ET Er) kOe NNLO) elaine dies vest ont:Fractures, dislocations and sprains: Texts ‘rates (hee or breakin te bone) aten ots flowing sect or rectnuy. wig, olen Tobin ny acter ate ee ‘cose, ere thesis intact oF {angoun, were thre breakin the oehing kin Daloeaton's whee bone i completely ple or teat en esis om is away om Choafected jane bow deoeton she fag on an ovttetched Nand Saran prt eruption of gant cps oot a ‘Simple Fracture ofLimbs Inmesatemaragerent: Hot on enteral haemorrhage by pessurebendageor direct presse * tmobiee the fete rea 1 Provide parle? circa asesment * Obtin complete patriot creumstancos amet ofnury "mediation hstery~engule about ameaaguant use og. wari «Barer sanded cine observations Bamine and cord cleus, warmth vere, sensation in hands. ane et fife eb) “+ Prtrm py examination amine places where espa any wound or sveting ‘lou ofthe whole tm spel pleas or lus eou) theskinvertefractre range moverest “pint faction above a blo the ry ste Chechen “hatin s out of shape compar onesie whe ther “etiam helm (alerting or geting bigger peer uses ae palpable Management: spe the Stef the facureidscaton sng plaster back to reduce pain vate the nb ng for sites, apo frleg nurs + Hindoubtover an injury teat asafacire 1 Adinser oagesa to pstntsin evee pl. ot teal gv morhine (pcerabie fallen twomorpine se fenton t + Conse compartment snd wher pin is sever and unlned by splinting and elevation 7 ‘ovodouesof alge + rotor 80.Mm rug Therapy Protocal [Acferen anos Heh Worker (MW) mus connie Heel OMe (MO) or Nurse Praciontr (NF. ‘lpnded Medes Rr loz Pracace Reged Nurse ay proceed rag Farm [engin [test TRaconmendedgome | Burton ‘Ae on eel G02 nego sma Tome sx ergine | Angate | 10min Adu ont deneron rm Ines cowot2 meter | Home Tew nayrer | 851 mainreneresons | oer corres oy | Fopeead er 3S es requires ronal ng Use te nro fos rrge in pers 270 years Prove Consumer Maine bora: adv can case aues and ening, owes. Rasprtary depen rare =f should oo pe aloe. “eclave orate tackla forarm Hactuos— use same pnp org retres 1. Meosure a londth of nar-corgresin cton skit om hf way up the mile rger tout teton te om, With sou be 2-2 om more han te wa ft ea fear 2. Wn oon pading ver np fete fullngn the stockinett—2 ayers, owe 3. Mesure len plaster ot Pac om share thon he pasang/stckinctil at ach end Fld the rain about ton yersto te same enh. 4. mero th nero pater in bow om tmgersre wate, lingo to ech end. Gey eae oi tho oes wate ‘5 Furey jewaley i remeved om there mb 6 hyn ne ib tthe carta of am and nan na rei poston. "Da gply poser oe Bory proioences. xr padi canbe paced on by prominence It We top bandage tly rune aster back ND OF PART A ‘THIS TEXT BOOKLET WILL BE COLLECTED Eel 81 i eos inant —PartA “TIE: 16 nto Ne Pe Lk hs fours, A, nthe spars Text Book + For ston, 120, lok teough th xt, A, ff the relevant information, + We your ast on he spaces provided in this Question Paper. + Anemer a he guastions within tho 1-inuto Seer + You rawr shouldbe croc spt Fractures, dislocations and sprains: Questions Questions 1-7 For each question, 1-7, decide unio text (A, 8, € oD) the frmaton mea fom. You may use eter more tan once Inwhieh ox can you find eatin bout 41 procadurs for desvaring pain i? 2 the procedure toftow when sling arated i? 3 whatto record when assessing a patent? 4 heterms used in doserbo diferent ypos of atures? 5 thopractonars who administer analgesis? 1+ what took far when chockng anny? 7 hem esckes can be cased? Questions 8-14 ‘swer ea he questions 8-44, wt 2 word or short phrase fom one of he ets. Each answer may iacods ‘words, names ce both 8 What should be used eleva 9 patents acted lag? 9 What isthe maximum dooo of morphine per kl opin’ weigh tnt canbe given using ‘ho rrasmuscular i route? 