean
16. Tissue ablative surgical
17. Hormonal hypothesis
18. Close follow up
19. 7 to 11/%
20. combination therapy
Reading test - part B – answer key

1. C
2. B
3. B
4. B
5. A
6. A
Reading test - part C – answer key

Text 1 - Answer key 7 – 14
7. B
8. B
9. A
10. B
11. D
12. C
13. D
14. A

15. D, 16. A, 17. C, 18. D, 19. A, 20. B, 21. B, 22. D
READING TEST 84
information.
PART A -TEXT BOOKLET – EVALUATING COGNITIVE FUNCTION
Text A
Terminology
Cognitive difficulties
Cognitive changes are normal for almost all people as they age, and
assessment should focus on differentiating the normal changes of
ageing from abnormal cognitive functioning. While concerns about
memory are common in older patients, when patients complain of
memory problems, they could be referring to difficulties in a number of
possible cognitive domains. Although learning and memory is often the
most salient of these domains, the problems could also be in:
 attention (ability to sustain or shift focus),
 language (naming, producing words, comprehension, grammar or
syntax),
 perceptual and motor skills (construction, visual perception),
 executive function (decision making, mental flexibility), or
 social cognition.
It is thus often more appropriate to refer to cognitive rather than memory
complaints or deficits.
Text B
Pharmacological treatments
There are currently no evidence-based recommendations on medications
to treat mild cognitive impairment (MCI). If dementia is suspected then
specialist referral is recommended for confirmation of the diagnosis. If
Alzheimer’s disease is confirmed then pharmacological treatment can be
considered (e.g. acetylcholinesterase inhibitors such as donepezil,
galantamine or rivastigmine).
A psychiatric or psychogeriatric referral should be considered for:
 patients who do not respond to first- or second-line treatment
 patients with atypical mental health presentations
 patients with significant psychiatric histories, including complicated
depression and/or anxiety or comorbid severe mental illnesses such
as schizophrenia and bipolar affective disorder.
Follow up
If the diagnosis remains unclear after a detailed assessment then provide
general advice and watchfully wait. All patients should have a cognitive
review with a screening instrument every 12 months, or sooner if
deterioration is detected by the patient or their family.
Risk factors for progression of MCI to dementia include older age, less
education, stroke, diabetes and hypertension. Patients who are younger,
more educated with higher baseline cognitive function and no amnesia
symptoms are more likely to revert from MCI to normal cognition. Even after
10 years, between 40 and 70% of patients with MCI may not have developed
dementia
Text C
Examples of skills Warning signs and questions
Domain
Short-term
Learning and recall memory Have you noticed that you have
Semantic and
been talking to someone and
autobiographical
soon after forget the
Long-term
conversation?
memory Implicit
Have you had difficulty
learning
remembering the names of
people you have just met?
Have you had trouble keeping
track of dates and
appointments?
Have you had any difficulty
remembering events from your
past?
Have you had difficulty doing
activities previously thought as
automatic, like driving or
typing?
[To informant] Has he or she
been repeating him or herself
lately?
Object naming
Language Have you noticed any word-
Word finding
finding difficulties?
Receptive
[To informant] Has he or she had
language
more difficulty understanding
you lately?
Planning
Executive function Have you had more difficulty
Decision making
managing your finances lately?
Working memory
[To informant] Have you noticed
Flexibility
difficulties with his or her
capacity to plan activities or
make decisions?
Perceptual motor function Visual Have you had trouble using day-
perception to-day objects, such as phone or
Perceptual- cutlery?
motor Co- Have there been new driving
ordination difficulties such as staying in the
lane?
Complex attention Sustained Are you having difficulty following

attention what’s
Selective going on around you?
attention [To informant] Have you noticed
that he or she is more easily
distracted?
Social Cognition Recognition of [To informant] Has he or

emotions she been behaving
Appropriateness inappropriately in social
of behaviour to situations?
social norms Is he or she able to recognise
social cues? Is she or she able
to motivate him or herself?
Text D
Dementia, now also referred to as ‘major neurocognitive disorder’ in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is defined
by the presence of substantial cognitive decline from a previous level of
functioning to the degree that the individual’s ability to live independently is
compromised owing to the cognitive deficits. Dementia is a syndrome with
many possible causes, with Alzheimer’s disease being the most common in
older people. It is generally of gradual onset with a chronic course, although
there are exceptions. Dementia must be distinguished from delirium (acute
confusional state), which by definition is of acute or recent onset and
associated with loss of awareness of surroundings, a global disturbance in
cognition, changes in perception and the sleep- wake cycle, and other
features.
PART A -QUESTIONS
Questions 1-7
In which text can you find information about...
1. what to ask patients when evaluating cognitive functioning?
2. possible choices for pharmaceutical treatments?
3. the best way to describe patient symptoms?
4. the defining features of dementia?
5. the proper focus of cognitive assessment?
6. different types of mental processing?
7. what to do when a diagnosis is remains uncertain?
Questions 8-14
spelled.
8. What is the other name for dementia?

9. What is the most common cause of dementia in older people?
10. Which domain of cognition is the skill of planning associated with?
11. What is the most appropriate way to confirm a diagnosis of dementia?
12. What is recommended for patients when standard treatments are
unsuccessful?
13. What is often the most noticeable of the many cognitive domains?
14. How often should a patient be cognitively screened if they are not getting
worse?
Questions 15-20
Complete each of the sentences, 15- 20, with a word or short phrase from one of the texts.
Each answer may include words, number or both. Your answers should be correctly spelled
15] Dementia differs in important ways from ______________, which, for

example, has a sudden onset
16] The DSM-5 defines dementia as substantial cognitive decline that
compromises the individual’s _______________
17] There are ________________ medications for MCI that are recommended
based on available research.
18] Many symptoms described as problems with memory are probably better
described as __________ complaints.
19] Social cognition includes the ability to follow accepted social rules and the
__________________
20] To assess perceptual motor functioning doctors can ask if patients have
had difficulty using __________ objects like knives and forks
professionals .
For questions 1-6, choose the answer (A, B or C) which you think fits best according
to the text. Write your answers on the separate Answer Sheet
Questions 1-6
1. The purpose of this memo is to
A. provide staff information on appropriate methods.

B. notify staff of a possible change in standard procedure.
C. remind staff of the importance of following best practice.
Memo to: Department physicians and clinical staff
Subject: Aseptic technique
Aseptic technique protects patients during invasive clinical procedures by
employing infection control measures that minimise, as far as practicably
possible, the presence of pathogenic organisms. Good aseptic technique
procedures help prevent and control healthcare associated infections and
must be preserved. As you are aware, the aim of every procedure should be
to maintain asepsis at all times by protecting the key parts and key sites
from contact contamination by microorganisms. This can be achieved
through correct hand hygiene, a non-touch technique, glove use and
ensuring asepsis and sterility of equipment. While the principles of aseptic
technique remain constant for all procedures, the level of practice will
change depending upon a standard risk assessment.
2. The guidelines require those administering thrombolysis to

A. explore other options before proceeding.
B. contact the coronary care unit prior to transfer.
C. ensure support staff are readily available.
6.2 Thrombolysis for STEMI patients

Primary percutaneous coronary intervention (PCI) is the treatment of
choice for patients presenting with an acute ST Elevation Myocardial
Infarction (STEMI). However, if it is not possible to transfer the patient to
the cardiac catheter laboratory immediately, for whatever reason, then the
need for thrombolysis to be given should be considered. The admitting
team must ask the primary PCI operator if they are able to achieve the
arrival in hospital to first balloon inflation target of 120 minutes. If not, then
thrombolysis will be given on the advice of the primary PCI operator
without delay. Support for this may be given by Coronary Care Unit (CCU)
staff/Chest Pain Nurses depending on the patient’s location. Transfer the
patient with resuscitation equipment to CCU immediately after
thrombolysis is administered.
3. The guidelines specify that those performing an MRI on patients with

implants or foreign bodies
A. should abandon the scan if unsure of the device.
B. have the final say in whether to scan a patient.
C. use a lower field strength for conditional items.
Guidelines for the management of implants and foreign bodies during
MRI scans
Implantable devices or other foreign bodies may contraindicate MRI
scanning and/or cause significant image artefacts. There is a growing
number of medical devices and implants that are classified as ‘MRI
conditional’, placing the responsibility for safety on the operator. It should
be stressed that safety at a defined field strength or for a specific MRI
system is no guarantee of safety at a higher (or lower) field strength, or a
different MRI system at the same field strength. If there is any doubt as to
the nature of a device then a scan should only proceed after a careful
assessment of the potential risks and benefits of the scan with the device
in situ. The MRI Safety Expert can assist with identifying and quantifying
the risks, but the decision to scan is a clinical one.
4. The manual informs us that the AP14 syringe pump

A. should be disconnected in times of power outage.
B. facilitates easy cleaning by its smooth exterior.
C. has a unique patient transportation feature.
Manual extract: Operation of AP14 Manual Syringe Pump

Pump Application
The AP 14 syringe pump is simple to operate, reliable and is of general
application. It is suitable for various types of single-use syringes. BOLUS
function enables quick and repeated delivery of bolus doses to the patient,
with accurately established volume and within a specified infusion time. The
pump can operate without connection to the mains, as it is automatically
supplied by the internal battery in cases, e. g. of mains failure. It also enables
to continue the infusion when the patient is being transported from one area of
the hospital to another. Simple casing, without any parts protruding from the
front panel, facilitates maintenance and disinfection
5. The notice on indwelling urinary catheters provides information about

A. the order for correct insertion.
B. optimal positioning of the patient.
C. how best to avoid harming patients.
Indwelling urinary catheters
Urethral, prostate or bladder neck injury resulting in false tracts, strictures
and bleeding are related to traumatic urethral insertion. Traumatic injury is
less likely to occur with appropriate catheter selection, lubrication, correct
patient positioning and insertion into a full bladder. Retention balloons
should only be inflated inside the bladder, which is indicated by urine return
with IUC inserted to the hilt. If there is any uncertainty regarding catheter
placement, the balloon should not be inflated. If the patient experiences pain
with inflation, deflate the balloon immediately and reassess IUC position as
this may indicate the catheter is outside the bladder. IUCs should be used
with caution in patients at risk of self-extraction, such as those with
dementia or who are delirious. When available, ultrasonography is
recommended to evaluate bladder volumes and guide SPC insertions.
6. This extract from a handbook says that patients with delirium experience
A. a similar cognitive decline as with dementia.
B. a loss of interest during conversations.
C. influences that may trigger the disorder.
Delirium is an acute deterioration in cognition, often with altered arousal

(drowsiness, stupor, or hyperactivity) and psychotic features (e.g. paranoia).
The main cognitive deficit in delirium is ‘inattention’, e.g. the patient is
distractible, cannot consistently follow commands, and loses the thread
during a verbal exchange. Delirium and dementia commonly co-exist,
however, with the latter there is a much slower deterioration in thinking,
perceiving and understanding, and inattention is much less prominent.
Because delirium is usually due to an interaction between multiple
predisposing and precipitating factors, management should be aimed at not
just finding and treating the assumed cause, but also optimising all aspects
of care
Part C -Text 1
Shedding Light on Complex Regional Pain Syndrome (CRPS)

Eleven years ago, Debbie had a routine bunion operation that changed
her life. Instead of finding relief, her pain grew worse, until it was
excruciating and constant. “I became disabled and had to stop working.
My foot is permanently in an air cast and I walk with a cane. Most of the
time the pain is a 10 out of 10,” she says. Debbie’s surgeon sent her to a
pain specialist, who recommended a psychiatrist. “I knew the pain wasn’t
in my head,” she says, but the medical community didn’t believe her. It
wasn’t until she met neurologist Anne Louise Oaklander that she finally
received a diagnosis: Complex Regional Pain Syndrome, or CRPS.
CRPS is a chronic pain condition that develops following trauma to a

limb, such as surgery or a fracture. As Debbie learned, “this is a very
controversial condition that not a lot of doctors understand,” says
Oaklander. “Historically, the field of medicine has been very sceptical of
patients with CRPS. On top of their illness, patients have had to navigate
a medical system that is suspicious of them and hasn’t had effective
treatment to offer. It adds insult to injury.” But those who treat CRPS are
hopeful the tide is turning. Recent attempts to better comprehend
CRPS have produced consensus guidelines for which patient outcomes
should be included in future research, as well as internationally agreed-
upon diagnostic criteria. Investigators are also learning more about the
causes of CRPS from laboratory studies.
CRPS starts off with a surprising amount of pain that doesn’t match the
initial trauma. In the first few months, instead of the expected healing,
patients describe an increase in pain levels. They often report that a cast
on the affected limb feels excessively tight and the sensation that the
limb might “explode,” says Candy McCabe, a CRPS clinician and
researcher at the University of the West of England, Bristol, UK. The limb
often swells, changes colour to red or purple, and is perceived by the
patient as either very cold or very hot. Changes in hair and nail growth,
and sweating are also common. Research from Oaklander’s lab has
identified persistent problems with certain neurons in patients’ injured
limbs. These nerve cells carry pain messages, but also control the small
blood vessels and sweat glands, explaining why patients have a
constellation of symptoms in addition to chronic nerve pain.
Many patients report that within a few days or weeks the limb feels
completely alien, and of a very different size and shape than it really is.
Many also describe very negative feelings toward the limb and a strong
desire to have it amputated. “In CRPS, the brain’s perception of the limb
changes pretty quickly,” McCabe says. The good news is that, while in
some cases CRPS becomes persistent, about 75% of people get better
without intervention, by six months to a year. “Getting a CRPS diagnosis
does not necessarily equate to a lifetime of disability,” she emphasises.
While the features mentioned above describe the “average” CRPS

patient, not everyone experiences the disease in the same way. Beyond
differences in the length and severity of the syndrome, different patients
report different symptoms as the most prominent and bothersome. For
some, movement problems cause the most difficulty, while for others, the
pain they experience may take centre stage. “The presentation of CRPS
is variable within a common picture, but unfortunately we don’t yet know
why these different scenarios happen,” says McCabe.
As reflected in the original name for CRPS, Reflex Sympathetic

Dystrophy, one of the earliest ideas about the biological underpinnings of
the condition is the presence of dysfunction of the sympathetic nervous
system, the network of neurons that governs the body’s automatic “fight
or flight” response. Currently, researchers believe that such alterations
are important in the initial generation and acute phase of CRPS. For
example, studies suggest that in the tibial fracture model, sympathetic
neurons release an immune system protein called interleukin-6 that
stimulates inflammation and pain. Andreas Goebel, a clinician and pain
researcher at the University of Liverpool, UK has identified a number of
autoantibodies, which are immune system proteins directed against a
person’s own tissues or organs, in the blood of people with chronic
CRPS.
The first CRPS trial is underway, to evaluate the efficacy and safety of
neridronate, a new bisphosphonate, which is a class of drugs already
widely used to prevent and treat osteoporosis. This is a placebo-
controlled clinical trial and has completed enrolment of 230 patients at 59
sites in the US and Europe. Debbie is one of the trial participants, and
has received several intravenous infusions. Neither she nor Oaklander
are aware as yet if she received neridronate or a placebo. “If this trial
finds neridronate to be safe and effective and receives approval to be
marketed for CRPS, it will be historic”, says Oaklander. “It’s only when
there’s an approved drug that there’s advertising, which increases public
awareness, and spurs doctors to learn more,” she adds. “I felt it was
important to participate in this trial because it makes a statement to the
world that CRPS is a real medical disease that deserves high quality
trials. This could be a landmark trial.”
7. In the first paragraph, the writer uses Debbie’s case to convey
A. The dangers of having even minor surgery

B. A lack of awareness of CRPS among the medical fraternity.
C. The psychological causes of pain experienced by CRPS sufferers.
D. That specialist attention is warranted in such instances
8. What is meant by the phrase the tide is turning in the second

paragraph?
A . Doctors now believe in the existence of CRPS.

B . Beneficial treatment is now more readily available.
C. Recent investigations are indicating a cure is in sight.
D. Possible reasons for the multitude of symptoms experienced.
9. Evidence mentioned in the third paragraph has revealed

A. Better post-operative care of limbs is needed.
B. Temperature patterns remain consistent throughout cases.
C. Further research is required into the possible causes of pain.
D. The medical community’s understanding is beginning to shift.
10. What do we learn about CRPS in the fourth paragraph?
A. Patients respond very differently to available treatment.

B. Professional diagnosis is necessary to see improvements.
C. Profound psychological impacts are often reported.
D. Amputation should only be performed when all else has failed.
11. In the fifth paragraph, what point is made about the symptoms of CRPS?
A. The length and severity of CRPS are quite consistent.

B. Pain is the dominant symptom for CRPS sufferers.
C. CRPS presents itself in a diverse number of ways.
12. What point is made about the sympathetic nervous system in the sixth
paragraph?
A. It only affects CRPS in the very early stages.

B. It causes CRPS following a fractured tibia.
C. It has a critical role from the outset of CRPS
D. It has less influence on CRPS than initially believed
13. Anne Louise Oaklander values the trials highly because
A. Of the inclusion of the recently created neridronate

B. They may help validate the authenticity of CRPS.
C. She gets to be a part of ground-breaking research
D. It is the first time a cohort of this size has been used
14. The final paragraph mentions that confirmation has yet to be received
regarding
A. Whether Debbie was given the neridronate infusion.

B. The final number of participant enrolments for the trial.
C. Having the backing of the entire medical community
D. The approval for public advertising campaigns
Part C -Text 2
Antibiotic Resistance now a global threat to public health

In 1945, Alexander Fleming, the man who discovered the first antibiotic said
in his Nobel Prize acceptance speech, “The time may come when
penicillin can be bought by anyone in the shops. Then there is the
danger that the ignorant may easily under dose themselves and by
exposing their microbes to non-lethal quantities of the drug, making them
resistant." A recent report from the Centres for Disease Control and
Prevention (CDC) revealed that more than 2 million people in the US
alone become ill every year as a result of antibiotic-resistant
infections, and 23,000 die from such infections.
The World Health Organization (WHO) has recently published their first
global report on the issue, looking at data from 114 countries. WHO
focused on determining the rate of antibiotic resistance to seven bacteria
responsible for many common infections, including pneumonia, diarrhoea,
urinary tract infections, gonorrhoea and sepsis. Their findings were
worrying. The report revealed that resistance to common bacteria has
reached "alarming" levels in many parts of the world, with some areas
already out of treatment options for common infections. For example,
they found resistance to carbapenem antibiotics used to tackle
Klebsiella pneumoniae - the bacteria responsible for hospital-acquired
infections such as pneumonia and infections in newborns - has spread to
all parts of the globe.
Dr Keiji Fukuda, WHO's assistant director-general for health security, said
of the report's findings: "Effective antibiotics have been one of the pillars of
recent generations, and unless we take significant actions to improve efforts
to prevent infections and also change how we produce, prescribe and use
antibiotics, the world will lose more and more of these global public health
goods that allow us to live longer, healthier lives, and the implications will
be devastating. We’re heading for a post-antibiotic era effectively wiping out
what is a marvel of modern medicine."
Bacteria have shown the ability to become resistant to an antibiotic with great
speed. “It’s true that they’ve saved millions of lives over the years, and
there’s also undoubtedly a growing worldwide need. But their use at any
time in any setting puts biological pressure on bacteria that promotes the
development of resistance. That’s where the blame lies, and only the
medical officer assumes this responsibility," says Dr Steve Solomon,
Director of the CDC's Office of Antimicrobial Resistance. “When antibiotics
are needed to prevent or treat disease, they should always be used. But
research has shown that as much as 50% of the time, antibiotics are
prescribed when they’re not needed or they’re dispensed incorrectly, such
as when a patient is given the wrong dose. Whether it's a lack of
experience or knowledge, or just the easier option, I really can’t say.”
Dr Charles Penn, coordinator of antimicrobial resistance at WHO, takes a

slightly different viewpoint from his peers. "One of many reasons why
antibiotic use is so high is that there is a poor understanding of the
differences between bacteria, viruses and other pathogens, and also of the
value of antibiotics," he said. "Too many antibiotics are prescribed for
viral infections such as colds, flu and diarrhoea. Unfortunately, these public
misconceptions are often perpetuated by marketing and advertising
campaigns through the use of generic terms such as 'germs' and 'bugs.' It’s
difficult to try and narrow down the blame to a single origin.”
Dr Penn noted that reliance on antibiotics for modern medical benefits has
contributed to drug resistance. "Surgery, cancer treatment, intensive care,
transplant surgery, even simple wound management would all become
much riskier, more difficult options if we could not use antibiotics to prevent
infection, or treat infections if they occurred," he said. "Similarly, we now take
it for granted that many infections are treatable with antibiotics, such as
tonsillitis, gonorrhoea and bacterial pneumonia. But some of these are now
becoming untreatable." Add to this the excessive and incorrect use of
antibiotics in food-producing animals since resistant bacteria can be
transmitted to humans through the food we eat, and you literally have a recipe
for disaster.
Dr Penn goes on to say, "Although many warnings about resistance were

issued, physicians, that is to say prescribers, became somewhat complacent
about preserving the effectiveness of antibiotics - new drugs always seemed
to be available. However, the pipeline for discovery of new antibiotics has
diminished in the past 30 years and has now run dry.” He noted,
however, that health care providers have now started to become more
vigilant in prescribing antibiotics. "Greater awareness of the urgency of the
problem has given new impetus to careful stewardship of existing
antibiotics. Medical practitioners are now heeding the warning that the
pioneer of the antibiotic gave all those years ago."
15. The writer quotes Alexander Fleming in the first paragraph to

A. Emphasise the impressive history of antibiotics.
B. Reveal the ease at which people may purchase antibiotics
C. Compare current usage of medication to an earlier time
D. Show that his prediction of antibiotic resistance was accurate
16. In the second paragraph, what does the writer find particularly
worrisome?
A. One particular antibiotic no longer provides resistance anywhere
B. New borns are quickly becoming resistant to all antibiotics
C. Resistance is at an all-time low for the most common infections
17. What is meant by one of the pillars in the third paragraph?
A. An innovation that changed the healthcare industry

B. A permanent fixture in the field of medicine
C. An essential component of the medical system
D. A remedy that is among the greatest inventions
18. According to Dr Steve Solomon, what is ultimately responsible for

antibiotic resistance?
A. Their everyday use for common diseases

B. The prescriber’s lack of experience
C. The increase in global demand
D. The medical professional’s misuse
19. In the fifth paragraph, Dr Charles Penn argues that when it comes to
antibiotic resistance
A. Increasing their cost would deter overuse
B. The general public should be held responsible
C. Mass media plays a crucial role in its demand
D. More understanding is needed to overcome it
20. In the sixth paragraph, Dr Penn gives examples of our dependence
on antibiotics to
A. Stress that substitute medications are needed.

B. Justify the need to change our habits
C. Show that it’s too late to reverse the damage
D. Highlight our lack of appreciation for current treatments
21. In the final paragraph, Dr Penn makes the point that medical
practitioners
A. Have depleted the supply of antibiotics through overuse
B. Were reluctant to take advice regarding antibiotics.
C. Once believed there was an endless supply of antibiotics.
D. Are yet to understand the damage caused by their actions.
22. In the final paragraph, the phrase heeding the warning refers to
A. Prescribers being attentive to the problem.
B. Doctors now issuing warnings to patients.
C. The medical community regretting their carelessness.
D. Practitioners looking ahead to a brighter future

1. C
2. B
3. A
4. D
5. A
6. C
7. B

8. major neurocognitive disorder
9. Alzheimer’s disease
10. executive function

11. specialist referral
12. psychiatric or psychogeriatric referral / psychogeriatric referral / psychiatric
referral / Psychiatric or psychogeriatric referral / Psychogeriatric referral /
Psychiatric referral
13. learning and memory
14. every 12 months / once a year / once per year

15. delirium
16. ability to live independently
17. no / zero / 0
18. cognitive
19. recognition of emotions
20. day to day objects / day-to-day objects

1. C
2. A
3. B
4. B
5. C
6. C
7. B
8. D
9. A
10. C
11. C
12. C
13. B
14. A
15. D
16. A
17. C
18. D
19. C
20. B
21. C
22. A
READING TEST 85
information.
PART A -TEXT BOOKLET - TRANSFUSION REACTION
Text A
INVESTIGATING ACUTE TRANFUSION REACTIONS
Immediately report all acute transfusion reactions with the exceptions of
mild hypersensitivity and non-haemolytic febrile transfusion reactions, to
the appropriate departments.
Record the following information on the patient’s notes:
 Type of transfusion reaction
 Length of time after the start of the transfusion and when the reaction
occurred
 Volume, type and pack numbers of the blood components transfused
Take the samples and send them to the appropriate laboratory

Immediate post-transfusion blood samples from a vein in the opposite arm:
 Group & Antibody Screen
 Direct Antiglobulin Test
 Blood unit and giving set should contain residues of the transfused
donor blood
Take the following samples and send them to the Haematology/ Clinical
Chemistry Laboratory for:
 Full blood count
 Urea
 Coagulation screen
 Electrolytes
 Creatinine
 Blood culture in an appropriate blood culture bottle
Complete a transfusion reaction report form.

