Reading

Class Work
READING TEST 01
 - the limb is warm
- the limb (if swollen) is throbbing or getting bigger
- peripheral pulses are palpable

Management:
• Splint the site of the fracture/dislocation using a plaster backslab to reduce pain
• Elevate the limb – a sling for arm injuries, a pillow for leg injuries
• If in doubt over an injury, treat as a fracture
• Administer analgesia to patients in severe pain. If not allergic, give morphine (preferable);
if allergic to morphine, use fentanyl
• Consider compartment syndrome where pain is severe and unrelieved by splinting and
elevation or two doses of analgesia
• X-ray if available

Text C
Drug Therapy Protocol:
Authorised Indigenous Health Worker (IHW) must consult Medical Officer (MO) or Nurse Practitioner
(NP). Scheduled Medicines Rural & Isolated Practice Registered Nurse may proceed.
Drug Form Strength Route of Recommended dosage Duration
administration

Adult only:
IM/SC 0.1-0.2 mg/kg to a max. of
10 mg Stat

Further
Morphine Ampoule 10 mg/Ml Adult only: doses on
IV Initial dose of 2 mg then MO/NP
(IHW may not 0.5-1 mg increments slowly, order
administer IV) repeated every 3-5
minutes if required to a
max. of 10 mg

Use the lower end of dose range in patients ≥70 years.

Provide Consumer Medicine Information: advise can cause nausea and vomiting, drowsiness.
Respiratory depression is rare – if it should occur, give naloxone.

Text D

Technique for plaster backslab for arm fractures – use same principle for leg fractures

1. Measure a length of non-compression cotton stockinette from half way up the middle finger to just
below the elbow. Width should be 2–3 cm more than the width of the distal forearm.

2. Wrap cotton padding over top for the full length of the stockinette — 2 layers, 50% overlap.
 3. Measure a length of plaster of Paris 1 cm shorter than the padding/stockinette at each end.
Fold the roll in about ten layers to the same length.
4. Immerse the layered plaster in a bowl of room temperature water, holding on to each end.
Gently squeeze out the excess water.
5. Ensure any jewellery is removed from the injured limb.

6. Lightly mould the slab to the contours of the arm and hand in a neutral position.

7. Do not apply pressure over bony prominences. Extra padding can be placed over bony
prominences if applicable.
8. Wrap crepe bandage firmly around plaster backslab.

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

Fractures, dislocations and sprains: Questions

Questions 1-7

1 procedures for delivering pain relief?

2 the procedure to follow when splinting a fractured

limb?
3 what to record when assessing a patient?

4 the terms used to describe different types of

fractures?
5 the practitioners who administer analgesia?

6 what to look for when checking an injury?

7 how fractures can be caused?

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, numbers or both

8. What should be used to elevate a patient’s fractured leg?

9. What is the maximum dose of morphine per kilo of a patient’s weight that
 can be given using the intra-muscular (IM) route?

10. Which parts of a limb may need extra padding?

______________________________________________________

11 What should be used to treat a patient who suffers respiratory depression?

12 What should be used to cover a freshly applied plaster backslab?

13 What analgesic should be given to a patient who is allergic to morphine?

14 What condition might a patient have if severe pain persists after

splinting, elevation and repeated analgesia?

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. Falling on an outstretched hand is a typical cause of a of the elbow

16. Upper limb fractures should be elevated by means of a______________.

17.Make sure the patient isn’t wearing any on the

part of the body where the plaster backslab is going to be placed.

18. Check to see whether swollen limbs are or

increasing in size.

19. In a plaster backslab, there is a layer of closest to the skin.

20. Patients aged and over shouldn’t be

given the higher dosages of pain relief.
 END OF PART A
THIS QUESTION PAPER 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 informs us that the Blood Pressure Monitor

A is likely to interfere with the operation of other medical equipment.

B may not work correctly in close proximity to some other devices.

C should be considered safe to use in all hospital environments

Instruction Manual: Digital Automatic Blood Pressure Monitor

Electromagnetic Compatibility (EMC)

With the increased use of portable electronic devices, medical equipment may be
susceptible to electromagnetic interference. This may result in incorrect operation of
the medical device and create a potentially unsafe situation. In order to regulate the
requirements for EMC, with the aim of preventing unsafe product situations, the
EN60601-1-2 standard defines the levels of immunity to electromagnetic interferences
as well as maximum levels of electromagnetic emissions for medical devices. This
medical device conforms to EN60601-1-2:2001 for both immunity and emissions.
Nevertheless, care should be taken to avoid the use of the monitor within 7 metres of
cellphones or other devices generating strong electrical or electromagnetic fields

2. The notice is giving information about

A ways of checking that an NG tube has been placed correctly.

B how the use of NG feeding tubes is authorised.

which staff should perform NG tube placement.

C
 NG feeding tubes

Displacement of nasogastric (NG) feeding tubes can have serious implications if undetected.
Incorrectly positioned tubes leave patients vulnerable to the risks of regurgitation and
respiratory aspiration. It is crucial to differentiate between gastric and respiratory placement
on initial insertion to prevent potentially fatal pulmonary complications. Insertion and care
of an NG tube should therefore only be carried out by a registered doctor or nurse who has
undergone theoretical and practical training and is deemed competent or is supervised by
someone competent. Assistant practitioners and other unregistered staff must never insert
NG tubes or be involved in the initial confirmation of safe NG tube position.

3. What must all staff involved in the transfusion process do?

A check that their existing training is still valid

B attend a course to learn about new procedures

C read a document that explains changes in policy

'Right Patient, Right Blood' Assessments

The administration of blood can have significant morbidity and mortality. Following the
introduction of the 'Right Patient, Right Blood' safety policy, all staff involved in the
transfusion process must be competency assessed. To ensure the safe administration of
blood components to the intended patient, all staff must be aware of their responsibilities in
line with professional standards.

Staff must ensure that if they take any part in the transfusion process, their competency
assessment is updated every three years. All staff are responsible for ensuring that they
attend the mandatory training identified for their roles. Relevant training courses are
clearly identified in Appendix 1 of the Mandatory Training Matrix.

4. The guidelines establish that the healthcare professional should

A aim to make patients fully aware of their right to a chaperone.

B
evaluate the need for a chaperone on a case-by-case basis.

respect the wishes of the patient above all else.

C
 Extract from ‘Chaperones: Guidelines for Good Practice’

A patient may specifically request a chaperone or in certain circumstances may nominate

one, but it will not always be the case that a chaperone is required. It is often a question of
using professional judgement to assess an individual situation. If a chaperone is offered and
declined, this must be clearly documented in the patient’s record, along with any relevant
discussion. The chaperone should only be present for the physical examination and should
be in a position to see what the healthcare professional undertaking
the examination/investigation is doing. The healthcare professional should wait until the
chaperone has left the room/cubicle before discussion takes place on any aspect of the
patient’s care, unless the patient specifically requests the chaperone to remain.

5. The guidelines require those undertaking a clinical medication review to

A involve the patient in their decisions.

B consider the cost of any change in treatments.

C
recommend other services as an alternative to medication.

Annual medication review

To give all patients an annual medication review is an ideal to strive for. In the meantime
there is an
argument for targeting all clinical medication reviews to those patients likely to benefit most.

Our guidelines state that ‘at least a level 2 medication review will occur’, i.e. the minimum
standard is a treatment review of medicines with the full notes but not necessarily with
the patient present. However, the guidelines go on to say that ‘all patients should have the
chance to raise questions and highlight problems about their medicines’ and that ‘any
changes resulting from the review are agreed with the patient’.

It also states that GP practices are expected to

• minimise waste in prescribing and avoid ineffective treatments.

• engage effectively in the prevention of ill health.

 • avoid the need for costly treatments by proactively managing patients to recovery
through
the whole care pathway.

6. The purpose of this email is to

A report on a rise in post-surgical complications.

B explain the background to a change in patient care.

C
remind staff about procedures for administrating drugs.

To: All staff

Subject: Advisory Email: Safe use of opioids

In August, an alert was issued on the safe use of opioids in hospitals. This reported

the incidence of respiratory depression among post-surgical patients to an average

0.5% – thus for every 5,000

surgical patients, 25 will experience respiratory depression. Failure to recognise

respiratory depression and institute timely intervention can lead to cardiopulmonary

arrest, resulting in brain injury or

death. A retrospective multi-centre study of 14,720 cardiopulmonary arrest cases showed

that

44% were respiratory related and more than 35% occurred on the general care floor. It

is therefore recommended that post-operative patients now have continuous monitoring,

instead of spot checks, of both oxygenation and ventilation.

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 according to
the text. Write your answers on the separate Answer Sheet
Text 1: Sleep deprivation

Millions of people who suffer sleep problems also suffer myriad health burdens. In
addition to emotional distress and cognitive impairments, these can include high
blood pressure, obesity, and metabolic syndrome. ‘In the studies we’ve done,
almost every variable we measured was affected. There’s not a system in the body
that’s not affected by sleep,’ says University of Chicago sleep researcher Eve Van
Cauter. ‘Every time we sleep-deprive ourselves, things go wrong.’

A common refrain among sleep scientists about two decades ago was that sleep
was performed by the brain in the interest of the brain. That wasn’t a fully elaborated
theory, but it wasn’t wrong. Numerous recent studies have hinted at the purpose of
sleep by confirming that neurological function and cognition are messed up during
sleep loss, with the patient’s reaction time, mood, and judgement all suffering if they
are kept awake too long.

In 1997, Bob McCarley and colleagues at Harvard Medical School found that when
they kept cats awake by playing with them, a compound known as adenosine
increased in the basal forebrain as the sleepy felines stayed up longer, and slowly
returned to normal levels when they were later allowed to sleep. McCarley’s team
also found that administering adenosine to the basal forebrain acted as a sedative,
putting animals to sleep. It should come as no surprise then that caffeine, which
blocks adenosine’s receptor, keeps us awake. Teaming up with Basheer and others,
McCarley later discovered that, as adenosine levels rise during sleep deprivation,
so do concentrations of adenosine receptors, magnifying the molecule’s sleep-
inducing effect. ‘The brain has cleverly designed a two-stage defence against the
consequences of sleep loss,’ McCarley says. Adenosine may underlie some of the
cognitive deficits that result from sleep loss. McCarley and colleagues found that
infusing adenosine into rats’ basal forebrain impaired their performance on an
attention test, similar to that seen in sleep-deprived humans. But adenosine levels
are by no means the be-all and end-all of sleep deprivation’s effects on the brain or
the body.
Over a century of sleep research has revealed numerous undesirable outcomes
from staying awake too long. In 1999, Van Cauter and colleagues had eleven men
sleep in the university lab. For three nights, they spent eight hours in bed, then for
six nights they were allowed only four hours (accruing what Van Cauter calls a
sleep debt), and then for six nights they could sleep for up to twelve hours (sleep
recovery). During sleep debt and recovery, researchers gave the participants a
glucose tolerance test and found striking differences. While sleep deprived, the
men’s glucose metabolism resembled a pre-diabetic state. ‘We knew it would be
affected,’ says Van Cauter. ‘The big surprise was the effect being much greater
than we thought.’
Subsequent studies also found insulin resistance increased during bouts of
sleep restriction, and in 2012, Van Cauter’s team observed impairments in
insulin signalling in subjects’ fat cells. Another recent study showed that sleep-
restricted people will add 300 calories to their daily diet. Echoing Van Cauter’s
results, Basheer has found evidence that enforced lack of sleep sends the brain
into a catabolic, or energy-consuming, state. This is
because it degrades the energy molecule adenosine triphosphate (ATP) to
produce adenosine monophosphate and this results in the activation of AMP
kinase, an enzyme that boosts fatty acid synthesis and glucose utilization. ‘The
system sends a message that there’s a need for more energy,’ Basheer says.
Whether this is indeed the mechanism underlying late-night binge-eating is still
speculative.

Within the brain, scientists have glimpsed signs of physical damage from sleep
loss, and the time-line for recovery, if any occurs, is unknown. Chiara Cirelli’s team
at the Madison School of Medicine in the USA found structural changes in the
cortical neurons of mice when the animals are kept awake for long periods.
Specifically, Cirelli and colleagues saw signs of mitochondrial activation – which
makes sense, as ‘neurons need more energy to stay awake,’ she says – as well as
unexpected changes, such as undigested cellular debris, signs of cellular aging
that are unusual in the neurons of young, healthy mice. ‘The number [of debris
granules] was small, but it’s worrisome because it’s only four to five days’ of sleep
deprivation,’ says Cirelli. After thirty-six hours of sleep recovery, a period during
which she expected normalcy to resume, those changes remained.
 Further insights could be drawn from the study of shift workers and insomniacs,
who serve as natural experiments on how the human body reacts to losing out on
such a basic life need for chronic periods. But with so much of
our physiology affected, an effective therapy − other than sleep itself – is hard
to imagine. ‘People like to define a clear pathway of action for health
conditions,’ says Van Cauter. ‘With sleep deprivation, everything you measure
is affected and interacts synergistically to produce the effect.’

Part C -Text 1: Questions 7-14

7. In the first paragraph, the writer uses Eve Van Cauter’s words to

A
explain the main causes of sleep deprivation.

B reinforce a view about the impact of sleep deprivation.

C question some research findings about sleep deprivation.

D describe the challenges involved in sleep deprivation research.

8. What do we learn about sleep in the second paragraph?

A Scientific opinion about its function has changed in recent years.

B There is now more controversy about it than there was in the past.

C Researchers have tended to confirm earlier ideas about its purpose.

D Studies undertaken in the past have formed the basis of current research.

9. What particularly impressed Bob McCarley of Harvard Medical School?

A the effectiveness of adenosine as a sedative

B the influence of caffeine on adenosine receptors

C the simultaneous production of adenosine and adenosine receptors

D the extent to which adenosine levels fall when subjects are allowed to sleep
10. In the third paragraph, what idea is emphasised by the phrase ‘by no means the be-all and end-
all’?

A Sleep deprivation has consequences beyond its impact on adenosine levels.

B Adenosine levels are a significant factor in situations other than sleep deprivation.

C The role of adenosine as a response to sleep deprivation is not yet fully understood.

D The importance of the link between sleep deprivation and adenosine should not be
underestimated.

11. What was significant about the findings in Van Cauter’s experiment?

A the rate at which the sleep-deprived men entered a pre-diabetic state

B the fact that sleep deprivation had an influence on the men’s glucose levels

C the differences between individual men with regard to their glucose tolerance

D the extent of the contrast in the men’s metabolic states between sleep debt and recovery

12. In the fifth paragraph, what does the word ‘it’ refer to?

A an enzyme

B new evidence
C a catabolic state
D enforced lack of sleep

13. What aspect of her findings surprised Chiara Cirelli?

A There was no reversal of a certain effect of sleep deprivation.

B The cortical neurons of the mice underwent structural changes.