10° Whe pas ot a tn may need extra pang?" 0 “ ‘What shou be usd oot 2 patient who sues resis depression? ‘What hous be usd to cover a teshlyapled pastor backs? ‘at nalgasi should be given to pat who is ergo morphine? ‘at condton might apationt have if saves pain persists a -wepestd analgesia? plising, lvaion and Questions 15.20 ‘complete each fhe serionces, 1520, wha werd or shar prose rom one of the ents. Ech answer may inesido words, numbers both 6 6 7 ® Fig on an outstotced hands apical cause at. Upper mb fractures Shaul be elevated by moans of Make sure te patient it wearing ay body where he past bakalab is going be psc cn the par ofthe Check o ee whether swolen ibs ae into orincrasing Ina plaster backs, there ayer of ones te in, Patonts aged houages of pan oe ‘2nd evr shout be given the higher END OF PART ‘TIS QUESTION PAPER WILL BE COLLECTED pron as reenecaPanB In his part of hotest, here are sx short exacts relating to he work of hea profesional, For questions 1-6, honee a anewer (A, B oC) whlch you thinks best according othe tex. 4, The manu intonns us tal he Sood Pressure Monitor @ ss tkey toicttee wih te operation of thr med equipment ® may not work corectyinclose proximily fo some cher devies. © shou be consiered sot ws in af hospital environmen. Instroction Manual Digtal Automatic Blood Pressure Monitor Elecromagnotic ompattiy (EMC) Wn the leresed use of portable lectc devine, medical equipment may bs suscepti to ‘leorrmagnetc interference. Thi nay osu in ncrrect operation ofthe medical devise and crete 8 potently unsafe stuson, i cde to regulate the oqurements or EMC, wih he alm of preventing Unsafe product situations, the EN6O601-1.2 standard defines the levels of immunity to electromagnetic inferences as we a masmum loves of tcromagnti eisslons for medical does. This medica ovo conforms lo ENBQS0'-1-2:2001 fr bath mimunly and emisions. Nevers, care should be ‘akan to avoid the use of the eno win 7 meses of eaphones oF ater devices generating tong octal of elecvomagnati fs 87 E pneowe ney"a not is ging nfrmation stout (A) weap of chectng tat an NG tbe has boon paced coe. (8) how he use of NG fesdng tubes is atherso, ©) hie sta hous pros NG tbo placement fading ues onplcrent of msagete NG edn tbescan have Serosiplatons if undetected. nore {ovine tubes eave pants verbo the feks of equghtion and seria sprain esc to {Mivnotebtesn gsc and resplatoy laement onto nsetinto prevent pony fatal pdonan, tounpcatons.nerton ad care ofan NG tube shoultherefore only arid out bya regered doctor of nn ahohas undergonetheortil anc praccl ing ondis deemed competent ois syperie by someone ‘ontet estan practioner and other aegistered staff must neverinsere NGtubesorbeimeledinthe ta oniation fae NG tbe positon, 3. What mus ll staffinvoed inthe transfusion process do? @ checktnat net extn ening is st va @ ston couse ean about new srocoderes © read a document nat xpans changes in poly ‘Right Patient, Fight Blood’ Assessments “The scat of blood can hve significant marily a moray, Following the inden of he Fight Paint, Right Boot safety poi, lst ted in the transfusion press must be comstoncy seaosced To nue he soe sdinistatlon of blog components to intended patent, al staf must be swe ofthe responsible nine wits pofossional standards, Staff must ensure that iy ake sy patin the ransfusion proces, ter competency ssseserient Updated every tes years Als re sponsible fr ensuing tat thay tnd the mandatory warn identi fr ther rls, Relevant ining courses are clearly Weittedin Appene* of he Maresony Teng Mati‘4. Tim guidlines estas hate heahcare profesional shoud @ aim tomate pants uty aware thigh to 8 chaperone ® vars he need tora chaperone ona casey css basis. © respect ne wshes of the pation above al ise, Extract from ‘chaperones: Guidelines for Good Practice’ ‘Npalon may speccay request chaperone or Saran crcurslanoes may noinse ene, butt wil ro lays beth casa that a chaperones require. tie on a quesson of using professional jadgerer, to stae an india stunion. 