Record the results of the investigations in the patient’s records for future
follow-up, if required.
Text B
RELEVANT
DRUGS & DOSES NOTES
EFFECTS
Name Route & Dosage
Oxygen 60-100% 1st line
500 micrograms im
Bronchodilator
Adrenaline repeated after 5 mins if 1st line
vasopressor
no better, or worse
Expand blood 0.9% - Saline, If patient hypotensive,
1st line
volume Gelufusine 20ml/kg over 5 minutes
2nd line
Reduce fever and
Oral or rectal Avoid aspirin containing
inflammatory Paracetamol
10mg/kg products if patient has
response
low platelet count
Inhibits histamine Chlorphenamine
IV 0.1 mg/kg 2nd line
mediated responses (Chlorpheniramine)
Inhibits immune By 5ml nebuliser

Salbutamol
mediated Use under expert 2nd line
bronchospasm Aminophylline
guidance
Adrenaline 6mg in
Vasopressor Use only under expert
100ml 5-10ml/hr
bronchodilator guidance
5% dextrose (6%)
Guidelines for recognition and management of acute transfusion reactions

Text C
Text D
Immediate Reaction - Life Threatening Situations
 Maintain airway and give high concentration oxygen by mask
 STOP the transfusion. Replace the giving set and keep the IV line open
 Manage as anaphylaxis protocol and ensure help is coming: stridor,
wheeze and hypotension require treatment with oxygen and adrenaline.
Critical Care admission.
 Notify consultant haematologist and Hospital Transfusion Laboratory
immediately.
 Send the blood unit with the giving set, freshly collected blood samples
with appropriate request form to the Hospital Transfusion Laboratory
for investigations.
 Check a fresh urine sample visually for signs of haemoglobinuria.
 Commence urine collection (24 hours) and record all intake and output.
Maintain fluid balance.
 Assess for bleeding from puncture sites or wounds.
 Reassess: 1. treat bronchospasm and shock as per protocol. 2.
Acute renal failure or hyperkalaemia may require urgent renal
replacement therapy.
PART A -QUESTIONS
Questions 1-7
In which text can you find information about...

1. the correct route for the administration of chlorphenamine?
2. the likely cause of rigors and fever?

3. the best way to describe patient symptoms?
4. initial steps to take when treating a critically ill patient?
5. the various symptoms of patients who have had a transfusion reaction?
6. where to document the findings of the appropriate investigations?
7. the effects of various medications for managing patient’s symptoms?
Questions 8-13
Answer each of the questions, 8-13, with a word or short phrase from one
of the texts.
Each answer may include words, number of the both. Your answers should
be correctly spelled.
8. For how long should a patient’s urine be collected and documented?

9. What should be used to appropriately transport a blood culture?
10. How long should 0.9% saline be given if the patient is hypotensive?
11. What type of admission is warranted for a patient experiencing stridor?
12. What might a category 3 patient show more than a twenty percent drop
in?
13. What is best avoided if the patient has a low platelet count?
Questions 14-20
Complete each of the sentences, 14- 20, with a word or short phrase from
one of the texts. Each answer may include words, number or both. Your
answers should be correctly spelled
14] A vein from the_______________ should be used for sample

collection if a reaction occurs following transfusion.
15] If a patient experiences pain close to the site of infusion, it’s likely to
be classified a ___________________ reaction.
16] A nebuliser should be used to administer ______________ at 5mg.
17] An assessment for bleeding from _____________ should be
conducted in an emergency situation
18] There is no need to report _______________ transfusion reactions if
they do indeed occur
19] Visual confirmation is sufficient to check for ___________________ in
a patient’s recent urine sample.
20] A patient may be considered __________________ if they experience
pruritus accompanied by a headache.
professionals .
Questions 1-6
1. The guidelines for infection control require dentists to
A. strictly abide by the rules set out within the document.
B. use their own judgement when putting the strategies into practice.
C. follow the example of well-established dental clinics.
1.12 Guidelines for Infection Control for Dental Practitioners

The routine work practises outlined here are designed to reduce the
number of infectious agents in the dental practice environment; prevent
or reduce the likelihood of transmission of these infectious agents from
one person or item/location to another; and make items and areas as
free as possible from infectious agents. It is important to acknowledge
that professional discernment is essential in determining the
application of these guidelines to the situation of the individual dental
practice environment. Individual dental practices must have their own
infection control procedures in place, which are tailored to their
particular daily routines. Professional awareness is critical when
applying these guidelines to the particular circumstances of each
individual dental practice. Each dental practitioner is responsible for
implementing these guidelines in their clinical practice and for ensuring
their clinical support staff are familiar with and able to apply them.
2. The email informs physiotherapists that
A. the option of consent ultimately lies with the patient.

B. information provided by the patient is confidential.
C. patient consent forms are a legally binding document.
To: All physiotherapists

From: Ken Macarthur, Head Physiotherapist
Subject: Patient consent forms
This is a courtesy email reminding all staff that it is standard practice to
not only provide the patient consent forms, but to also verbally go
through all aspects of the form with the patient prior to the
commencement of treatment. The purpose of this is to inform the patient
of their rights and how we address the issue of a collaborative decision
making and informed consent between physiotherapist and patient.
The patient’s condition and options for treatment must be discussed so
they are appropriately informed and are in a position to make decisions
relating to their treatment. They must also be informed that they may
choose to consent or refuse any form of treatment for any reason
including religious or personal grounds. Once they have given consent,
they may withdraw that consent at any time.
3. What does the policy for manual handling equipment tell employers?
A. All areas of the hospital should be fitted with overhead tracking.
B. Assistance devices should be used over physically handling the patient.
C. Patients have the final decision on how they should be assisted.
Policy for manual handling equipment

The provision of ceiling hoist technology and air assisted patient lifting
equipment should be considered as the first line handling aid by
employers as significant evidence exists that their use reduces operator
and patient injuries. Overhead tracking should be installed in all new or
refurbished facilities. This should cover beds as a minimum, but should
extend to ensuites and other areas of the facility where patients are
likely to require assistance. Once an assessment has been made that
equipment should be used for safe patient handling then equipment
should be made available and used, even in situations where the patient
and/or family’s preference is for it not to be used.
4. The purpose of the notice is to explain to occupational therapists that

A. confirmation of equipment is subject to availability at the time of request.
B. mattresses are of standard size so may not be suitable for all bed types.
C. patient factors must be considered prior to lodging a request form.
Equipment Request Form (ERF) for Pressure Care Mattresses

It is the responsibility of the occupational therapist attending to the
individual patient to submit an Equipment Request Form (ERF) based
on equipment eligibility criteria. A pressure mattress may be appropriate
when someone is at risk of a pressure injury as evidenced by
documented sound clinical reasoning and their pressure injury risk is
unlikely to significantly change. Environmental and equipment
considerations must be confirmed such as that a patient’s weight is
within the safe workload of the equipment requested. The size of the
mattress must also be compatible with other bed equipment and
accessories and the patient has been informed regarding the
contraindications of placing items (e.g. continence products,
sheepskins, electric blankets, ill-fitting bed sheets) on top of the
mattress. Only after this confirmation should an ERF be submitted.
5. The memo about use of smart phones during surgery tells staff that
A. their use may be a violation of patient confidentiality.
B. they are to be used only by the surgeon
C. they can potentially lead to patient harm.
Memo: Restricted use of smart phones during surgery.

As smart phone technology has become increasingly common, it is now
cause for concern when used within the operating rooms, especially as
a major source of distraction. For this reason, the use of smart phones
within the operating rooms will now be restricted.
The undisciplined use of smart phones - whether for telephone, email or
data communication, and whether by the surgeon or other members of
the surgical team may compromise patient care.
Whenever possible, members of the operating suite team should only
engage in urgent outside communication during surgery. Personal and
routine calls should be minimised and be kept as brief as possible.
Incoming calls should be forwarded to voicemail or to the reception desk
to be communicated promptly. Any use of a device or its accessories
must not compromise the integrity of the sterile field and special care
should be taken to avoid sensitive communications within the hearing of
awake or sedated patients.
6. The main point of the extract on subcutaneous cannulas is to explain

A. the versatility of their design and function.
B. that they must only be used by registered nurses.
C. the need for a backup cannula in case of malfunction.
Subcutaneous cannulas
A subcutaneous cannula is a small plastic tube designed to carry
medication into a person’s body. One end, inserted by a registered
nurse, sits just under the person’s skin. The other end divides into two
parts and is shaped like a Y. One part of the Y-arm can be connected to
a syringe driver or infusion pump; the other can be used for
subcutaneous injections. The nurse may insert a second cannula in a
different part of the body. This is in case the original cannula stops
working and ensures that there will be no delay in giving medications to
the person you are caring for. It can be especially useful if the original
cannula stops working at night when nurses may not readily available or
have the same level of support as during the day.
Part C -Text 1
Witnessed resuscitation attempts - a question of support.

The idea of supporting relatives who witness resuscitation is nothing new,
with research and reports going back to the 1980s. In 1996, the
Research Councils UK (RCUK) published a booklet called Should
Relatives Witness Resuscitation? Since then, practice has moved on, but
many of its core elements are still considered valid today. It was
suggested that family members who witness the resuscitation process
may have a healthier bereavement, as they will find it easier to come to
terms with the reality of their relative’s death, and may feel reassured
that everything possible has been done. It acknowledged that the reality
of CPR may be distressing, but argued that it is “more distressing for a
relative to be separated from their family member” at this critical time.
In the latest edition of its Advanced Life Support manual, the RCUK
remains adamant that “many relatives want the opportunity to be present
during the attempted resuscitation of their loved one.” But do they have
the right to demand it? ‘The resuscitation team and the nurse caring for
the patient have the responsibility of deciding whether to offer
relatives the opportunity to witness a resuscitation attempt’ says Judith
Goldman, clinician and researcher at the University of Michigan, USA.
‘Sometimes resuscitation teams may decide not to offer relatives the
option of witnessing resuscitation; but this should never be based on their
own anxieties rather than on evidence-based practice’.
When a patient is admitted to intensive care the question may be asked by
the medical team whether the patient would want CPR. This would also
provide an opportunity for witnessed resuscitation to be discussed with
patients and relatives upon admission. ‘The subject would have to be
approached sensitively, but ascertaining patients’ and/or relatives’ wishes
before an admission to intensive care would certainly help’ says Frank
Lang, researcher for the European Resuscitation Council. ‘Recent
studies show both public support for witnessed resuscitation and a
desire to be included in the resuscitation process and of those who have
had this experience; over 90% would wish do so again” he says.
‘Still, the decision regarding whether to be present during resuscitation

should be left to the individual person because it’s certainly not for
everyone,’ he adds. ‘Medical teams also need to gauge whether
witnessed resuscitation would have benefits for the patient and/or the
relatives, which can only be done through a holistic assessment of the
specific situation at the time. It needs to remain a personal approach’ he
says. What this way of thinking suggests is that regardless of research,
witnessing resuscitation can be traumatic for all involved, particularly
for family members, so it seems appropriate that health professionals
explain everything that is happening. Even more so that a member of
the team, ideally the nurse caring for the patient in cardiac arrest, be
designated for that role and remain with the family during the whole
process.
‘Nurses need to discuss the wishes of the patient and/or relatives as soon
as possible to act in the best interests of both while remaining non-
judgemental whatever the relatives decide, whether they choose to be
present or not, and support them in making the decision’ says Judith
Goldman. ‘Once it has been established that relatives want to be
present, the nurse should inform the resuscitation team leader, seek
their approval and ask them when the relatives should enter the
resuscitation area. The team who are providing direct care retains the
option to request that the family be escorted away from the bedside and/or
out of the room
if deemed appropriate’, she says.
Such decisions to request family removal are not taken lightly. ‘There are
the more obvious occasions that family members must be removed, for
instance, if they disrupt the work of the resuscitation team either through
excessive grief, loss of self-control, exhibit violent or aggressive
behaviour or try to become physically involved in the CPR attempt’ she
says. ‘But the team also need to consider times when during a
resuscitation attempt all members of staff are fully occupied and there is
no one available to stay with the family. This is especially hard for them to
take.’
If the family do remain present, and regardless of patient outcome,

providing assistance is crucial for families to get through such a stressful
and shocking event. Frank Lang recommends that ‘the nurse who is
directing the family should point them towards all or any available
support service within the hospital as well as towards professional
bereavement counselling outside of the hospital. The latter provides
distance from the scene and can help with symptoms of post-traumatic
stress disorder.’ Throughout any decision-making, however, it is clear that
the patient’s welfare, privacy and dignity must remain the utmost priority of
the resuscitation team.
7. In the first paragraph, the writer quotes the RCUK in order to
A. stress the significance of family involvement in resuscitation attempts.

B. show the significant benefits of family presence during resuscitation.
C. highlight that many now consider witnessed resuscitation outdated.
D. demonstrate that being witness to a resuscitation attempt is traumatic.
8. In the second paragraph, Judith Goldman says that witnessed

resuscitation should not be the sole decision of the resuscitation team.
A. needs to be made available to all families.

B. must not be denied because of personal feelings.
C. is requested by a large number of relatives.
9. In the second paragraph, the phrase ‘remains adamant’ is

used to
A. argue that relatives should have the ultimate decision.

B. show that the opinion of the RCUK has not changed.
C. express that greater understanding is needed from staff.
D. emphasise RCUK’s opposition to excluding family.
10. In the third paragraph, Frank Lang suggests that patients and family
members
A. would struggle to comprehend the process of CPR.
B. require follow up support from resuscitation teams.
C. have a good understanding of witnessed resuscitation.
D. would benefit from early consultation with staff.
11. In paragraph four, the writer believes that a team member present at
resuscitation attempts
A. should provide the family with constant reassurance.

B. will find the experience as stressful as family members.
C. should focus on the patient rather than the relatives.
D. needs to explain the process to each individual family member.
12. What does Judith Goldman regard as important during resuscitation?
A. establishing that the resuscitation team are in charge.

B. that relatives are instructed on whether to be present or not.
C. the point at which family members enter or leave the scene.
D. remaining courteous when requesting relatives to leave.
13. In the sixth paragraph, Judith Goldman suggests that families who
wish to be present
A. must understand that extra staff may not always be available.
B. at times struggle to understand why they cannot enter.
C. prefer to remain with the allocated member of staff.
D. are sometimes concerned about witnessing the resuscitation.
14. In the final paragraph, Frank Lang insists that despite the
outcome of the resuscitation attempt, families
A. are required to seek counselling as soon as appropriate.

B. should utilise the hospital network before outside assistance.
C. sometimes regret their decision to remain present.
D. will still often struggle to overcome the experience.
Part C -Text 2
A smoker’s right to surgery
Smokers who do not try or do not succeed in quitting should not be
offered a wide range of elective surgical procedures, according to an
editorial published in The Medical Journal of Australia. The authors
acknowledge this would be a controversial, overtly discriminatory
approach, but they say it is also evidence-based. Dr Matthew Peters and
colleagues from Concord Repatriation General Hospital say smokers who
undergo surgery have substantially higher risks, poorer surgical outcomes
and therefore consume more healthcare resources than non-smokers.
Surprisingly, these new concerns are not based on cardiac and respiratory
risks, but increased wound infection.
"A randomised study examining smoking cessation intervention before

joint replacement surgery, saw wound infection rates reduced from 27
per cent in continuing smokers to zero in those who quit smoking," Dr
Peters said. “Almost 8 per cent of breast reconstruction patients who
smoke experience abdominal wall site necrosis, compared with 1 per
cent of non-smokers. These results are obviously significant.” He
believes that its much better that the prioritisation occurs on the basis of
good evidence rather than on a whim or some political influence. "If there
was a health care system that had everything patients need and want
immediately, there wouldn’t be a problem. But we don’t have that and as
far as I’m aware no country truly does. You have to determine priorities,"
Peters says.
However, not everyone agrees. Professor Andrew Coats, dean of the

University of Sydneys faculty of medicine believes this is not accepted
medical treatment. “You do not arrange patients based on them being
more deserving or less deserving. You give treatment based on need
and how a person will benefit. It’s the urgency of that need that’s the
main factor." Coats says lifestyle factors should only affect treatment in
very limited circumstances. "If, because of lifestyle factors, a treatment is
not likely to work or it will be harmful, then obviously it should not proceed.
But we don’t take these factors into account in prioritising; that would be
the end of the healthcare system as we know it." He says if a doctor
believes a patient could give up smoking and therefore reduce
complication rates, they should encourage the patient to quit, but he says
you cannot withhold an operation as punishment for not giving up. "Many
people are not able to give up cigarettes. It is a real chemical condition."
Dr Mike Kramer, the Royal College of Surgeons representative agrees

that smokers need to be treated differently. "You need to take risk into
account. The risks of procedure versus the benefits, and that is affected
by the smoking status of the patient," he says. Kramer, a
cardiothoracic surgeon, says complications associated with smoking are
so significant he will delay an operation for the removal of a lung
cancer so a patient can stop smoking for a minimum of four weeks
before an operation. "This is not a moral judgement or an ethical
judgement. It is a pure clinical judgement for the benefits of a patients
outcome," he says.
There is also the heavy burden of financial pressure that must be

considered when dealing with the limited health dollar. Reverend
Norman Ford, the director of the Caroline Chisholm Centre for Health
Ethics, says while there should be no blanket ban or refusal for any
surgery, the allocation of public health funds needs to be taken into
account. "Why should non- smokers fork out for smokers?" Ford says
the additional costs of wound infection complications should be
calculated and smokers who refuse to quit before surgery should pay
the additional expense if wound infections occur. "If they give up smoking
they should be treated the same as non-smokers. If they dont give up
smoking they should pay the difference," he says. "Youve got to
motivate them to stop smoking and the pocket is a great motivator - if
theyve got it. So their ability to pay should be means tested.”
The essence of this argument comes down to the question of whether

people who are knowingly doing things that may be harmful to their
health are entitled to health care. Surgery is routinely performed on
diabetics, who also are at risk of increased postoperative complications.
If surgery can be denied to smokers, or even delayed, should the
same treatment, or lack thereof be given diabetics with poor glycaemic
control because they don’t comply with diet or medications? Refusing to
operate on smokers could land us on a very slippery slope, eventually
allowing surgeons to choose to operate only on low risk patients.
Perhaps it would be more prudent for physicians to educate their patients
about the risks of smoking, as well as other risk factors, prior to surgery
and entitle patients to make an informed decision about their healthcare.
15. What possible reason does the writer give for refusing current
smokers the opportunity for surgery?
A. the negative effects seen in systematic research

B. the overall increased costs to the hospital system
C. the known impact on the patient’s heart and lungs
D. the higher possibility of post-operative infection
16. In the second paragraph, Dr Peters says that prioritising patients
A. is unfortunately necessary.
B. is less expensive in the long run.
C. should start at a government level.
17. In the second paragraph, the writer uses the term ‘on a whim’ to show
Dr Peters’ belief that
A. further research should be carried out.

B. current healthcare systems are not adequate.
C. the findings of recent research are remarkable.
D. careful consideration is extremely important.
18. In the third paragraph, Professor Coates says that treatment should be
provided
A. to all patients based on a system of merit.
B. according to the necessity of the individual patient.
C. regardless of a patient’s lifestyle factors.
D. once a patient has reduced their intake of cigarettes.
19. What does Dr Mike Kramer regard as a significant factor when treating
a smoker?
A. the length of time a patient has refrained from smoking
B. providing an unbiased assessment of each individual
C. considering the ethical implications of each case
D. the patient’s attitude towards smoking cessation
20. In the fifth paragraph, Reverend Norman Ford says that when
considering the financial burden of healthcare
A. smokers should fund their own operations.
B. more public funding is needed to help smokers quit.
C. making a smoker pay incentivises change.
D. patients who smoke should not be held accountable.

21. In the fifth paragraph, what opinion is highlighted by the phrase ‘fork
out’?
A. Patients that continue to smoke should still have rights.

B. Those that don’t smoke have less complications.
C. The public should not bear the cost of smokers’ healthcare.
D. Non-smokers are less of a burden on public funding.
22. In the final paragraph, the writer argues that treating smokers
differently
A. is fair as other patients haven’t made such poor lifestyle choices.
B . could in turn lead to poor decisions concerning other patients.
C. may ultimately cause such patients to avoid having health checks.
D. may lead surgeons to discriminate against patients with diabetes.

1. B
2. C
3. A
4. D
5. C
6. A
7. B
8. 24 hours / twenty four hours (Text D)
9. (a) blood culture bottle/(an) appropriate blood culture bottle (Text A)
10. 5 minutes/five minutes (Text B)
11. Critical Care (admission) (Text D)
12. Systolic BP/blood pressure (Text C)
13. Aspirin containing products (Text B)
14. Opposite arm (Text A)

15. Category 3/life threatening (Text C)
16. Salbutamol (Text B)
17. Puncture sites or wounds (Text D)
18. Mild hypersensitivity and non-haemolytic febrile (Text A)
19. (signs of) haemoglobinuria (Text D)
20. Category 2/moderately severe (Text C)

1. A
2. A
3. B
4. B
5. C
6. A
7. A
8. C
9. B
10 D
11. A
12. C
13. B
14. D

15. D
16. A
17. D
18. B
19. A
20. C
21. C
22. B
METHOD OF ANSWERING
STEP 1.
FLASH READING
Flash reading refers to high-speed reading of the whole reading passage
in few minutes, without thinking anything in your head
(not even trying to guess meaning of the unfamiliar words/phrases). It
helps to provide a vague idea about the matters that are discussed in the
reading passage. It also forms a clear map in mind showing the order of
statements as they appear in the passage, which eases locating the
extract/paragraph referred in questions while answering.
STEP 2.
FOCUSED READING
After finishing flash reading, start answering the questions. Eliminate all
the irrelevant and impossible options from the multiple choices. Find a
quick fix on location of the extract/paragraph referred in the questions and
read the extract/paragraph quickly (strictly not more than twice, if it is a
paragraph and not more than thrice if it is a short extract) with complete
focus. Write the answer you had found only if you are sure enough.
If the answer is confusing (if you find more than one possible answer for
the question), write the answer you think to have more possibility to be
correct on your answer sheet, along noting the question and two or three
other possible answer for later reference. This will avoid wastage of time
due to fixating over confusing questions.
If the question is so tough that you fail to find a proper answer to it, then
leave it blank and note the question number for later reference.
Focused reading helps to answer all easy question in the reading test
correctly, instead of losing marks on them in the last minute rush.
STEP 3.
THOROUGH READING
After finishing all the questions in the test, you can start answering the
tough questions by reading thoroughly the referred extract/paragraph by
reading. Thorough reading refers to slow reading with maximum
concentration to find all possible meanings between the lines, so that you
arrive at a possible answer. Don’t read more than twice.
After finishing tough questions, start answering questions with confusing
answers in the same manner. If you follow these three steps you can
spend time wisely, while attending a reading test. Avoid wasting time by
going after tips for reading, when you are not getting desired results.
There are only two things that can improve your OET reading score:
1. Efficient management of time
2. Practicing more and more reading sample tests.
WORK HARD, SCORE MORE!
READING TEST 86
information.
PART A -TEXT BOOKLET - DISEASES OF AFFLUENCE

Text A
Tobacco
Tobacco smoking is also an important risk factor for cardiovascular
diseases. Currently, an estimated 967 million of the world’s 7.6 billion
smokers live in the developing world. Tobacco smoking increased among
men, followed by women, in industrialized nations in the last century, and
has subsequently declined in some nations such as Canada, the United
States, and the United Kingdom. Descriptive models based on historical
patterns in the industrialized world predict a reduction in the number of
male smokers and
an increase in the number of female smokers in the developing world over
the coming decades. However, there have been major recent
transformations in global tobacco trade, marketing, and regulatory control.
As a result, tobacco consumption among men and women in most nations
is primarily determined
by opposing industry efforts and tobacco control measures, and by the
socio- cultural context, rather than national income.
Text B
BMI
The observed rapid BMI increase with national income indicates that
preventing obesity, which may be more effective than reacting after it has
occurred, should be a priority during economic growth and urbanization of
a nation. Overweight and obesity are also important because they cause a
number of non- cardiovascular outcomes including cancers, diabetes, and
osteoarthritis which cannot be addressed by reducing risk factors such as
blood pressure and cholesterol. Current intervention options for obesity in
principle include those that reduce calorie intake and increasing energy
expenditure of a population through urban design which incorporates space
for outdoor activities.
Text C
Current Research
(WHO, 2018)
Background
Cardiovascular diseases and their nutritional risk factors—including
overweight and obesity, elevated blood pressure, and cholesterol—are
among the leading causes of global mortality and morbidity, and have
been predicted to rise with economic development in countries and
societies throughout the world.
Methods and Findings
We examined age-standardized mean population levels of body mass
index (BMI), systolic blood pressure, and total cholesterol in relation to
national income, food share of household expenditure, and urbanization in
a cross- country analysis. Data were from a total of over 100 countries and
were obtained from systematic reviews of published literature, and from
national and international health agencies. BMI and cholesterol increased
rapidly in relation to national income, then flattened, and eventually
declined. BMI increased most rapidly until an income of about I$ 5,000
(international dollars) and peaked at about I$ 12,500 for females and I$
17,000 for males. Cholesterol’s point of inflection and peak were at higher
income levels than those of BMI (about I$ 8,000 and l$ 18,000,
respectively). There was an inverse relationship between BMI/cholesterol
and the food share of household expenditure, and a positive relationship
with proportion of population in urban areas. Mean population blood
pressure was not significantly affected by the economic factors considered.
Conclusions
When considered together with evidence on shifts in income—risk
relationships within developed countries, the results indicate that
cardiovascular disease risks are expected to systematically shift to low and
middle income countries and, together with the persistent burden of
infectious diseases, further increase global health inequalities. Preventing
obesity should be a priority from early stages of economic development,
accompanied by measures to promote awareness of the causes of high
blood pressure and cholesterol.
Text D
Health Repercussions of Western Lifestyle
Factors associated with the increase of these illnesses appear to
be, paradoxically, things which many people would regard as
lifestyle improvements. They include:
Less strenuous physical exercise, often through increased use of

a car
Easy accessibility in society to large amounts of low-cost food
More food generally, with much less physical exertion expended
to obtain a moderate amount of food
More high fat and high sugar foods in the diet are common in the
affluent developed economies
Higher consumption of meat and dairy products -Higher
consumption of grains and white bread
More foods which are processed, cooked, and commercially
provided (rather than seasonal, fresh foods prepared locally at
time of eating)
PART A -QUESTIONS
Questions 1-7
In which text can you find information about