C There was evidence of an increased need for energy in the brains of the mice.

D The neurological response to sleep deprivation only took a few hours to become apparent.
14. In the final paragraph, the quote from Van Cauter is used to suggest that

A the goals of sleep deprivation research are sometimes unclear.

B it could be difficult to develop any treatment for sleep deprivation.

C opinions about the best way to deal with sleep deprivation are divided.

D there is still a great deal to be learnt about the effects of sleep deprivation.

Text 2: ADHD

The American Psychiatric Association (APA) recognised Attention Deficit

Hyperactivity Disorder (ADHD) as a childhood disorder in the 1960s, but it wasn’t
until 1978 that the condition was formally recognised as afflicting adults. In recent
years, the USA has seen a 40% rise in diagnoses of ADHD in children. It could be
that the disorder is becoming more prevalent, or, as seems more plausible, doctors
are making the diagnosis more frequently. The issue is complicated by the lack of
any recognised neurological markers for ADHD. The APA relies instead on a
set of behavioural patterns for diagnosis. It specifies that patients under 17
must display at least six symptoms of inattention and/or hyperactivity; adults
need only display five.

ADHD can be a controversial condition. Dr Russell Barkley, Professor of

Psychiatry at the University of Massachusetts insists; ‘the science is
overwhelming: it’s a real disorder, which can be managed, in many cases, by using
stimulant medication in combination with other treatments’. Dr Richard Saul, a
behavioural neurologist with five decades of experience, disagrees; ‘Many of us
have difficulty with organization or details, a tendency to lose things, or to be
forgetful or distracted. Under such subjective criteria, the entire population could
potentially qualify. Although some patients might need stimulants to function well
in daily life, the lumping together of many vague and subjective symptoms could
be causing a national phenomenon of misdiagnosis and over-prescription of
stimulants.’

A recent study found children in foster care three times more likely than others
to be diagnosed with ADHD. Researchers also found that children with ADHD in
foster care were more likely to have another disorder, such as depression or
anxiety. This finding certainly reveals the need for medical and behavioural
services for these children, but it could also prove the non-specific nature of the
symptoms of ADHD: anxiety and depression, or an altered state, can easily be
mistaken for manifestations of ADHD.

ADHD, the thinking goes, begins in childhood. In fact, in order to be diagnosed

with it as an adult, a patient must demonstrate that they had traits of the condition
in childhood. However, studies from the UK and Brazil, published in JAMA
Psychiatry, are fuelling questions about the origins and trajectory of ADHD,
suggesting not only that it can begin in adulthood, but that there may be two
distinct syndromes: adult-onset ADHD and childhood ADHD. They echo earlier
research from New Zealand. However, an editorial by Dr Stephen Faraone in
JAMA Psychiatry highlights potential flaws in the findings. Among them,
underestimating the persistence of ADHD into adulthood and overestimating the
prevalence of adult-onset ADHD. In Dr Faraone’s words, ‘the researchers found a
group of people who had sub-threshold ADHD in their youth. There may have
been signs that things weren’t right, but not enough to go to a doctor. Perhaps
these were smart kids with particularly supportive parents or teachers who
helped them cope with attention problems. Such intellectual and social
scaffolding would help in early life, but when the scaffolding is removed, full ADHD
could develop’.
Until this century, adult ADHD was a seldom-diagnosed disorder. Nowadays
however, it’s common in mainstream medicine in the USA, a paradigm shift
apparently driven by two factors: reworked – many say less stringent – diagnostic
criteria, introduced by the APA in 2013, and marketing by manufacturers of ADHD
medications. Some have suggested that this new, broader definition of ADHD was
fuelled, at least in part, to broaden the market for medication. In many instances,
the evidence proffered to expand the definitions came from studies funded in
whole or part by manufacturers. And as the criteria for the condition loosened,
reports emerged about clinicians involved in diagnosing ADHD receiving money
from drug-makers.

This brings us to the issue of the addictive nature of ADHD medication. As Dr Saul
asserts, ‘addiction to stimulant medication isn’t rare; it’s common. Just observe the
 many patients periodically seeking an increased dosage
as their powers of concentration diminish. This is because the body stops
producing the appropriate levels of neurotransmitters that ADHD drugs replace − a
trademark of addictive substances.’ Much has been written about the staggering
increase in opioid overdoses and abuse of prescription painkillers in the USA, but
the abuse of drugs used to treat ADHD is no less a threat. While opioids are more
lethal than prescription stimulants, there are parallels between the opioid epidemic
and the increase in problems tied to stimulants. In the former, users switch from
prescription narcotics to heroin and illicit fentanyl. With ADHD drugs, patients are
switching from legally prescribed stimulants to illicit ones such as
methamphetamine and cocaine. The medication is particularly prone to abuse
because people feel it improves their lives. These drugs are antidepressants, aid
weight-loss and improve confidence, and can be abused by students seeking to
improve their focus or academic performance. So, more work needs to be done
before we can settle the questions surrounding the diagnosis and treatment of
ADHD.

Part C -Text 2: Questions 15-22

15. In the first paragraph, the writer questions whether

A adult ADHD should have been recognised as a disorder at an earlier date.

B ADHD should be diagnosed in the same way for children and adults.

C ADHD can actually be indicated by neurological markers.

D cases of ADHD have genuinely increased in the USA.

16. What does Dr Saul object to?

A the suggestion that people need stimulants to cope with everyday life

B the implication that everyone has some symptoms of ADHD

C the grouping of imprecise symptoms into a mental disorder

D the treatment for ADHD suggested by Dr Barkley

17. The writer regards the study of children in foster care as significant because it

A highlights the difficulty of distinguishing ADHD from other conditions.

B focuses on children known to have complex mental disorders.

C suggests a link between ADHD and a child’s upbringing.

D draws attention to the poor care given to such children.

18. In the fourth paragraph, the word ‘They’ refers to

A syndromes.

B questions.

C studies.

D origins.

19. Dr Faraone suggests that the group of patients diagnosed with adult-onset ADHD

A had teachers or parents who recognised the symptoms of ADHD.

B should have consulted a doctor at a younger age.

C had mild undiagnosed ADHD in childhood.

D were specially chosen by the researchers.

20. In the fifth paragraph, it is suggested that drug companies have

been overly aggressive in their marketing of ADHD medication.
A

B influenced research that led to the reworking of ADHD diagnostic criteria.

12 crêpe/crepe bandage
13 fentanyl
14 compartment syndrome

Part A - Answer key 15 – 20

15 dislocation
16. sling
17. jewellery
18. throbbing
19. (cotton / non-compression) stockinette
20. 70 / seventy (years / yrs)

Reading test - part B – answer key

1 B may not work correctly in close proximity to some other devices.
2 C which staff should perform NG tube placement.
3 A check that their existing training is still valid
4 B evaluate the need for a chaperone on a case-by-case basis.
5 A involve the patient in their decisions.
6 B explain the background to a change in patient care.

Reading test - part C – answer key

Text 1 - Answer key 7 – 14
7 B reinforce a view about the impact of sleep deprivation.
8 C Researchers have tended to confirm earlier ideas about its purpose.
9 C the simultaneous production of adenosine and adenosine receptors
10 A Sleep deprivation has consequences beyond its impact on adenosine levels.
11 D the extent of the contrast in the men’s metabolic states between sleep debt and recovery
12 D enforced lack of sleep
13 A There was no reversal of a certain effect of sleep deprivation.
14 B it could be difficult to develop any treatment for sleep deprivation.

Text 2 - Answer key 15 – 22

15 D cases of ADHD have genuinely increased in the USA.
16 C the grouping of imprecise symptoms into a mental disorder
17 A highlights the difficulty of distinguishing ADHD from other conditions.
18 C studies.
19 C had mild undiagnosed ADHD in childhood.
20 B influenced research that led to the reworking of ADHD diagnostic criteria.
21 A a physiological reaction.
22 C Insufficient attention seems to have been paid to it.
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
In which text can you find information about
1 the various symptoms of patients who have taken too much
paracetamol?

2 the precise levels of paracetamol in the blood which require urgent

intervention?
3 the steps to be taken when treating a paracetamol overdose patient?

4 whether paracetamol overdose was intentional?

5 the number of products containing paracetamol?

6 what to do if there are no details available about the time of the

Que 7 dealing with paracetamol overdose patients who have not received
stio adequate nutrition?
ns
8-
13

Answer each of the questions, 8-4, 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.If paracetamol is used as a long-term painkiller, what symptom may get worse?

9. It may be dangerous to administer paracetamol to a patient with which viral condition?

__________________________________________
10 What condition may develop in an overdose patient who presents with jaundice?
_____________________________________________
11. What condition may develop on the third day after an overdose?

12. What drug can be administered orally within 10 - 12 hours as an alternative to acetylcysteine?

13. What treatment can be used if a single overdose has occurred less than an hour ago?
 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. If a patient has taken metoclopramide alongside paracetamol, this may affect the

of the paracetamol.

15. After 24 hours, an overdose patient may present with pain in the .

16. For the first 24 hours after overdosing, patients may only have such symptoms as

17. Acetylcysteine should be administered to patients with a paracetamol level above the

high-risk treatment line who are taking any type of medication.

18. A non-high-risk patient should be treated for paracetamol poisoning if their paracetamol level is

above_________________ mg/litre 8 hours after overdosing.

19. A high-risk patient who overdosed hours ago

should be given acetylcysteine if their paracetamol level is 25 mg/litre or higher.

20. If a patient does not require further acetylcysteine, they should be given treatment categorised as

only.

END OF PART A
THIS QUESTION PAPER 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. This guideline extract says that the nurse in charge

A must supervise the opening of the controlled drug cupboard.

B should make sure that all ward cupboard keys are kept together.

C can delegate responsibility for the cupboard keys to another ward.

Medicine Cupboard Keys

The keys for the controlled drug cupboard are the responsibility of the nurse in charge. They

may be passed to a registered nurse in order for them to carry out their duties and returned to
the nurse in charge. If the keys for the controlled drug cupboard go missing, the locks must
be changed and pharmacy informed and an incident form completed. The controlled drug

cupboard keys should be kept separately from the main body of keys. Apart from in
exceptional circumstances, the keys should not leave the ward or department. If necessary,
the nurse in charge should arrange for the keys to be held in a neighbouring ward or

department by the nurse in charge there.

2. When seeking consent for a post-mortem examination, it is necessary to

A give a valid reason for conducting it.

B allow all relatives the opportunity to decline it.

C only raise the subject after death has occurred.

Post-Mortem Consent
A senior member of the clinical team, preferably the Consultant in charge of the care, should raise
the possibility of a post-mortem examination with the most appropriate person to give consent. The
person consenting will need an explanation of the reasons for the post-mortem examination and
what it hopes to achieve. The first approach should be made as soon as it is apparent that a post-
mortem examination may be desirable, as there is no need to wait until the patient has died. Many
relatives are more prepared for the consenting procedure if they have had time to think about it
beforehand.
3. The purpose of these notes about an incinerator is to

A help maximise its efficiency.

B give guidance on certain safety procedures.

C recommend a procedure for waste separation.

Low-cost incinerator: General operating notes

3.2.1 Hospital waste management
Materials with high fuel values such as plastics, paper, card and dry textile will help maintain high
incineration temperature. If possible, a good mix of waste materials should be added with each
batch. This can best be achieved by having the various types of waste material loaded into
separate bags at source, i.e. wards and laboratories, and clearly labelled. It is not recommended
that the operator sorts and mixes waste prior to incineration as this is potentially hazardous. If
possible, some plastic materials should be added with each batch of waste as this burns at high
temperatures. However, care and judgement will be needed, as too much plastic will create
dense dark smoke.

4. What does this manual tell us about spacer devices?

A Patients should try out a number of devices with their inhaler.

B They enable a patient to receive more of the prescribed medicine.

C Children should be given spacers which are smaller than those for adults.

Manual extract: Spacer devices for asthma patients

Spacer devices remove the need for co-ordination between actuation of a pressurized metered-
dose inhaler and inhalation. In addition, the device allows more time for evaporation of the
propellant so that a larger proportion of the particles can be inhaled and deposited in the lungs.
Spacer devices are particularly useful for patients with poor inhalation technique, for children, for
patients requiring higher doses, for nocturnal asthma, and for patients prone to candidiasis with
inhaled corticosteroids. The size of the spacer is important, the larger spacers with a one-way
 valve being most effective. It is important to prescribe a spacer device that is compatible with the
metered-dose inhaler. Spacer devices should not be regarded as interchangeable; patients
should be advised not to switch between spacer devices.

5. The email is reminding staff that the

A benefits to patients of using bedrails can outweigh the dangers.

B number of bedrail-related accidents has reached unacceptable levels.

C patient’s condition should be central to any decision about the use of bedrails.

To: All Staff

Subject: Use of bed rails

Please note the following.

Patients in hospital may be at risk of falling from bed for many reasons including
poor mobility, dementia or delirium, visual impairment, and the effects of treatment
or medication. Bedrails can be used as safety devices intended to reduce risk.
However, bedrails aren’t appropriate for all patients, and their use involves risks.
National data suggests around 1,250 patients injure themselves on bedrails annually,
usually scrapes and bruises to their lower legs. Statistics show 44,000 reports of
patient falls from bed annually resulting in 11 deaths, while deaths due to bedrail
entrapment
occur less than one every two years, and are avoidable if the relevant advice is

6. What does this extract from a handbook tell us about analeptic drugs?

A They may be useful for patients who are not fully responsive.

B Injections of these drugs will limit the need for physiotherapy.

C Care should be taken if they are used over an extended period.

 Analeptic drugs
Respiratory stimulants (analeptic drugs) have a limited place in the treatment of ventilatory failure
in patients with chronic obstructive pulmonary disease. They are effective only when given by
intravenous injection or infusion and have a short duration of action. Their use has largely been
replaced by ventilatory support. However, occasionally when ventilatory support is contra-
indicated and in patients with hypercapnic respiratory failure who are becoming drowsy or
comatose, respiratory stimulants in the short term may arouse patients sufficiently to co-operate
and clear their secretions. Respiratory stimulants can also be harmful in respiratory failure since
they stimulate non-respiratory as well as respiratory muscles. They should only be given under
expert supervision in hospital and must be combined with active physiotherapy. At present, there
is no oral respiratory stimulant available for long- term use in chronic respiratory failure.

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 according to
the text. Write your answers on the separate Answer Sheet

Text 1: Patient Safety

Highlighting a collaborative initiative to improve patient safety

In a well-documented case in November 2004, a female patient called Mary was admitted to a
hospital in Seattle, USA, to receive treatment for a brain aneurysm. What followed was a tragedy,
made worse by the fact that it needn’t have occurred at all. The patient was mistakenly injected
with the antiseptic chlorhexidine. It happened, the hospital says, because of ‘confusion over the
three identical stainless steel bowls in the procedure room containing clear liquids —
chlorhexidine, contrast dye and saline solution’. Doctors tried amputating one of Mary’s legs to
save her life, but the damage to her organs was too great: she died 19 days later.