2 chaperone is fered an doctned, tis must be larly documented Inthe patents record, ang wit ny event scuesion, The chaperone should only be present forthe physcal examination an shouldbe palono eee what the hetticaeprfesionalunstaking ‘he exainatoninvestgaton fe deng, The hese peeosslonl should wa unl the chaperone hs lot th omelets dacusion ake aceon any aspect ofthe paint’ cae, ues the ptt spectealy rquests e chaperone to rea 5, The-gudees require those undertaking a cna medcation review to @ vo te patortin be desons © consider te costo an chargointreatnens © ‘econmand aber sences as an atemat median. “ove apatite an arnual medion review ian ideo stve fo Inthe meantime thaw an argument fr targeting al ini medication reas to those pation kay to bene ost (Our guides state that tess leva? madcton row wi occu, Lethe minirum standards ‘reatment evow of racines withthe ll dots bt not nceszaiy wih the paint reson. Hower, ‘he guidsines goon o say ha al palentsshoud have the chanoa to raise question ad highight robin about thelr mene! and that ‘any changes suing rom the review se agreed wth the ator Iso states hat GP pracices aro expected to + minimise waste in prosciing ac avoid inetectve eaten + engage efactveyn the prevention oil neal. + avoid he nod for costyteatments by proctvly managing patios o recovery tough ‘ho whole care pathway.“The purpose ofthis eras isto ® rept on 2 tse in post surgical complications. ® eran te bokaround wa changin pation car. © remind tal abou procedures fr adnan ups. ‘To: Al satt ‘Subject “Advisory Ema: Safe use of opbids 1 August, an alr wasesued on the safe Use af pois in hose. This reported the reldence of respratory depression aman post-suicalpatients to an average 0.5% — tus for every 5,000, surgical patients, 25 wil experence respratery depression. Fare to recognise respiratory depression and Instat tinal intervention can aad to cardapulmonay ares, rsutng in ran ny or oath. retrospective multi-centre study of 16,720 cardiopulmonary arost ase showed tat «44% more respiratory ated and more than 35% occarred oa the general cre ont is erfore recommended tat post-operative patients now have cntnuousrnitorng, stad ef spot checks, of both oxygenation an vntatn, 92Pate In ths part the test, there are wo tots abou fret aspects of hance For questions 7-22, choos the ‘nner (A.B, Gor whch you tank fs best accoring a the txt Text 1: Sleep deprivation ‘ions of peopl who sur sleep problems sao euler mad heath burdens. I adtion to emetiona ress and cogitv impaimets, thee can Inc nigh bcos pressure, best, anid metabo syd inthe ios ‘weve done, aos! every vaable we measured was affocad, Theres ro a syst nthe body that's not ces by slp sys Univ f Chloage sloep researcher Eve Van Cau. "Every tine wo Seap-deprve ousetes things 90 wions A coman refs among seep scientit abut wo decades 290 was tha sloop was perormed by he brn nthe Inert of ho bral, That wasn Sly slsberated any, but wasnt wrong, Norerous recent tusies nae ined st tne purpose of lop by cotming tht neurlgical fnetin and cognon are messed up during sleep bss, wth ‘he pants acon tne, ood, se judgement suttoring thoy are kop awake to kong. 1n 1997, Bob McCarley and colleagues at Harvard Medical School ound tht when thay kept cas awake by paying wih ther, a compound known a adenosine increased in the basal ferbran asthe soopy felines stayed wp longer and tow retuned to norma loves whan they wor lr allowed to sleep, MeCaey'team also found ‘hat adrnistaig adnan phe basal forbade sedative, puting ara lep. should came at no sures hen that catia, which blocks adenosine’ ecto, kops us