1. from where did the data for the research were collected?
2. name one important risk factor for cardiovascular diseases?
3. what does the observed rapid BMI increase with national income
indicate?
4. which types of foods are common in the affluent developed economies?
5. what can cause a number of non- cardiovascular outcomes?
6. what was the influence of economic factors on the mean population

blood pressure?
7. how many smokers are there in the developing world?
Questions 8-13
spelled.
8. Who conducted the current research on diseases of affluence?
9. How many countries contributed the data for the research?
10. What is the efficient way to minimize diseases of affluence?
11. What are the basis of description models that predicts number of
smokers?
12. What is the estimated population of the world?
13. Where did tobacco smokers increased in the last century?
Questions 14-20
texts. Each answer may include words, number or both. Your answers should be correctly
spelled
14 Cholesterol is one among the leading causes of __________ and

morbidity
15 Current intervention option for ______________ in principle include

reducing calorie intake
16. Overweight and obesity can cause _________________ outcomes

including cancers, diabetes, and osteoarthritis
17. Preventing obesity should be a priority during economic growth and

_______ of a nation.
18. There have been major recent transformations in global __________
marketing, and regulatory control.
19. There was an inverse relationship between BMI/cholesterol and the

food share of ________________
20. Factors of these illnesses are things which many people would regard as
_________________
professionals .
Questions 1-6
1. The manual informs us that the ultrasound machines

A. are used to give images of structures with the body.
B. have a printer attached for recording images.
C. poses negligible danger to the human body.
Ultrasound Machines
Diagnostic ultrasound machines are used to give images of structures

within the body. The diagnostic machine probes, which
produce the ultrasound, come in a variety of sizes and styles, each type
being produced for a particular special use. Some require a large trolley
for all the parts of the unit, while the smallest come in a small box with
only a audio loudspeaker as output. They may be found in cardiology,
maternity, outpatients and radiology departments and will often have a
printer attached for recording images. Unlike X-rays, ultrasound poses no
danger to the human body.
2. The guidelines establish that the healthcare professional should

A. must ensure proper safety protocols.
B. evaluate the radiation absorbed by bones and tissues.
C. respect the wishes of the patient above all else.
X-Ray Machines
X-rays are high energy electromagnetic waves. The transformer produces

a high voltage that directs electrons onto a target in the machine head. X-
rays are produced by the target and are directed into beams by a
collimator towards the human body. Soft body tissue absorbs less X-rays,
i.e., passes more of the radiation, whereas bone and other solids prevent
most of the X-rays from going through. Users must ensure proper
radiation safety protocols and supervision are in place.
3. The purpose of this email is to

A. inform biomedical waste rules are framed by the Central
Pollution Control Board.
B. inform users must beware of the systems that exist and follow local
procedures.
C. inform users must keep biomedical waste separate from other
waste.
Biomedical waste
Biomedical waste is all waste tissue and body fluids, including clinical
items contaminated with these. It is covered under the rules framed by the
Central Pollution Control Board. Hospital
management must take steps to segregate, manage and safely dispose
of this waste. Equipment users must be aware of the systems that exist
for this and follow local procedures. Most importantly, users must keep
biomedical waste separate from other waste.
4. The manual informs us that the intensive care units
A. are cleaned thrice a day
B. are wet cleaned more frequently
C. frequency of cleaning corresponds to nature of operation
Hygienic requirements for cleaning
All healthcare and social care facilities are wet cleaned daily and even
more frequently if necessary. According to the nature of the operation, the
floor must be suitable for this method of cleaning. In operating theatres
using invasive procedures, cleaning is carried out both pre and post
surgery for each patient. Intensive care units and the rooms for collecting
biological material are cleaned three times a day. The frequency of
cleaning in other workplaces corresponds to the nature of the operation. In
the event of
cleaning by a subject other than the healthcare or social care facility
provider, the designated worker must proceed according to the contract
and the disinfecting or cleaning rules.
5. The notice is giving information about

A. cleaning process before disinfection process
B. cleaning process before decontamination process
C. cleaning process after disinfection process
Decontamination
Decontamination procedures include mechanical cleaning, which removes

impurities and reduces the presence of microorganisms. In the event of
contamination by biological material, it is necessary to include mechanical
cleaning before the disinfection process. Detergents with a disinfectant
effect are applied manually or by washing and cleaning machines,
pressure guns, ultrasonic devices, etc. All tools and equipment must be
kept clean. Cleaning machines and other equipment are used in
accordance with the manufacturer’s instructions, including checks of the
cleaning process.
6. What must all staff involved in the physical disinfection process do?
A. Boil under atmospheric pressure for at least 20 minutes
B. Boil under atmospheric pressure for at least 30 minutes
C. Boil in pressurized containers for at least 30 minutes
Physical disinfection
• Boiling under atmospheric pressure for at least 30 minutes.
• Boiling in pressurized containers for at least 20 minutes.
• Disinfection in equipment at a temperature determined by parameter A.
The equipment must guarantee to reduce living microorganisms on the
disinfected object at a given temperature to a predetermined level suitable
for further use.
Part C -Text 1
Breast Cancer and the Elderly
Breast cancer is one of the highest-profile diseases in women in

developed countries. Although the risk for women younger than 30 years
is minimal, this risk increases with age. One-third of all breast cancer
patients in Sweden, for example, are 70 years or older at diagnosis.
Despite these statistics, few breast cancer trials take these older women
into account. Considering that nowadays a 70-year-old woman can
expect to live for at least another 12–16 years, this is a serious gap in
clinical knowledge, not least because in older women breast cancer is
more likely to be present with other diseases, and doctors need to know
whether cancer treatment will affect or increase the risk for these
diseases.
In 1992, guidelines were issued to the Uppsala/Örebro region in Sweden
(with a population of 1.9 million) that all women with breast cancer should
be able to receive equal treatment. At the same time, a breast cancer
register was set up to record details about patients in the region, to
ensure that the guidelines were being followed. Sonja Eaker and
colleagues set out to assess data from the register to see whether
women of all ages were receiving equal cancer treatment.
They compared the 5-year relative survival for 9,059 women with breast
cancer aged 50–84 years. They divided them into two age groups: 50–69
years, and 70–84 years. They also categorized the women according to
the stage of breast cancer. They looked at differences between the
proliferative ability of breast cancer cells, estrogen receptor status, the
number of lymph nodes examined, and lymph node involvement. The
researchers also compared types of treatment—i.e., surgical, oncological
(radiotherapy, chemotherapy, or hormonal)—and the type of clinic the
patients were treated in.
They found that women aged 70–84 years had up to a 13% lower chance
of surviving breast cancer than those aged 50–69 years. Records for
older women tended to have less information on their disease, and these
women were more likely to have unknown proliferation and estrogen
receptor status. Older women were less likely to have their cancer
detected by mammography screening and to have the stage of disease
identified, and they had larger tumours. They also had fewer lymph nodes
examined, and had radiotherapy and chemotherapy less often than
younger patients.
Current guidelines are vague about the use of chemotherapy in older
women, since studies have included only a few older women so far, but
this did not explain why these women received radiotherapy less often.
Older women were also less likely to be offered breast-conserving
surgery, but they were more likely to be given hormone treatment such as
tamoxifen even if the tumours did not show signs of hormone sensitivity.
The researchers suggest that this could be because since chemotherapy
tends to be not recommended for older women, perhaps clinicians
believed that tamoxifen could be an alternative.
The researchers admit that one drawback of their study is that there was
little information on the other diseases that older women had, which might
explain why they were offered treatment less often than younger patients.
However, the fact remains that in Sweden, women older than 70 years
are offered mammography screening much less often than younger
women— despite accounting for one-third of all breast cancer cases in
the country— and those older than 74 years are not screened at all.
Eaker and co-workers’ findings indicate that older women are urgently in
need of better treatment for breast cancer and guidelines that are more
appropriate to their age group. Developed countries, faced with an
increasingly aging population, cannot afford to neglect the elderly.
Q7. The main idea presented in paragraph one is that……

a. only older women need to be concerned about breast cancer.
b. breast cancer trials seldom consider older women.
c. breast cancer is more common than other diseases in older woman.
d. older woman do not take part in breast cancer trials.
Q8. Regarding cancer treatment, it can be concluded that….
a. doctors know cancer treatment will increase the risk of disease in
elderly patients.
b. cancer treatments may be a risk for all elderly people
c. it is unknown whether or not cancer treatments will affect the treatment
of other diseases in elderly people.
d. older woman are less likely to have other diseases
Q9. 1992 Guidelines issued to the Uppsala/Orebro region in Sweden stated

that…
a. Sweden has a population of 1.9 million.
b. women with breast cancer need to register their condition to ensure
they receive equal treatment.
c. identical breast cancer treatment should be available to women of all
ages.
d. all women with breast cancer should have access to equivalent
breast cancer treatment.
Q10. Which of the following was not part of Sonja Eaker and her colleagues
research?
a. Comparing ability of breast cancer cells to increase in number.
b. Grouping woman according to their survival rate.
c. Identifying differences in treatment methods.
d. Splitting the groups based on age.
Q11. Findings by the researchers indicate that…….
a. older women are less likely to have chemotherapy recommended.
b. older women prefer hormone treatment to breast-conversing surgery.
c. older women have fewer lymph nodes.
d. older women respond better to chemotherapy than to hormone

treatment.
Q12. The word vague is paragraph 5 means……

a. uncertain
b. unclear
c. unknown
d. doubtful
Q13. One limitation of the study is that…..

a. older women are treated less often than younger women.
b. older women have a lower incidence of breast cancer.
c. younger women are treated more often than older women.
d. there is a lack of information on other diseases which older women have.
Q14. Which of the following statements best represents the view expressed
by the writer at the end of the article?
a. Due to ageing population in developed countries, the needs of the
elderly must not be ignored.
b. Older women need more appropriate treatment to suit their age.
c. Developed countries have neglected the elderly for too long.
d. It is too expensive treat the elderly.
Part C -Text 2
Parents, Kids & Vegies

Most parents have waged epic battles with their kids over eating vegies.
But if they don’t clean their plate of the last brussels sprout, does it
really matter? Vegetables are behind some of the greatest battles
between parents and children. Most parents have dinnertime horror
stories involving small bits of vegetable and lots of screaming, and while
these stories can be entertaining, the research showing how few vegies
our kids are eating is not.
The 2009 Australian Institute of Health and Welfare national report card
found that a whopping 78 per cent of 4-8 year olds, 86 per cent of 9-13
year- olds and 95 per cent of 14-16 year-olds are not eating the
recommended daily servings of vegetables. Take out potatoes, which
most kids eat as chips, and the percentage of kids not getting the
nutrition they need jumps to 97, 98 and 100 per cent respectively. Other
research has made similar findings.
But Australian children are hardly going to starve if they don’t eat
vegetables and it’s not easy for parents to keep cooking meals that are
left on the plate or worse, tipped on the floor. Does it really matter if our
kids don’t eat their greens? Professor Louise Baur, paediatrician and
director of weight management services at The Children’s Hospital at
Westmead, says we all need to eat a wide variety of foods - including
vegetables - and children are no different. Research shows vegetable
consumption can help prevent chronic diseases such as heart disease,
type 2 diabetes and a range of cancers.
According to Australia’s dietary guidelines, children aged between four

and seven should be eating two to four serves of vegetables daily. Eight
to 11 year olds should be eating an extra serve; teenagers should have
between four to six serves every day. One serve of vegetables is one
cup of raw salad vegetables, one medium potato or half a cup of cooked
vegetables or legumes.
In the short-term, children who don’t eat vegetables can end up with
dental issues, constipation (especially if they skip on fruit as well) and
on rare occasions nutritional deficiencies, Baur says. But perhaps more
importantly, we tend to develop our eating habits in childhood, so if
you’re not eating vegetables and other healthy foods as a child then you
are less likely to do so as an adult.
Excess weight is also a problem; between 6-8 per cent of school age
children in Australia are obese and at least another 17 per cent are
overweight. You won’t automatically put on weight if you don’t eat
vegetables, Baur says, but children who don’t eat vegetables are often
eating foods that are high in saturated fats, sugar and salt. Children who
are overweight are more likely to become overweight or obese adults,
who are then at greater risk of chronic diseases.
And while the most hardened young vegie hater might enjoy an apple,
banana or piece of watermelon, Baur says fruit doesn’t contain the iron
and other minerals found in vegetables, and it also contains more
sugars. While fruit is an important part of a healthy diet, the dietary
guidelines suggest kids under 12 only need one to two serves a day. So
we know that kids need their vegies, but getting them to eat a mouthful,
let alone several cups can be a challenge.
Nutritionist Dr Rosemary Stanton suggests nutrition should be a whole

family affair; you can boost your child’s vegetable intake by eating your
evening meal together at the dinner table, preferably with the television
off. “Vegetables have traditionally been eaten mainly at dinner and with
many families no longer having a family meal, many kids get
themselves something to eat - often instant noodles, pizza or some
kind of pasta dish (rarely with vegies),” Stanton says.
Children are also more likely to eat and enjoy vegetables, and other
healthy foods, if they find them interesting, says Stanton. “Several
studies show that when kids grow vegies or attend a school with a
kitchen garden, they tend to eat more vegies… For those in flats, there
are community gardens in some areas, or if they have a balcony lettuces,
herbs, cherry tomatoes etc …can all be grown in pots.”
You can also pique your child’s interest in vegetables by including them
in a range of tasks, such as grocery shopping, going to markets or by
getting them to help prepare meals. Small children can toss a salad
(you can rewash any salad leaves that end up on the floor), and older
children can take on more difficult tasks, for example peeling and cutting
vegetables. But perhaps the most important thing parents can do is
model healthy eating. Research has shown children’s eating patterns
are affected by the family’s eating behaviour. Lisa Renn, spokesperson
for the Dietitians Association Australia, encourages parents to be
persistent.
She says there are many easy and crafty ways to get vegies off your
children’s plates and into their mouths:
• grate extra vegetables and add them to a favourite pasta sauce
• make green mash, add spinach or rocket when mashing potato
• serve vegie sticks with dips (think avocado, pumpkin or sweet potato)
and other snacks
• add extra vegetables or legumes to your next soup or stew
make muffins using vegetables - corn, pumpkin and sweet potato all
work well
She also suggests the scattergun approach: offering a wide variety of

vegetables (the more different colours the better) in small amounts
throughout the day, not just at dinner time. There’s no denying these
suggestions require time, effort and creative ‘marketing’. Ultimately,
says Renn, “you do what you can do, get them in where you can, be as
inventive as possible and be persistent”.
Q15. According to the passage what is the reason behind the battle
between parents & children?
a. over eating of vegies
b. not cleaning
c. vegetables
d. not eating vegies
Q16. Who stand first is avoiding vegies from daily servings?

a. 4-8 years
b. Teen years
c. 14-16 years
d. Kids
Q17. Why do parents feel discomfort in cooking vegetables?

a. Children won’t eat them
b. Vegetables will be in plates/ floors
c. Children will starve
d. b and c.
Q18. Who cannot be eliminated according to Prof. Louise?

a. diabetic patients
b. children
c. children prone to cancer
d. a and c
Q19. Along with a potato how munch vegetables should be taken in a
day?
a. a cup
b. a cup of cooked veggies
c. none of the above
d. a and b
Q20. Which has the less possibility to occur with eating les veggies?
a. Dental issues
b. Constipation
c. Deficiency
d. None
Q21. What will automatically happen when you are not eating
vegetables?
a. put on weight
b. reduce in weight
c. occurrence of obese
d. nothing will happen
Q22. Who needs 2 serves of vegetables a day according to the passage?

a. 4-7 years
b. 8-11 years
c. Below 12 years
d. A and c

1. C
2. A
3. B
4. D
5. B
6. C
7. A

8. WHO
9. 100
10. preventing obesity
11. historical patterns
12. 7.6 billion
13. industrialized nations
14. global mortality

15. obesity
16. non- cardiovascular
17. urbanization
18. tobacco trade
19. household expenditure
20. lifestyle improvements
1. B
2. A
3. C
4. A
5. A
6. B
7. b
8. c
9. d
10. b
11. a
12. b
13. d
14. a

15. d
16. b
17. b
18. b
19. c
20. c
21. d
22. d
READING TEST 87
information.
PART A -TEXT BOOKLET - JUNIOR SPORTS INJURIES
Text A
Junior Sports Injuries
Title: Patterns of injury in US high school sports: A review.
OBJECTIVE: To characterize the risk of injury associated with 10 popular

high school sports by comparing the relative frequency of injury and
selected injury rates among sports, as well as the participation conditions
of each sport.
DESIGN AND SETTING: A cohort observational study of high school

athletes using a surveillance protocol whereby certified athletic trainers
recorded data during the 2016-2017 academic years.
SUBJECTS: Players listed on the school’s team rosters for football,

wrestling, baseball, field hockey, softball, girls’ volleyball, boys’ or girls’
basketball, and boys’ or girls’ soccer.
MEASUREMENTS: Injuries and opportunities for injury (exposures) were

recorded daily. The definition of reportable injury used in the study
required that certified athletic trainers evaluate the injured players and
subsequently restrict them from participation.
RESULTS: Football had the highest injury rate per 1000 athlete-exposures
at 8.1, and girls’ volleyball had the lowest rate at 1.7. Only boys’ (59.3%)
and girls’ (57.0%) soccer showed a larger proportion of reported injuries for
games than practices, while volleyball was the only sport to demonstrate a
higher injury rate per 1000 athlete-exposures for practices than for games.
More than 73% of the injuries restricted players for fewer than 8 days. The
proportion of knee injuries was highest for girls’ soccer (19.4%) and lowest
for baseball (10.5%). Among the studied sports, sprains and strains
accounted for more than 50% of the injuries. Of the injuries requiring
surgery, 60.3% were to the knee.
CONCLUSIONS: An inherent risk of injury is associated with participation

in high school sports based on the nature of the game and the activities of
the players. Therefore, injury prevention programs should be in place for
both practices and games. Preventing re-injury through daily injury
management is a critical component of an injury prevention program.
Although sports injuries cannot be entirely eliminated, consistent and
professional evaluation of yearly injury patterns can provide focus for the
development and
evaluation of injury prevention strategies.
Text B
Literature review extract: Prevention of sports injuries.
... Langran and Selvaraj conducted a study in Scotland to identify risk
factors for snow sports injuries. They found that persons under 16 years of
age most frequently sustained injury, which may be attributed to
inexperience. They conclude that protective wrist guards and safety
release binding systems for ski-boards helps prevent injury to young or
inexperienced skiers and snowboarders. Ranalli and Rye provide an
awareness of the oral health care needs of the female athlete. They report
that a properly fitted, custom- fabricated or mouth-formed mouth-guard is
essential in preventing intraoral soft tissue lacerations, tooth and jaw
fractures and dislocations, and indirect
concussions in sports.
Although custom-fabricated mouth-guards are expensive, they have been
shown to be the most effective and most comfortable for athletes to wear.
Pettersen conducted a study to determine the attitudes of Canadian rugby
players and coaches regarding, the use of protective headgear. Although
he found that few actually wear headgear, the equipment is known to
prevent lacerations and abrasions to the scalp and may minimize the risk of
concussion.
Text C
Best practice guidelines for junior sports injury management and
return to play
When coaches, officials, sports first aiders, other safety personnel, parents
and participants follow the safety guidelines the risk of serious injury is
minimal. If an injury does occur, the golden rule in managing it is “do no
further damage”. It is important that the injured participant is assessed and
managed by an appropriately qualified person such as a sports first aider or
sports trainer. Immediate management approaches include DRABCD
(checking Danger, Response, Airway, Breathing, Compression and
Defibrillation) and RICER NO HARM (when an injury is sustained apply
Rest, Ice, Compression, Elevation, Referral and NO Heat, Alcohol, Running
or Massage). Young participants returning to activity too early after an injury
are more susceptible to further injury.
Before returning to participation the participant should be able to answer
yes to the following questions:
Is the injured area pain free?
Can you move the injured part easily through a full range of
movement?
Has the injured area fully regained its strength?
Whilst serious head injuries are uncommon in children and young peoples’
sport, participants who have lost consciousness or who are suspected of
being concussed must be removed from the activity. Prior to returning to
sport or physical activity, any child who has sustained an injury should
have medical clearance.
Text D
Research briefs on sports injuries in Canada
Approximately 3 million children and adolescents aged 14 and
under get hurt annually playing sports or participating in
recreational activities.
Although death from a sports injury is rare, the leading cause of
death from a sports-related injury is a brain injury.
Sports and recreational activities contribute to approximately 18
percent of all traumatic brain injuries among Canadian children
and adolescents.
The majority of head injuries sustained in sports or recreational
activities occur during cycling, skateboarding, or skating incidents
PART A -QUESTIONS
Questions 1-7
For each of the questions, 1-7, decide which text (A, B, C or
D) the information comes from. You may use any letter more
than once
1. what does ‘DRABCD’ stands for?
2. who conducted the study in Scotland to identify risk factors for snow
sports injuries?
3. when does majority of head injuries sustained in sports or recreational
activities occur?
4. what does ‘RICER NO HARM’ stands for?
5. who conducted the study among Canadian rugby players and coaches?
6. which game has highest injury rate in US high school sports?
7. what is the leading cause of death from a sports-related injury?
Questions 8-13
Answer each of the questions, 8-13, with a word or short phrase from one of
the texts.
Each answer may include words, number of the both. Your answers should
be correctly spelled.
8. What type of injuries are rare in children and young peoples’ sport?
9. Which equipment prevents lacerations and abrasions to the scalp?
10. Which game has lowest injury rate in US high school sports?
11. Which type of injury required surgery among majority players in US
high school sports?
12. What is the golden rule in managing an injury?
13. what is the most effective and most comfortable protective gear for
athletes?
Questions 14-20
Complete each of the sentences, 14- 20, with a word or short phrase from
one of the texts. Each answer may include words, number or both. Your
answers should be correctly spelled
14] Majority of head injuries sustained in sports or ______________ occur

during cycling, skateboarding, or skating incidents.
15] Preventing ______________________ through daily injury management
is a critical component of an injury prevention program
16] __________________ and safety release binding systems for ski-boards

helps prevent injury to skiers and snowboarders
17] __________ showed a larger proportion of reported injuries for games

than practices in US high school sports.
18] Prior to returning to sport, any child who has sustained an injury should
Have _______________________
19] Injured participant should be assessed and managed by

______________
20] Ranalli and Rye provide an awareness of the oral health care needs of
____________

professionals .
Questions 1-6
1.What does this manual tell us about platelet plug?

A. obstruct the aperture and contain the blood flow
B. occludes the aperture and continues the blood flow
C. open the aperture and stops the blood flow
Platelet function analyzer 100 system

It creates an artificial vessel consisting of a sample reservoir, a capillary,
and a biologically active membrane with a central aperture coated with
collagen plus ADP, or collagen plus epinephrine. The application of
constant negative pressure aspirates the anticoagulated blood of the
sample from the reservoir through the capillary and the aperture. A platelet
plug is formed which gradually occludes the aperture and ultimately the
blood flow through the aperture gradually decreases and eventually stops.
The time needed for blood flow interruption is recorded.
2. The purpose of these notes about an mannequins is to
A. introducing a form of substitute training.
B. give guidance on potentially dangerous procedures.
C. recommend a new procedure in a safe way.
Mannequins
Mannequins are a great way to familiarise yourself with a new procedure
and also maintain familiarity with a previously learnt procedure in a safe
way. They are especially useful for infrequently performed, potentially
dangerous procedures such as surgical chest drain insertion. Mannequins
alone are not an acceptable substitute for multiple supervised procedures
on ‘real’ patients. Other forms of substitute training include the use of
animal models, which carries ethical implications, and high-fidelity
simulation.
3. The email is reminding staff that log book should not
A. contain the frequency of procedures performed
B. have any personal details of patients
C. have any unique identifiers of patients
Logbooks and assessment forms

It is essential to keep a logbook of the practical procedures you perform.
Many professions have mandatory logbooks for all trainees provided by
their governing body. A logbook shows not only the number of
procedures performed but also how frequently and under what
circumstances. The logbook should not contain patients’ personal details,
although unique identifiers (e.g. their hospital number) are permitted.

A. sterilize medical equipment according to manufacturer’s
instructions
B. create, document, implement and maintain a certified quality
assurance system
C. kill all microorganisms capable of reproduction, including spores
Sterilization
Sterilization is the process that results in the killing of all microorganisms
capable of reproduction, including spores, and to the irreversible
inactivation of viruses and to killing medically significant worms and eggs.
Medical equipment and items intended for sterilization and pre-sterilization
preparation are used in accordance with the manufacturer’s instructions.
For sterilization of medical equipment, the healthcare provider will create,
document, implement and maintain a certified quality assurance system of
sterilization, including the controlled release of the medical equipment.
5. The guidelines require those undertaking hand washing
procedure to
A. rinse hands with warm water
B. rinse hands under flowing water
C. wash hands for almost 30 seconds
Hand washing procedure
• Rinse hands with water.