This and similar incidents are what inspired Professor Dixon-Woods of the University of
Cambridge, UK, to set out on a mission: to improve patient safety. It is, she admits, going to be
a challenge. Many different policies and approaches have been tried to date, but few with
widespread success, and often with unintended consequences.
Financial incentives are widely used, but recent evidence suggests that they have little effect.
‘There’s a danger that they tend to encourage effort substitution,’ explains Dixon-Woods. In
other words, people concentrate on the areas that are being incentivised, but neglect other areas.
‘It’s not even necessarily conscious neglect. People have only a limited amount of time, so it’s
inevitable they focus on areas that are measured and rewarded.’

In 2013, Dixon-Woods and colleagues published a study evaluating the use of surgical
checklists introduced in hospitals to reduce complications and deaths during surgery. Her
research found that that checklists may have little impact, and in some situations might even
make things worse. ‘The checklists sometimes introduced new risks. Nurses would use the
lists as box-ticking exercises – they would tick the box to say the patient had had their
antibiotics when there were no antibiotics in the hospital, for example.’ They also reinforced the
hierarchies – nurses had to try to get surgeons to do certain tasks, but the surgeons used the
situation as an opportunity to display their power and refuse.
Dixon-Woods and her team spend time in hospitals to try to understand which systems are in place
and how they are used. Not only does she find differences in approaches between hospitals, but
also between units and even between shifts. ‘Standardisation and harmonisation are two of the
most urgent issues we have to tackle. Imagine if you have to learn each new system wherever
you go or even whenever a new senior doctor is on the ward. This introduces massive risk.

Dixon-Woods compares the issue of patient safety to that of climate change, in the sense that it is a

‘problem of many hands’, with many actors, each making a contribution towards the outcome, and

there is difficulty in identifying where the responsibility for solving the problem lies. ‘Many patient

safety issues arise at the level of the system as a whole, but policies treat patient safety as an issue

for each individual organisation.’

Nowhere is this more apparent than the issue of ‘alarm fatigue’, according to Dixon-Woods.
Each bed in an intensive care unit typically generates 160 alarms per day, caused by machinery
that is not integrated. ‘You have to assemble all the kit around an intensive care bed manually,’
she explains. ‘It doesn’t come built as one like an aircraft cockpit. This is not something a
hospital can solve alone. It needs to be solved at the sector level.’

Dixon-Woods has turned to Professor Clarkson in Cambridge’s Engineering Design Centre to

help. ‘Fundamentally, my work is about asking how we can make it better and what could possibly
go wrong,’ explains Clarkson. ‘We need to look through the eyes of the healthcare providers to
see the challenges and to understand where tools and techniques we use in engineering may be
of value.’ There is a difficulty, he concedes: ‘There’s no formal language of design in healthcare.
Do we understand what the need is? Do we understand what the requirements are? Can we think
of a range of concepts we might use and then design a solution and test it before we put it in
place? We seldom see this in healthcare, and that’s partly driven by culture and lack of training,
but partly by lack of time.’ Dixon-Woods agrees that healthcare can learn much from engineers.
‘There has to be a way of getting our two sides talking,’ she says. ‘Only then will we be able to
prevent tragedies like the death of Mary.’

Part C -Text 1: Questions 7-14

7. What point is made about the death of a female patient called Mary?

A It was entirely preventable.

B Nobody was willing to accept the blame.

C Surgeons should have tried harder to save her life.

D It is the type of incident which is becoming increasingly common.

8. What is meant by the phrase ‘effort substitution’ in the second paragraph?

A Monetary resources are diverted unnecessarily.

B Time and energy is wasted on irrelevant matters.

C Staff focus their attention on a limited number of issues.

D People have to take on tasks which they are unfamiliar with.

9. By quoting Dixon-Woods in the second paragraph, the writer shows that the professor

A understands why healthcare employees have to make certain choices.

B doubts whether reward schemes are likely to put patients at risk.

C believes staff should be paid a bonus for achieving goals.

 D feels the people in question have made poor choices.

10. What point is made about checklists in the third paragraph?

A Hospital staff sometimes forget to complete them.

B Nurses and surgeons are both reluctant to deal with them.

C They are an additional burden for over-worked nursing staff.

D The information recorded on them does not always reflect reality.

11. What problem is mentioned in the fourth paragraph?

A failure to act promptly

B outdated procedures

C poor communication

D lack of consistency

12. What point about patient safety is the writer making by quoting Dixon-Woods’
comparison with climate change?

A The problem will worsen if it isn’t dealt with soon.

B It isn’t clear who ought to be tackling the situation.

C It is hard to know what the best course of action is.

D Many people refuse to acknowledge there is a problem

13. The writer quotes Dixon-Woods’ reference to intensive care beds in order to

A present an alternative viewpoint.

B
 illustrate a fundamental obstacle.

C show the drawbacks of seemingly simple solutions.

D give a detailed example of how to deal with an issue

14. What difference between healthcare and engineering is mentioned in the final paragraph?

A the types of systems they use

B the way they exploit technology

C the nature of the difficulties they face

D the approach they take to deal with challenges

Text 2: Migraine – more than just a headache

When a news reporter in the US gave an unintelligible live TV commentary of an awards

ceremony, she became an overnight internet sensation. As the paramedics attended, the worry
was that she’d suffered a stroke live on air. Others wondered if she was drunk or on drugs.
However, in interviews shortly after, she revealed, to general astonishment, that she’d simply
been starting a migraine. The bizarre speech difficulties she experienced are an uncommon
symptom of aura, the collective name for a range of neurological symptoms that may occur just
before a migraine headache. Generally aura are visual – for example blind spots which increase
in size, or have a flashing, zig-zagging or sparkling margin, but they can include other odd
disturbances such as pins and needles, memory changes and even partial paralysis.

Migraine is often thought of as an occasional severe headache, but surely symptoms such as
these should tell us there’s more to it than meets the eye. In fact many scientists now consider
it a serious neurological disorder. One area of research into migraine aura has looked at the
phenomenon known as Cortical Spreading Depression (CSD) – a storm of neural activity that
passes in a wave across the brain’s surface. First seen in 1944 in the brain of a rabbit, it’s
now known that CSD can be triggered when the normal flow of electric currents within and
around brain cells is somehow reversed. Nouchine Hadjikhani and her team at Harvard
Medical School managed to record an episode of CSD in a brain scanner during migraine aura
(in a visual region that responds to flickering motion), having found a patient who had the rare
ability to be able to predict when an aura would occur. This confirmed a long-suspected link
between CSD and the aura that often precedes migraine pain. Hadjikhani admits, however, that
other work she has done suggests that CSD may occur all over the brain, often unnoticed, and
may even happen in healthy brains. If so, aura may be the result of a person’s brain being
more sensitive to CSD than it should be.

Hadjikhani has also been looking at the structural and functional differences in the brains of
migraine sufferers. She and her team found thickening of a region known as the somatosensory
cortex, which maps our sense of touch in different parts of the body. They found the most
significant changes in the region that relates to the head and face. ‘Because sufferers return to
normal following an attack, migraine has always been considered an episodic problem,’ says
Hadjikhani. ‘But we found that if you have successive strikes of pain in the face area, it actually
increases cortical thickness.’
Work with children is also providing some startling insights. A study by migraine expert Peter
Goadsby, who splits his time between King’s College London and the University of California, San
Francisco, looked at the prevalence of migraine in mothers of babies with colic - the uncontrolled
crying and fussiness often blamed on sensitive stomachs or reflux. He found that of 154 mothers
whose babies were having a routine two-month check-up, the migraine sufferers were 2.6 times
as likely to have a baby with colic. Goadsby believes it is possible that a baby with a tendency to
migraine may not cope well with the barrage of sensory information they experience as their
nervous system starts to mature, and the distress response could be what we call colic

Linked to this idea, researchers are finding differences in the brain function of migraine sufferers,
even between attacks. Marla Mickleborough, a vision specialist at the University of Saskatchewan
in Saskatoon, Canada, found heightened sensitivity to visual stimuli in the supposedly ‘normal’
period between attacks. Usually the brain comes to recognise something repeating over and over
again as unimportant and stops noticing it, but in people with migraine, the response doesn’t
diminish over time. ‘They seem to be attending to things they should be ignoring,’ she says.

Taken together this research is worrying and suggests that it’s time for doctors to treat the condition
more aggressively, and to find out more about each individual’s triggers so as to stop attacks from
happening. But there is a silver lining. The structural changes should not be likened to dementia,
Alzheimer’s disease or ageing, where brain tissue is lost or damaged irreparably. In migraine, the
brain is compensating. Even if there’s a genetic predisposition, research suggests it is the disease
itself that is driving networks to an altered state. That would suggest that treatments that reduce the
frequency or severity of migraine will probably be able to reverse some of the structural changes too.
Treatments used to be all about reducing the immediate pain, but now it seems they might be able to
achieve a great deal more

Part C -Text 2: Questions 15-22

15. Why does the writer tell the story of the news reporter?

A to explain the causes of migraine aura

B to address the fear surrounding migraine aura

C to illustrate the strange nature of migraine aura

D to clarify a misunderstanding about migraine aura

16. The research by Nouchine Hadjikhani into CSD

A has less relevance than many believe.

B did not result in a definitive conclusion.

C was complicated by technical difficulties.

D overturned years of accepted knowledge.

17. What does the word ‘This’ in the second paragraph refer to?

A the theory that connects CSD and aura

B the part of the brain where auras take place

C the simultaneous occurrence of CSD and aura

D the ability to predict when an aura would happen

18. The implication of Hadjikhani’s research into the somatosensory cortex is that

A migraine could cause a structural change.

B a lasting treatment for migraine is possible.

C some diagnoses of migraine may be wrong.

D having one migraine is likely to lead to more.

19.What does the writer find surprising about Goadsby’s research?

A the idea that migraine may not run in families

B the fact that migraine is evident in infanthood

C the link between childbirth and onset of migraine

D the suggestion that infant colic may be linked to migraine

20. According to Marla Mickleborough, what is unusual about the brain of migraine sufferers?

A It fails to filter out irrelevant details.

B It struggles to interpret visual input.

C It is slow to respond to sudden changes.

D It does not pick up on important information.

21. The writer uses the phrase ‘a silver lining’ in the final paragraph to emphasise

A the privileged position of some sufferers.

B a more positive aspect of the research.

 Part A - Answer key 15 – 20
15 right upper quadrant
16 nausea OR vomiting OR nausea and vomiting OR vomiting and nausea
17 enzyme-inducing
18 100 OR a hundred OR one hundred
19 12 OR twelve
20 supportive (treatment)

Reading test - part B – answer key

PART B: QUESTIONS 1-6

1 C can delegate responsibility for the cupboard

2 A keys
give atovalid
another ward.
reason for conducting it.
3 A help maximise its efficiency.
4 B They enable a patient to receive more of the
5 A prescribed medicine.
benefits to patients of using bedrails can
6 A outweigh
They maythe be dangers.
useful for patients who are not
fully responsive.
PART C: QUESTIONS 7-14

7 A It was entirely preventable.

8 C Staff focus their attention on a limited number of
9 A issues.
understands why healthcare employees have to
10 D makeinformation
The certain choices.
recorded on them does not
11 D always reflect reality.
lack of consistency
12 B It isn’t clear who ought to be tackling the situation.
13 B illustrate a fundamental obstacle.
14 D the approach they take to deal with challenges
 PART C: QUESTIONS 15-22

15 C to illustrate the strange nature of

16 B migraine aurain a definitive conclusion.
did not result
17 C the simultaneous occurrence of CSD
18 A and aura could cause a structural
migraine
19 D change.
the suggestion that infant colic may be
20 A linked
It fails to
to migraine
filter out irrelevant details.
21 B a more positive aspect of the research.
22 B They are unlikely to be permanent.
 Sample Test 3

READING TEST:03

READING SUB-TEST – TEXT BOOKLET: PART A

CANDIDATE NUMBER:

LAST NAME:

FIRST NAME:
Passport Photo
OTHER NAMES: Your details and photo will be printed here.

E
PROFESSION:

L
VENUE:

TEST DATE:

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CANDIDATE SIGNATURE:

A M
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[CANDIDATE NO.] READING TEXT BOOKLET PART A 01/04

 Management of burns: Texts

Text A

Burn depth
Burn injuries are classified according to how much tissue damage is present.

1 Superficial partial thickness burns (also known as first and second degree)
Present in most burn wounds. Injuries do not extend through all the layers of skin.

2 Full thickness burns (also known as third degree)

• Burn extends into the subcutaneous tissues
•

E
Underlying tissue may appear pale or blackened
• Remaining skin may be dry and white, brown or black with no blisters

L
• Healing associated with considerable contraction and scarring.

3 Mixed depth burns

P
Burns are frequently of mixed depth. The clinician should estimate the average depth by the appearance
and the presence of sensation.
Resuscitation should be based on the total of second and third degree burns, and local treatment should

M
be based on the burn thickness at any specific site.

A
Text B

S
Fluid resuscitation

If the burn area is over 15% of the TBSA (Total Body Surface Area) in adults or 10% in children, intravenous
fluids should be started as soon as possible on scene, although transfer should not be delayed by more
than two cannulation attempts. For physiological reasons the threshold is closer to 10% in the elderly (>60
years).

Suggested regimen for fluid resuscitation

Adults
Resuscitation fluid alone (first 24 hours)

• Give 3–4ml Hartmann's solution (3ml in superficial and partial thickness burns/4ml in full
thickness burns or those with associated inhalation injury) per kg body weight/% TBSA burned. Half
of this volume is given in the first 8 hours after injury and the remaining half in the second 16-hour
period

Children
Resuscitation fluid as above plus maintenance (0.45% saline with 5% dextrose):
• Give 100ml/kg for the first 10kg body weight plus 50ml/kg for the next 10kg body weight plus
20ml/kg for each extra kg

SAMPLE

[CANDIDATE NO.] READING TEXT BOOKLET PART A 02/04

 Text C

Management for Burns

1. Assess the patient status: airway, breathing, circulation, IV access.
2. Assess the burn depth and extent. A sheet can be placed on burns during this time.
3. Cooling: Remove jewellery or hot clothing. Limit inflammation and pain by using cool water, cool
saline soaked gauze or a large sheet in the case of a large wound. Cool the wound not the patient,
taking care not to cause hypothermia.
4. Pain Control: Acetaminophen usually helpful but may need to use opiates such as codeine.
5. Check immunization status and update tetanus if necessary.
6. If possible, begin fluid resuscitation.

E
7. Debridement of blisters – there are some differences of opinion regarding breaking of blisters.
a. Some suggest leaving intact because the blister acts as a barrier to infection and others

L
debride all blisters.
b. Most agree that necrotic skin should be removed following blister ruptures.