awake, Teaming up with Basher and ‘there, MoCo ner covered that, 9 adenosine oval is ding stop depruaton,s0 do concentrates of denasin receptors, maghiing he molecdss eopnducingofet, The bain hss cevery designed a two-stage dbofence aginst he consequancas asleep lose’ McCarey says. Adenosine may wndete somo the cognitive fis tat est tom sleep lose. MaCarly and colleagues found that fusing adenosine nto rate basal 'reran Impaed hel performance on an attention tet, sina oat seen In Seep deprived humans, But adenosine loves ae by no means the be-all and endl sleep depations fects on the bran othe body (vor canto stoop research has reveled numerous undesirable outcomes ram staying awake oolong. I 140, Vn Cater and coleagues had eleven men slop in ho university fab, Forts igh, they spent ht hours nad, hn fr 3 ight hey were alowed ony four hous (acouing what Van Castar cals a slaop db), ‘and Du fr sc gh ey cu esp for to woe hors up Fecovery). During slop debt an recovery, itu fe patganta a glucose lrance fost nd found stiking erences. Wil Soop doped tho ns ce abi esembed a pro-dabetc tte, We knew woul be afectd, says Van Caute: "Tha iy amb was the ff boing much grater than we thoveh Beal 93 fl. t pane nienincaterenrianimsese ane eas‘subvert tudes also found insu resistance neressed during bouts of sop recto, and in 2012 Yan CCout’s wa cbecrvd ipaiments in insuin sgnaling In subj ft ols. Anon recent study shower thal slep-estrictod people wil dé 20 clorias oto aly lt ching Van Cauto’s ests, BAsheer as found evidence tat enfrcd lock of sleep sands the ran ints 2 cabot, or energy consuming, sae THs 16 because i degrees the energy molecule adenosine tiphespate (ATP o produce adenosine onophosste ‘2nd th repulse acvaton of AMP kirase, an enzyme that boos faty ai snes id gucose utzon. “Tha aster sends a mestage thal there's 2 ned for more energy’ Bashoor says. Whether hiss indeed he rmochaniam underying ani binge-eatig sl spscultve. ‘Within te brain, conse have raed signs of physial darsage ram ap ss, and he mo-no for recovery, if ary oct, is nkooun, Chara Calis tam at he Mason School Medcnein the USA found struc changes inthe cote neurons of mice wen he anima te kept awa or fog periods, Specialty, Cla ant ‘leagues sat sgns of mitochon! acvabon~wbich makes Sans, as neurons need more energy to ay she: sheoaye~ a2 well as unexpectd changes, such ae undgestod oaliar debris, sos of ear ang st ‘=< unuaualin the neurons of yourg,helty mice. "The number ff dors granules] was mall, but i's wonisome ‘sca t's ont furto ve day’ of sleep deprivation’ aays Creal. Aer ity hours step recovery. patod «tng which se expected erate to resume, those changes remained, Further nights coud be raw ram the study of shit wrk and insomnia, who serve as natal exprienis ‘on how the human body east ang ton such a base now fr chron poids, Bu with so muck of our physiology fected, an efectve theapy~ other han sloop self —hardo imagine "eople the to deine 3 ‘ear pathway of acon fer haath canton, says Van Couto Wh sles depiaton, enyting you mexsue tact and imeracts synergistic to produce the ect”‘Text 1: Questions 7-14 7. Inthe first paragtaph, the wter uses Eve Van Cavters words to @ oxpiain ho main causes of stop deptuston © reeere view about he inpac ot Seep dptvtion © ueston ome research firings aout sleep deprivation. © snr charges oko step denaton each 8. What dowe lam about stop inthe second paragraph? ® scientcoprion abouts uncon has changed in recent yeas. © Tews eow more controversy about than hee was inthe pa. © Ressercharshave tended contin earier eas bout ts pupose © suse undertakan inthe past ave formed he bass of curent research, 2, What parculaty impressed Hob Mectey of Harv Medical Schoo? @ the eectveress of ssenasno a a sedate © ‘meinfuonce of care on adenosine receptors © te srutancousprosucon of adenosine and adenosine receptors © tmeescentio which adenosine evel when sj are alone slop Ino he paragraph, what aa ie emphasis by tho phrase ‘by no means the be-all and endl? (A) Sloop dopaon has consequences beyond ts mpact on adennsine levels. 