• Apply enough soap to cover the entire surface of the hands, using a
small amount of water to create the foam.
• Wash hands for at least 30 seconds.
• Rinse hands under the running water.
• Carefully dry the hands with a disposable towel.
• Avoid using hot water; repeated skin exposure to hot water can
increase the risk of damage to the skin.
6. This guideline extract says that the nurse in charge

A. should inform relatives about patient’s discharge if the patient’s health
condition requires it
B. should arrange transportation from the hospital if the patient’s
health condition requires it
C. should book an ambulance from the hospital if the patient’s health
condition requires it
Patient discharge
If the patient’s condition improves so that treatment can be continued
through an outpatient facility or at home, then the patient is discharged.
The patient may also be discharged at their own request, known as
DAMA, i.e. a declaration that they are leaving on their own request. The
release is decided by the attending doctor after consultation with the
senior consultant. After that the patient deals with the necessary matters,
such as transportation from the hospital and notifies their relatives. If the
patient is not collected by relatives, the nurse will book an ambulance if
the patient’s health condition requires it.
Part C -Text 1
Swine Flu Found in Birds
Last week the H1N1 virus was found in turkeys on farms in Chile. The UN
now says poultry farms elsewhere in the world could also become infected.
Scientists are worried that the virus could theoretically mix with more
dangerous strains. It has previously spread from humans to pigs. However,
swine flu remains no more severe than seasonal flu.
Chilean authorities first reported the incident last week. Two poultry farms
are affected near the seaport of Valparaiso. Juan Lubroth, interim chief
veterinary officer of the UN Food and Agriculture Organization (FAO), said:
“Once the sick birds have recovered, safe production and processing can
continue. They do not pose a threat to the food chain.”
Chilean authorities have established a temporary quarantine and have

decided to allow the infected birds to recover rather than culling them. It is
thought the incident represents a “spill-over” from infected farm workers to
turkeys. Canada, Argentina and Australia have previously reported spread
of the H1N1 swine flu virus from farm workers to pigs.
The emergence of a more dangerous strain of flu remains a theoretical risk.

Different strains of virus can mix in a process called genetic re-assortment
or recombination. So far, there have been no cases of H5N1 bird flu in
flocks in Chile. However, Dr Lubroth said: “In Southeast Asia there is a lot
of the (H5N1) virus circulating in poultry. “The introduction of H1N1 in these
populations would be of greater concern.”
Colin Butter from the UK’s Institute of Animal Health agrees. “We hope it is
a rare event and we must monitor closely what happens next,” he told BBC
News. “However, it is not just about the H5N1 strain. Any further spread of
the H1N1 virus between birds, or from birds to humans would not be good.
“It might make the virus harder to control, because it would be more likely to
change.”
William Karesh, vice president of the Wildlife Conservation Society, who
studies the spread of animal diseases, says he is not surprised by what
has happened. “The location is surprising, but it could be that Chile has a
better surveillance system. “However, the only constant is that the
situation keeps changing.”
The United States has counted 522 fatalities through Thursday, and nearly
1,800 people had died worldwide through August 13, U.S. and global
health officials said. In terms of mortality rate, which considers flu deaths
in terms of a nation’s population, Brazil ranks seventh, and the United
States is 13th, the Brazilian Ministry of Health said in a news release
Wednesday.
Argentina, which has reported 386 deaths attributed to H1N1 as of August

13, ranks first per capita, the Brazilian health officials said, and Mexico,
where the flu outbreak was discovered in April, ranks 14th per capita.
Brazil, Argentina, Chile, Mexico and the United States have the most total
cases globally, according to the World Health Organization.
The Brazilian Ministry of Health said there have been 6,100 cases of flu in
the nation, with 5,206 cases (85.3 percent) confirmed as H1N1, also
known as swine flu. The state of Sao Paulo had 223 deaths through
Wednesday, the largest number in the country. In addition, 480 pregnant
women have been confirmed with H1N1, of whom 58 died. Swine flu has
been shown to hit young people and pregnant women particularly hard.
Many schools in Sao Paulo have delayed the start of the second semester
for a couple of weeks, and students will have to attend classes on
weekends to catch up. Schools also have suspended extracurricular
activities such as soccer, volleyball and chess to try to curtail spread of the
disease.
Flu traditionally has its peak during the winter months, and South
America, where it is winter, has had a large number of cases recently.
The World Health Organization said this week that the United States and
other heavily populated Northern Hemisphere countries need to brace for
a second wave of H1N1 as their winter approaches
Officials at the Centres for Disease Control and Prevention and other U.S.
health agencies have been preparing and said this week that up to half of
the nation’s population may contract the disease and 90,000 could die
from it. Seasonal flu typically kills about 64,000 Americans each year.
A vaccine against H1N1 is being tested but is not expected to be available

until at least mid-October and will probably require two shots at least one
week apart, health officials have said. Since it typically takes a couple of
weeks for a person’s immunity to build up after the vaccine, most
Americans would not be protected until sometime in November. The World
Health Organization in June declared a Level 6 worldwide pandemic, the
organization’s highest classification.
Q7. Scientists are worried that the virus could potentially spread
a.) from pigs to humans
b.) to chicken and turkey farms elsewhere
c.) to other types of animals
d.) to the seaport of Valparaiso
Q8. What does Dr. Lubroth recommend should be done with the sick birds?
a.) They should be processed immediately.
b.) They should be killed.
c.) They should be allowed to recover.
d.) They should be given Tamiflu.
Q9. What is the meaning of the “spill-over” effect mentioned in the passage?
a.) The virus has spread from Chile to Argentina.
b.) The virus has spread from factory workers to birds.
c.) Turkey blood has been spilled during the production process.
d.) Turkeys have become infected by eating spilled contaminated pig food.
Q10. Which possibility is Dr. Lubroth most concerned about?
a.) H5N1 virus spreading to Chile
b.) H591 virus spreading to Australia
c.) H191 virus spreading to Asia
d.) H191 virus spreading to Canada
Q11. Which statement best describes the opinion of the representative from
the Institute of Animal Health?
a.) He doesnʼt want the virus to spread further because it could lead to
genetic reassortment.
b.) He thinks H5N1 is no longer important but he is worried about H1N1.
c.) He hopes that BBC News will pay more attention to closely monitoring
the virus.
d.) Birds and humans should be under more control otherwise the virus
may change.
Q12. Which statement best describes the opinion of the Vice President of
the Wildlife Conservation Society?
a.) He is not surprised that not enough people are studying the spread of
animal diseases.
b.) He is not surprised that swine flu has been reported in birds in Chile.
c.) He is surprised that the situation is constantly changing.
d.) He is surprised that swine flu has been reported in birds in Chile, but
suspects other countries may be unaware of the spread to birds.
Q13. According to the Brazilian Ministry of Health

a.) The United States has counted 522 fatalities.
b.) more people have died in Brazil than in the USA.
c.) more people have died in the USA than in Brazil.

d.) Brazil is the 13th worst country for swine flu deaths
Q14. Which of the following statements is FALSE?
a.) 52 pregnant women have died of Swine Flu in Brazil.
b.) Argentina has reported 386 H591 related deaths.

c.) Swine flu was first discovered in Mexico in April.
d.) The USA is one of the most severely affected countries annually.
Part C -Text 2
Alzheimer Disease
Physicians now commonly advise older adults to engage in mentally
stimulating activity as a way of reducing their risk of dementia. Indeed, the
recommendation is often followed by the acknowledgment that evidence of
benefit is still lacking, but “it can’t hurt.” What could possibly be the problem
with older adults spending their time doing crossword puzzles and
anagrams, completing puzzles, or testing their reaction time on a
computer? In certain respects, there is no problem. Patients will probably
improve at the targeted skills, and may feel good—particularly if the activity
is both challenging and successfully completed.
But can it hurt? Possibly. There are two ways that encouraging mental
activity programs might do more harm than good. First, they can falsely
raise expectations. Second, individuals who do develop dementia might be
blamed for their condition. When heavy smokers get lung cancer, they are
sometimes seen as having contributed to their own fates. People with
Alzheimer disease might similarly be viewed as having brought it on
themselves through failure to exercise their brains.
There is some evidence to support the idea that mental exercise can
improve one’s chances of escaping Alzheimer disease. Having more
years of education has been shown to be related to a lower prevalence of
Alzheimer disease. Typically, the risk of Alzheimer disease is two to four
times higher in those who have fewer years of education, as compared to
those who have more years of education. Other epidemiological studies,
although with less consistency, have suggested that those who engage in
more leisure activities have a lower prevalence and incidence of
Alzheimer disease. Additionally, longitudinal studies have found that older
adults without dementia who participate in more intellectually challenging
daily activities show less decline over time on various tests of cognitive
performance.
However, both education and leisure activities are imperfect measures of

mental exercise. For instance, leisure activities represent a combination of
influences. Not only is there mental activation, but there may also be
broader health effects, including stress reduction and improved vascular
health— both of which may contribute to reducing dementia risk. It could
also be that a third factor, such as intelligence, leads to greater levels of
education and more engagement in cognitively stimulating activities, and
independently, to lower risk of dementia. Research in Scotland, for
example, showed that IQ test scores at age 11 were predictive of future
dementia risk .
The concept of cognitive reserve is often used to explain why education

and mental stimulation are beneficial. The term cognitive reserve is
sometimes taken to refer directly to brain size or to synaptic density in the
cortex. At other times, cognitive reserve is defined as the ability to
compensate for acquired brain pathology. Taken together, the evidence is
very suggestive that having greater cognitive reserve is related to a
reduced risk of Alzheimer disease. But the evidence that mental exercise
can increase cognitive reserve and keep dementia at bay is weaker. In
addition, people with greater cognitive reserve may choose mentally
stimulating leisure activities and jobs, which makes is difficult to precisely
determine whether mentally stimulating activities alone can reduce
dementia risk.
Cognitive training has demonstrable effects on performance, on views of
self, and on brain function—but the results are very specific to the skills
that are trained, and it is as yet entirely unknown whether there is any
effect on when or whether an individual develops Alzheimer disease.
Further, the types of skills taught by practicing mental puzzles may be less
helpful in everyday life than more straightforward techniques, such as
concentrating, or taking notes, or putting objects in the same place each
time so that they won’t be lost.
So far, there is little evidence that mental practice will help prevent the
development of dementia. There is better evidence that good brain health
is determined by multiple factors, that brain development early in life
matters, and that genetic influences are of great importance in accounting
for individual differences in cognitive reserve and in explaining who
develops Alzheimer disease and who does not. At least half of the
explanation for individual differences in susceptibility to Alzheimer disease
is genetic, although the genes involved have not yet been completely
discovered. The balance of the explanation lies in environmental
influences and behavioral health practices, alone or in interaction with
genetic factors. However, at this stage, there is no convincing evidence
that memory practice and other cognitively stimulating activities are
sufficient to prevent Alzheimer disease; it is not just a case of “use it or
lose it.”
Q15. According to paragraph 1, which of the following statements matches

the opinion of most doctors?
a. Mentally stimulating activities are of little use
b. The risk of dementia can be reduced by doing mentally
stimulating activities
c. The benefits of mentally stimulating activities are not yet proven
d. Mentally stimulating activities do more harm than good
Q16. In paragraph 2, the author expresses the opinion that …….

a. Mentally stimulating activities may offer false hope
b. Dementia sufferers often blame themselves for their condition
c. Alzheimer’s disease may be caused lack of mental exercise
d. Mentally stimulating activities do more harm than good
Q17. In paragraph 3, which of the following does not match the information
on research into Alzheimer disease?
a. People with less education have a higher risk of Alzheimer disease
b. Cognitive performance can be enhanced by regularly doing
activities which are mentally challenging
c. Having more education reduces the risk of Alzheimer disease
d. Regular involvement in leisure activities may reduce the risk of Alzheimer
disease
Q18. According to paragraph 4, which of the following statements is false?

a. The impact of education and leisure is difficult to measure
b. Better vascular health and reduced stress can decrease the risk of
dementia
c. People with higher IQ scores may be less likely to suffer from dementia
d. Cognitively stimulating activities reduce dementia risk
Q19. Which of the following is closest in meaning to the expression: keep
dementia at bay?
a. delay the onset of dementia
b. cure dementia
c. reduce the severity of dementia
d. treat dementia
Q20. Which of the following phrases best summarises the main idea
presented in paragraph 6?
a. The effect cognitive training has on Alzheimer disease is limited
b. Doing mental puzzles may not be as beneficial as concentrating
in everyday life
c. Cognitive training improves brain performance
d. The effect cognitive training has on Alzheimer disease is indefinite
Q21. According to paragraph 7, which of the following is correct regarding

the development of dementia?
a. Genetic factors are the most significant
b. Environmental factors interact with behavioural factors in
determining susceptibility to Alzheimer disease
c. Good brain health can reduce the risk of developing Alzheimer disease
d. None of the above
Q22. Which of the following would be the best alternative title for the essay?
a. New developments in Alzheimer research
b. Benefits of education in fighting Alzheimer disease
c. Doubts regarding mental exercise as a preventive measure for
Alzheimer disease
d. The importance of cognitive training in preventing early onset of
Alzheimer disease

1. C
2. B
3. D
4. C
5. B
6. A
7. D

8. serious head injuries
9. protective headgear
10. volleyball
11. knee injuries
12. do no further damage
13.custom-fabricated mouth-guards
14. recreational activities

15. re-injury
16. protective wrist guards
17. soccer
18. medical clearance
19. an appropriately qualified person
20. the female athlete
1. A
2. A
3. B
4. A
5. B
6. C
7. b
8. c
9. b
10. a
11. b
12. c
13. d
14. b

15. c
16. a
17. b
18. d
19. a
20. d
21. a
22. c
READING TEST 88
information.
PART A -TEXT BOOKLET – MANAGEMENT OF MIGRAINE IN NEW ZEALAND

GENERAL PRACTICE
Text A
OBJECTIVES: To determine the proportion of patients who have a
diagnosis of migraine in a sample of New Zealand general practice
patients, and to review the prophylactic and acute drug treatments used
by these patients.
DESIGN, SETTING AND PARTICIPANTS: A cohort of general
practitioners collected data from about 30 consecutive patients each as
part of the BEACH (Bettering the Evaluation and Care of Health) program;
this is a continuous national study of general practice activity in New
Zealand. The migraine sub study was conducted in June-July 2017 and
December 2017- January 2018.
MAIN OUTCOME MEASURES: Proponion of patients with a current
diagnosis of migraine; frequency of migraine attacks; current and previous
drug treatments; and appropriateness of treatment assessed using
published guidelines.
RESULTS: 191 GPs reported that 649 of 5663 patients (11.5%) had
been diagnosed with migraine. Prevalence was 14.9% in females and
6.1% in males. Migraine frequency in these patients was one or fewer
attacks per month in 77.1% (476/617), two per month in 10.5% (65/617),
and three or more per month in 12.3% (76/617) (missing data excluded).
Only 8.3% (54/648) of migraine patients were currently taking
prophylactic medication.
Patients reporting three or more migraines or two migraines per month
were significantly more likely to be taking prophylactic medication (19.7%
and 25.0%, respectively) than those with less frequent migraine attacks
(3.8%) (P
< 0.0001). Prophylactic medication had been used previously by 15.0%
(96/640). The most common prophylactic agents used currently or
previously were pizotifen and propranolol; other appropriate agents were
rarely used,
and inappropriate use of acute medications accounted for 9% of
‘prophylactic treatments’. Four in five migraine patients were currently
using acute medication as required for migraine, and 60.6% of these
medications conformed with recommendations of the National Prescribing
Service.
However, non-recommended drugs were also used, including opioids
(38% of acute medications).
CONCLUSIONS: Migraine is recognised frequently in New Zealand
general practice. Use of acute medication often follows published
guidelines.
Prophylactic medication appears to be underutilised, especially in patients
with frequent migraine. GPs appear to select from a limited range of
therapeutic options for migraine prophylaxis, despite the availability of
several other well documented efficacious agents, and some use
inappropriate drugs for migraine prevention.
Text B
Table 1: Economic burden of migraine in the USA
Cost element Men (US$) Women(US$) Total(US$)
Medical 193 1,033 1,226
Missed workdays 1,240 6,662 7,902
Lost productivity 1,420 4,026 5,446
Total 14,574
Text C
Case 1:
‘Jane’ experienced pressure from employers due to her migraine
absences. She had three days off work in the first quarter of the year, and
this was deemed unacceptable and unsustainable by her employers;
therefore, she has just resigned from her job and hopes that her future
employers will be more understanding.
Case 2:
‘Sally’s’ employers and colleagues are aware of her migraine symptoms
and are alert to any behaviour changes, which might indicate an
impending attack. In addition, colleagues have supporters’ contact
numbers, should she need to be escorted during a migraine. As her
employers are pan of the government ‘Workstep Programme’, she has
accessed a number of allowances and initiatives: her migraines have
been classified as a long-term health condition rather than sickness
absence, which permits her a higher absence threshold. She now works
flexible hours and has received funding for eye examinations, prescription
glasses, and a laptop to enable her to work from home.
Text D
Research brief on migraines in the US
Migraine prevalence is about 7% in men and 20% in women

over the ages 20 to 64.
The average number of migraine attacks per year was 34 for
men and 37 for Women.
Men will need nearly four days in bed every year. Women will
need six.
The average length of bed rest is five to six hours.
Only about 1 in 5 sufferers seek help from a
doctor.
PART A -QUESTIONS
Questions 1-7
For each of the questions, 1-7, decide which text (A, B, C or D) the information
comes from. You may use any letter more than once
1. what is the average length of bed rest?
2. Does employee experience pressure from employers due to migraine
absences?
3. which patients are more likely to take prophylactic medication?
4. what does ‘BEACH’ stands for?
5. how much economic burden does migraine causes in the US?
6. which government program gives allowances for migraine patients?
7. what type of drugs are popular non-recommended drugs for migraine?
Questions 8-13
spelled.
8. Which are the most common prophylactic agents used?
9. What is the migraine prevalence among women over the ages 20 to
64 in the US?
10 .How many migraine patients are currently taking prophylactic medication
in New Zealand?
11. What is the migraine prevalence among men in New Zealand?
12. How many GPs reported patients who had been diagnosed with migraine
in New Zealand ?
13. What is the average length of bed rest for migraine in the US?
Questions 14-20
texts. Each answer may include words, number or both. Your answers should be correctly
spelled
14. In the US, only about 1 in 5 sufferers seek help from a

______________
15. _________________ appears to be underutilised in patients with

frequent migraine
16. In New Zealand inappropriate use of _____________ accounted for 9%
of ‘prophylactic treatments’
17. The average number of migraine attacks per year was 37 for
________________ in the U.S
18. The study concluded that migraine is recognized_____________ in New
Zealand general practice.
19. In New Zealand, GPs appear to select from a limited range of
______________________ for migraine prophylaxis.
20.Women will need nearly _____________________ days in bed every

year in the US.
professionals .
Questions 1-6
involve children in
A. all discussions even if consent does not lie with the child
B. most possible discussions even if consent does lie with the child
C. most convenient discussions even if consent does not lie with the
child
Children and consent

The law regarding children’s consent is complicated and regularly
updated. The healthcare professional should involve children as much as
is practicably possible in discussions about their care; this is the case
even if the ultimate decision or ‘consent’ does not lie with the child. In the
UK and most of the developed world a young person is assessed on an
individual basis on their ability to understand and weigh up options, rather
than on their age. This ability to take decisions is known as ‘Gillick’
competence and originated from a court case regarding the prescription
of oral contraceptives to young people under the age of 16.
2. The guidelines require those undertaking a surgical scrub to

A. apply a bactericidal, detergent, surgical scrub solution to warm
hands
B. ensure hands are positioned so as to avoid soap and water

running onto
C. dry thoroughly by patting with non-sterile paper towels
Surgical scrub
This involves the use of a chemical disinfection and prolonged
washing to physically remove and kill surface organisms in the
deeper layers of the epidermis. This should be done before any
invasive or surgical procedure.
• Apply a bactericidal, detergent, surgical scrub solution to wet hands
and massage in using an 8-point technique, extending the wash to
include the forearms.
• Ensure the hands are positioned so as to prevent soap and water
running onto and contaminating the hands from unwashed areas of the
arms.
• Rinse in warm water.
• Dry thoroughly by patting with sterile paper towels.
3. The email is reminding staff that the risk of infection does not
A. vary depending on the type of bloodborne virus
B. varies depending on the infectivity of the source patient
C. varies depending on the contaminated instrument
Needlestick injury
Needlestick or sharps injuries are a daily risk for healthcare workers and
can lead to infection with bloodborne viruses (BBVs) such as hepatitis or
HIV. The risk of infection following a single sharps (percutaneous) injury
varies depending on the type of BBV. The risk is approximately:
• 1 in 3 if the instrument is contaminated with hepatitis B
• 1 in 30 if the instrument is contaminated with hepatitis C
• 1 in 300 if the instrument is contaminated with HIV, though this
depends on the infectivity of the source patient.
4. The email is reminding staff that the

A. immobile patients must be very attentive
B. immobile patients must be well taken care of
C. immobile patients must be also taken care of
Equipment for patient safety

The side rails are the most commonly used equipment in order to reduce
the risk of falling. Older types are removable side rails, although side rails
that are part of the bed are more frequently used. Side rails can be
lowered.
Procedure for lowering side rails: First, press the small tab on the side of
the rails, then the round button and hold the rails with your other hand
while lowering them. Staff must be very attentive with immobile patients –
i.e, check the position of the parts of the body (e.g. hands) when lowering
the side rails to avoid injury.
5. What does this extract from a handbook tell us about
immobility problems?
A. are addressed by rehabilitation by a physiotherapist doctor prescribed
B. are seen patients with coma and lower limb fractures
C. are seen patients with coma, lower limb fractures and bronchial
asthma
Immobility levels:
• Complete immobility – e.g. patient in a coma
• Partial immobility – e.g. patients with lower limb fractures
• Limited activity associated with disease – e.g. patients with
bronchial asthma
Mobility and immobility problems are addressed by rehabilitation, which
extends to physiotherapy knowledge and practical skills. The job of the
physiotherapist and as prescribed by a doctor, is to practice movement,
deep breathing using breathing techniques etc. with the patient. The
nurse, in collaboration with the patient, continues with the exercise and
in maintaining mobility throughout the day and checks the functioning of
the patient’s proper position, while the position of immobile patients is
adjusted at regular intervals.
6. When preparing patients for a procedure, it is necessary to
A. clearly explain, describe and possibly demonstrate on them

B. include both verbal and nonverbal communication
C. inform of the procedure they will be partaking in
Patient preparation
It is important that the patient is informed of the procedure they will be
partaking in. The procedure should be clearly explained, described, and
possibly demonstrated on them. Verbal and nonverbal communication
between the staff and the patient is very important. Communication with
the patient should be by short and simple sentences according to their
mental level, their ability to receive and follow instructions and the
degree of willingness to cooperate. Communicating with understanding
and open minded people makes it easier to gain their trust and
cooperation.
In this part of the test, there are two texts about different aspects of
healthcare.
Part C -Text 1
OBESITY IS THE BIGGEST PUBLIC HEALTH HURDLE OF

THE CENTURY
Like many nations, Australia is in the throes of an unprecedented
epidemic of obesity and type 2 diabetes – an epidemic in acceleration
mode. Over the last week, more than 2500 scientists have been in
Sydney for the 10th International Congress of Obesity. The theme of the
congress was “From Science to Action”. Its aim has been to produce
workable strategies to counter the obesity pandemic and to deliver to
communities and governments the leadership that only a meeting of this
significance and magnitude can offer.
Obesity is the single most important challenge for public health in the
21st century. More than 1.5 billion adults worldwide and 10 per cent of
children are now overweight or obese. Yes the world’s waistline in
bulging – some cynics call the phenomenon “Globesity”. Professor
Phillip James, chairman of the International Obesity Task Force,
warned the congress that it is sweeping the world with terrifying
rapidity.
Obesity is the driving force behind type 2 diabetes, which causes

significant cardiovascular complications, kidney failure, blindness and
amputations. This is leading to decreased life expectancy from type 2
diabetes, cardiovascular disease and some forms of cancer.
The selection of Sydney as the host city for the conference was made
eight years ago, but in the meantime Australia has assumed the not-
so-welcome honour as the nation with one of the fastest-growing rates
of obesity in the world. The 2000 AusDiab study, undertaken by the
International Diabetes Institute, showed that more than 60 per cent of
our adult population is overweight or obese, along with 20 per cent of
our children. It is a tripling in numbers over the last 20 years.
The Pharmaceutical Benefits Scheme subsidised the obesity-related

conditions diabetes and heart disease by more than $2 billion last year,
and the costs are still rising. This is replicated in many nations and this
“diabesity” pandemic is now set to bankrupt health budgets all over the
world. Emerging from the conference was some important new
scientific research.
In the last decade, fat has moved from being viewed as inert “blubber” to
probably the most active endocrine (hormonal) organ in the human
body. It makes a vast range of chemical substances vital to body
function – from control of appetite, energy balance, our immunity and
blood clotting, to regulation of insulin and other hormonal actions. Fat in
the abdominal cavity, the “Aussie beer gut” makes chemicals that cause
type 2 diabetes and heart disease.
On the public health side, VicHealth CEO Robert Moodie, noted that
there was a role for government regulation and, without it, we will not
be able to curb the epidemic. He said that the contemporary
environment promotes obesity. The obesity diabetes epidemic will
continue unless we accept that many years of health promotion aimed
at individuals seem to have had virtually no effect.
Our own state and local governments may have inadvertently

contributed to this epidemic by allowing developers to create urban
social problems. New developments lack proper attention to sidewalks,
bike paths, public transport corridors, playing fields and friendly
exercise areas that are essential to maintain a healthy lifestyle.
We can rejoice that obesity has implanted itself firmly on government

radars. Tackling obesity and its consequences has been taken to a new
political level. Our federal and state governments have recognised the
need for action to tackle obesity and diabetes through the Better Health
Initiative. Federal Health Minister Tony Abbot and John Howard have
been powerful advocates of action – with certain reservations such as in
the area of banning TV advertising
We don’t have the luxury of time to deal with the epidemic – it’s as big
a threat as global warming and bird flu. Solutions are urgently needed,
and involve more basic issues than more exercise and correcting diet.
The way ahead for us to address this “globesity” crisis is not for obesity
researchers, scientists, health professionals and politicians to live in
their silos with pet beliefs on issues of taxing junk foods and banning
TV advertising. What is needed is a big- picture approach, and to
acknowledge our lives and the environment have changed in the last
20 or 30 years.
Just three weeks ago, Professor Phillip James and I wrote an editorial
for the Medical Journal of Australia (2006;185:187-8) which outlined
some key legislative and regulatory measures that are required to turn
the epidemic around, particularly in relation to childhood obesity. We
need urban planning to help people exercise more, physical activity
reintroduced into curricula, nutrition education in schools, production
and availability of cheap healthy foods, and responsible labelling and
advertising.
At the congress, a major topic was the call by many for bans on
marketing and TV advertising to children. While this seems sensible,
the evidence that it translates into reduced obesity rates is not yet
available. Certainly stronger guidelines are needed, and we may need
to implement guidelines for food labelling. Currently, labels cannot be
understood by consumers – and health claims are often misleading.
Looking at the big picture, the prevention of obesity and type 2 diabetes
requires co-ordinated policy and legislative changes, with greater
attention on our urban environment, transportation infrastructure, and
workplace opportunities for education and exercise. Governments –
local, state and federal should commit to optimising opportunities for
exercise in a safe environment. A multidisciplinary, politically driven, co-
ordinated approach in health, finance, education, sports and agriculture
can contribute to reversing the underlying causes of the obesity
epidemic. This may well be the single and most important challenge for
public health in the 21st century. It is a battle than we can and must win.