8. Application of antibiotics in the form of ointment. Should always be used to prevent infection in any

P
non-superficial burns.
9. Apply suitable dressing to the wound area.

M
Text D

A
Adult Analgesic Guidelines

The following table provides recommended short term (<72 hours) oral analgesia guidelines for the

S
management of burn injuries. Aim for pain scores of 4 or less at rest. Analgesia should be reviewed after
72 hours and adjusted according to pain scores. Patient management should be guided by individual
case and clinical judgement.

Pain score elicited from patient (Scale 1 – 10)

Mild Pain Moderate Pain Severe Pain
Pain Score 1 - 3 Pain Score 4 - 6 Pain Score 7 - 10
Recommended analgesia: Recommended analgesia in Recommended analgesia in
addition to column 1: addition to column 1 & 2:
Paracetamol 1g 4 x daily Tramadol 50 – 100mg 4 x daily Strong opioids
Oxycontin SR 10mg (2 x daily)
And if needed: If above unsuccessful:
Naproxen 250mg 2 x daily Endone (immediate release Endone, 2 - 4 hourly as needed
oxycodone) 5 – 10mg (2 - 4
hourly)
Review in 72 hours Review in 72 hours
If pain cannot be controlled
with oral medications, consider
admission to burns unit.

Paediatric Analgesia Guidelines

• Paracetamol (15 mg/kg (max 90 mg/kg/day) orally or per rectum (PR))
• Non Steroidal Anti-Inflammatory Drugs
• naproxen 5 - 10 mg/kg (max 500 mg) 12-hrly orally or PR
• ibuprofen 2.5 - 10 mg/kg (max 600 mg) 6-8hrly orally
• Opioids (codeine 0.5 - 1 mg/kg orally)

END OF PART A SAMPLE

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[CANDIDATE NO.] READING TEXT BOOKLET PART A 03/04

 Sample Test 3

READING SUB-TEST – QUESTION PAPER: PART A

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
MIDDLE NAMES: Passport Photo

E
PROFESSION: Candidate details and photo will be printed here.

L
VENUE:
TEST DATE:

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CANDIDATE DECLARATION
By signing this, you agree not to disclose or use in any way (other than to take the test) or assist any other person to disclose or use any OET
test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice

M
or information, you may be disqualified and your results may not be issued at the sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
malpractice, their personal details and details of the investigation may be passed to a third party where required.

A
CANDIDATE SIGNATURE:

TIME: 15 MINUTES

INSTRUCTIONS TO CANDIDATES
S
DO NOT open this Question Paper or the Text Booklet until you are told to do so.
Write your answers on the spaces provided on this Question Paper.
You must answer the questions within the 15-minute time limit.
One mark will be granted for each correct answer.
Answer ALL questions. Marks are NOT deducted for incorrect answers.
At the end of the 15 minutes, hand in this Question Paper and the Text Booklet.
DO NOT remove OET material from the test room.

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[CANDIDATE NO.] READING QUESTION PAPER PART A 01/04

 Part A
TIME: 15 minutes
• 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 in the spaces provided in this Question Paper.

• Answer all the questions within the 15-minute time limit.

• Your answers should only be taken from texts A-D and must be correctly spelt.

Management of burns: Questions

E
Questions 1-5

L
For each question, 1-5, decide which text (A, B, C or D) the information comes from. You may use any
letter more than once.

P
In which text can you find information about

1 age-related considerations for initial treatment of burns injuries?

M
2 the risks involved in certain treatments?

3 when to start thinking about specialist treatment options?

A
4 treatment informed by patient self-assessment?

S
5 how to categorise the severity of a burn?

Questions 6-13

Complete each of the sentences, 6-13, with a word or short phrase from one of the texts. Each answer may include
words, numbers or both.

6 Classification of burn injuries depends on the amount of

caused.

7 Patients recovering from third degree burns are likely to experience a great deal of shrinkage and

of their skin.

8 When evaluating mixed depth burns, you should take into account how the burn looks and whether

there is in the affected area.

9 You should cool burn injuries by taking off any or jewellery that
the patient is wearing.

SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PART A 02/04

 10 When cooling the wound, make sure that you don’t put the patient at risk

of .

11 The patient may require a booster, depending on when they

were last immunised.

12 You should consider leaving undisturbed, as these may help

prevent infection.

E
13 You should apply ointments containing to all deeper burns.

L
Questions 14-20

P
Answer each of the questions, 14-20, with a word or short phrase from one of the texts. Each answer may include
words, numbers or both.

M
14 In the case of mixed depth burns, what factor determines the local treatment to give?

A
15 What is the maximum number of tries recommended for attaching a drip at the scene of a burns

S
incident?

16 How much resuscitation fluid should a child receive per kilo over 20kg?

17 Before attaching a fluid resuscitation drip to a 9-year-old burns patient, what percentage of the body

needs to be affected?

18 What additional analgesic is recommended in the first instance for a patient with a moderate level of

pain?

19 What route should be used to administer ibuprofen to children?

20 After how long should a patient’s pain relief regime be re-evaluated?

END OF PART A
THIS QUESTION PAPER WILL BE COLLECTED
SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PART A 03/04

 Sample Test 3

READING SUB-TEST – QUESTION PAPER: PARTS B & C

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
MIDDLE NAMES: Passport Photo

E
PROFESSION: Candidate details and photo will be printed here.

L
VENUE:
TEST DATE:

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CANDIDATE DECLARATION
By signing this, you agree not to disclose or use in any way (other than to take the test) or assist any other person to disclose or use any OET
test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice

M
or information, you may be disqualified and your results may not be issued at the sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
malpractice, their personal details and details of the investigation may be passed to a third party where required.

A
CANDIDATE SIGNATURE:

TIME: 45 MINUTES

INSTRUCTIONS TO CANDIDATES S
DO NOT open this Question Paper until you are told to do so.
One mark will be granted for each correct answer.
Answer ALL questions. Marks are NOT deducted for incorrect answers.
At the end of the test, hand in this Question Paper.
DO NOT remove OET material from the test room.

HOW TO ANSWER THE QUESTIONS

Mark your answers on this Question Paper by filling in the circle using a 2B pencil. Example: A
B
C

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[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 01/16
 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. A
B
Fill the circle in completely. Example: C

1. Doctors are advised to break patient confidentiality if

A failure to do so would put other people in danger.

E
B they inform the patient of their intention in advance.

C a patient refuses to disclose information relevant to their care.

Patient Confidentiality

P L
M
Confidentiality is central to trust between doctors and patients. Without assurances about confidentiality,

patients may be reluctant to seek medical attention or to give doctors the information they need in order

A
to provide good care.

However, faced with a situation in which a patient’s refusal to consent to disclosure leaves others

S
exposed to a risk so serious that it outweighs the patient’s and the public interest in maintaining

confidentiality, or if it is not practical or safe to seek the patient’s consent, information should be

disclosed promptly to an appropriate person or authority. The patient should be informed in advance that

the doctor will be disclosing the information, provided this is practical and safe, even if the doctor intends

to disclose without the patient’s consent.

SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 02/16

 2. According to the guidance notes, all staff involved in transferring patients from critical to general care must

A obtain all necessary consent from any interested parties.

B ensure that the patient’s personal care plan is also transferred.

C make arrangements for ongoing co-operation once the transfer is complete.

E
Transfer of patients

1.15

L
The critical care area transferring team and the receiving ward team should take shared responsibility for
the care of the patient being transferred. They should jointly ensure that:

P
• there is continuity of care through a formal structured handover from critical care area staff to ward
. staff (including both medical and nursing staff), supported by a written plan;

M
• the receiving ward, with support from critical care if required, can deliver the agreed plan.

1.16

A
When patients are transferred to the general ward from a critical care area, they should be offered
information about their condition and encouraged to actively participate in decisions that relate to their

S
recovery. The information should be tailored to individual circumstances. If they agree, their family and
carers should be involved.

SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 03/16

 3. The memo says failure to screen a patient for malnutrition may result in

A a change in overall health.

B a prolonged stay at the care facility.

C care providers being unaware of an issue.

E
Memo

To: Hospital staff

L
Re: Nutrition screening

P
This is to remind staff of the importance of nutrition screening to identify problems which may go unrecognised

and, therefore, remain untreated during the patient’s hospital stay. Nutrition screening should occur on

M
admission and then weekly during the patient’s episode of care; at least monthly in slower stream facilities; or if

the patient’s clinical condition changes.

A
All patients should have their weight and height documented on admission, and weight should continue to

be recorded at least weekly. Patients whose score is ‘at risk’ on a validated screening tool or whose clinical

S
condition is such that their treating team identifies them as at risk of malnutrition should be referred to a

dietitian for a full nutrition assessment and nutrition support as appropriate.

SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 04/16

 4. This policy document states that nurses

A must sign a paper form if they want any new stock.

B can order medicines from the pharmacy in some cases.

C should speak to the pharmacist if a drug is needed urgently.

E
Stock requisitioning

If stock levels of a medicine are low, the nurse should firstly liaise directly with their ward-based team to

L
arrange urgent stock replenishment. If the ward-based team is unavailable, the nurse should complete
a request form online and email it to the pharmacy stores. Paper-based ordering systems are available

P
(e.g. the ward medicines requisition book); however these should not be relied on if ward stock is urgently
needed.

M
“At risk medicines” – Diazepam/Codeine Phosphate/Co-codamol – may only be ordered for stock when
a paper requisition is written. Paper-based requisitions should be complete, legible and signed, and then

A
sent to the pharmacy department.

Wards/clinical areas using Mediwell 365 cabinets will have orders transmitted automatically to Pharmacy

S
on a daily basis, as stock is used.

SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 05/16

 5. The extract from the guidelines states that

A ICU staff can be seconded to other wards.

B only a consultant can refer a patient to the ICU.

C the ICU is fully responsible for a patient in their care.

E
6.2 Intensive Care Unit (ICU)

L
6.2.1 Unplanned admissions to the ICU need a referral at consultant level. In exceptional circumstances,
referrals will be discussed with the Ward Registrar looking after the patient if a delay in referral to ICU

P
would lead to the rapid deterioration of a patient.

6.2.2 All patients discussed with the ICU staff but not admitted remain under the care of the primary team
and as such they remain responsible for reviewing and escalating care should deterioration occur.

M
6.2.3 We encourage collaborative patient-centred care. However the ICU is defined as a closed unit.

A
This means that when patients are admitted into the ICU, they are under the care of the ICU team. It is
expected that members of the primary referring team will liaise daily with the ICU team to discuss the
patient’s management. However, it is up to the ICU team to make final decisions.

SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 06/16

 6. When dealing with patients following a safety incident, staff must avoid

A saying anything until the facts have been established.

B speculating on the possible causes of the incident.

C contradicting what has been said by other staff.

Patient Safety Incidents

E
Information about a patient safety incident must be given to patients and/or their carers in a truthful

L
and open manner by an appropriately nominated person. Patients want a step-by-step explanation of
what happened that considers their individual needs and is delivered openly. Communication must also

P
be timely – patients and/or carers should be provided with information about what happened as soon
as practicable. It is also essential that any information given is based solely on the facts known at the

M
time. Healthcare staff should explain that new information may emerge as an incident investigation is
undertaken, and patients and/or their carers will be kept up-to-date with the progress of an investigation.

A
The Duty of Candour Regulations require that information be given as soon as is reasonably practicable
and be given in writing no later than 10 days after the incident was reported through the local systems.

SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 07/16

 Part C

In this part of the test, there are two texts about different aspects of healthcare. For questions 7-22, choose the
A
answer (A, B, C or D) which you think fits best according to the text. B
C
Fill the circle in completely. Example: D

Text 1: Allergic to eating

Lucy Smith was strolling through Canberra last July. Within moments she couldn't stand, gripped by pain so severe
she feared she would pass out – the first sign of paralysing diarrhoea. This dramatic episode turned out to be

E
caused by a newly-acquired food allergy – to red meat. Food allergies affect one per cent of the adult population of
Australia. Most don’t hit with the same force as Lucy's, but the physical and mental impact can nonetheless turn a

L
person's life upside down, and may even be life-threatening. Lucy deduced that she was allergic to red meat, one
of the less common allergenic foodstuffs. Only after several further attacks of varying severity, was her suspicion

P
eventually confirmed by a specialist.

An allergy, according to immunologists, is the immune system over-reacting to a substance that would ordinarily

M
be considered benign. However the term 'allergy' is used more loosely by the general public. People say they
are allergic to a substance because it brings about some kind of adverse reaction in their bodies, some of which

A
can be severe and may resemble true allergic reactions, but unless the immune system itself is directly involved,
experts categorise it as 'intolerance'. Constant sneezing, itchy eyes or throat and inner ears, asthma, rashes, and

S
diarrhoea can all be signs of food allergies. Intolerance can bring on similar warning signs as well as things such as
headaches, bloating, and general lethargy. Over time, some allergy sufferers lose weight because there are so few
foods they can eat. Of course the social implications are huge too – eating is a major social event.

To diagnose a food allergy, immunologists use a 'skin-prick test' in which a drop of a commercially extracted
allergen is placed on the skin and the first couple of skin layers are pricked with a lancet. If a person is allergic,
the immune system is stimulated sufficiently to produce a mosquito bite-like bump within fifteen minutes. This
testing method is, however, somewhat unreliable in detecting intolerances, because, while not fully understood,
they operate via a different biological mechanism possibly involving chemicals in food irritating nerve endings
in the body. They are generally diagnosed by following an exclusion diet in which suspect foods are gradually
reintroduced and their effects monitored.

SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 08/16

 According to paediatric immunology specialist Dr Velencia Soutter, around six to eight per cent of babies are
affected by allergy. While most children will outgrow them, some actually grow into them. The mechanisms that
provoke an allergy remain a grey area. Soutter says: 'It’s like throwing a match into a fireworks factory. Hit the right
place and you set off a chain reaction. Miss it and the match just fizzles out. That difference between lighting up or
fizzling out isn’t well understood.'

Broadly speaking, Dr Soutter says the ideal recipe for a food allergy is to be born of allergic parents and then
to have a high exposure to an allergenic foodstuff. But there are so many exceptions to this rule that other
forces are clearly at work, and who’s to say what 'high' exposure is anyway? In contrast, the so-called hygiene

E
hypothesis suggests too low an exposure to allergens is to blame. The idea is that today's clean environments

L
leave our immune systems with too little to do, encouraging them to turn on the wrong culprits. Clearly, the field of
immunology has only just scratched the surface of understanding.

P
Interesting flakes of information are gradually being peeled off that surface, however. There is evidence that
allergens can be transferred through a mother's breast milk to her child, and possibly also through the placenta.