8) Adenosine levels ae 2 ignliont factor in stutons cher ban sleep depivtion (6) Toro of otenosine a a espense to eep derivation na yet ily undorstood. (©) Thwnpatance ofthe ik betwen seen deprivation and edenosine should not be underestinatd Eel 8 eee+1, Whatwas snteant out hefiingsin Van Cautes experiment? ® ‘worse stutieh ne sloopcopiad moneda pessoas © eter tt Soop depvson haan uence on tear hse ele © ‘ecineercestetaen vil nen woh reget er ge nce © tortor o he contrast the mons rsaboi sats between sles det and recovery 12, inthe ft praproh, what dows the wordt weterto? ® merame ® roweviderca © 2 camdote state © ecteced iackot oop 12, What aspect her findings sured Ciara Cea? @ Tere was 0 revert of cota fet of ep depron. © ‘recor! neurons othe mice ndénwent stata charges. © ‘here was dere oan ineoated ned fr ent into rans th mice ® The neurcogal response to Sep depen on ook ow hours wo Become apparent “Inthe iat peraroph the aut am Van Caters used o vanes hat @ we goats ot @ ‘eauktbeaieut to dove any teaent to sleep depiaion © prions sbeut he best way to doa! wth sleep derivation are cvs © eres rest oa obo lar abou the ees of sloop cepiraton dpciton researc 0 somes undar.Text 2: ADHD ‘The American Psychiat Assocation (APA) recognised Attention Defi Hypeactiy Dire (ADHD) at8 chithoos deoder in the 18608, but twat unt 1978 ht the conéton was omy ecognved 9s ting ‘ds. cent years, he USA has an 8 40% opin dagnosos of ADHO In chien could be that he dorder {a becoming moe rovaleto, 2 same mero paulo, doctors are making the agnoss more equanty. The ‘ssf compte by tha lak of any recognised neurological markers for ADHD. The APA rls istoad an @ stot bahaioua pts for dagnosis, specs tat patents under 17 must splay elas si symptens of Inatenion andl hyperactivity; adits need only asia ve. ADHD can be a controversial contin, De Russel Baroy, Professor of Peyctity atte Uiversy af Massachusetts he econce ie overatling 2 feal lsd which canbe managed many ces, by sing stmulant medicaon combination wth etor reatmant) Or Richard Sau, a behaviours neulogt wh five decades of expeence, disagrees Many of us have ificuty with organization or dels, teency olose ‘ings, tobe age cr detracted. Under uch ebjoctve cer, the entre population cou poral ually _Athough some pallets might need mula o functor wellin daly ie, te lumping togather of many vague and subjacte symptoms ool be causing a naonal phenomenon of misdagnoss and over pescipton of stants” Areca toy fod chon nfs crete nes more kay than xhers tbo diagnosed wit ADH. Reeeochers ls found ha ire wth ADHD in fester care wera mori te have another corde, ach 8 depression o nny Ths ng certainly revels the need for mescal anc behaviours sence fo these dren, uli cous ls prove the nan-apedfe nature fhe symptoms of ADHD: nse and depression or an ered tte, can easy bo mistaken for manifestations of ADMD, ADHD. tne thinking oes, bins in chidhon In fsck in eer oe cagnasod wet as an adult a pation must ‘femansrato that hey had ras ofthe condo in chidhood, Mover, tus fom the UK ae Br, pusichos In. JAMAPsyoty, te uling quastions about ho origins and Waco of ADHD, suggesting nt oiy lit can bin in adultheed, but hat tere maybe two esne eynromes: adult onset ADMD and chilthod ACD. “Toy oho oar research rn Naw Zeal, However, an eto by Dr Stephan Farane in JAMA Payity ‘hts pote Rawsin ta findings. Among them, underestimating he pecitence of ADHD int sutiond 109 of at oneet ADHD. n Or Faraone words, he researchers found 2 goup ‘ooh