7. According to the article, in Australia
a) There are more overweight children than adults
b) Australia has the fastest growth rate of obesity
c) In the past 2 decades Australia’s rate of obesity has increased 3 fold.
d) None of the above
8. Which among the following describes the term ‘inadvertently’?
a. Without knowledge
b. Without advertising
c. Without acting or without participating
d. without intending to or without realizing
9. According to Robert Moodie

a) Government regulation will not help lessen the epidemic
b) Modern lifestyle encourages obesity
c) Health promotion is a good way to reduce obesity
d) Obesity is a bigger problem than diabetes
10. ‘to curb something’ means
a. To destroy something
b. To cut something
c. To control or limit something
d. To stop something
11. Which of the following statements are true

a) New suburbs do not encourage people to develop a healthy routine
b) Australians have too much time to enjoy luxury foods
c) John Howard and Tony Abbot support prohibiting TV advertisements
d) obesity is a greater danger than bird flu & global warming
12. Professor Philip James believes

a) Advertisements must be labelled
b) Make healthy food more affordable
c) Physical education reduces academic levels
d) Education is necessary to encourage people to exercise
13. According to the article it can be concluded that

a) Lack of exercise is the number one cause of obesity
b) Modern lifestyle is not as healthy as a traditional lifestyle
c) Obesity and type 2 diabetes can only be reduced if governments
are involved in the process
14. Which among the following describes the word ‘cynic’ in the passage?
a. Somebody who is crucial to society
b. Somebody who is critical and sarcastic
c. Somebody who is determined
d. Somebody who hates people
Part C -Text 2
Medical staff working the night shift: can naps help?

Delivering medical care is a 24-hour business that inevitably involves
working the night shift. However, night shift requires the health
professional to work when thebody’s clock (circadian system)
demands sleep. Added to this is the problem of “sleep debt”, arising
from both prolonged prior wakefulness on the first night shift and
cumulative sleep debt after several nights’ work and repeated
unsatisfactory daytime sleeps.
A further aggravation, particularly for trainee medical staff in teaching

hospitals, has been the demand for excessive work hours across the
working week. As has been dramatically shown in recent well controlled
studies, the net result of this assault on the sleep of health professionals
can be impaired patient safety, and the health and safety of health
professionals themselves.
The good news is that health organisations and regulators are beginning
to treat the matter seriously. In Australia, the United States and Europe,
work hours of medical staff have recently been shortened by
government regulation, and bodies such as the Australian Medical
Association and professional colleges are advising their members on
strategies to improve their sleep health and thus work safety.
A recent publication prepared by the Royal College of Physicians
(London) (RCP), Working the night shift: preparation, survival and
recovery. A guide for junior doctors, is an excellent example. One
proposed countermeasure for excessive sleepiness is the use of
strategically placed naps both before and during the night shift. But does
napping either before or during the night shift reduce sleepiness and
improve performance, and, if so, how practical is it?
There are two important, independent mechanisms of sleep and

sleepiness that hold the key to these questions. Probably the more
potent mechanism impairing night-shift alertness is the circadian
system. For most individuals, even those working permanent night shift,
the circadian system is in sleep mode during the night. This causes
slowed reactions, increased feelings of fatigue, impaired concentration,
and increased sleep propensity
The second important mechanism affecting night-time alertness is

homeostatic sleep drive. This increases in intensity the longer we are
awake and, like appetite which is sated by eating, homeostatic sleep
drive is reduced by sleeping. If the first night shift starts at midnight
following a normal wake time at about 8 am, about 16 hours of wake
sleep debt has already been accrued and the rest of the night shift will
be performed under intense homeostatic, in addition to circadian, sleep
drive.
Performance decrements during this night period can be similar to those

measured in the daytime with a blood alcohol concentration of 0.05%–
0.10%. Day sleep in the home environment is likely to be shorter and
less effective than night sleep so, even though second and subsequent
night shifts may follow fewer wakeful hours (8–10 hours), homeostatic
sleep drive is likely to remain elevated during night shifts because of
incomplete repayment of the previous sleep debt.
To a limited extent, it is possible to “bank” sleep (or pay off residual sleep
debt) before the first night shift, potentially reducing subsequent night-
time homeostatic sleep drive and improving alertness and work safety. A
long (1–2 hours) nap in the afternoon, as recommended in the RCP
report, is best. Afternoon sleep is more efficient than early evening sleep
as it uses the natural afternoon “dip” in circadian physiology and avoids
the risk of post-sleep grogginess or sleep inertia impinging on the start
of night duty. Between subsequent night shifts, the aim should be to
maximise daytime sleep length (at least 7 hours) and efficiency by
including the afternoon sleepy period (1–4 pm).
What about napping during a night shift to improve alertness and reduce
errors and accidents? Brief afternoon naps of 10–30 minutes (so-called
power naps) improve alertness and performance. We compared
afternoon naps of 5, 10, 20, and 30 minutes of total sleep. The 10 minute
sleep (about a 15 minute nap opportunity) produced improvements over
the 3 hour post- nap period in all eight alertness and performance
measures, without any of the post-nap impairment of sleep inertia that
followed the 20 and 30 minute naps. Whether these results would be
replicated at, say, 3 am in a night- shift environment, with considerably
greater homeostatic and circadian sleep drive, is now being tested.
Only a few studies have measured the effects of night-shift napping. Long
naps of about 2 hours appear as effective at about 3 am as at 3 pm.
However, 1–2 hour naps were followed by sleep inertia, during which
alertness was impaired for up to an hour. Longer naps, although beneficial
once sleep inertia has been dissipated, may be used reluctantly by
medical staff wishing to maintain continuity of patient care. Briefer naps
(18–26 minutes) have also improved performance in night-shift
environments
Therefore, the picture emerging from night-shift napping studies is

similar to that from the afternoon studies. Very brief naps (10–15
minutes of sleep) may improve alertness immediately without the
negative effects of sleep inertia. How long this improvement lasts and
what is the optimal nap length on the night shift remains to be
determined. In the meantime, as recommended in the recent RCP
guide, health professionals who work night shift should, for the sake of
their own health and safety and that of their patients, consider the
benefits of night-shift napping. Optimal benefit and a higher take-up rate
are likely for sleep lengths of 10–15 minutes.

15. Which of the following is not mentioned a cause of sleep debt?
a) Regular lack of sleep during the day

b) Staying awake for a long period before the first night shift
c) Poor health among health professionals
d) A build up of sleep debt during the night shift period
16. Which of the following statements is not mentioned?

a) Lack of sleep among health professionals can affect the safe
treatment of patients
b) Lack of sleep among health professionals can affect the health of
health professionals
c) Long hours are very common for trainee medical staff
d) Most health professionals don’t get adequate sleep
17. According to the article which of the following statement is false?

a) people who work the night shift during sleep mode may have
increased appetite
b) people who work the night shift during sleep mode may feel exhausted
c) people who work the night shift during sleep mode may be unable to
keep their mind on the job
d) people who work the night shift during sleep mode may respond
slowly to certain situations
18. Which of the following statements is true?
a) It is beneficial to sleep between 1- 4 p.m.
b) If you sleep in the early evening you will be fully alert at work
c) Do not sleep more than 7 hours during the day before your night shift
d) All of the above
19. Recent studies have shown that

a) Long 2 hour naps are more beneficial at night
b) Short naps are equally effective at night as they are during the day
c) Short daytime naps are less beneficial than longer daytime naps
d) none of the above
20. Overall the purpose of the article is to explain that

a) Health professionals don’t get enough sleep
b) Both short and long naps during night shift will improve
work performance and patient treatment
c) Short naps during night shift may be the best way to improve
work performance and patient treatment
d) Tired health professionals are less efficient than alert health
professionals
21. What is the duration of Briefer naps?

a) 18–26 minutes
b) 10–15 minutes
c) 20–26 minutes
d) 5–10minutes
22. Which naps are known as power naps?
a) Very brief afternoon naps
b) Briefer afternoon naps
c) Brief afternoon naps
d) Briefer forenoon naps

1. D
2. C
3. A
4. A
5. B
6. C
7. A

8. pizotifen and propranolol
9. 20%
10. 54
11. 6.1%
12. 191
13. 5 to 6 hours
14. doctor
15. prophylactic medication
16. acute medications
17. women
18. frequently
19. therapeutic options
20. six

1. C
2. B
3. C
4. B
5. A
6. C
7. c
8. d
9. b
10. c
11. a
12. b
13. c
14. b

15. c
16. d
17. a
18. a
19. b
20. c
21. a
22. c
READING TEST 89
information.
PART A -TEXT BOOKLET - STUDY INTO KID’S INHALER USE
Text A
Inhalers may do nothing to help more than one in 10 children with asthma
who have been found to carry a mutated gene. A British study of nearly
1200 youngsters found children with a genetic variation called Arg16 are
twice as likely as other asthmatics not to respond to Ventolin inhalers, the
most common treatment for asthma. But experts, including Dr Noela
Whitby, of the National Asthma Council of Australia, have said children
need to continue using inhalers.
Text B
BREATHTAKING NEW DISCOVERY OF ASTHMA GENE
Researchers in the UK have uncovered a gene that triggers asthma. Bill
Cookson and colleagues’, from London’s Imperial College, compared the
genes of 1000 children with asthma and 1000 healthy ‘controls’ to track
down genes that were more common in the asthmatics and might
therefore provoke the condition. To do this the team used a system of
genetic markers called SNPs or single nucleotide polymorphisms. These
flag certain genetic sequences. By analysing large numbers of people
with a disease, and comparing them with people who don’t have the
condition, you can see SNPs, and hence DNA hotspots, that crop up
more often in the diseased individuals than in the healthy ones.
Using this technique, the team were able to home in on several DNA
hotspots on chromosome 17, and also identify a new gene, called
ORMDL3, which was much more common in the children with asthma
than the healthy controls. ‘This gene occurs in about 30% of children with
asthma,’ says Cookson. ‘It seems to have a fundamental role in the
working of the immune system, but we don’t know what it does yet.’ So
the next step will be to study where in the body it operates and how it
works. This could well open up new avenues for the treatment or even
prevention of asthma. But the fact that only 30% of the asthmatic children
were carrying it shows that there’s much more to asthma than just
genetics, and that mystery still needs to be solved.
Text C
Turbuhaler Instructions
Before using your Turbuhaler, please read these instructions and follow
them carefully. Turbuhaler is a breath-activated inhaler. This means that
when you inhale from the Turbuhaler the medication is drawn into your
lungs. Unlike aerosol sprays, no propellants are necessary to deliver your
medication. This means that you will probably not feel anything as you
inhale the medication. If you carefully follow the four simple steps you can
be confident you have received the correct dose of medication. If you
require, further information about your medication ask your doctor or see
your pharmacist for a Consumer Medicine Information leaflet. You may
also like to contact the Asthma Foundation in your state (Australia) or
region (New Zealand) for further information about asthma.
Text D
How to use your Turbuhaler
1. REMOVE THE CAP
Unscrew and lift off the
cap.
2. LOAD THE TURBUHALER
Hold your Turbuhaler upright. Hold it by the white body, with the coloured
base at the bottom. Turn the coloured base in one direction as far as it will
go. Then turn it back in the opposite direction. During this procedure you
will hear a click.
3. INHALE THE MEDICATION
Breathe out gently away from the Turbuhaler. Hold the coloured base and
place the tip of the mouthpiece (sloping part) between your lips. Breathe in
forcefully and deeply through your mouth. Do not chew or bile the
mouthpiece. Remove your Turbuhaler from your mouth before breathing
out. If you require a second dose, simply repeat steps 2 and 3.
4. REPLACE THE CAP
Remember to screw the cap back on.
NOTE- If you are using Pulmicort Turbuhaler rinse mouth with water after
each use.
PART A -QUESTIONS
Questions 1-7
1. who discovered the gene that triggers asthma?
2. what are the user instructions of Turbuhaler?
3. what does SNP stands for?
4. give an example for breath-activated inhaler?
5. how many subjects were there in the British study?
6. what is the most common treatment for asthma?
7. name the genetic variation found in children with asthma?
Questions 8-13
spelled.
8. What are responsible for medication delivery in aerosol sprays?

9. Which gene is more common in the children with asthma?
10. Who provides consumer medicine information leaflet for Turbuhaler?
11. Which Turbuhaler users are required to rinse mouth with water after
each use?
12. How many steps are there to ensure the proper usage of Turbuhaler?
13. How many subjects’ genes were compared with healthy controls by
researchers in UK?
Questions 14-20
correctly spelled
14. You will probably not feel anything as you inhale the medication from
________
15. During the completion of loading procedure of Turbuhaler, you will
hear________
16. Genetic markers help to flag certain ____________
17. While inhaling the Turbuhaler, you have to hold____________
18. Researchers in UK were able to home in on several DNA hotspots
on_______
19. After using Turbuhaler, do not forget to _________________ back on
20. ______________ seems to have a fundamental role in the working of
the immune system against asthma
professionals .
Questions 1-6
1. What does this manual tell us about local anaesthetic agents?
A. for both epithermal and central nerve blocks
B. work by dispersing across the myelin sheath or neuron
membrane
C. are used by anaesthetists and other experienced medical
practitioners
Local anaesthetic agents

Local anaesthetic agents are used by anaesthetists and other experienced
practitioners for both peripheral and central nerve blocks, examples being
femoral nerve block and spinal
(subarachnoid) block, respectively. Less commonly now, regional
intravenous blockade (Biers’ block) of limbs may be performed.
Local anaesthetics work by diffusing across the myelin sheath or neuron
membrane in their non-ionised form. More lipid-soluble agents are more
potent because more of the drug can cross into the neurone.
2. The guidelines require those administrating flumazenil to

A. remember that it has a short-term life
B. should continually monitor patient for occurring sedation
C. should be prepared to give additional doses
Antagonist
Flumazenil is a competitive inhibitor at the benzodiazepine binding site. It
is available in 5-mL ampoules containing 500 microgrammes (µg) of drug.
A dose of 200 µg should be administered over 15 seconds in suspected
benzodiazepine overdose, with supplementary boluses of 100 µg if the
patient fails to respond. It should be remembered that flumazenil has a
short half-life compared with most benzodiazepines; the patient should
be continually monitored for recurring sedation and the practitioner
prepared to give additional doses.
3. The purpose of these notes about diagnostic pleural is to
A. help maximise its efficiency.
B. give guidance on the procedure.
C. recommend a procedure for anaesthesia.
Diagnostic pleural aspiration (tap)

For a diagnostic pleural tap attach a green needle to the 50-mL
syringe and insert the needle through the area of skin which has been
anaesthetised. Again, the needle should be inserted just above the upper
border of the rib. Aspirate 50 mL of pleural fluid then withdraw the needle
and apply a dressing to the site. Some hospitals have ready-made
pleural aspiration packs.
4. The purpose of this email is to

A. report on a rise in use of rehabilitation aids.
B. explain different types of rehabilitation aids.
C. remind staff about procedures for usage of rehabilitation aids.
Rehabilitation aids
Active rehabilitation most frequently involves activity, which may be
preformed with or without aids to facilitate movement. Today, there are
many types of aids that facilitate patient mobility and make the work of
staff easier.
The following examples of rehabilitation aids are used to facilitate mobility
in the patient:
• Walkers – solid, underarm, two, three and four-wheel
• Crutches, walking sticks
• Wheelchairs – mechanical, electrical
• Verticalization tables
• Suitable for fitness exercises: Exercise bike, rehabilitation pedal
exerciser to strengthen the lower limbs, and similar.
A. ways of checking that breathing exercises has been done
correctly.
B. how breathing exercises are performed and recommended.
C. which staff should perform breathing exercises.
Breathing exercises
Breathing exercises can be performed separately or they can be part of
fitness or specially targeted exercises. Breathing exercises (breathing
gymnastics) have preventative and therapeutic importance. These are
included if it is necessary to increase lung ventilation, improve
expectoration of secretions from the respiratory tract, etc. Exercise
should be according to the current medical condition of the patient; the
usual recommendation is 20 times, at least 4 – 5 times a day.
6. Which healthcare professional should lead fitness exercise

A. either physiotherapist or nurse
B. neither physiotherapist nor nurse
C. both physiotherapist and nurse
Fitness exercise
Fitness exercise is one of the simplest forms of physical activity for
recumbent and walking patients. It is performed in line with the medical
condition of the patient, usually 1 to 2 times a day for 10 to 15 minutes,
individually or in groups. The physiotherapist or nurse leads the exercise
in a group of patients with the same movement limitations, lying down,
sitting up or standing. The exercise is performed in a well-ventilated
room, usually in the patient’s room.
Part C -Text 1
Acupuncture
If you’re in pain, the last thing you may want is someone sticking needles
in you. But plenty of people turn to acupuncture for pain relief. So what is
the evidence? If the idea of someone sticking needles into you sounds
painful, imagine having it done when you are already in pain. It may sound
counterintuitive, but many people turn to acupuncture for pain relief.
Acupuncture is a component of traditional Chinese medicine, and

involves inserting of very thin, metal needles into specific ‘points’ on the
body. The theory, says Dr Marc Cohen, a professor of complementary
medicine at RMIT University, is that inserting the needles stimulates
these ‘points’ and unblocks the natural flow of light energy (qi or ch’i)
through your body. Blocked qi is thought to cause disease. Unblocking qi
allows your body to heal itself, says Cohen.
You can also think of acupuncture as a way of defusing pain trigger points,
says Cohen. “If you can find a trigger point that reproduces the pain you’re
experiencing... that’s a point where you put the needle [to relieve it],” he
says. Interestingly, these acupuncture ‘trigger’ points are not always in the
same spot as your pain. For example, says Cohen, people who have eye
pain often find a tender spot between their first and second toes. The
acupuncture point for frozen shoulder, a painful condition that immobilises
the shoulder joint, is on your chin. Scientific evidence
However, although acupuncture has been practiced for several thousand

years, scientists struggle to explain how it works. One theory suggests the
needling encourages the release of endorphins natural painkillers
produced by the brain) and sets off an inflammatory response that allows
the body to heal itself. Another theory is that acupuncture has a powerful
effect on the mind, says Cohen, which may also help to activate the
body’s pain-relieving mechanisms.
Modern science also has surprisingly little to say on whether acupuncture

successfully relieves pain or not. There are some high- quality studies,
mainly focusing on the relief of back pain and headache but they are small
– so what researchers have done is pool the results. A 2009 review of 22
existing studies on the prevention of migraine with acupuncture found that
people receiving acupuncture had fewer headaches after three to four
months than those who received either no treatment or routine drug
treatment. Those receiving acupuncture also had fewer undesired
consequences, such as drug side-effects. Another review from the same
year found that acupuncture also reduces the intensity and frequency of
tension-type headaches.
For chronic lower back pain, a 2007 German study of 1162 participants
found that the effectiveness of acupuncture after six months was almost
twice that of conventional therapy (drugs, physical therapy and exercise).
A 2009 American study of 638 people found similar results. However, the
most current reviews pooling all available evidence on chronic lower back
pain don’t paint such a conclusive picture: they found that while
acupuncture is a useful addition to conventional therapies, there isn’t
sufficient evidence that it’s any more effective than other treatments.
In addition, a 2009 review of acupuncture for various types of pain found

that while acupuncture has a small analgesic effect, we can’t be sure this
isn’t caused by the psychological impact of the treatment. In spite of the
lack of conclusive evidence, many people turn to acupuncture to treat all
types of pain, including toothache, menstrual cramps and tennis elbow. If
you want to try acupuncture, you can go to a GP who practices
acupuncture (more than 15 per cent of GPs in Australia do) or a traditional
Chinese medicine practitioner
“A GP will have recourse to western medicine and will be covered by

Medicare, whereas a traditional Chinese medicine practitioner will put…
more emphasis on the traditional Chinese medicine diagnosis and
philosophy, including tongue diagnosis and pulse diagnosis,” says Cohen.
Sessions generally go for 15-30 minutes, and an initial course of once a
week for six weeks is normal for chronic pain, says Cohen. You may need
fewer sessions for acute pain. You should feel some immediate benefit for
acute pain, says Cohen. For chronic pain, you should feel some
immediate benefit that might initially wane off between sessions before
getting better.
But you do need to give acupuncture a chance to work. “Give it at least
three or four treatments, up to six treatments before you say it doesn’t
work,” says Cohen. Acupuncture administered by a qualified person is
extremely safe, says Cohen. “All drugs have side-effects and certainly
pain medications (such as steroids and anti-inflammatory medications)
can have very severe side-effects.” Practitioners use disposable needles,
so there is minimal risk of infection. It’s worth asking practitioners about
their qualifications (they should have completed a four to five year
degree), whether they are registered with their professional association,
and what their experience is with the condition you’re seeing them for,
says Cohen.
If you do decide to try acupuncture for your pain, it is important that you
still initially seek medical treatment so that you do not miss any underlying
conditions. Nevertheless, many pain specialists caution against becoming
overly reliant on acupuncture, or any other treatment, to help you manage
pain. Dr Paul Wrigley, senior staff specialist at the Pain Management
Research Institute in Sydney, suggests that learning ways to self-manage
your pain – for example by pacing yourself and learning to reduce your
anxiety levels – can help reduce the degree to which pain interferes with
your life. Therefore, while acupuncture helps some people manage their
pain, in the end, you need to figure out what works best for you.
7. Acupuncture ___________ of the body

a. Needle stimulates
b. Unblocks the energy flow
c. None of the above
d. A and b
8. How does heating occur in Acupuncture?

a. by unblocking
b. by itself
c. both the above
d. none
9. Acupuncture is a pain trigger point method.
a. yes
b. no
c. not given
d. only for few disease
10. Acupuncture point for frozen shoulder is
a. chin
b. a point in toes
c. a point face
d. all the above
11. Endoprins are _____________
a. painkillers
b. part of brain
c. only (a) or only (b)
d. both a and b
12. To treat ___________ acupuncture was used.

a. Migraine
b. Head aches
c. Both the above
d. None of the above
13. For what does acupuncture gives immediate relief?
a. head aches
b. acute pain
c. migrants
d. none of the above
14. Patients who wish to take acupuncture
a. can follow other treatment

b. should take other treatment
c. in starting go for other treatment
d. all the above
Part C -Text 2
SKIN CANCER MEDICINE IN PRIMARY CARE