M
Since the immaturity of babies' immune systems might make them more vulnerable to an inherited allergic
tendency, women in allergic families could be advised to avoid certain foods during pregnancy and breastfeeding. It

A
is possible, though, that some allergies or intolerances are purely imaginary and this can also have consequences
for children. One US study found that parents sometimes avoided foods to which they erroneously believed their

S
children were allergic, occasionally leaving the children severely underfed.

In Australia, the number of people with genuine and severe allergies is growing. Some doctors speculate whether
the increased amount of new chemicals in the environment and in food is perhaps damaging immune systems
− making them more prone to react adversely. Much more research needs to be done to provide evidence for
that hypothesis. Anecdotally though, some experts say that staying off processed foods resolves the problem in
a significant number of cases. Dr Soutter speculates that a rise in peanut allergy cases makes up the bulk of the
increase in food allergies. Greater exposure has probably allowed more peanut allergies to flourish, she thinks.
Peanut consumption per capita is rising. It's a common ingredient in Asian and vegetarian dishes, which have
grown in popularity, and the diet-conscious population is increasingly turning to nuts as a source of healthy fats.

SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 09/16

 Text 1: Questions 7-14

7. The case of Lucy Smith highlights the fact that food allergies

A may be difficult to diagnose in certain people.

B are relatively rare in the adult population.

C can cause debilitating symptoms.

D often require urgent treatment.

E
8. In the second paragraph, what point is made about food intolerances?

L
A Scientists continue to disagree about their root causes.

P
B The symptoms are indistinguishable from those of allergies.

C They can have an unpredictable impact on the person affected.

M
D The distinction between them and allergies is not widely appreciated.

A
9. The phrase ‘via a different biological mechanism’ in the third paragraph explains

S
A the way the skin-prick test works in diagnosing food intolerances.

B how the presence of food impurities impacts on the skin-prick test.

C why the skin-prick test may not accurately diagnose food intolerance.

D how food allergies are triggered by substances used in the skin-prick test.

10. Dr Soutter uses the image of a fireworks factory to illustrate that

A the factors triggering an allergic reaction still remain unclear.

B allergic attacks can occur suddenly any time in a person’s life.

C it’s difficult to foresee which family member an allergy will affect.

D the identification of a food allergy is basically a matter of chance.

SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 10/16

 11. In the fifth paragraph, what point is made about the two hypotheses mentioned?

A They both appear to be credible.

B They directly contradict each other.

C They fail to define their terms adequately.

D They should both be studied in more depth.

E
12. What does the phrase ‘this rule’ in the fifth paragraph refer to?

L
A the likelihood of having an inherited allergy to certain foods

P
B the type of diet in which food allergies more commonly occur

C the degree of contact with allergens needed to trigger a reaction

M
D the order of events most commonly found prior to allergic attacks

A
13. What does the sixth paragraph suggest about the transference of allergies between mother and child?

S
A It is only possible with particular individuals.

B It can result in instances of malnourishment.

C It may be avoidable if certain precautions are taken.

D It is most likely to take place before the baby is born.

14. Dr Soutter suggests that the rise in cases of one allergy may be partly due to

A attempts to improve eating habits.

B changes in food manufacturing methods.

C the adoption of new agricultural practices.

D increased levels of harmful substances in the atmosphere.

SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 11/16

 Text 2: Prenatal origins of heart disease

Heart disease is the greatest killer in the developed world today, currently accounting for 30% of all deaths in
Australia. A concept which is familiar to us all is that traditional risk factors such as smoking, obesity, and genetic
make-up increase the risk of heart disease. However, it is now becoming apparent that another factor is at play – a
developmental programming that is predetermined before birth, not only by our genes but also by their interaction
with the quality of our prenatal environment.

Pregnancies that are complicated by sub-optimal conditions in the womb, such as happens during pre-eclampsia or

E
placental insufficiency, enforce physiological adaptations in the unborn child and placenta. While these adaptations
are necessary to maintain viable pregnancy and sustain life before birth, they come at a cost. The biological trade-

L
off is reduced growth, which may in turn affect the development of key organs and systems such as the heart and
circulation, thereby increasing the risk of cardiovascular disease in adult life. Overwhelming evidence in more than

P
a dozen countries has linked development under adverse intrauterine conditions leading to low birth weight with
increased rates in adulthood of coronary heart disease and its major risk factors – hypertension, atherosclerosis

M
and diabetes.

The idea that a foetus’s susceptibility to disease in later life could be programmed by the conditions in the womb

A
has been taken up vigorously by the international research community, with considerable efforts concentrating on
nutrient supply across the placenta as a risk factor. But that is just part of the story: how much oxygen is available

S
to the foetus is also a determinant of growth and of the risk of adult disease. Dr Dino Giussani’s research group
at Cambridge University in the UK is asking what effect reduced oxygen has on foetal development by studying
populations at high altitude.

Giussani’s team studied birth weight records from healthy term pregnancies in two Bolivian cities at obstetric
hospitals and clinics selectively attended by women from either high-income or low-income backgrounds. Bolivia
lies at the heart of South America, split by the Andean Cordillera into areas of very high altitude to the west and
areas at sea-level to the east, as the country extends into the Amazon Basin. At 400m and almost 4000m above
sea-level, respectively, the Bolivian cities of Santa Cruz and La Paz are striking examples of this difference.
Pregnancies at high altitude are subjected to a lower partial pressure of oxygen in the atmosphere compared with
those at sea-level. Women living at high altitude in La Paz are more likely to give birth to underweight babies than
women living in Santa Cruz. But is this a result of reduced oxygen in the womb or poorer nutritional status?

SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 12/16

 What Giussani found was that the high-altitude babies showed a pronounced reduction in birth weight compared
with low-altitude babies, even in cases of high maternal nutritional status. Babies born to low-income mothers at
sea-level also showed a reduction in birth weight, but the effect of under-nutrition was not as pronounced as the
effect of high altitude on birth weight; clearly, foetal oxygenation was a more important determinant of foetal growth
within these communities. Remarkably, although one might assume that babies born to mothers of low socio-
economic status at high altitude would show the greatest reduction in birth weight, these babies were actually
heavier than babies born to high-income mothers at high altitude. It turns out that the difference lies in ancestry.

The lower socio-economic groups of La Paz are almost entirely made up of Aymara Indians, an ancient ethnic

E
group with a history in the Bolivian highlands spanning a couple of millennia. On the other hand, individuals of

L
higher socio-economic status represent a largely European and North American admixture, relative newcomers
to high altitude. It seems therefore that an ancestry linked to prolonged high-altitude residence confers protection
against reduced atmospheric oxygen.

P
Giussani’s group also discovered that they can replicate the findings observed in Andean pregnancies in hen

M
eggs: fertilised eggs from Bolivian birds native to sea-level show growth restriction when incubated at high altitude,
whereas eggs from birds that are native to high altitude show a smaller growth restriction. Moving fertilised eggs

A
from hens native to high altitude down to sea-level not only restored growth, but the embryos were actually larger
than sea-level embryos incubated at sea-level. The researchers could thereby demonstrate something that only
generations of migration in human populations would reveal. What’s more, when looking for early markers of

S
cardiovascular disease, the researchers discovered that growth restriction at high altitude was indeed linked with
cardiovascular defects – shown by an increase in the thickness of the walls of the chick heart and aorta. This all
suggests the possibility of halting the development of heart disease at its very origin, bringing preventive medicine
back into the womb.

SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 13/16

 Text 2: Questions 15-22

15. What information can be found in the first paragraph?

A reference to some recent findings relating to heart disease

B indication of the greatest risk factor associated with heart disease

C mention of a misconception about the chief causes of heart disease

D figures showing the country with the highest mortality rate from heart disease

E
16. When the writer uses the word ‘cost’ in the second paragraph she is referring to

L
A overwhelming evidence.

P
B placental insufficiency.

C viable pregnancy.

M
D reduced growth.

A
17. In the third paragraph, what does the author suggest about the work of the international research

S
community on this subject?

A Their focus has been too narrow.

B Some of their studies may be flawed.

C There is nothing original about their research.

D They were overly keen to seize on a particular idea.

18. What was the aim of the study described in the fourth paragraph?

A to compare neonatal records between the UK and Bolivia

B to assess the relative significance of two risk factors for newborns

C to find a link between birth weight and predisposition to heart disease

D to determine the likelihood of high-altitude babies being carried to full term

SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 14/16

 19. What assumption was proved wrong by the results of the study?

A Lower-income mothers generally give birth to lower weight babies.

B A baby born at high altitude will typically weigh less than one born at sea level.

C Levels of oxygen have a greater impact on birth weight than nutritional status does.

D There is a correlation between prenatal oxygen levels and predisposition to heart disease.

E
20. In the sixth paragraph, what is suggested about the inhabitants of La Paz?

L
A The altitude affects all socio-economic groups in a similar way.

P
B There is a high degree of ethnic diversity at all levels of society.

C Most residents have a shared ancestry going back two thousand years.

M
D Poorer residents have a genetic advantage over those with higher incomes.

A
21. The purpose of the information in the sixth paragraph is to provide

S
A an alternative approach to a puzzle.

B a confirmation of a hypothesis.

C an explanation for a finding.

D a solution to a problem.

22. What advantage of the research involving hen eggs is mentioned in the final paragraph?

A the availability of supplies

B the simplicity of the procedure

C the reliability of the data obtained

D the speed with which results are seen

END OF READING TEST

THIS BOOKLET WILL BE COLLECTED
SAMPLE

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 15/16

 Sample Test 3
READING TEST:03

READING SUB-TEST – ANSWER KEY

PART A

L E
P
A M
S

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© Cambridge Boxhill Language Assessment – ABN 51 988 559 414
READING SUB-TEST – ANSWER KEY

PART A: QUESTIONS 1-20

1 B

2 C

3 D

4 D

5 A

6 tissue damage

7 scarring

E
8 sensation

9 hot clothing

L
10 hypothermia

11 tetanus

P
12 blisters

13 antibiotics

M
14 thickness

15 2 / two

A
16 20ml

17 10% / ten percent

S
18 Tramadol

19 orally

20 72 hours

1
 Sample Test 3

READING SUB-TEST – ANSWER KEY

PARTS B & C

L E
P
A M
S

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© Cambridge Boxhill Language Assessment – ABN 51 988 559 414
READING SUB-TEST - ANSWER KEY

PART B: QUESTIONS 1-6

1 failure to do so would put other people in danger.

2 B ensure that the patient’s personal care plan is also transferred.

3 care providers being unaware of an issue.

4 B can order medicines from the pharmacy in some cases.

5 the ICU is fully responsible for a patient in their care.

6 B speculating on the possible causes of the incident.

E
PART C: QUESTIONS 7-14

L
7 C can cause debilitating symptoms.

P
8 D The distinction between them and allergies is not widely appreciated.

9 C why the skin-prick test may not accurately diagnose food intolerance.

M
10 A the factors triggering an allergic reaction still remain unclear.

11 They directly contradict each other.

A
12 D the order of events most commonly found prior to allergic attacks

13 C It may be avoidable if certain precautions are taken.

S
14 A attempts to improve eating habits.

PART C: QUESTIONS 15-22

15 A reference to some recent findings relating to heart disease

16 D reduced growth.

17 A Their focus has been too narrow.

18 B to assess the relative significance of two risk factors for newborns

19 A Lower-income mothers generally give birth to lower weight babies.

20 D Poorer residents have a genetic advantage over those with higher incomes.

21 an explanation for a finding.

22 D the speed with which results are seen

1
 READING TEST:04
OCCUPATIONAL ENGLISH TEST

READING SUB-TEST - TEXT BOOKLET: PART A

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
MIDDLE NAMES: Passport Photo

PROFESSION:
VENUE:
TEST DATE:

CANDIDATE DECLARATION
By signing this, you agree not to disclose or use in any way (other than to take the test) or assist any other person to disclose or use any OET
test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice
or information, you may be disqualified and your results may not be issued at the sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
malpractice, their personal details and details of the investigation may be passed to a third party where required.

www.occupationalenglishtest.org
© Cambridge Boxhill Language Assessment -ABN 51 988 559 414

[CANDIDATE NO.] READING TEXT BOOKLET PART A 01/04

 The use of feeding tubes in paediatrics: Texts

Text A
Paediatric nasogastric tube use
Nasogastric is the most common route for enteral feeding. It is particularly useful in the short
term, and when it is necessary to avoid a surgical procedure to insert a gastrostomy device.
However, in the long term, gastrostomy feeding may be more suitable.
Issues associated with paediatric nasogastric tube feeding include:
• The procedure for inserting the tube is traumatic for the majority of children.
• The tube is very noticeable.
• Patients are likely to pull out the tube making regular re-insertion necessary.
• Aspiration, if the tube is incorrectly placed.
• Increased risk of gastro-esophageal reflux with prolonged use.
• Damage to the skin on the face.

Text B
Inserting the nasogastric tube
All tubes must be radio opaque throughout their length and have externally visible markings.

1. Wide bore:

- for short-term use only.

- should be changed every seven days.
- range of sizes for paediatric use is 6 Fr to 10 Fr.

2. Fine bore:

- for long-term use.

- should be changed every 30 days.
In general, tube sizes of 6 Fr are used for standard feeds, and 7-10 Fr for higher density and
fibre feeds. Tubes come in a range of lengths, usually 55cm, 75cm or 85cm.
Wash and dry hands thoroughly. Place all the equipment needed on a clean tray.
• Find the most appropriate position for the child, depending on age and/or ability to co-
operate. Older children may be able to sit upright with head support. Younger children may
sit on a parent's lap. Infants may be wrapped in a sheet or blanket.
• Check the tube is intact then stretch it to remove any shape retained from being packaged.
• Measure from the tip of the nose to the bottom of the ear lobe, then from the ear lobe to
xiphisternum. The length of tube can be marked with indelible pen or a note taken of the
measurement marks on the tube (for neonates: measure from the nose to ear and then to
the halfway point between xiphisternum and umbilicus).
• Lubricate the end of the tube using a water-based lubricant.
• Gently pass the tube into the child's nostril, advancing it along the floor of the nasopharynx
to the oropharynx. Ask the child to swallow a little water, or offer a younger child their
soother, to assist passage of the tube down the oesophagus. Never advance the tube
against resistance.
• If the child shows signs of breathlessness or severe coughing, remove the tube
immediately.
• Lightly secure the tube with tape until the position has been checked.
TextC

• Estimate NEX measurement (Place exit port of tube at tio of nose. Extend tube to earlobe, and then to
xiphistemum)
• Insert fully radio-opaque nasogastric tube for feeding (follow manufacturer's instructions for insertion)
• Confirm and document secured NEX measurement
• Aspirate with a syringe using gentle suction

YES NO

Try each of these techniques to help gain aspirate:

• If possible, turn child/infant onto left side
• Inject 1-5ml air into a tube using a syringe
• Wait for 15-30 minutes before aspirating again
• Advance or withdraw tube by 1-2cm
• Give mouth care to patients who are nil by mouth
(stimulates gastric secretion of acid)
• Do not use water to flush
Test aspirate on CE marked
pH indicator paper for use on
human gastric aspirate -~---------.___A=s'""'p"'"'ir=a=te'-o;;;..;;b;;;..;;t=ai=n~ed=?'-.__,
YES NO

Proceed to x-ray, ensure reason for x-ray documented

pH between pH NOT between on request form
1 and 5.5 1 and 5.5

Competent clinician (with evidence of training) to

r PROCEED TO FEED or USETUBE" ..___ ___,. document confirmation of nasogastric tube position
Record result in notes and YES in stomach
subsequently on bedside NO
documentation before each
~feed/medication/flush DO NOT FEED or USE TUBE
Consider re-siting tube or call for senior advice

A pH of between 1 and 5.5 is reliable confirmation that the tube is not in the lung, however, it does not confirm
gastric placement. If this is any concern, the patient should proceed to x-ray in order to confirm tube position.
Where pH readings fall between 5 and 6 it is recommended that a second competent person checks the
reading or retests.