lb subtheeshok ADHD in he youth. Ther may have been sins that things were ight but ot no oo doctor Perhaps these were srt kids wh particulary supportive parents or tsachers who Inc vn x wth tention problems. Such tects and sok seafoing woud hopin ety If, bu whe skh are, ADHD could devel’ eng te re 7Unt hs cert, adult ADHD was a seidom-agnoeed corr, Nowadays however, i's common in maisteom medicine inthe USA & prac shit apparent divon by two factors: awerked— many say less stingen~ gost cet, toduced by tha APA n 2013, and marketing by manufactures of ADHO modiations. Sone have svgestes nat is rew, broader denon of ADHD was tue, east np, to broaden the market for ‘mediation. lamary instances, the evidence profered to expand the defnton came from studs funded nwhole or prt by manulacires. And as he ceria forthe contion nosed, repos emerged about cna invcved 1m lognsing ADHD receiving money tom érug makes “This binge us othe eave of he asc nature of ADHO medication. As Dr Saul assets, ‘adds o simula rmodicaton ft ae; ts cmon. ut cbuerve the ay pairs prodialy seeking an nreased dosage ther power of concentration dish. Tis is boca the body stops producing the snpropit eves of rurtrananiter that ADHD dug replace ~ a radamark of adv subsnoss” Muchas been witlor about the staggering increase m opi overdoses and abuee of preston pinkiosin the USA, but he abuse rugs wed ote ADHD eno loss ist Whe opis are more thal han praszipton sults, tere aro paral bewoon th oid epider andthe inerea in poblems to sits. nthe ore, wor ttc ‘rom prescriton nares to hercin andi etany. With ADHD crus, patios ao sching rom egy resid smulnts oct ones such as metamphetanine and cocsno. The medcaton is parulaty pone to abuse because people fea improves he hes. Thase rug are anidprescnts, ad welghoss and inarve confidence, an canbe used by students seeking improve the focus or academic perfomance. So, nore ‘wrk nods lobe done before we can set tha questions surounding fe ckagns and wostment of ADHD,‘Text 2: Questions 15-22 15, _Inthefist paragraph, the wir questions whether @ ss.ADH0 sed nave boon caren 3 rte tan eatir dt. © A040 should be dagrceed inh sameway fer len and ais © AOr0 can scaly bo indatad by nee! markers © cases ot ADHD have gains ncwased in he USA. 16, What does Dr Saul object to? ® weagoesion et pope need smarts cope wth everyday © We tmlicston mat eveyone hae sme sympas of ADH © ‘mearovpng of mpraces symp in mona arr © Me wostartior ADHD sunges by Oroakey 47. Ther egards the saty of iden foster care as slgnilar becouse it ® Nore ne cay of stequshng ADHD fom ater constons. @ toeweson ern noun to have col mens borers © sages ak detwsen ADHD ad chs upbnges. © crave atonton toto poor care given o sch iden 18, nthe four paraorah, te word They eer o @ seen © custom © studies. © otone 29 eevee18, Dr Faraone suggests hat the group of patntsagncsad wth edutonsat ADHD ® estoacors or parents wh recognise he spam of ADHD. ® shes have const doctor a young 90 © hadi nsgnceas ADHD inchihood © wore special chosen by to ressarchrs. 20, Inthe ith paragoph, ts suggested hat ru companies have ® boon ovr aaressiven ee marking ot ADHO mein © ‘intwences research hate ote ovrkng ADHD saga cea, © stones o change thers about incenves fr decors ho Bagrase ADHD. ® enesuraged he APAto rush hough changas toa rer fr agnotng ADHD. 21, Inthe Sia paragraph he wor ‘eademar refers to ® spryiogeat eaten ® ssvostutoradicaton, © reed orrosearch. © aconmen east 22, Inthe ina paragraph, wat dos he wetter py about sdlcton to ADHD medkeaton? ® is nitty tu to robe onthe sal ofthat cased by oni abuse © Trootects aw mor marked in carsn sectors of he popuaton © besten tenon eens o have been gid 0 © Treressona rit eno ye uly undrtod. END OF READING TEST ‘THIS BOOKLET WILL BE COLLECTED 100 i.