The recent report of a patient who attended a skin cancer clinic in New
South Wales in 2016, and apparently failed to have a melanoma
diagnosed, and then sued his attending practitioner, sends a chill through
every doctor who has ever assessed a pigmented skin lesion. Although
settled out of court, this case highlights the clinical challenges of screening
for and diagnosing skin cancer, and throws into sharp relief the issue of
quality and safety in skin cancer clinics in Australia.
In the Newcastle Herald in July 2018, Emeritus Professor Bill McCarthy of

the Sydney Melanoma Unit is quoted as saying “I want to make it clear
that I believe some clinics are very careful and do good work”. However,
he also expressed concern that quality across the clinics was patchy:
Obviously, some people have seen an entrepreneurial opportunity and

some clinics have been put together by non-medical people who have
simply advertised for doctors to work for them. The staffs of some clinics
do not have any specialised training: they may have just qualified or they
may be overseas practitioners. Some fancy themselves as surgeons and
maybe some were in other countries but they may not meet Australian
standards. There is no quality control and no accreditation scheme. Some
have come to me for advice. They might tell me they are going to work in a
skin cancer clinic in a country town, for example. They sit in on my clinics
for a day and, while that isn’t training, it’s better than nothing.
Skin cancer is by far the most common cancer in Australia. The most
common and important skin cancers are basal cell carcinoma (BCC),
squamous cell carcinoma (SCC), and malignant melanoma. In 2015, there
were estimated to be 374 000 cases of BCC plus SCC. The age-
standardised incidence of BCC alone in men was 1150/100 000; more than
10 times that of prostate cancer, the next most common cancer. Most
BCCs and SCCs occur in older Australians, causing considerable
morbidity, but little mortality. In 2013–2014, they were also the most
expensive cancer to treat, costing $264 million, followed by breast cancer
at $241 million. Melanoma is the most common cancer among those aged
15–44 years, and the second most common cause of cancer death in that
age group, and it accounts for 3% of all cancer deaths in all ages (1199
deaths in 2014).
Skin cancers are the most common cancers managed by general
practitioners, with more than 800 000 patient encounters each year.
While historically GPs have managed most skin cancers, in recent years,
with the rapid growth of “skin cancer clinics”, there has been a dramatic
change. Little is known about these clinics; some include large
“corporate” chains and others comprise smaller independent operators.
Anecdotally, most doctors working in these clinics seem to be GPs, or at
least non-specialist doctors, from a variety of backgrounds.
Some concerns have been raised about the type and quality of work
performed within these clinics from other sectors of the profession.
The pros and cons of “the fragmentation of general practice”, typified by
skin cancer clinics, travel medicine clinics, women’s health clinics and
others have been considered previously.
Currently, in Australia, there are:
no barriers to working in skin cancer medicine in primary care;

limited training opportunities for generalist doctors wanting
to do this work (and no formal award courses);
no opportunities for skin cancer clinics to be accredited
against defined standards; and
no quality framework to support this work.
In August this year, the Skin Cancer Society of Australia was formed to
provide one mechanism to redress some of these deficiencies.
Two of us (AD, PB) have worked in the skin cancer field for over 20
years, and A D has provided formal training for 15 years. When one of
us (DW) decided to start working in this field at the beginning of 2018,
there was no barrier to taking a position in a skin cancer clinic, and no
formal assessment of competency. There was also no barrier to
accessing the Medicare Benefits Schedule (MBS) item numbers that
relate specifically to the management of skin cancer, including some
that relate to fairly significant plastic surgical procedures. There were
no easily accessible training opportunities, or postgraduate awards for
general practitioners in skin cancer medicine.
Furthermore, as skin cancer clinics are demonstrably not general

practices, they cannot be accredited through the mechanisms that apply
to Australian general practice. It is unclear whether the concerns
expressed by other sectors of the profession lie in the age-old debate
“GPs versus specialists”, or whether it is “skin cancer clinic doctors
versus the rest”. Perhaps it is some of both. Certainly, there is real
concern among mainstream general practice that skin cancer clinics are
an expression (or the cause of) fragmentation, and there is real concern
from dermatologists and plastic surgeons about encroachment on their
domains of practice.
Without doubt, some dermatologists believe that they are the doctors
best placed to diagnose and manage patients with skin cancer.
However, there are hardly enough dermatologists to cope with current
demand for their general services, let alone enough to manage the
majority of skin cancers in Australia. Furthermore, some plastic
surgeons believe that patients receiving surgical treatment for skin
cancer should be treated exclusively by them, but the geographic
distribution of dermatologists and plastic surgeons in Australia
precludes their managing most patients. The perception may exist
among some GPs that skin cancer doctors are taking a lucrative
(procedural) aspect of their practice away. At least some of this debate
seems to be vested in professional self-interest, rather than a
dispassionate consideration of what is best for the patient.
Most patients with skin cancer can be competently diagnosed and
treated by appropriately trained, non-specialist primary care physicians,
whether they are working in skin cancer clinics or in mainstream
general practice. We also believe that consultants, such as
dermatologists and plastic surgeons, have a crucial role to play in
helping manage the more complex cases, as well as providing training.
However, much more needs to be done if we are to collectively ensure
that patients enjoy maximal health outcomes, and that doctors are well
trained and supported.

15. There is concern about quality and safety in skin
cancer clinics because:
a) some doctors employed lack the required skills
b) Australian standards are difficult to meet
c) they are in country towns
d) Doctors rarely attend training
16. Which of the following statements is not true?

a) Prostate cancer is less common than skin cancer
b) People often die from BCCs & SCCs
c) Melanoma is a common cancer for people aged
between 15~44
d) The older the person the greater the risk of BCCs
17. Which of the following is not mentioned as a problem in Australia

a) Lack of education & training
b) Lack of patients
c) Lack of recognised guidelines for the clinics
d) Ease at which doctors can choose to work in this area
18. Dermatologists and plastic surgeons view skin cancer
clinics as a threat to their business.
a) True
b) False
c) Not mentioned
d) Author has no opinion
19. In the paragraph beginning with Without doubt the

author’s view is
a) Dermatologists can provide better treatment for
skin cancer patients
b) Only plastic surgeons should provide surgery
c) GPs earn a lot of money from skin cancer patients
d) That some practitioners are more concerned about
their professional reputation instead of patient benefit.
20. Which is the right heading for the first section of the
article?
a) Where does the divide lie?
b) The problem
c) Skin cancer in Australia
d) Skin cancer in general practice: emergence of new models of
care
21. Which is the right heading for the last section of the
article?
a) Where does the divide lie?
b) The problem
c) Skin cancer in Australia
d) Skin cancer in general practice: emergence of new
models of care
22. Which is not one among the most common type of skin cancers in
Australia?
a) basal cell carcinoma
b) actinic keratoses
c)squamous cell
carcinoma
d) malignant melanoma


1. B
2. D
3. B
4. C
5. A
6. A
7. A

8. propellants
9. ORMDL3
10. pharmacist
11. Pulmicort
12. four
13. 1000
14. Turbuhaler

15. a click
16. genetic sequences
17. the coloured base
18. chromosome 17
19. screw the cap
20. ORMDL3

1. C
2. C
3. B
4. B
5. B
6. A

7. c
8. c
9. c
10. c
11. a
12. d
13. b
14. c

15. a
16. b
17. b
18. b
19. d
20. c
21. a
22. b
READING TEST 90
information.
PART A -TEXT BOOKLET - THE GLOBAL BURDEN OF DEMENTIA
Text A
An expert group, working for Alzheimer’s Disease International, recently
estimated that 24.2 million people live with dementia worldwide (based
upon systematic review of prevalence data and expert consensus), with
4.6 million new cases annually (similar to the annual global incidence of
non-fatal stroke).
• Most people with dementia live in Low and Middle Income
Countries - 60% in 2017 rising to 71% by 2040.
• Numbers will double every twenty years to over 80 million by 2040.
• Increases to 2040 will be much sharper in developing (300%)
than developed regions (100%).
• Growth in Latin America will exceed that in any other world region.
Well designed epidemiological research can generate awareness, inform
policy, and encourage service development. However, such evidence is
lacking in many world regions, and patchy in others, with few studies and
widely varying estimates. There is a particular lack of published
epidemiological studies in Latin America with two descriptive studies
only, from Brazil and Colombia.
Text B
Some Little Known Facts about Dementia
• A Canadian study found that a lifetime of bilingualism has a marked
influence on delaying the onset of dementia by an average of four years
when compared to monolingual patients (at 75.5 years and 71.4 years
old, respectively).
• Adult daycare centres provide specialized care for dementia
patients, including supervision, recreation, meals, and limited
health care to participants, as well as providing respite for
caregivers.
Text C
The Effect of Aging World Populations on Healthcare
Demographic ageing proceeds apace in all world regions, more rapidly
than at first anticipated. The proportion of older people increases as
mortality falls and life expectancy increases.
Population growth slows as fertility declines to replacement levels. Latin
America, China and India are currently experiencing unprecedentedly
rapid demographic ageing.
In the health transition accompanying demographic ageing, non-
communicable diseases (NCD) assume a progressively greater
significance in low and middle-income countries. NCDs are already the
leading cause of death in all world regions apart from sub-Saharan
Africa. Of the 35 million deaths in 2017 from NCDs, 80% will have been
in low and middle-income countries. This is partly because most of the
world’s older people live in these regions - 60% now rising to 80% by
2050. However, changing patterns of risk exposure also contribute.
Latin America exemplifies the third stage of health transition. As life
expectancy improves, and high fat diets, cigarette smoking and sedentary
lifestyles become more common, so NCDs have maximum public health
salience - more so than in stage 2 regions (China and India) where risk
exposure is not yet so elevated, and in stage 4 regions (Europe) where
public health measures have reduced exposure levels. The
INTERHEART cross- national case-control study suggests that risk
factors for myocardial infarction operate equivalently in all world regions,
including Latin America and China.
Text D
Agitation in Dementia Patients
Agitation often accompanies dementia and often precedes the diagnosis
of common age-related disorders of cognition such as Alzheimer’s
disease
(AD). More than 80% of people who develop AD eventually become
agitated or aggressive.
Evaluation
It is important to rule out infection and other environmental causes of
agitation, such as disease or other bodily discomfort, before initiating any
intervention. If no such explanation is found, it is important to support
caregivers and educate them about simple strategies such as distraction
that may delay the transfer to institutional care (which is often triggered
by the onset of agitation).
Treatment
There is no FDA-approved treatment for agitation in dementia.
Medical treatment may begin with a cholinesterase inhibitor, which
appears safer than other alternatives although evidence for its efficacy
is mixed. If this does not improve the symptoms, atypical antipsychotics
may offer an alternative, although they are effective against agitation
only in the short-term while posing a well-documented risk of
cerebrovascular events (e.g. stroke). Other possible interventions, such
as traditional antipsychotics or antidepressants, are less well studied
for this condition.
PART A -QUESTIONS
Questions 1-7
1. which study found out bilingualism can delay the onset of dementia?
2. why the proportion of older people is increasing?
3. what are the possible interventions for agitation in dementia?
4. what does ‘NCD’ stands for?
5. who provide specialized care for dementia patients?
6. what is the predicted rise in dementia patients in low and middle income
countries?
7. How do the risk factors for myocardial infarction operate across the
world?
Questions 8-13
spelled.
8. what does ‘AD’ stands for?

9. Who conducted cross-national case-control study?
10. What is the estimated count of people living with dementia worldwide?
11. Name the region in the world, where NCDs aren’t the leading causeof
death.
12. Give two examples for stage 2 regions
13. Name one stage 4 region.
Questions 14-20
correctly spelled
14. There is no _________________ treatment for agitation in dementia
15. There is a particular lack of published epidemiological studies in

___________
16. _________________ often accompanies dementia and often precedes
the diagnosis of Alzheimer’s disease
17. The proportion of older people increases as mortality falls

and_____________ increases.
18. Medical treatment for agitation in dementia may begin

with_______________
19. More than 80% of people who develop AD eventually become agitated
or ____________
20. _________________ proceeds apace in all world regions.
professionals .
Questions 1-6
1. What does this manual tell us about modern peripheral cannulae?

A. contain a ‘flashback chamber’
B. made from polyurethane
C. are more non-flexible
Cannulae
A cannula is composed of several parts: the needle, catheter, wings,
valve, injection port and Luer-Lok™ cap. Most cannulae also contain a
‘flashback chamber’ giving the practitioner visual confirmation that the
cannula has entered the vein. Modern peripheral cannulae are made
from polyurethane. This is preferable to older materials such as PVC and
Teflon® as the cannulae are more flexible, softer and cause less intimal
damage. They are also latex free.

A. ways of checking venous accesses has been placed correctly.
B. how to avoid consequences of air embolism.
C. steps to minimize the chances of air embolism.
Air embolism
All forms of venous access, but especially central access, may cause
air embolism which can have catastrophic consequences. This occurs
when air is aspirated into the vein during the procedure. The air
embolus can translocate to the lung and if the volume is sufficient it can
cause fatal cardiovascular and respiratory collapse. The likelihood may
be reduced by keeping the patient in a head down position and
ensuring that the vein is open to the external environment for as little
time as possible.
3. What does this extract from a handbook tell us about
intraosseous space?
A. consists of spongy cancellous epiphyseal bone
B. houses a vast collapsible venous plexus
C. consists of physeal medullary cavity
Intraosseous access
The intraosseous (IO) space consists of spongy cancellous epiphyseal
bone and the diaphyseal medullary cavity. It houses a vast non-
collapsible venous plexus that communicates with the arteries and veins
of the systemic circulation via small channels in the surrounding
compact cortical bone. Drugs or fluids administered into the intraosseous
space via a needle or catheter will pass rapidly into the systemic
circulation at a rate comparable with central or peripheral venous
access. Any drug, fluid or blood product that can be given intravenously
can be given via the intraosseous route.
4. The purpose of these notes about verticalization is to
A. help maximise its efficiency.
B. give guidance on certain safety procedures.
C. recommend a procedure to increase mobility.
Verticalization
The term verticalization means a gradual change in the patient position
to the vertical position. The physical load after each mobility restriction
must be gradual and smooth. At first, practice sitting, standing beside
the bed, and then walk around the bed, then later in the corridor.
Patient verticalization is prescribed by a doctor. The doctor sometimes
also prescribes to measure the blood pressure and pulse, e.g. before
and after walking.
5. In Fowler’s position head are raised at an angle of

A. ≥45°
B. >45°
C. ≤45°
Fowler’s position
This position is used in patients with respiratory problems and
cardiopulmonary diseases, in the prevention of bronchopneumonia in
bedridden patients, after abdominal and thoracic surgery, etc.
Patients are put into Fowler’s position during normal daily activities
(eating, reading, watching TV, etc.). The sitting or semi- sitting position
on the bed, when the patient’s head and torso are raised by 15-45° (in
relation to the lower limbs) is called Fowler’s position (see Fig. 6.1-3). In
the high Fowler’s position, the torso and head are raised at an angle of
45-90°.

A. the disposable cover is disposed of before using a thermo gel
pad
B. the reusable cover is placed in dirty laundry bag after using a
thermo gel pad
C. the thermo gel pad is disposed of after using a thermo gel pad
Thermal gel pads in various sizes
After using a thermo gel pad, the disposable cover is disposed of or the
reusable cover is placed in the dirty laundry bag. The thermal gel pad is
soaked in disinfectant solution according to the ward disinfection
programme, and is then dried and prepared for the next use. A hot
water bottle is a rubber bottle with a plastic stopper, which is filled up to
two thirds full with water at 50 to 60 °C while the remaining air is forced
out.
In this part of the test, there are two texts about different aspects of
healthcare.
For questions 7-22, choose the answer (A, B, C or D) which you think fits
best according to the text. Write your answers on the separate Answer
Sheet
Part C -Text 1
ARTHRITIS - A Holistic Approach Can Help

Mosby’s Medical and Nursing Dictionary defines arthritis as any
inflammatory condition of the joints, characterized by pain and swelling.
The name derives from the Greek word “arthron” which means joint and
“itis” which means inflammation. In its various forms arthritis afflicts
millions throughout the world from juveniles to the elderly.
A 2003-2005 National Health Interview Survey in the United States of

America reported 21.6% of adults have self reported, doctor diagnosed
arthritis. In Australia it is estimated that by 2020 one in every five
Australians will have arthritis. To date, despite the expenditure of an
enormous amount of money on research and the considerable efforts of
scientists throughout the world, a cure for arthritis has proved elusive.
Medical treatments range from simple pain relievers like Paracetamol,

which eases pain and if taken as recommended has few side effects, to
powerful non-steroidal anti-inflammatory drugs and corticosteroids. Such
drugs can provide effective relief from the pain, joint stiffness and
inflammation but do not result in a permanent cure. Unlike Paracetamol,
these medications taken long term can have serious side effects and
they must be regularly and carefully monitored. There may also be
contraindications relating to other medical conditions, use during
pregnancy or lactation and adverse reactions as a result of allergies.
Surgical interventions such as hip and other joint replacements are usually
performed to relieve severe pain and loss of function where other non-
surgical treatments are unable to bring sufficient relief. Such procedures
can be highly effective in enhancing mobility in the majority of cases. The
need for hip replacement surgery is becoming increasing common among
the elderly as longevity increases. For example the 2007 Spring Issue
Joint News reports “over the last ten years, hip replacement surgery has
increased in Australia by 94.1%”.
Other non-pharmacological treatments such as physiotherapy,

acupuncture, therapeutic massage and aqua aerobics can help to relieve
some symptoms. There are also a number of nutritional supplements that
may relieve the inflammation, pain and slow degeneration of effected
joints. Such
supplements are advertised widely and available from chemists, health
food outlets, and many supermarkets. However even “natural” products
can have side effects or conflict with other medication so always check
first with your doctor or pharmacist.
In relation of dietary supplements, a number of studies conclude that Fish

Oils containing omega-3 fatty acids can help reduce inflammation
associated with osteoarthritis and rheumatoid arthritis. Research
published in a reputable medical journal also suggests a glucosamine
dietary supplement can slow down the deterioration of joints associated
with osteoarthritis. As a result selected hospitals are conducting clinical
research trials to determine the validity of the research.
While there is no “miracle food” that cures arthritis, general dietary advice
recommends a healthy balanced diet rich in foods that contain calcium to
reduce the risk of osteoporosis. A wide range of fresh fruit and
vegetables, plenty of fluids, preferably water and fresh fruit juices rather
than carbonated drinks are recommended. The intake of alcohol should
preferably be kept to low level.
Dieticians also advise arthritis sufferers to eat fatty fish such as herring,
tuna, mackerel, salmon or sardines at least twice a week. There is also
anecdotal evidence from people with arthritis that certain foods impact
negatively on their condition. Keeping a food diary over a period of a
month or more could help individuals identify any particular foods that
appear to regularly provoke their arthritic symptoms.
It is universally acknowledged that exercise programs which improve the

fitness of the heart and lungs, correct poor posture, build muscular
strength, increase joint flexibility and improve balance are beneficial to
people of all ages and can reduce the pain and stiffness associated with
arthritis. The ancient Chinese martial art of Tai Chi, in an appropriately
modified style, is a form of exercise which achieves all this and also
enhances both mental and physical relaxation.
Dr Paul Lam, a family physician who lives in Sydney Australia began to

have signs of arthritis after graduating from medical school. He took up
Tai Chi and found it improved his arthritis and enabled him to enjoy his
chosen and busy lifestyle. He is now a highly respected Tai Chi teacher
and practitioner and has created a number of Tai Chi programs to
improve people’s health and well being. Arthritis Foundations and
organisations in the Britain, America and Australia, New Zealand support
his work. He has travelled the world to train instructors in the Tai Chi for
Arthritis Program and produced books, videos and DVDs.
The Sun style Tai Chi movements are fluid, gentle and slow and help
reduce the pain and stiffness associated with arthritic conditions. The
movements incorporate breathing techniques and place an emphasis on
posture and on the importance of weight transference which is an
essential component of good balance. To ensure smoothness and
harmony they require a mental as well as a physical commitment.
People who practice these movements regularly, either individually in
their homes or with a group in a park or community hall, report many
benefits.
In many countries there are government funded and other support

organizations whose purpose is not only to fund raise for further medical
research into a cure for arthritis but also equally to provide
comprehensive advice and assistance for people living with arthritis.
This can include running education programs and seminars to provide
the public with reliable and well researched information and also to
providing aids to help in everyday living. These aids range from simple
devices to assist in opening jars and cans and to larger equipment to
assist with mobility.
Ultimately, to live as full a life as possible with an arthritic condition, you

need to gain a full understanding of your condition. This can be achieved
by working with a medical care team who shares their knowledge, is
supportive and recognizes the contributions you can make. The best
outcomes require a close partnership between you, your doctor and any
health professionals or practitioners involved in your treatment
A degree of self management has proved effective in managing arthritic

conditions. This can be achieved in a number of ways. Keep up to date
and enquire about the latest research results. Learn about and choose
foods that will ensure you have a healthy well balanced diet. Always take
medicines as directed and do not try any new “natural” supplement or
medication without first consulting with your doctor or pharmacist.
Undertake an exercise regime such as Tai Chi that is suitable to you and
that you can enjoy in the company of others.
Until such time as a cure for all forms of arthritis becomes a reality, a
holistic approach to the control of arthritis incorporating many of the
treatments, therapies and concepts outlined in this article, will help you
discover that living with arthritis does not mean you cannot have an
enjoyable and fulfilling life.
7. Which of the following statements is correct?

a) More adults in Australia have arthritis than in the US
b) More adults in the US have arthritis than in Australia
c) Over 20 % of Australians have arthritis
d) 4 in every hundred people have arthritis
8. According to the article a cure for arthritis is:

a) Much too expensive to justify
b) A major focus for Australian scientists
c) Hard to find
d) Likely within 2 - 3 years
9. Which of the following statements is not reflected in the article?

a) Paracetamol has few side effects
b) Some powerful drugs can provide a permanent cure
c) Pregnancy and lactation contraindicate the use of certain drugs
d) Powerful non-steroidal anti- inflammatory drugs can provide
effective relief from pain, joint stiffness and inflammation.
10. Which of the following statements is correct?

a) In the US hip replacement surgery has increased by 94.1% in the
last decade
b) Such surgery is unsuitable for the elderly
c) Hip replacement surgery usually improves mobility
d) Hip replacement surgery is not expensive and is easily accessible
11. According to the article which one of the following statements is false?
a) Glucosamine dietary supplement is clinically proven
b) Natural products can have side effects
c) A number of nutritional supplements may relieve the inflammation, pain
and slow degeneration of effected joints.
d) Omega-3 fatty acids can help reduce inflammation
12. In paragraph 8 the expression anecdotal evidence can best be described
as:
a) A personal observation
b) Scientific investigation
c) An old wives tale
13. Which of the following statements appear in the article relating to diet?
a) Alcohol in moderation is beneficial
b) Carbonated drinks are recommended
c) Arthritis sufferers indicate that some foods adversely affect their condition
d) Fatty fish such as herring, tuna, mackerel and sword fish must be
eaten twice weekly
14. In which paragraph can you find a description a style of Tai Chi which is
useful for sufferers of arthritis?
a) Paragraph 9
b) Paragraph 10
c) Paragraph 11
d) Paragraph 12
Part C -Text 2
Infectious Diseases and Climatic Influences

Complex dynamic relationships between humans, pathogens, and the
environment lead to the emergence of new diseases and the re-
emergence of old ones. Due to concern about the impact of increasing
global climate variability and change, many recent studies have focused on
relationships between infectious disease and climate.
Climate can be an important determinant of vector-borne disease

epidemics: geographic and seasonal patterns of infectious disease
incidence are often, though not always, driven by climate factors.
Mosquito- borne diseases, such as malaria, dengue fever, and Ross River
virus, typically show strong seasonal and geographic patterns, as do some
intestine diseases. These patterns are unsurprising, given the influence of
climate on pathogen replication, vector and disease reservoir populations,
and human societies. In Sweden, a trend toward milder winters and early
spring arrival may be implicated in an increased incidence of tick- borne
encephalitis. The recent resurgence of malaria in the East African
highlands may be explained by increasing temperatures in that region.
However, yet there are relatively few studies showing clear climatic
influences on infectious diseases at inter-annual or longer timescales.
The semi-regular El Niño climate cycle, centred on the Pacific Ocean, has
an important influence on inter-annual climate patterns in many parts of
the world. This makes El Niño an attractive, albeit imperfect, analogue for
the effects of global climate change. In Peru, daily admissions for
diarrhoea increased by more than 2-fold during an El Niño event,
compared with expected trends based on the previous five years. There is
evidence of a relationship between El Niño and the timing of cholera
epidemics in Peru and Bangladesh; of ciguatera in the Pacific islands; of
Ross River virus epidemics in Australia; and of dengue and malaria
epidemics in several countries. The onset of meningococcal meningitis in
Mali is associated with large-scale atmospheric circulation.
These studies were performed mostly at country scale, reflecting the
availability of data sources and, perhaps, the geographically local effects
of El Niño on climate. In part because of this geographic “patchiness” of
the epidemiological evidence, the identification of climatic factors in
infectious disease dynamics, and the relative importance of the different
factors, remains controversial. For example, it has been suggested that
climate trends are unlikely to contribute to the timing of dengue epidemics
in Thailand. However, recent work has shown a strong but transient
association between dengue incidence and El Niño in Thailand. This
association may possibly be caused by a “pacemaker-like” effect in which
intrinsic disease dynamics interact with climate variations driven by El
Niño to propagate travelling waves of infection.
A new study on cutaneous leishmaniasis by Chaves and Pascual also

provides fresh evidence of a relationship between climate and vector-
borne disease. Chaves and Pascual use a range of mathematical tools to
illustrate a clear relationship between climatic variables and the dynamics
of cutaneous leishmaniasis, a skin infection transmitted by sandflies. In
Costa Rica, cutaneous leishmaniasis displays three‐year cycles that
coincide with those of El Niño. Chaves and Pascual use this newly
demonstrated association to enhance the forecasting ability of their
models and to predict the epidemics of leishmaniasis up to one year
ahead.
Interestingly, El Niño was a better predictor of disease than temperature,

possibly because this large-scale index integrates numerous
environmental processes and so is a more biologically relevant measure
than local temperature. As the authors note, the link between El Niño and
epidemics of leishmaniasis might be explained by large-scale climate
effects on population susceptibility. Susceptibility, in turn, may be related
to lack of specific immunity or poor nutritional status, both of which are
plausibly influenced by climate.
Chaves and Pascual have identified a robust relationship between climate

and disease, with changes over time in average incidence and in cyclic
components. The dynamics of cutaneous leishmaniasis evolve coherently
with climatic variables including temperature and El Niño indices,
demonstrating a strong association between these variables, particularly
after 1996. Long- term changes in climate, human demography, and social
features of human populations have large effects on the dynamics of
epidemics as underlined by the analyses of some large datasets on
whooping cough and measles. Another illuminating example is the
transient relationship between cholera prevalence and El Niño oscillations.
In Bangladesh, early in the 20th century, cholera and El Niño appeared

unrelated, yet a strong association emerged in 1980– 2001. Transient
relationships between climate and infectious disease may be caused by
interactions between climate and intrinsic disease mechanisms such as
temporary immunity. If population susceptibility is low, even large
increases in transmission potential due to climate forcing will not result in
a large epidemic.
A deeper understanding of infectious disease dynamics is important in

order to forecast, and perhaps forestall, the effects of dramatic global
social and environmental changes. Conventional statistical methods may
fail to reveal a relationship between climate and health when discontinuous
associations are present. Because classical methods quantify average
associations over the entire dataset, they may not be adequate to decipher
long‐term but discontinuous relationships between environmental
exposures and human health. On the other hand, relationships between
climate and disease could signal problems for disease prediction. Unless
all important effects are accounted for, dynamic forecast models may
prove to have a limited shelf life.