Text D
Administering feeds/fluid via a feeding tube
Feeds are ordered through a referral to the dietitian.
When feeding directly into the small bowel, feeds must be delivered continuously via a
feeding pump. The small bowel cannot hold large volumes of feed.
Feed bottles must be changed every six hours, or every four hours for expressed breast
milk.
Under no circumstances should the feed be decanted from the container in which
it is sent up from the special feeds unit.
All feeds should be monitored and recorded hourly using a fluid balance chart.
If oral feeding is appropriate, this must also be recorded.
The child should be measured and weighed before feeding commences and then twice
weekly.
The use of this feeding method should be re-assessed, evaluated and recorded daily.

END OF PART A
THIS TEXT BOOKLET WILL BE COLLECTED
OCCUPATIONAL ENGLISH TEST

READING SUB-TEST - QUESTION PAPER: PART A

CANDIDATE NUMBER:

LAST NAME:

FIRST NAME:

MIDDLE NAMES: Passport Photo

PROFESSION:

VENUE:

TEST DATE:

CANDIDATE DECLARATION
By signing this, you agree not to disclose or use in any way (other than to take the test) or assist any other person to disclose or use any OET
test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice
or information, you may be disqualified and your results may not be issued at the sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
malpractice, their personal details and details of the investigation may be passed to a third party where required.

TIME: 15 MINUTES

INSTRUCTIONS TO CANDIDATES
DO NOT open this Question Paper or the Text Booklet until you are told to do so.

Write your answers on the spaces provided on this Question Paper.

You must answer the questions within the 15-minute time limit.

One mark will be granted for each correct answer.

Answer ALL questions. Marks are NOT deducted for incorrect answers.

At the end of the 15 minutes, hand in this Question Paper and the Text Booklet.

DO NOT remove OET material from the test room.

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© Cambridge Boxhill Language Assessment - ABN 51 988 559 414

[CANDIDATE NO.] READING QUESTION PAPER PART A 01/04

 Part A

TIME: 15 minutes

• Look at the four texts, A-0, in the separate Text Booklet.

• For each question, 1-20, look through the texts, A-0, 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.

The use of feeding tubes in paediatrics: Questions

Questions 1-7

For each question, 1-7, decide which text (A, B, C or D) the information comes from. You
may use any letter more than once.

In which text can you find information about

1 the risks of feeding a child via a nasogastric tube?

2 calculating the length of tube that will be required for a

patient?

3 when alternative forms of feeding may be more

appropriate than nasogastric?

4 who to consult over a patient's liquid food requirements?

5 the outward appearance of the tubes?

6 knowing when it is safe to go ahead with the use of a

tube for feeding?

7 how regularly different kinds of tubes need replacing?

Questions 8-15

Answer each of the questions, 8-15, with a word or short phrase from one of the texts. Each
answer may include words, numbers or both.

8 What type of tube should you use for patients who need nasogastric feeding for an
extended period?

9 What should you apply to a feeding tube to make it easier to insert?

1O What should you use to keep the tube in place temporarily?

11 What equipment should you use initially to aspirate a feeding tube?

12 If initial aspiration of the feeding tube is unsuccessful, how long should you wait
before trying again?

13 How should you position a patient during a second attempt to obtain aspirate?

14 If aspirate exceeds pH 5.5, where should you take the patient to confirm the
position of the tube?

15 What device allows for the delivery of feeds via the small bowel?
Questions 16-20

Complete each of the sentences, 16-20, with a word or short phrase from one of the texts. Each
answer may include words, numbers or both.

16 If a feeding tube isn't straight when you unwrap it, you should

-----------it.

17 Patients are more likely to experience _ _ _ _ _ _ _ _ _ _ _ if they need

long-term feeding via a tube.

18 If you need to give the patient a standard liquid feed, the tube to use is

_ _ _ _ _ _ _ _ _ _ _ in size.

19 You must take out the feeding tube at once if the patient is coughing badly or is

experiencing _ _ _ _ _ _ _ _ _ __

20 If a child is receiving _ _ _ _ _ _ _ _ _ _ _ via a feeding tube, you should

replace the feed bottle after four hours.

END OF PART A

THIS QUESTION PAPER WILL BE COLLECTED

~eJET
OCCUPATIONAL ENGLISH TEST

READING SUB-TEST - QUESTION PAPER: PARTS B & C

CANDIDATE NUMBER:

LAST NAME:

FIRST NAME:

MIDDLE NAMES: Passport Photo

PROFESSION:

VENUE:

TEST DATE:

CANDIDATE DECLARATION
By signing this, you agree not to disclose or use in any way (other than to take the test) or assist any other person to disclose or use any OET
test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice
or information, you may be disqualified and your results may not be issued at the sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
malpractice, their personal details and details of the investigation may be passed to a third party where required.

TIME: 45 MINUTES

INSTRUCTIONS TO CANDIDATES
DO NOT open this Question Paper until you are told to do so.

One mark will be granted for each correct answer.

Answer ALL questions. Marks are NOT deducted for incorrect answers.

At the end of the test, hand in this Question Paper.

HOW TO ANSWER THE QUESTIONS:

Mark your answers on this Question Paper by filling in the circle using a 28 pencil. Example: @
®
©

www.occupationalenglishtest.org
©Cambridge Boxhill LanguageAssessment-ABN 51988559 414
[CANDIDATE NO.] READING QUESTION PAPER PARTS 8 & C 01/16
 Part 8
In this part of the test, there are six short extracts relating to the work of health professionals.
For questions 1-6, choose answer (A, B or C) which you think fits best according to the text.

1. If vaccines have been stored incorrectly,

@ this should be reported.

@ staff should dispose of them securely.

@ they should be sent back to the supplier.

Manual extract: effective cold chain

The cold chain is the system of transporting and storing vaccines within the
temperature range of +2°C to +S°C from the place of manufacture to the point of
administration. Maintenance of the cold chain is essential for maintaining vaccine
potency and, in turn, vaccine effectiveness.
Purpose-built vaccine refrigerators (PBVR) are the preferred means of storage for
vaccines. Domestic refrigerators are not designed for the special temperature needs of
vaccine storage.
Despite best practices, cold chain breaches sometimes occur. Do not discard or
use any vaccines exposed to temperatures below +2°C or above +S°C without
obtaining further advice. Isolate vaccines and contact the state or territory public
health bodies for advice on the National Immunisation Program vaccines and the
manufacturer for privately purchased vaccines.
2. According to the extract, prior to making a home visit, nurses must

@ record the time they leave the practice.

@ refill their bag with necessary items.

@ communicate their intentions to others.

Nurse home visit guidelines

When the nurse is ready to depart, he/she must advise a minimum of two staff
members that he/she is commencing home visits, with one staff member responsible
for logging the nurse's movements. More than one person must be made aware of the
nurse's movements; failure to do so could result in the breakdown of communication
and increased risk to the nurse and/or practice.
On return to the practice, the nurse will immediately advise staff members of his/her
return. This time will be documented on the patient visit list, and then scanned and
filed by administration staff. The nurse will then attend to any specimens, cold chain
requirements, restocking of the nurse kit and biohazardous waste.
3. What is being described in this section of the guidelines?

@ changes in procedures

@ best practice procedures

@ exceptions to the procedures

Guidelines for dealing with hospital waste

All biological waste must be carefully stored and disposed of safely. Contaminated
materials such as blood bags, dirty dressings and disposable needles are also potentially
hazardous and must be treated accordingly. If biological waste and contaminated
materials are not disposed of properly, staff and members of the community could be
exposed to infectious material and become infected. It is essential for the hospital to have
protocols for dealing with biological waste and contaminated materials. All staff must be
familiar with them and follow them.
The disposal of biohazardous materials is time-consuming and expensive, so it is
important to separate out non-contaminated waste such as paper, packaging and non-
sterile materials. Make separate disposal containers available where waste is created so
that staff can sort the waste as it is being discarded.
4. When is it acceptable for a health professional to pass on confidential information
given by a patient?

@ if non-disclosure could adversely affect those involved

@ if the patient's treatment might otherwise be compromised

@ if the health professional would otherwise be breaking the law

Extract from guidelines: Patient Confidentiality

Where a patient objects to information being shared with other health professionals
involved in their care, you should explain how disclosure would benefit the continuity
and quality of care. If their decision has implications for the proposed treatment, it will be
necessary to inform the patient of this. Ultimately if they refuse, you must respect their
decision, even if it means that for reasons of safety you must limit your treatment options.
You should record their decision within their clinical notes.
It may be in the public interest to disclose information received in confidence without
consent, for example, information about a serious crime. It is important that confidentiality
may only be broken in this way in exceptional circumstances and then only after careful
consideration. This means you can justify your actions and point out the possible harm to
the patient or other interested parties if you hadn't disclosed the information. Theft, fraud
or damage to property would generally not warrant a breach of confidence.
5. The purpose of the email to practitioners about infection control obligations is to

@ act as a reminder of their obligations.

@ respond to a specific query they have raised.

@ announce a change in regulations affecting them.

Email from Dental Board of Australia

Dear Practitioner,
You may be aware of the recent media and public interest in standards of infection
control in dental practice. As regulators of the profession, we are concerned that there
has been doubt among registered dental practitioners about these essential standards.
Registered dental practitioners must comply with the National Board's Guidelines on
infection control. The guidelines list the reference material that you must have access
to and comply with, including the National Health and Medical Research Council's
(NHMRC) Guidelines for the prevention and control of infection in healthcare.
We believe that most dental practitioners consistently comply with these guidelines and
implement appropriate infection control protocols. However, the consequences for non-
compliance with appropriate infection control measures will be significant for you and
also for your patients and the community.
6. The results of the study described in the memo may explain why

@ superior communication skills may protect women from dementia.

@ female dementia sufferers have better verbal skills.

@ mild dementia in women can remain undiagnosed.

Memo to staff: Women and Dementia

Please read this extract from a recent research paper

Women's superior verbal skills could work against them when it comes to recognizing
Alzheimer's disease. A new study looked at more than 1300 men and women divided into
three groups: one group comprised patients with amnestic mild cognitive impairment; the
second group included patients with Alzheimer's dementia; and the final group included
healthy controls. The researchers measured glucose metabolic rates with PET scans.
Participants were then given immediate and delayed verbal recall tests.
Women with either no, mild or moderate problems performed better than men on the verbal
memory tests. There was no difference in those with advanced Alzheimer's.
Because verbal memory scores are used for diagnosing Alzheimer's, some women may be
further along in their disease before they are diagnosed. This suggests the need to have an
increased index of suspicion when evaluating women with memory problems.
 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 according to the text.

Text 1 : Asbestosis

Asbestos is a naturally occurring mineral that has been linked to human lung disease.
It has been used in a huge number of products due to its high tensile strength, relative
resistance to acid and temperature, and its varying textures and degrees of flexibility. It
does not evaporate, dissolve, burn or undergo significant reactions with other chemicals.
Because of the widespread use of asbestos, its fibres are ubiquitous in the environment.
Building insulation materials manufactured since 1975 should no longer contain asbestos;
however, products made or stockpiled before this time remain in many homes. Indoor air
may become contaminated with fibres released from building materials, especially if they
are damaged or crumbling.

One of the three types of asbestos-related diseases is asbestosis, a process of lung

tissue scarring caused by asbestos fibres. The symptoms of asbestosis usually include
slowly progressing shortness of breath and cough, often 20 to 40 years after exposure.
Breathlessness advances throughout the disease, even without further asbestos inhalation.
This fact is highlighted in the case of a 67-year-old retired plumber. He was on ramipril to
treat his hypertension and developed a persistent dry cough, which his doctor presumed to
be an ACE inhibitor induced cough. The ramipril was changed to losartan. The patient had
never smoked and did not have a history of asthma or COPD. His cough worsened and
he complained of breathlessness on exertion. In view of this history and the fact that he
was a non-smoker, he was referred for a chest X-ray and to the local respiratory physician.
His doctor was surprised to learn that the patient had asbestosis, diagnosed by a high-
resolution CT scan. The patient then began legal proceedings to claim compensation as
he had worked in a dockyard 25 years previously, during which time he was exposed to
asbestos.

There are two major groups of asbestos fibres, the amphibole and chrysotile fibres. The
amphiboles are much more likely to cause cancer of the lining of the lung (mesothelioma)
and scarring of the lining of the lung (pleural fibrosis). Either group of fibres can cause
disease of the lung, such as asbestosis. The risk of developing asbestos-related lung
cancer varies between fibre types. Studies of groups of patients exposed to chrysotile
fibres show only a moderate increase in risk. On the other hand, exposure to amphibole
fibres or to both types of fibres increases the risk of lung cancer two-fold. Although the
Occupational Safety and Health Administration (OSHA) has a standard for workplace
exposure to asbestos (0.2 fibres/millilitre of air), there is debate over what constitutes
a safe level of exposure. While some believe asbestos-related disease is a 'threshold
phenomenon', which requires a certain level of exposure for disease to occur, others
believe there is no safe level of asbestos.
Depending on their shape and size, asbestos fibres deposit in different areas of the lung.
Fibres less than 3mm easily move into the lung tissue and the lining surrounding the lung.
Long fibres, greater than 5mm cannot be completely broken down by scavenger cells
(macrophages) and become lodged in the lung tissue, causing inflammation. Substances
damaging to the lungs are then released by cells that are responding to the foreign
asbestos material. The persistence of these long fibres in the lung tissue and the resulting
inflammation seem to initiate the process of cancer formation. As inflammation and damage
to tissue around the asbestos fibres continues, the resulting scarring can extend from the
small airways to the larger airways and the tiny air sacs (alveoli) at the end of the airways.

There is no cure for asbestosis. Treatments focus on a patient's ability to breathe.

Medications like bronchodilators, aspirin and antibiotics are often prescribed and such
treatments as oxygen therapy and postural drainage may be recommended. If symptoms
are so severe that medications don't work, surgery may be recommended to remove scar
tissue. Patients with asbestosis, like others with chronic lung disease, are at a higher risk
of serious infections that take advantage of diseased or scarred lung tissue, so prevention
and rapid treatment is vital. Flu and pneumococcal vaccinations are a part of routine care
for these patients. Patients with progressive disease may be given corticosteroids and
cyclophosphamide with limited improvement.

Chrysotile is the only form of asbestos that is currently in production today. Despite their
association with lung cancer, chrysotile products are still used in 60 countries, according
to the industry-sponsored Asbestos Institute. Although the asbestos industry proclaims the
'safety' of chrysotile fibres, which are now imbedded in less friable and 'dusty' products,
little is known about the long term effects of these products because of the long delay
in the development of disease. In spite of their potential health risks, the durability and
cheapness of these products continue to attract commercial applications. Asbestosis
remains a significant clinical problem even after marked reductions in on-the-job exposure
to asbestos. Again, this is due to the long period of time between exposure and the onset
of disease.
Text 1: Questions 7-14

7. The writer suggests that the potential for harm from asbestos is increased by

@ a change in the method of manufacture.

@ the way it reacts with other substances.

@ the fact that it is used so extensively.

@ its presence in recently constructed buildings.

8. The word 'ubiquitous' in paragraph one suggests that asbestos fibres

@ can be found everywhere.

@ may last for a long time.

@ have an unchanging nature.

@ are a natural substance.

9. The case study of the 67-year-old man is given to show that

@ smoking is unrelated to a diagnosis of asbestosis.

@ doctors should be able to diagnose asbestosis earlier.

@ the time from exposure to disease may cause delayed diagnosis.

@ patients must provide full employment history details to their doctors.

10. In the third paragraph, the writer highlights the disagreement about

@ the relative safety of the two types of asbestos fibres.

@ the impact of types of fibres on disease development.

@ the results of studies into the levels of risk of fibre types.

@ the degree of contact with asbestos fibres considered harmful.

11. In the fourth paragraph, the writer points out that longer asbestos fibres

@ can travel as far as the alveoli.

@ tend to remain in the pulmonary tissue.

@ release substances causing inflammation.

@ mount a defence against the body's macrophages.

12. What is highlighted as an important component of patient management?

@ the use of corticosteroids

@ infection control

@ early intervention

@ excision of scarred tissue

13. The writer states that products made from chrysotile

@ have restricted application.

@ may pose a future health threat.

@ enjoy approval by the regulatory bodies.

@ are safer than earlier asbestos-containing products.

14. In the final paragraph, the word 'this' refers to

@ the interval from asbestos exposure to disease.

@ the decreased use of asbestos in workplaces.

@ asbestosis as an ongoing medical issue.

@ occupational exposure to asbestos.

Text 2: Medication non-compliance

A US doctor gives his views on a new program

An important component of a patient's history and physical examination is the question of

'medication compliance,' the term used by physicians to designate whether, or not, a patient is
taking his or her medications. Many a hospital chart bears the notorious comment 'Patient has
a history of non-compliance.' Now, under a new experimental program in Philadelphia, USA,
patients are being paid to take their medications. The concept makes sense in theory - failure to
comply is one of the most common reasons that patients are readmitted to hospital shortly after
being discharged.

Compliant patients take their medications because they want to live as long as possible; some
simply do so because they're responsible, conscientious individuals by nature. But the hustle and
bustle of daily life and employment often get in the way of taking medications, especially those
that are timed inconveniently or in frequent doses, even for such well-intentioned patients. For the
elderly and the mentally or physically impaired, US insurance companies will often pay for a daily
visit by a nurse, to ensure a patient gets at least one set of the most vital pills. But other patients
are left to fend for themselves, and it is not uncommon these days for patients to be taking a
considerable number of vital pills daily.

Some patients have not been properly educated about the importance of their medications
in layman's terms. They have told me, for instance, that they don't have high blood pressure
because they were once prescribed a high blood pressure pill - in essence, they view an
antihypertensive as an antibiotic that can be used as short-term treatment for a short-term
problem. Others have told me that they never had a heart attack because they were taken to
the cardiac catheterization lab and 'fixed.' As physicians we are responsible for making sure
patients understand their own medical history and their own medications.

Not uncommonly patients will say, 'I googled it the other day, and there was a long list of side
effects.' But a simple conversation with the patient at this juncture can easily change their
perspective. As with many things in medicine, it's all about risks versus benefits - that's what
we as physicians are trained to analyse. And patients can rest assured that we'll monitor them
closely for side effects and address any that are unpleasant, either by treating them or by trying
a different medication.

But to return to the program in Philadelphia, my firm belief is that if patients don't have strong
enough incentives to take their medications so they can live longer, healthier lives, then the
long-term benefits of providing a financial incentive are likely to be minimal. At the outset, the
rewards may be substantial enough to elicit a response. But one isolated system or patient
study is not an accurate depiction of the real-life scenario: patients will have to be taking these
medications for decades.

Although a simple financial incentives program has its appeal, its complications abound. What's
worse, it seems to be saying to society: as physicians, we tell our patients that not only do we
work to care for them, but we'll now pay them to take better care of themselves. And by the
way, for all you medication-compliant patients out there, you can have the inherent reward of a
longer, healthier life, but we're not going to bother sending you money. This seems like some
sort of implied punishment.
But more generally, what advice can be given to doctors with non-compliant patients? Dr John
Steiner has written a paper on the matter: 'Be compassionate,' he urges doctors. 'Understand
what a complicated balancing act it is for patients.' He's surely right on that score. Doctors
and patients need to work together to figure out what is reasonable and realistic, prioritizing
which measures are most important. For one patient, taking the diabetes pills might be more
crucial than trying to quit smoking. For another, treating depression is more critical than treating
cholesterol. 'Improving compliance is a team sport,' Dr Steiner adds. 'Input from nurses, care
managers, social workers and pharmacists is critical.'

When discussing the complicated nuances of compliance with my students, I give the example
of my grandmother. A thrifty, no-nonsense woman, she routinely sliced all the cholesterol and
heart disease pills her doctor prescribed in half, taking only half the dose. If I questioned this,
she'd wave me off with, 'What do those doctors know, anyway?' Sadly, she died suddenly,
aged 87, most likely of a massive heart attack. Had she taken her medicines at the appropriate
doses, she might have survived it. But then maybe she'd have died a more painful death from
some other ailment. Her biggest fear had always been ending up dependent in a nursing home,
and by luck or design, she was able to avoid that. Perhaps there was some wisdom in her 'non-
compliance.'
Text 2: Questions 15-22

15. In the first paragraph, what is the writer's attitude towards the new programme?

@ He doubts that it is correctly named.

@ He appreciates the reasons behind it.

@ He is sceptical about whether it can work.

@ He is more enthusiastic than some other doctors.

16. In the second paragraph, the writer suggests that one category of non-compliance is

@ elderly patients who are given occasional assistance.

@ patients who are over-prescribed with a certain drug.

@ busy working people who mean to be compliant.

@ people who are by nature wary of taking pills.

17. What problem with some patients is described in the third paragraph?

@ They forget which prescribed medication is for which of their conditions.

@ They fail to recognise that some medical conditions require ongoing treatment.

@ They don't understand their treatment even when it's explained in simple terms.

@ They believe that taking some prescribed pills means they don't need to take others.

18. What does the writer say about side effects to medication?

@ Doctors need to have better plans in place if they develop.

@ There is too much misleading information about them online.

@ Fear of them can waste a lot of unnecessary consultation time.

@ Patients need to be informed about the likelihood of them occurring.

 19. In the fifth paragraph, what is the writer's reservation about the Philadelphia program?

@ the long-term feasibility of the central idea

@ the size of the financial incentives offered

@ the types of medication that were targeted

@ the particular sample chosen to participate

20. What objection to the program does the writer make in the sixth paragraph?

@ It will be counter-productive.

@ It will place heavy demands on doctors.

@ It sends the wrong message to patients.

@ It is a simplistic idea that falls down on its details.

21. The expression 'on that score' in the seventh paragraph refers to

@ a complex solution to patients' problems.

@ a co-operative attitude amongst medical staff.

@ a realistic assessment of why something happens.

@ a recommended response to the concerns of patients.

22. The writer suggests that his grandmother

@ may ultimately have benefited from her non-compliance.

@ would have appreciated closer medical supervision.

@ might have underestimated how ill she was.

@ should have followed her doctor's advice.

END OF READING TEST

TH IS BOOKLET WILL BE COLLECTED

READING SUB-TEST-ANSWER KEY

PART A: QUESTIONS 1-20

1 A

2 B

3 A

4 D
5 B

6 c
7 B

8 fine bore

9 water-based lubricant

10 tape

11 (a) syringe

12 15-30 minutes/mins OR fifteen-thirty minutes/mins

13 (turn) on(to) left side

14 (to) x-ray (department) OR (to) radiology

15 (a) feeding pump

16 stretch

17 gastroesophageal reflux

18 6/six Fr/French

19 breathlessness

20 (expressed) breast milk

Reading sub-test
Answer Key - Parts B & C
READING SUB-TEST-ANSWER KEY

PART B: QUESTIONS 1-6

1 A this should be reported.

2 c communicate their intentions to others.

3 8 best practice procedures

4 A if non-disclosure could adversely affect those involved

5 A act as a reminder of their obligations.

6 c mild dementia in women can remain undiagnosed.

PART C: QUESTIONS 7-14

7 c the fact that it is used so extensively.

8 A can be found everywhere.

9 c the time from exposure to disease may cause delayed diagnosis.

10 D the degree of contact with asbestos fibres considered harmful.

11 B tend to remain in the pulmonary tissue.

12 B infection control

13 8 may pose a future health threat.

14 c asbestosis as an ongoing medical issue.

PART C: QUESTIONS 15-22

15 B He appreciates the reasons behind it.

16 c busy working people who mean to be compliant.

They fail to recognise that some medical conditions require

17 8
ongoing treatment.

Patients need to be informed about the likelihood of them

18 D
occurring.

19 A the long-term feasibility of the central idea

20 c It sends the wrong message to patients.

21 D a recommended response to the concerns of patients.

22 A may ultimately have benefited from her non-compliance.

READING TEST:05 Tetanus: Texts

Text A
Tetanus is a severe disease that can result in serious illness and death. Tetanus vaccination
protects against the disease.
Tetanus (sometimes called lock-jaw) is a disease caused by the bacteria Clostridium tetani.
Toxins made by the bacteria attack a person's nervous system. Although the disease is fairly
uncommon, it can be fatal.
Early symptoms of tetanus include:
• Painful muscle contractions that begin in the jaw (lock jaw)
• Rigidity in neck, shoulder and back muscles
• Difficulty swallowing
• Violent generalized muscle spasms
• Convulsions
• Breathing difficulties
A person may have a fever and sometimes develop abnormal heart rhythms. Complications
include pneumonia, broken bones (from the muscle spasms), respiratory failure and cardiac
arrest.
There is no specific diagnostic laboratory test; diagnosis is made clinically. The spatula test is
useful: touching the back of the pharynx with a spatula elicits a bite reflex in tetanus, instead
of a gag reflex.

Text B
Tetanus Risk

Tetanus is an acute disease induced by the toxin tetanus bacilli, the spores of which are
present in soil.
A TETANUS-PRONE WOUND IS:
• any wound or burn that requires surgical intervention that is delayed for> 6 hours
• any wound or burn at any interval after injury that shows one or more of the following
characteristics:
- a significant degree of tissue damage
- puncture-type wound particularly where there has been contact with soil or organic
matter which is likely to harbour tetanus organisms
• any wound from compound fractures
• any wound containing foreign bodies
• any wound or burn in patients who have systemic sepsis
• any bite wound
• any wound from tooth re-implantation
Intravenous drug users are at greater risk of tetanus. Every opportunity should be taken to
ensure that they are fully protected against tetanus. Booster doses should be given if there is
any doubt about their immunisation status.
lmmunosuppressed patients may not be adequately protected against tetanus, despite having
been fully immunised. They should be managed as if they were incompletely immunised.
TextC
Tetanus Immunisation following injuries

Thorough cleaning of the wound is essential irrespective of the immunisation history of the
patient, and appropriate antibiotics should be prescribed.

Immunisation Clean Wound Tetanus-prone wound

Status
Vaccine Human Tetanus
Vaccine lmmunoglobulin
(HTIG)
Fully immunised 1 Not required Not required Only if high risk 2
Primary Not required Not required Only if high risk 2
immunisation
complete, boosters
incomplete but up to
date
Primary Reinforcing dose Reinforcing dose Yes (opposite limb to
immunisation and further doses and further doses vaccine)
incomplete or to complete to complete
boosters not up to recommended recommended
date schedule schedule
Not immunised or Immediate dose of Immediate dose of Yes (opposite limb to
immunisation status vaccine followed by vaccine followed by vaccine)
not known/uncertain 3 completion of full completion of full
5-dose course 5-dose course
Notes
1. has received total of 5 doses of vaccine at appropriate intervals
2. heavy contamination with material likely to contain tetanus spores and/or extensive
devitalised tissue
3. immunosuppressed patients presenting with a tetanus-prone wound should always be
managed as if they were incompletely immunised
Text D
Human Tetanus lmmunoglobulin (HTIG)
Indications
- treatment of clinically suspected cases of tetanus
- prevention of tetanus in high-risk, tetanus-prone wounds
Dose
Available in 1ml ampoules containing 2501U

Prevention Dose I Treatment Dose

250 IU by IM injection 1
Or
500 IU by IM injection 1 if >24 hours since injury/risk of heavy contamination/burns
5,000 - 10,000 IU by IV infusion
Or
150 IU/kg by IM injection 1 (given in multiple sites) if IV preparation unavailable
1
Due to its viscosity, HTIG should be administered slowly, using a 23 gauge needle

Contraindications
- Confirmed anaphylactic reaction to tetanus containing vaccine
- Confirmed anaphylactic reaction to neomycin, streptomycin or polymyxin B

Adverse reactions
Local - pain, erythema, induration (Arthus-type reaction)
General - pyrexia, hypotonic-hyporesponsive episode, persistent crying

END OF PART A
THIS TEXT BOOKLET WILL BE COLLECTED
~eJET
OCCUPATIONAL ENGLISH TEST

READING SUB-TEST - QUESTION PAPER: PART A

CANDIDATE NUMBER:

LAST NAME:

FIRST NAME:

MIDDLE NAMES: Passport Photo

PROFESSION:

VENUE:

TEST DATE:

CANDIDATE DECLARATION
By signing this, you agree not to disclose or use in any way (other than to take the test) or assist any other person to disclose or use any OET
test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice
or information, you may be disqualified and your results may not be issued at the sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
malpractice, their personal details and details of the investigation may be passed to a third party where required.