15. According to paragraph 2, which of the following is true?
a. The incidence of infectious diseases is rarely caused by climatic

factors.
b. Seasonal variations and geography always lead to increases in
mosquito borne diseases.
c. An increase in the rate of tick-borne encephalitis has been caused by
milder winters and early arrival spring in Sweden.
d. Malaria may have reappeared in East African highlands due to
higher temperatures.
16. Which of the following would be the most appropriate heading for the
paragraph 2?
a. The link between global warming and disease epidemics .
b. The strong relationship between climate and outbreaks of
disease.
c. The unexpected influence of climate on infectious diseases.
d. The need for further research into climate change and infectious
diseases.
17. Which of the following is closest in meaning to the expression relatively

few?
a. comparatively few
b. several
c. quite a few
d. three
18. In paragraph 3, which of the following is not true?
a. In Peru, the El Nino event led to increased rates of diarrhoea .

b. El-Nino has a significant yearly effect on global climate patterns.
c. Outbreaks of cholera in Bangladesh and Peru can be linked to El
Nino.
d. Meningococcal meningitis in Mali is influenced by weather

patterns.
19. The main point the author wishes to raise in paragraph 4 is
.
a. Despite differing opinions, there is strong current evidence
linking climate factors and infectious disease.
b. There is insufficient data to determine how significant climatic factors
are on infectious disease.
c. The link between climate trends and disease epidemics is still
inconclusive.
d. There is no connection between climatic trends and dengue fever in
Thailand.
20. According to paragraph 5 which of the following statements is correct?

a. Outbreaks of cutaneous leishmaniasis in Costa Rica correspond with
El Nino events.
b. The mathematical tools used by Chaves and Pascual demonstrate the
link between sandflies and cutaneous leishmaniasis.
c. Research by Chaves and Pascual will allow for annual prediction of
leishmaniasis outbreaks.
d. El Nino is an accurate predictor disease due its complexity and
biological relevance.
21. Which of the following is closest in meaning to the word plausibly?

a. definitely
b. possibly
c. regularly
d. occasionally
22. According to paragraph 6, which of the following statements is correct?
a. The relationship between climate and disease is constant.
b. Outbreaks of cholera appear to be unrelated to El Nino patterns.
c. The dynamics of epidemics are affected by changes in
population, society and weather.
d. Large epidemics rarely occur due to climate changes.

1. B
2. C
3. D
4. C
5. B
6. A
7. C
8. Alzheimer’s disease
9. INTERHEART
10. 24.2 million
11. sub-Saharan Africa
12. India and China
13. Europe
14. FDA-approved
15. Latin America
16. Agitation
17. life expectancy
18. a cholinesterase inhibitor
19. aggressive
20. Demographic ageing
1. B
2. C
3. A
4. C
5. C
6. B
7. b
8. c
9. b
10. c
11. a
12. a
13. c
14. c
15. d
16. b
17. a
18. b
19. a
20. a
21. b
22. c
READING TEST 91
information.
PART A -TEXT BOOKLET – INTRAVENOUS CANNULATION
Text A
Overview
Intravenous (IV) cannulation is a technique in which a cannula placed
inside a vein to provide venous access.
Indications
Indications for IV cannulation include the following
 repeated blood sampling
 fluid administration
 medications administration
 chemotherapy administration
 nutritional support
 blood or blood products administration
 administration of radiologic contrast agents for computed
tomography(CT), magnetic resonance imaging (MRI), or nuclear
imaging
Contraindications
No absolute contraindications to IV cannulation exist but avoid injured,
infected, or burned extremities if possible. Some vesicant and irritant
infusions (pH <5, pH> 9, or osmolarity >600 mOsm/L) can cause tissue
necrosis they leak into the tissue, including sclerosing solutions, some
chemotherapeutic agents, and vasopressors. These fluids are more safely
infused into a central vein. They should only be given through a peripheral
vein in emergency situations or when central line is not readily available
Text B
Technique Rationale
After skin preparation, use a tourniquet Increases surface tension so facilitates

increase the venous pressure and pull smoother incision of skin with less
skin taut in opposite direction of needle surface area contacting cutting edge of
insertion. Avoid excessive pressure to needle.
cannulation site to prevent fattening of
vessel.
For an easily palpated vessel, use Less steep angles increase the risk of
approximately 250 angle with the bevel needle cutting along surface of vessel.
up. Steeper angles increase risk of
perforating the back wall of the vessel.
Once vessel has been penetrated Any manipulation may traumatise the
 Advance the needle slowly with intima of the vessel. The use of a back-
the cutting edge facing the top of eye needle will eliminate the need to
the vessel and do not rotate the rotate the needle due to poor flows.
axis
Tape the needle at the same angle or Pressing the needle shaft against the
one similar to the angle of insertion skin moves the needle tip from the
desired position within the vessel.
Remove needle at angle similar to angle Avoid trauma to the intima by dragging
of insertion and never apply pressure the cutting edge along it.
before the needle is completely out.
Text C
Size Flow rate Recommended use
14G 300ml/min
For patients in shock, eg. GI bleeds or trauma. Also
for peripheral administration of amiodarone,
16G 200ml/min dopamine.
18G 90ml/min For blood transfusions or high volume infusions.
20G 61 ml/min Multi-purpose IV; for medications, hydration and day-

to-day therapies.
22G 36 ml/min For patients with small veins; elderly or paediatric

patients. Only for use with saline, standard antibiotics
and heparin.
Text D
Phlebitis is associated with IV therapy, and can occur in as many as 70% of

patients. It is defined as the acute inflammation of the internal lining of the
vein. Phlebitis is characterised by pain and tenderness along the course of
the vein, redness and swelling and warmth can be felt at the insertion site.
Phlebitis Scale
Grade Clinical Criteria
0 No symptoms at access site
1 Erythema
2 As 1, plus pain
3 As 2, plus streak formation and a palpable venous cord
4 As 3 with a palpable venous cord > 1 inch in length and
purulent drainage
Prevention measures include:
 Adhering to aseptic technique during insertion, dressing changes,
mixing or drawing up of solutions or medications, accessing ports or
hubs on IV equipment.
 Cannula site rotation.
 Using the smallest gauge cannula in the largest vein.
 Adequate securement of the IV device.
 Close and regular monitoring of the IV site
 Patient education of the signs and symptoms of phlebitis.
 Following guidelines on dilution of solutions to prevent particulate
matter and to ensure that the medication or solution doesn't have too
high or too low a pH
PART A -QUESTIONS
Questions 1-7
1. when it's better not to insert an IV cannula?

2. a frequent complication associated with cannula use?
3. how to decide which is the most appropriate cannula?
4. ways of keeping a cannula site healthy?
5. the correct way to insert a cannula?
6. using cannulas to help with diagnosis?
7. a ranking system to help judge the seriousness of a problem?
Questions 8-14
spelled.
8. What size cannula should you use on children?

9. What is the best size cannula to use for routine treatments?
10. What can happen if you use excessive pressure when inserting the
needle?
11. What size cannula should you use to administer a large quantity of
fluids?
12. What kind of needle should you choose to ensure you don't have to
twist it after insertion?
13. What part of the blood vessel is at risk of damage while you are taking
the needle out?
14. What part of the vein is affected in phlebitis?
Questions 15-20
correctly spelled
Inserting the cannula

15. When preparing to insert a cannula, clean the skin and then apply a
____________
16. Inserting the needle too steeply can result in _________________ the
underside of the vein.
17. When you are pushing the needle into the vein, keep the
____________ face up
18. When securing the IV device, make sure the ________________ of the
needle remains as it was when you inserted it
Assessing and avoiding complications

19. If the patient's only symptom is _______________, then they have
grade 1 phlebitis
20. Make sure that there is no ______________ in IV solutions that you
make up
21. Make sure you stick to ____________ working practices when handling
IV equipment
22. The presence of a thickened vein together with _____________ tells
you the patient has grade 4 phlebitis
professionals .
Questions 1-6
1. What was the reason for recent changes in healthcare?
A. Reluctant to act friendly by doctors with patients.

B. Nurse practitioners are acquiring high-positions, equal to doctors,
because for extra qualifications.
C. Lack of sufficient doctors in primary Healthcare hospitals
Changing the healthcare Landscape?

Most of us have memories of visiting the family doctor when we were sick
as children. This friendly and familiar figure checked your sore ears,
listened to your heartbeat and gave you jellybeans at the end of your visit
Unfortunately, the doctor shortage means it is getting harder to see a

doctor, any doctor when you really need them, especially if you live in a
rural or regional area.
But recent Medicare changes could bring about a change in our healthcare
landscape with growing numbers of nurse practitioners likely to be working
in primary and community care.
Unlike the practice nurse at your local GP surgery or a registered nurse

that you may come across in hospital, nurse practitioners have extra
qualifications allowing them to provide some of the care that previously only
doctors could offer.
2. The information in these notes is intended to
A. assist in the development of suitable procedures to this end.

B. be conscious in operating with electrical equipment.
C. project the lack of strict guidelines on operational handlings.
Hazards of Medical Electrical Equipment

Medical electrical equipment can present a range of hazards to the patient,
the user, or to service personnel. Many such hazards are common to many
or all types of medical electrical equipment, whilst others are peculiar to
particular categories of equipment.
The hazard presented by electricity exists in all cases where medical

electrical equipment is used, and there is therefore both a moral and legal
obligation to take measures to minimize the risk. Because there is currently
very little official guidance on precisely what measures should place in to
ac respect to equipment, user organisations have developed procedures
based on their own experience and risk assessments
3. What does this extract from a handbook tell us about Microvascular

Bleeding?
A. Transfusion of blood components performed at the time of an operation

B. Hemostatic function can minimize the process of excessive bleeding.
C. Use of potent platelet inhibitors to stop blood transfusion.
Microvascular Bleeding (MVB)

Patients undergoing cardiac surgery with cardiopulmonary bypass are at
increased risk for microvascular bleeding that requires perioperative
transfusion of blood components. Platelet-related defects have been shown
to be the most important hemostatic abnormality in this setting. The exact
association between preoperative use of potent platelet inhibitors and
either bleeding or transfusion in patients undergoing cardiac surgical
procedures is currently being defined.
Laboratory evaluation of platelets and coagulation factors can facilitate the

optimal administration of pharmacologic and transfusion-based therapy.
However, their turnaround time makes laboratory-based methods
impractical for concurrent management of surgical patients, which has led
many investigators to study the role of point-of-care coagulation tests in this
setting. Use of point-of-care tests of hemostatic function can optimize the
management of excessive bleeding and reduce transfusion.
4. Why Clinical Medication Review gained prominence in recent times?
A. Inability to accommodate patients in hospitals

B. To provide patient safety and for better health outcomes
C. Inappropriate medications are reflecting in hospital admissions
Manual extract : Clinical Medication Review
Medication is by far the most common form of medical intervention. Four
out of five people over 75 years take a prescription medicine and 36% are
taking four or more drugs. However, we also know that up to 50% of drugs
are not taken as prescribed, 2, 3, many drugs in common use can cause
problems and that adverse reactions to medicines are implicated in 5-17%
of hospital admissions. This leads to difficult decisions, particularly with the
frail elderly, whether to initiate or discontinue medication.
Medication review is recognized as a cornerstone of medicines preventing

unnecessary ill health and avoiding waste. Involving patients in prescribing
decisions and supporting them in taking their medicines is a key part of
improving patient safety, health outcomes and satisfaction with clinical
care.
5. Why Are Case-Control Studies Used?
A. To evaluate a conceivable relationship between an introduction and

result.
B. If the result of intrigue is uncommon or sets aside a long opportunity to
happen.
C. To alleviate recall and observation bias.
Case-Control Studies
Case-control studies are time-efficient and less costly than RCTs,
particularly when the outcome of interest is rare or takes a long time to
occur, because the cases are identified at study onset and the outcomes
have already occurred with no need for a long-term follow up. The case-
control design is useful in exploratory studies to assess a possible
association between an exposure and outcome. Nested case-control
studies are less expensive than full cohort studies because the exposure is
only assessed for the cases and for the selected controls, not for the full
cohort.
Case-control studies are retrospective and data quality must be carefully
evaluated to avoid bias. For instance, because individuals included in the
study and evaluators need to consider exposures and outcomes that
happened in the past, these studies may be subject to recall bias and
observer bias.
6. Why does a patient cannot find the one who have checked his case file?
A. Healthcare is not having good security approach.

B. Ethical privacy will make its prominence here.
C. It is the policy of the Digital Health Research Centre.
Lax security culture in hospitals

A patient can look up My Health Record to check a log of which healthcare
providers have opened their record, but won't be able to identify the
individual health practitioner.
When asked who records which individual doctors have accessed it, the
ADHA declined to disclose this for security reasons".
"When you have logins and you don't change them, and you have shared
passwords, then yes it's difficult to tell who did what because your audit
logs are going to have whoever was supposedly logged on," said Professor
Trish Williams, Co-director of Flinders Digital Health Research Centre.
She said lax practices develop in hospitals due to time pressures and
suggested the solution was to make logging on and off easier in the
hospital environment.
"One of the reasons why healthcare has been so bad at security has been
the workflow,. Professor Williams said.
Part C -Text 1
Depression
It was an ordinary day: me and my sister watching TV. Between endless
series of horrifying news, we see one about the increasing number of both
men and women who seek medical assistance and medication for
depression. The same report informed my sister and I about the
seriousness of the consequences of untreated depression, among these is
suicide.
A couple years ago was the moment when I first saw news about
depression that triggered my attention. I have experienced quite a few
moments when I felt sad and needed to be alone. The constant invasion in
the media about depression and how far things can get if not treated, taking
into consideration my moments of weakness, have made me to even
wonder myself: "What if my moments of sadness are signs of depression?
Shall I look for help?
Mental states characterized by feelings of sadness, hopelessness, and loss

of interest. This is how depression is defined in the Oxford Dictionary of
Sociology. What is more interesting is the fact that depression is
considered to be evolved from melancholia. People feel melancholic
because they are homesick or miss a friend.
It is normal to have moments when we miss someone so much that it hurts

and we are sad because we cannot be with that person at that very precise
moment, so we might wish to have some time for us, alone, to recover. But
from experiencing this state of sadness, for the moment to give it a name,
depression, there is only one small step in the eyes of the specialists.
When I got in contact with the university life and found out more about the
society, as well as read Mills book The Sociological Imagination, I further
realized that the problems an individual experiences are issues with which
the society confronts to and the dimension is much greater than believed.
Therefore, my occasional sadness would probably be called, by specialists,
mild depression, but this problem I am confronting sometimes has reached
within the society a dimension that challenges me to further investigate the
issue of depression.
The pharmaceutical industry has played an important role in the treatment

of depression because these companies came up with an entire range of
treatments meant to treat depression. However, this story with the
pharmaceutical companies as the saviors of the emotional well-being of the
people is quite an ambiguous one because it is hard to tell whether at first
people experienced depression and then the drugs were invented, or the
pharmaceutical industry made the drugs for the emotion+nal recovering
from sadness and renamed the state of sadness as depression, and then
people started to use them.
In this journal I have chosen to focus on the subject of depression because

I feel it is a personal topic. Experiencing minor episodes of depression
myself. I would very much like to seek the history of depression and reveal
whether depression is socially constructed or not, and acknowledge the
true influence of the pharmaceutical industry in the treatment of depression.
For a long period of time, the concepts of illness and social reality were
regarded as separate In the 1960s, Szasz argued that the psychiatric
perceptions about disease are actually social attributes to deviant
behaviors because they are not built on an 'organic base. In 1970, two
perspectives were brought. On the one hand, Eliot Freidson made a
distinction between the social constructed illness and the biological
constructed illness and observed how particular problems or conditions of
the human beings come to be defined as illnesses and bring a
Supplementary gain to the medical institutions and representatives. On the
other hand, Foucault stated that people's behaviors, personal experiences
and shape of identity can be influenced by the medical discourse. A few
years after Friedson and Focault's appreciations, Eisenberg claimed that
there should be a differentiation between cultural and biological illness.
In the current society, medical sociologists include some forms of behavior

and experiences of the people as medical conditions. This is why the
illness is shaped by a wide range of phenomena such as culture,
knowledge, social contact and power, culture has an important meaning
because it determines the way in which the illness is experienced, the
reaction of the society towards illness, as well as the measures taken to
cope with the illness. A very controversial and well known topic of the
present society has been through a complicated process in which culture
has played an important role is depression.
7. What made the author to think "Shall I look for help’’ in the second
paragraph?
A. He has lost someone, who is very lovable with him

B. Sudden outbreak of news in Media about depression
C. Author's perception about his state of mental condition
D. While seeing a article in a newspaper regarding suicidal cases
increased abruptly in the last few years
8. What led the author to investigate about depression eagerly?
A. Melancholia is considered to be a source of depression

B. Because of his incidental sadness confronts within the society
C. To find out illness is made by a wide range of phenomena
D. To disprove FouCault statements on depression.
9. The author suggests that problems as individual facing issues are

confronting with society has___________
A. wide range of dimensions to believe

B. has perspectives that built on an organic base
C. acknowledged the true influence of the pharmaceutical industry
D. supplementary gain to the medical institutions
10. The word Ambiguous in the fifth paragraph implies that the role played
by pharmaceutical companies as the saviors is
A. underpinned
B. explicit
C. dishonest
D. obscure
11. What made the author to feel depression as personal topic?
A. The role played by the Pharmaceutical companies as the saviors

B. He himself has faced mild signs of depression
C. To deter the opinion of differentiation between cultural and biological
illness.
D. An inspiration brought by reading the Mills Book
12. Authors view on Mental illness is
A. the concepts of illness and social reality were regarded as same

B. it is shaped by a wide range of phenomena
C. culture alone influences a person mental condition
D. there will be no evidence of social construction
13. How Szasz observations are different from others?
A Latter found them to be false

B. Former observations are not Organic based
C. Focused mainly on cultural observations
D. Confined to behavioural features
14. What does the word this in the final paragraph referring?
A. Cultural process
B. Behaviours and experiences
C. Mental illness
D. Medical conditions
Part C -Text 2
Alternative menopause therapies not best choice?
Too many Australian women are using treatments for menopause

symptoms that don't work, the authors of a new study say. It's estimated
nearly 500.000 women a month are using these medicines to control so-
called vasomotor symptoms like night sweats, vaginal dryness and hot
flushes says Dr Roisin Worsley, from Monash University's School of Public
Health and Preventive Medicine. While some complementary therapies for
menopause problems have not been as well researched as others, black
cohosh and phytoestrogens at least have been the subject of multiple high
quality studies known as randomised controlled trials and meta analyses,
Worsley says. ‘’There really was no evidence of any benefit’’.
Most alternative menopause therapies may also cause shorter term side
effects including nausea, headache and upset stomach. Some known side
effects of ginseng include hypertension, diarrhoea and sleeplessness. "It
will reduce hot flushes by 80 per cent in most people’’, for instance,
Worsley says. "It's really amazing how quickly it works as well’’. But women
and doctors alike were scared off HRT after research findings released in
2002 suggested it increased the risk of breast cancer. The fear was
understandable because ‘’it was very scary evidence at the time’’. But the
original analysis of study data was misleading because it focused on older
women (average age 69) and those taking hormones for longer periods.
This is because the original study set out to investigate a different question:
whether oestrogen therapy could help prevent heart disease and dementia
in older women. While the analysis showed HRT was linked with a raised
risk of breast cancer, blood clots and strokes, ‘’these were older women,
who had already developed some forms of disease anyway’’.
Now the data has been reanalysed to work out the effect of the hormones
on women who ‘'actually want to use hormone therapy for their hot
flushes". These are younger women (usually in their early 50s) who use
hormones for a shorter period of time - and the conclusions are offbeat.
"The reanalysis of the old data suggests the benefits of hormone therapy
[for menopause symptoms) outweigh the risks for short-term use in healthy
women’’. Current guidelines say women should take the lowest dose of
HRT for the shortest amount of time possible, but can use it for up to five
years. However, all women should discuss their individual risk and personal
preference with their doctor.
Phytoestrogens are compounds from plants that mimic the action of the
human hormone oestrogen. Taken either as food supplements or in
concentrated tablet form, they are the most commonly used
complementary and alternative medicine for menopausal symptoms. "We
always thought they would help with hot flushes but unfortunately that
hasn't worked out’’. Worsley says. What's more phytoestrogens may pose
a health risk because studies have shown when they are applied to isolated
breast cancer cells in a laboratory dish, the cells multiply. Because of this,
"we actually recommend if women have had breast cancer they shouldn't
take these substances’’. Whether phytoestrogens might increase the risk of
breast cancer in healthy women isn't known. ‘’That's another point women
don't realise: we don't have the long-term safety data on a lot of these
remedies. They are a bit of an unknown quantity’’.
But treatments other than hormone therapy do exist and if women want to
try them, Worsley thinks that's "completely reasonable’’. They include
low-dose antidepressants and anticonvulsants. The key is to get good
advice about options, something that can be tricky as it is very hard for GPs
to stay up to date. "It's a really complicated topic and it's been changing
rapidly over the last decade’’.
At present, "women with very severe debilitating symptoms have to

navigate this really complex pathway. They try all different types of
practitioners, they try every kind of diet and detox and various exercise
things. And they're trying all kinds of supplements. I think a lot of women
are not getting high quality information on which to make a decision’’. She
suggests seeking out a '’really good GP who's got an interest in women's
health" or ask for a referral to a specialist who deals with menopausal
symptoms. These are often gynaecologists or hormone specialists. There
are also some lifestyle measures that can help. While menopause is a
natural process, it "can be really disabling" for some women. "You can see
why women are trying everything they possibly can to try and deal with it’’.
15. The writer suggests that the potential harm to women was?
A. Approaching artificial menopause therapies.

B. Failing to take medication appropriately
C. Looking for traditional therapies for longer benefits
D. Modern lifestyle adaptations
16. When commenting on the Alternative menopause therapies, Dr Roisin

Worsley shows his?
A. Frustration on women depending alternative menopause therapies

B. Reluctance of using those medicines that cause side effects
C. Surprise that how most people are using these medicines
D. Concern over the approaching of traditional therapies
17. The author used the words it was very scary evidence at the time in the
second paragraph to denote?
A. A situation, when alternative therapies ending with cancer in people.

B. The HRT research results feared off patients and doctors alike
C. The fear of attacking cancer to the people, who have undergone regular
therapies
D. Mistaken view of the people, who had HRT research.
18. The meaning of the word offbeat in the third paragraph is
A. different
B. alike
C. confusing
D. uncommon
19. After analyzing the data, the effect of hormonal therapy on women is?
A. Minimal
B. Severe
C. Negligible
D. Outweighed
20. What drawback does the author mention in the fourth paragraph?
A. Phytoestrogens are not suitable to consume as food supplements

B. Phytoestrogens may cause breast cell multiply, which leads to cancer
C. Oestrogen is taken as complementary food supplement
D. Author recommending to take them in conc. tablet form
21. Worsley used the expression completely reasonable in fifth paragraph,

it says
A. he wants people to undergo continual alternative menopause therapies

B. suggesting other hormonal therapies
C. to provide them better advice on treatment
D. very hard to cope with regular therapies
22. What does the word "they in the final paragraph refer to?
A. Women
B. Practitioners
C. Gynaecologists
D. Symptoms


1. A
2. D
3. C
4. D
5. B
6. A
7. D

8. 22G
9. 20G
10. flattening of vessel
11. 18G
12. (a) back-eye (needle)
13. (the) intima
14. (the) internal lining

15. tourniquet
16. perforating
17. cutting edge (bevel)
18. angle
19. erythema
20. particulate matter
21. aseptic (technique)
22. purulent drainage

1. C
2. A
3. C
4. C
5. A
6. A
7. C
8. A
9. A
10. D
11. B
12. B
13. B
14. C

15. B
16. B
17. B
18. A
19. C
20. C
21. C
22. D
READING TEST 92
information.
PART A -TEXT BOOKLET - ORAL REHYDRATION THERAPY
Text A
Diarrhoea and Oral Rehydration Therapy
Acute diarrhoeal diseases are one of the leading causes of mortality in

infants and young children in many developing countries. In most cases,
death is caused by dehydration
Dehydration from diarrhoea can be prevented by giving extra fluids at

home, or it can be treated simply, effectively, and cheaply in all age-groups
and in all but the most severe cases by giving patients by mouth an
adequate glucose-electrolyte solution.
This way of giving fluids to prevent or treat dehydration is called oral

rehydration therapy (ORT). ORT, combined with guidance on appropriate
feeding practices, is the main strategy recommended by the WHO
Department of Child and Adolescent Health and Development (CAH) to
achieve a reduction in diarrhoea-related mortality and malnutrition in
children.
Oral rehydration therapy (ORT) can be delivered by village health workers
and practiced in the home by mothers with some guidance, and thus is a
technology highly suited to the primary health care approach.
Text B
TABLE 1. Composition of the new ORS formulation

New ORS Grams/litre % New ORS Mmol/litre
Sodium 2.6 12.683 Sodium 75

chloride
Glucose, 13.5 65.854 Chloride 65

anhydrous
Potassium 1.5 7.317 Glucose, 75

chloride anhydrous
Trisodium 2.9 14.146 Potassium 20

citrate, Citrate 10
dehydrate
Total 20.5 100.00 Total 245

Osmolarity
Text C
Abstract: Replacement of Water and Electrolyte Losses in Cholera by

an Oral Glucose-Electrolyte Solution (Pierce et al, 1969)
Background: The efficacy of an orally administered glucose-electrolyte

solution in replacing stool losses of water and electrolytes in severe cholera
was evaluated.
Methods: After initial intravenous rehydration, intravenous fluids were

discontinued, and subsequent water and electrolyte losses were replaced
by the oral solution administered via nasogastric tube
Results: In 9 of 10 patients so treated, water, electrolyte, and acid-base

balances were adequately maintained by this method until diarrhoea
ended. One patient with very severe diarrhoea required small amounts of
additional intravenous fluids to maintain water balance. Patients receiving
the oral solution had a small but significant increase in stool output during
oral fluid administration when compared with the 10 patients in the control
group who received only intravenous replacement of stool losses.
Calculated absorption of the oral fluid was 87%.
Conclusion: Duration of diarrhoea and of VIBRIO CHOLERAE excretion

were not prolonged by the oral solution administration. The role of glucose
in the absorption of water and sodium by the small bowel is discussed. The
study suggests a useful role for such an orally administered glucose-
electrolyte solution in the management of cholera.
Text D
Therapeutic Mechanisms of ORS
The pharmacokinetics and mechanisms of therapeutic action of the
substances in the ORS solution are as follows:
Glucose facilitates the absorption of sodium (and hence water) on a 1:1
molar basis in the small intestine.
Sodium and potassium are needed to replace the body losses of these
essential ions during diarrhoea (and vomiting)
Citrate corrects the acidosis that occurs as a result of diarrhoea and
dehydration. The particular advantage of citrate containing ORS (over
bicarbonate containing ORS) is its stability in tropical countries where
temperatures up to 60°C can occur. A shelf-life of 2-3 years can be
assumed without any particular storage precautions.
PART A -QUESTIONS
Questions 1-7
In which text can you find information about.

1. The ingredients found in oral rehydration salts?
2. Research on how we can treat cholera?
3. How oral rehydration salts work?
4. The effects of diarrhoea on the body?
5. How citrate helps the body?
6. How dehydration can be prevented?
7. Why diarrhoea requires sodium replacement?
Questions 8-14
spelled.
8. Which component of ORS has the fewest grams per liter?

9. How was the oral solution administered in the study by Pierce et al?
10. In the same study, what did one patient require small amounts of?
11. Acute diarrhoeal diseases are a leading cause of death in which
groups?
12. Who can deliver oral rehydration therapy for diarrhoea?
13. Where is the glucose found in ORS absorbed?
14. How long can ORS be stored for safely?
Questions 15-20
texts. Each answer may include words, number or both.
Your answers should be correctly spelled once.
15. Adding citrate to ORS makes it particularly useful in____________

where temperatures can be quite high
16. The duration of diarrhoea was______________ in the study by Pierce
et al
17. Researchers observed a _____________ increased in stool output
amongst some patients.
18. The main component of the new ORS formulation is _____________
19. The World Health Organisation recommends that ORT is
____________ advice of food intake.
20. The ease of administration of ORT makes it _____________ to a
home or village environment.
professionals .
Questions 1-6
1. Healthcare workers who are in a teaching position should
A. Make sure patients maintain their own comfort and dignity

B. Put patient care above their students' educational needs
C. Make sure patients are fully informed of the student's role
Code of Ethics: Clinical Teaching

 Honour your obligation to pass on your professional knowledge and
skills to colleagues and students.
 Before embarking on any clinical teaching involving patients, ensure
that patients are fully informed and have consented to participate.
 Respect the patient's right to refuse or withdraw from participating in
clinical teaching at any time without compromising the doctor-patient
relationship or appropriate treatment and care.
 Avoid compromising patient care in any teaching exercise. Ensure
that your patient is managed according to the best-proven diagnostic
and therapeutic methods and that your patient's comfort and dignity
are maintained at all times.
 Where relevant to clinical care, ensure that it is the treating doctor
who imparts feedback to the patient.
 Refrain from exploiting students or colleagues under your supervision
in any way
2. The grading system below aims to
A. identify the ability of the patient to perform daily functions

B. identify the greatest level of functioning for the patient being tested
C. identify the greatest level of disability for the patient being tested
Limb Strength
The weakest muscle in each group defines the score for that muscle group.
Use of functional tests, such as hopping on one foot and walking on heels /
toes, are recommended in order to assess BMRC grades 3-5
0 = no muscle contraction detected
1 = visible contraction without visible joint movement
2 = visible movement only on the plane of gravity
3 = active movement against gravity, but not against resistance
4 = active movement against resistance, but not full strength
5 = normal strength
Functional Tests
Pronator Drift (upper extremities)
0 = none
1 = mild
2 = evident
Position Test
(lower extremities - ask patient to lift both legs together, with legs fully
extended at the knee). Assess whether sinking is:
0 = none
1 = mild
2 = evident
3 = able to lift only one leg at a time
4 = unable to lift one leg at a time
3. patient-reported outcomes
A. Can often be surprising to their treating clinicians

B. Are sometimes very different to the actual stage of their condition
C. Closely reflect the degree of nerve damage that has occurred
Patient-reported outcomes are becoming increasingly important to

provide a comprehensive assessment of chemotherapy-induced
neuropathy significance and severity. Perhaps not surprisingly, patients
report significantly greater neuropathy than is reported by clinicians.
Patient-reported outcomes provide an accurate assessment of neuropathy.

Accordingly, several patient questionnaires are now available, including the
European Organization for Research and Treatment of Cancer (EORTC)
QLQ- CIPN20 questionnaire, the Functional Assessment of
Cancer/Gynecologic Oncology Group - Neurotoxicity (FACT/GOG-Ntx)
questionnaire, and the Patient Neurotoxicity Questionnaire (PNQ). In
addition, future versions of the National Cancer Institute (NCI) scale will
include patient assessment components.
The FACT/GOG-Ntx is a questionnaire comprising 12 neuropathy-related

questions and has been validated with excellent internal consistency. The
questionnaire strongly correlates with measures of daily functioning, quality
of life and objective neuropathy. The questionnaire also provides greater
sensitivity, with each increase in NCI grade corresponding to a 4- to 6-point
worsening on the FACT / GOG-Ntx scale.
4. The recommendations below
A. Must be adjusted to each patient's individual circumstances

B. Must be adhered to by clinicians treating anyone with osteoporosis
C. Must be followed in order to effectively treat osteoporosis
Recommendations to Clinicians Treating Patients with Osteoporosis:

 Counsel on the risk of osteoporosis and related fractures.
 Advise on a diet that includes adequate amounts of total calcium
intake (1000 mg/day for men 50-70; 1200 mg/day for women 51 and
older and men 71 and older), incorporating dietary supplements if diet
is insufficient.
 Advise on vitamin D intake (800 - 1000 IU/day), including
supplements if necessary for individuals age 50 and older.
 Recommend regular weight-bearing and muscle-strengthening
exercise to improve agility, strength, posture, and balance; maintain
or improve bone strength; and reduce the risk of falls and fractures.
 Assess risk factors for falls and offer appropriate modifications (e.g.
home safety assessment, balance training exercises, correction of
vitamin D insufficiency, avoidance of central nervous system
depressant medications, careful monitoring of antihypertensive
medication, and visual correction when needed)
 Advise on cessation of tobacco smoking and avoidance of excessive
alcohol intake.
5. Health workers might help prevent antimicrobial resistance by
A. Implementing stewardship programmes specific to their workplace

B. Implementing stewardship programmes in primary health settings
C. Implementing stewardship programmes covering humans and animals
Antimicrobial stewardship (AMS): refers to coordinated actions designed

to promote and increase the appropriate use of antimicrobials and is a key
strategy to conserve the effectiveness of antibiotics. In health care settings,
AMS programmes have been shown to improve the appropriateness of
antibiotic use: reduce institutional rates of resistance, morbidity and
mortality; reduce health care costs, including pharmacy costs; and reduce
the adverse consequences of antibiotic use, including toxicity.
AMS programmes do not currently exist for all settings in which antibiotics
are used. Setting-specific, evidence-based guidelines and other resources
and approaches are needed to encourage the development and
implementation of AMS in primary health care settings, residential aged
care facilities, kennels and catteries, veterinary practices, aquaculture and
farms.
Stewardship programmes covering antibiotic use in animals and food
production may have significant public health value in preventing the
emergence of resistant strains and their spread to humans.
6. The main message of the text is that
A. Physical activity is risky and should be undertaken with caution

B. Children should be discouraged from sports that can cause injury
C. People should not avoid physical activity due to perceived risks
Health risks of physical activity

Concerns about safety may be a barrier to participation in some sports,
particularly among children. A survey of parents in NSW identified that
more than one quarter parents of active children aged 5-12 years reported
discouraging or preventing children from playing a particular sport because
of injury and safety concerns. While some sports are offered to children in a
modified format, which increases safety, other sport and leisure time
activities could also be modified to increase participant safety.
For adults, there are some forms of physical activity that have increased
rates of injury. In some instances, safety equipment may be used to reduce
risk of injury. There are also risks associated with participation in too much
exercise, particularly among those who have previously been sedentary.
However, the benefits largely outweigh the risks, and efforts should be
made to encourage participation.
Part C -Text 1
Asbestosis
Asbestos' refers to a group of naturally-occurring mineral fibres composed
of hydrated magnesium silicates. It was popular in commercial construction
and was widely integrated into NSW homes between 1960-70. Asbestos
inhalation can cause asbestosis, lung cancer and mesothelioma, with an
increased risk associated with higher exposure.
Those particularly at risk of asbestos inhalation include people working in

asbestos or milling, those who make or install asbestos products and the
immediate families of these workers. Exposure to asbestos may also occur
in the worker's home due to dust that has accumulated on the worker's
clothing. Additionally, large quantities of asbestos still remain in buildings
that were built prior to the restriction of asbestos use that applies in many
countries. The weathering and aging of such buildings may cause asbestos
fragments to be released in the air and create a potential hazard to building
occupants.
When asbestos is released into the air, inhaled asbestos fibres enter the
lungs. The foreign bodies (asbestos fibers) cause the activation of the
lungs' local immune system and provoke an inflammatory reaction. Over
time, chronic inflammation leads to scar formation, also known as fibrosis.
The scarring of lung tissue resulting from the inhalation of asbestos fibers is
specifically known as asbestosis. The scarring causes alveolar walls to
thicken, which reduces elasticity and gas diffusion, reducing oxygen
transfer to the blood as well as the removal of carbon dioxide. This can
result in shortness of breath, a common symptom exhibited by individuals
with asbestosis.
There is no cure available for asbestosis, but symptoms can be relieved

with treatment. Oxygen therapy at home is often necessary to reduce
shortness of breath and correct underlying low blood oxygen levels.
Supportive management includes respiratory physiotherapy to remove
secretions from the lungs by postural drainage, chest percussion, and
vibration. Nebulized medications may be prescribed in order to looser
secretions or treat underlying chronic obstructive pulmonary disease.
In addition to asbestosis, exposure to asbestos is associated with all major
histological types of lung cancer (adenocarcinoma, squamous cell
carcinoma, large-cell carcinoma and small-cell carcinoma). The latency
period between exposure and development of lung cancer is 20 to 30
years. It is estimated that 3%-8% of all lung cancers are related to
asbestos. The risk of developing lung cancer depends on the level,
duration and frequency of asbestos exposure (cumulative exposure).
The industrial use of asbestos was banned in Australia by 2003, but not
before its widespread use left a legacy of in-situ asbestos in our built
environment. Currently, about one third of Australian homes contain
asbestos, mostly in the form of bonded asbestos cement materials.
Generally speaking, houses built before 1987 are likely to contain
asbestos, especially in the eaves, internal and external wall cladding.
ceilings (particularly in wet areas such as bathrooms and laundries) and
fences. Caution must be exercised if these houses are to be renovated
When asbestos is suspected of being present in building materials, it is

important to have the materials tested by a qualified laboratory. Visual
inspection alone is not enough to identify the presence of asbestos.
However, such testing may not be warranted if the material is in good
condition, in which case it is best to leave it in place. If you are carrying out
maintenance such as painting or sealing on suspected asbestos-containing
surfaces without sanding, wire brushing or scraping (i.e. you are not
releasing any asbestos fibres into the air), you only need to take the usual
precautions for these activities (such as working in a ventilated area). If the
material is damaged, or will be disturbed during normal household activities
or remodeling, it should be professionally tested.
Worldwide, Australia has the highest reported incidence per-capita of

asbestos-related disease. Asbestos-related disease has killed thousands of
Australians. An increasing number of new cases are being found in people
who were exposed to asbestos fibres whilst renovating homes that were
built during the period when asbestos-containing products were widely
used. It is estimated that up to 25,000 more Australians will die from
asbestos-related mesothelioma over the next 40 years. Thus, the effects of
exposure to asbestos will need to be managed for many years to come.
7. According to the first paragraph,
A. Asbestos has been used in Australia since the 1950s

B. Inhaling naturally occurring fibre can lead to asbestosis.
C. Asbestos causes harm by increasing our exposure to mesothelioma
D. Many of the commercially-constructed buildings built in 1960 contain
asbestos.
8. People are most likely to be exposed to asbestos inhalation when.....
A. Working in the coal mining industry.

B. Renovating buildings constructed prior to the restriction of its use.
C. Living with people who install asbestos products
D. They have comorbidities that increase their risk of asbestosis exposure.
9. Regarding the mechanism of damage caused by asbestos fibres.....
A. The fibres cause a prolonged inflammatory reaction in alveoli

B. Some forms can penetrate more deeply into the lungs than others
C. Fibres that reach the alveoli cause oxygen transfer into the blood
D. The immune system is unable to respond to inhaled fibres.
10. Which of the following would be the best heading for the fourth
paragraph?
A. Palliative treatment options for patients with asbestosis.

B. Improving the quality of life for patients with asbestosis.
C. Supportive management of shortness of breath due to asbestosis.
D. Treatment of chronic obstructive pulmonary disease.
11. According to the fifth paragraph,

A. Asbestos inhalation can cause skin tumours such as squamous cell
carcinoma.
B. Exposure to asbestos fibres can cause lung cancer 30 years later.
C. Cigarette smoking causes a larger proportion of lung cancers than
asbestosis
D. Frequency of exposure to asbestos can predict the risk of lung cancer
developing.
12. The presence of asbestos in Australian homes...
A. Was eliminated after a ban on the industrial use of asbestos from 2003
B. Is only a concern in houses that are to be renovated
C. Left a legacy of using asbestos in the construction industry.
D. is most likely if the home was constructed prior to 1987
13. Regarding testing for the presence of asbestos, which of the following
is most correct?
A. Materials that are suspected to contain asbestos should always be

tested
B. Visual inspection can be used to determine if further testing is necessary
C. The best course of action is to leave the suspected material in place
D. Household activities may determine the necessity of testing
14. What is the main reason why asbestos is a concern in Australia?
A. On average, 500 people a year will die due to asbestos exposure

B. 25,000 Australians are currently diagnosed with asbestos-related
mesothelioma.
C. There is an increasing incidence of asbestos-related disease.
D. It has the highest number of people with asbestos-related disease
worldwide.
Part C -Text 2
Treatments for Epilepsy

Epileptic seizures are estimated to affect approximately 5 in every 1000
children. They have a significant impact on childhood development, with 15
to 25% of cases associated greater than 5 minutes is recommended under
a recent set of US guidelines based on a systematic review of available
literature. However, anti-epileptic drugs (AEDS) have a significant adverse
effect profile, and therefore it is imperative to weigh the benefits of
treatment with its risks
Benzodiazepines are the most effective and most highly studied form of
acute seizure treatment with relatively few severe adverse effects aside
from respiratory depression and temporary cognitive impairment. Whilst
appropriate in an acute setting, long term development of tolerance
(reducing its effect over time) and eventually dependence with
serial use means that frequent or prolonged use is not appropriate.
Midazolam is an appropriate choice in many cases. It is a proven,

efficacious treatment. A single dose resolves 70% of seizures lasting more
than 5 minutes by 10 minutes, which is equivalent to the effects of
diazepam and lorazepam, and more efficacious than other agents including
sodium valproate or phenytoin. Especially in the context of a prehospital
setting, intranasal midazolam produces results equivalent to other routes of
administration that does not necessitate obtaining time-consuming IV
access. In addition, it has a short half-life of 2 to 7 hours which is less than
half of other comparable benzodiazepines due to its water solubility at
physiological pH, reducing the duration of adverse effects.
Neuronal action potentials depend on a rapid influx of sodium through

voltage-gated sodium channels to cause depolarization. Carbamazepine
stabilises these channels in their inactive state, thereby reducing the ability
of sodium to influx into a neuron - hence it reduces their excitability and
reduces the risk of the uncontrolled electrical activity that characterises a
seizure. Sodium valproate and phenytoin also have a similar function of
voltage-gated sodium channel blockade-the full mechanism of sodium
valproate is not fully understood, and is hypothesized to additionally
increase levels of GABA within the central nervous system.
Few high-quality studies exist on the efficacy of carbamazepine on
childhood epilepsy compared to placebo. Of those that do exist, many have
small sample sizes leading to lower power. One study suggests that
approximately 45% of children become seizure free after commencing
carbamazepine. The majority of studies regarding carbamazepine are
comparative studies with other AEDs. These show similar efficacy
compared to sodium valproate, phenytoin and topiramate. There is still no
unequivocally 'best' first-choice AED for generalised seizures in children.
AEDS including carbamazepine come with a significant profile of adverse

effects, especially cognitive, due to their mechanism of action that reduces
neuronal activity. One survey revealed that carbamazepine therapy
produced sedative effects in 43% of the study population, ataxia in 20 %,
other CNS disturbances such as vertigo in 17% and negative behavioural
changes in 5%. Other effects include nausea and skin rash. Only 30%
reported no side effects. Measures can be taken to reduce these effects
the primary being to split the dose to twice a day to reduce the peak
concentration of the medication. Carbamazepine also has significant drug
interactions which must be taken into account, including accelerating the
hepatic metabolism or other lipid soluble drugs, including the OCP and
sodium valproate.
Patients and their families often receive education about epilepsy via
outreach, including basic seizure first aid. This simple, non-
pharmacological approach slightly improved quality of life outcomes in a
US study. More importantly perhaps, those with greater health literacy were
also found to be more compliant with medications, which may lead to better
long-term outcomes. Unfortunately, little evidence exists as to long-term
prognostic outcomes of epilepsy education.
15. Seizures caused by epilepsy...
A. Should be treated only if they last more than 5 minutes

B. Occur in around 0.5% of children.
C. Cause developmental delay in up to 25% of children
D. Can be caused by developmental problems.
16. The effectiveness of benzodiazepines...
A. Means that their dose needs to be reduced over time.

B. Makes them inappropriate for repeated use
C. Is outweighed by serious side effects, such as respiratory depression
D. Leads to some patients taking them even when they are not having
seizures.
17. Which of the following is MOST true about midazolam?
A. It is excreted relatively quickly by the body

B. The adverse effects are less severe than other benzodiazepines.
C. It can effectively stop the majority of seizures.
D. it has similar effectiveness to sodium valproate and phenytoin.
18. Which of the following paragraphs would this be an appropriate heading

for “Treating seizures by reducing neuronal activity"?
A. Paragraph 2
B. Paragraph 4
C. Paragraph 5
D. Paragraph 7
19. What does the author suggest in the sixth paragraph regarding the
AEDs that are currently available?
A. The current evidence is insufficient to make any one AED preferable

over the others.
B. Carbamazepine is comparative to other AEDs.
C. There are Insufficient studies comparing carbamazepine to placebo
D. Carbamazepine can be expected to work in about half of children.
20. Regarding the side effects of AEDS, which of the following is NOT true?
A. One study found that 70% of people taking carbamazepine experience
side effects
B. Carbamazepine can speed up the clearance of some other medication
C. The side effects can be reduced by adjusting the dosing regime.
D. The most common side effects of carbamazepine are ataxia, vertigo, a
negative behavioural changes.
21. What is the most significant effect of educational interventions?
A. Improved quality of life for people with epilepsy.

B. Improved health literacy amongst epileptic patients.
C. Increased medication compliance in health-literate patients.
D. Better long-term outcomes for epileptic patients.
22. Which of the following would be the best alternative title for this text?
A. Treatment considerations in children with epilepsy.

B. The pharmacology of various epileptic treatments
C. The use of benzodiazepines in epilepsy.
D. Challenges in the management of epilepsy.

1. B
2. C
3. D
4. A
5. D
6. A
7. D
8. potassium chloride
9. via nasogastric tube
10. additional intravenous fluids
11. infants and young children
12. village health workers
13. small intestine
14. 2-3 years
15. tropical countries
16. not prolonged
17. small but significant
18. glucose
19. combined with
20. highly suited

1. B
2. C
3. C
4. A
5. A
6. C

7. D
8. C
9. A
10. A
11. B
12. D
13. D
14. A

15. B
16. D
17. A
18. C
19. A
20. D
21. C
22. A

Oet Materials PDF

Загружено:

Сведения о документе

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Oet Materials PDF

Загружено:

Авторское право:

Доступные форматы

READING TEST 83

READING SUB-TEST : PART A

PART A -TEXT BOOKLET - BENIGN PROSTATIC HYPERPLASIA

A 62-year-old man with a 4-year progressive history of :

What is his risk of progression?

∝ - blocker therapy, or very careful watchful waiting.

Despite the deceptively simple description of benign prostatic hyperplasia

1. About combination therapy?

20. can be used for patients with BPH progression.

END OF PART A THIS TEXT BOOKLET WILL BE COLLECTED

READING SUB-TEST : PART B

Manual extract: Kuschall ultra-light wheelchair

2. These guidelines contain instructions for staff who

A. need to screen patients for MRSA

MRSA Screening guidelines

3. The main point of the notice is that hospital staff

A. need to be aware of the relative risks of various bodily fluids.

Infection prevention depends upon a system of practices in which all blood

4. What do nursing staff have to do?

Extract from a monograph: Salbutamol Sulphate Inhalation Aerosol

During worldwide marketing experience, rare cases of various congenital

6. What is the purpose of this extract?

Extract from a textbook: debridement

READING SUB-TEST : PART C

One modifiable behaviour with major therapeutic implications for CVD is

Several occupational studies have shown adequate physical activity in the

The cardiovascular beneficial effects of regular exercise for patients with a

Among patients with experience of heart failure, regular physical activity

General physicians can play an important role in counselling patients and

Part C -Text 1: Questions 7-14

A. Measures to treat CVD have failed to contain its spread.

A. demonstrate the value of a certain piece of medical advice.

A. believes that health education has failed the public.

A. Its benefits are most dramatic amongst patients with pre-existing

A. it is likely to have more than just health benefits for them.

Kaptchuk needle/pill experiment shows that the methods of placebo

Years of considering this problem led Kaptchuk to his next clinical

But to really change minds in mainstream medicine, researchers have to

Another biological study showed that patients with a certain variation of a

A. varies from one trial to another.

A. surprising findings are often overturned by further studies

A. The use of placebos is justifiable in some settings.

19. What is suggested about conventional treatments in the fourth

A. Patients would sometimes be better off without them,

A. improvements in the design of placebo studies

21. In the fifth paragraph, it is suggested that Kaptchuk's research may

A. the financial success of drug companies.

22. According to the final paragraph, it would be advantageous for

A. understand why some patients dont respond to a particular drug.

END OF READING TEST, THIS BOOKLET WILL BE COLLECTED

Reading test 83 : Answer Key

Part A - Answer key 1 – 7

12. 5 ∝ reductase inhibitor therapy

Reading test - part B – answer key

Reading test - part C – answer key

Text 2 - Answer key 15 – 22

PART A -TEXT BOOKLET – EVALUATING COGNITIVE FUNCTION

Complex attention Sustained Are you having difficulty following

Social Cognition Recognition of [To informant] Has he or

8. What is the other name for dementia?

15] Dementia differs in important ways from ______________, which, for

END OF PART A THIS TEXT BOOKLET WILL BE COLLECTED

READING SUB-TEST : PART B