TIME: 15 MINUTES

INSTRUCTIONS TO CANDIDATES
DO NOT open this Question Paper or the Text Booklet until you are told to do so.

Write your answers on the spaces provided on this Question Paper.

You must answer the questions within the 15-minute time limit.

One mark will be granted for each correct answer.

Answer ALL questions. Marks are NOT deducted for incorrect answers.

At the end of the 15 minutes, hand in this Question Paper and the Text Booklet.

DO NOT remove OET material from the test room.

www.occupationalenglishtest.org
© Cambridge Boxhill Language Assessment - ABN 51 988 559 414

[CANDIDATE NO.] READING QUESTION PAPER PART A 01/04

 Part A

TIME: 15 minutes

• 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.

 Tetanus: Questions

Questions 1-6

For each question, 1-6, decide which text (A, B, C or D) the information comes from.
You may use any letter more than once.

In which text can you find information about

1 the type of injuries that may lead to tetanus?

2 signs that a patient may have tetanus?

3 how to decide whether a tetanus vaccine is necessary?

4 an alternative name for tetanus?

5 possible side-effects of a particular tetanus

medication?

6 other conditions which are associated with tetanus?

Questions 7-13

Complete each of the sentences, 7-13, with a word or short phrase from one of the texts.
Each answer may include words, numbers or both.

Patients at increased risk of tetanus:

7 If a patient has been touching _ _ _ _ _ _ _ _ _ _ _ or earth, they are more

susceptible to tetanus.

8 Any _ _ _ _ _ _ _ _ _ _ _ lodged in the site of an injury will increase the

likelihood of tetanus.

9 Patients with _ _ _ _ _ _ _ _ _ _ _ fractures are prone to tetanus.

10 Delaying surgery on an injury or burn by more than _ _ _ _ _ _ _ _ _ __

increases the probability of tetanus.

11 If a burns patient has been diagnosed with _ _ _ _ _ _ _ _ _ _ _ they are

more liable to contract tetanus.

12 A patient who is _ _ _ _ _ _ _ _ _ _ _ or a regular recreational drug user

will be at greater risk of tetanus.
 Management of tetanus-prone injuries:

13 Clean the wound thoroughly and prescribe _ _ _ _ _ _ _ _ _ _ _ if

necessary, followed by tetanus vaccine and HTIG as appropriate.

Questions 14-20

Answer each of the questions, 14-20, with a word or short phrase from one of the texts. Each
answer may include words, numbers or both.

14 Where will a patient suffering from tetanus first experience muscle contractions?

15 What can muscle spasms in tetanus patients sometimes lead to?

16 If you test for tetanus using a spatula, what type of reaction will confirm the
condition?

17 How many times will you have to vaccinate a patient who needs a full course of
tetanus vaccine?

18 What should you give a drug user if you're uncertain of their vaccination history?

19 What size of needle should you use to inject HTIG?

20 What might a patient who experienced an adverse reaction to HTIG be unable to

stop doing?

END OF PART A
THIS QUESTION PAPER WILL BE COLLECTED
~eJET
OCCUPATIONAL ENGLISH TEST

READING SUB-TEST - QUESTION PAPER: PARTS B & C

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test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice
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further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
malpractice, their personal details and details of the investigation may be passed to a third party where required.

TIME: 45 MINUTES

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[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 01116
 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 answer (A, B or C) which you think fits best according to the text.

1. Nursing staff can remove a dressing if

@ a member of the surgical team is present.

@ there is severe leakage from the wound.

@ they believe that the wound has healed.

Post-operative dressings

Dressings are an important component of post-operative wound management. Any

dressings applied during surgery have been done in sterile conditions and should ideally
be left in place, as stipulated by the surgical team. It is acceptable for initial dressings to be
removed prematurely in order to have the wound reviewed and, in certain situations, apply
a new dressing. These situations include when the dressing is no longer serving its purpose
(i.e. dressing falling off, excessive exudate soaking through the dressing and resulting in a
suboptimal wound healing environment) or when a wound complication is suspected.
2. As explained in the protocol, the position of the RUM container will ideally

@ encourage participation in the scheme.

@ emphasise the value of recycling.

@ facilitate public access to it.

Unwanted medicine: pharmacy collection protocol

A Returned Unwanted Medicine (RUM) Project approved container will be delivered by the
wholesaler to the participating pharmacy.

The container is to be kept in a section of the dispensary or in a room or enclosure in

the pharmacy to which the public does not have access. The container may be placed
in a visible position, but out of reach of the public, as this will reinforce the message that
unwanted prescription drugs can be returned to the pharmacy and that the returned
medicines will not be recycled.

Needles, other sharps and liquid cytotoxic products should not be placed in the container,
but in one specifically designed for such waste.
3. The report mentioned in the memo suggests that

@ data about patient errors may be incomplete.

@ errors by hospital staff can often go unreported.

@ errors in prescriptions pose the greatest threat to patients.

Memo: Report on oral anti-cancer medications

Nurse Unit Managers are directed to review their systems for the administration of oral
anti-cancer drugs, and the reporting of drug errors. Serious concerns have been raised in a
recent report drawing on a national survey of pharmacists.

Please note the following paragraph quoted from the report:

Incorrect doses of oral anti-cancer medicines can have fatal consequences. Over
the previous four years, there were three deaths and 400 patient safety issues
involving oral anti-cancer medicines. Half of the reports concerned the wrong dosage,
frequency, quantity or duration of oral anti-cancer treatment. Of further concern is that
errors on the part of patients may be under-reported. In light of these reports, there is
clearly a need for improved systems covering the management of patients receiving
oral therapies.
4. What point does the training manual make about anaesthesia workstations?

@ Parts of the equipment have been shown to be vulnerable to failure.

® There are several ways of ensuring that the ventilator is working effectively.

Monitoring by health professionals is a reliable way to maintain patient

@ safety.

Anaesthesia Workstations
Studies on safety in anaesthesia have documented that human vigilance alone is
inadequate to ensure patient safety and have underscored the importance of monitoring
devices. These findings are reflected in improved standards for equipment design,
guidelines for patient monitoring and reduced malpractice premiums for the use of
capnography and pulse oximetry during anaesthesia. Anaesthesia workstations integrate
ventilator technology with patient monitors and alarms to help prevent patient injury in
the unlikely event of a ventilator failure. Furthermore, since the reservoir bag is part of
the circuit during mechanical ventilation, the visible movement of the reservoir bag is
confirmation that the ventilator is functioning.
5. In cases of snakebite, the flying doctor should be aware of

@ where to access specific antivenoms.

@ the appropriate method for wound cleaning.

@ the patients most likely to suffer complications.

Memo to Flying Doctor staff: Antivenoms for snakebite

Before starting treatment:

• Do not wash the snakebite site.
• If possible, determine the type of snake by using a 'snake-venom detection kit' to test a bite
site swab or, in systemic envenoming, the person's urine. If venom detection is not available
or has proved negative, seek advice from a poisons information centre.
• Testing blood for venom is not reliable.
• Assess the degree of envenoming; not all confirmed snakebites will result in systemic
envenoming; risk varies with the species of snake.
• People with pre-existing renal, hepatic, cardiac or respiratory impairment and those taking
anticoagulant or antiplatelet drugs may have an increased risk of serious outcome from
snakebite. Children are also especially at increased risk of severe envenoming because of
smaller body mass and the likelihood of physical activity immediately after a bite.
6. What was the purpose of the BMTEC forum?

@ to propose a new way of carrying out cleaning audits

@ to draw conclusions from the results of cleaning audits

@ to encourage more groups to undertake cleaning audits

Cleaning Audits

Three rounds of environmental cleaning audits were completed in 2013-2014. Key personnel
in each facility were surveyed to assess the understanding of environmental cleaning from
the perspective of the nurse unit manager, environmental services manager and the director
of clinical governance. Each facility received a report about their environmental cleaning
audits and lessons learned from the surveys. Data from the 15 units were also provided to
each facility for comparison purposes.

The knowledge and experiences from the audits were shared at the BMTEC Forum in August
2014. This forum allowed environmental services managers, cleaners, nurses and clinical
governance to discuss the application of the standards and promote new and improved
cleaning practice. The second day of the forum focused on auditor training and technique with
the view of enhancing internal environmental cleaning auditing by the participating groups.
 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 according to the text.

Text 1: Does homeopathy 'work'?

For many, homeopathy is simply unscientific, but regular users hold a very different view.

Homeopathy works by giving patients very dilute substances that, in larger doses, would
cause the very symptoms that need curing. Taking small doses of these substances
- derived from plants, animals or minerals - strengthens the body's ability to heal and
increases resistance to illness or infection. Or that is the theory. The debate about its
effectiveness is nothing new. Recently, Australia's National Health and Medical Research
Council (NHMRC) released a paper which found there were 'no health conditions for
which there was reliable evidence that homeopathy was effective'. This echoed a report
from the UK House of Commons which said that the evidence failed to show a 'credible
physiological mode of action' for homeopathic products, and that what data were available
showed homeopathic products to be no better than placebo. Yet Australians spend at least
$11 million per year on homeopathy.

So what's going on? If Australians - and citizens of many other nations around the world -
are voting with their wallets, does this mean homeopathy must be doing something right?
'For me, the crux of the debate is a disconnect between how the scientific and medical
community view homeopathy, and what many in the wider community are getting out of it,'
says Professor Alex Broom of the University of Queensland. 'The really interesting question
is how can we possibly have something that people think works, when to all intents and
purposes, from a scientific perspective, it doesn't?'

Part of homeopathy's appeal may lie in the nature of the patient-practitioner consultation. In
contrast to a typical 15-minute GP consultation, a first homeopathy consultation might take
an hour and a half. 'We don't just look at an individual symptom in isolation. For us, that
symptom is part of someone's overall health condition,' says Greg Cope, spokesman for the
Australian Homeopathic Association. 'Often we'll have a consultation with someone and find
details their GP simply didn't have time to.' Writer Johanna Ashmore is a case in point. She
sees her homeopath for a one-hour monthly consultation. 'I feel, if I go and say I've got this
health concern, she's going to treat my body to fight it rather than just treat the symptom.'

Most people visit a homeopath after having received a diagnosis from a 'mainstream'
practitioner, often because they want an alternative choice to medication, says Greg Cope.
'Generally speaking, for a homeopath, their preference is if someone has a diagnosis from a
medical practitioner before starting homeopathic treatment, so it's rare for someone to come
and see us with an undiagnosed condition and certainly if they do come undiagnosed, we'd
want to refer them on and get that medical evaluation before starting a course of treatment,'
he says.
Given that homeopathic medicines are by their very nature incredibly dilute - and, some
might argue, diluted beyond all hope of efficacy - they are unlikely to cause any adverse
effects, so where's the harm? Professor Paul Glasziou, chair of the NHMRC's Homeopathy
Working Committee, says that while financial cost is one harm, potentially more harmful are
the non-financial costs associated with missing out on effective treatments. 'If it's just a cold,
I'm not too worried. But if it's for a serious illness, you may not be taking disease-modifying
treatments, and most worrying is things like HIV which affect not only you, but people
around you,' says Glasziou. This is a particular concern with homeopathic vaccines, he
says, which jeopardise the 'herd immunity' - the immunity of a significant proportion of the
population - which is crucial in containing outbreaks of vaccine-preventable diseases.

The question of a placebo effect inevitably arises, as studies repeatedly seem to suggest
that whatever benefits are being derived from homeopathy are more a product of patient
faith rather than of any active ingredient of the medications. However, Greg Cope dismisses
this argument, pointing out that homeopathy appears to benefit even the sceptics: 'We might
see kids first, then perhaps Mum and after a couple of years, Dad will follow and, even
though he's only there reluctantly, we get wonderful outcomes. This cannot be explained
simply by the placebo effect.' As a patient, Johanna Ashmore is aware scientific research
does little to support homeopathy but can still see its benefits. 'If seeing my homeopath
each month improves my health, I'm happy. I don't care how it works, even if it's all in the
mind - I just know that it does.'

But if so many people around the world are placing their faith in homeopathy, despite
the evidence against it, Broom questions why homeopathy seeks scientific validation.
The problem, as he sees it, lies in the fact that 'if you're going to dance with conventional
medicine and say "we want to be proven to be effective in dealing with discrete physiological
conditions", then you indeed do have to show efficacy. In my view this is not about broader
credibility per se, it's about scientific and medical credibility - there's actually quite a lot of
cultural credibility surrounding homeopathy within the community but that's not replicated in
the scientific literature.'
Text 1: Questions 7-14

7. The two reports mentioned in the first paragraph both concluded that homeopathy

@ could be harmful if not used appropriately.

@ merely works on the same basis as the placebo effect.

@ lacks any form of convincing proof of its value as a treatment.

@ would require further investigation before it was fully understood.

8. When commenting on the popularity of homeopathy, Professor Broom shows his

@ surprise at people's willingness to put their trust in it.

@ frustration at scientists' inability to explain their views on it.

@ acceptance of the view that the subject may merit further study.

@ concern over the risks people face when receiving such treatment.

9. Johanna Ashmore's views on homeopathy highlight

@ how practitioners put their patients at ease.

@ the key attraction of the approach for patients.

@ how it suits patients with a range of health problems.

@ the opportunities to improve patient care which GPs miss.

10. In the fourth paragraph, it is suggested that visits to homeopaths

@ occasionally depend on a referral from a mainstream doctor.

@ frequently result from a patient's treatment preferences.

@ should be preceded by a visit to a relevant specialist.

@ often reveal previously overlooked medical problems.

11. What particularly concerns Professor Glasziou?

@ the risks to patients of relying on homeopathic vaccinations

@ the mistaken view that homeopathic treatments can only do good

@ the way that homeopathic remedies endanger more than just the user

@ the ineffectiveness of homeopathic remedies against even minor illnesses

12. Greg Cope uses the expression 'wonderful outcomes' to underline

@ the ability of homeopathy to defy its scientific critics.

@ the value of his patients' belief in the whole process.

@ the claim that he has solid proof that homeopathy works.

@ the way positive results can be achieved despite people's doubts.

From the comments quoted in the sixth paragraph, it is clear that Johanna
13.
Ashmore is

@ prepared to accept that homeopathy may depend on psychological factors.

@ happy to admit that she was uncertain at first about proceeding.

@ sceptical about the evidence against homeopathic remedies.

@ confident that research will eventually validate homeopathy.

14. What does the word 'this' in the final paragraph refer to?

@ the continuing inability of homeopathy to gain scientific credibility

® the suggestion that the scientific credibility of homeopathy is in doubt

the idea that there is no need to pursue scientific acceptance for

@
homeopathy

the motivation behind the desire for homeopathy to gain scientific

@
acceptance
Text 2: Brain-controlled prosthetics

Paralysed from the neck down by a stroke, Cathy Hutchinson stared fixedly at a drinking straw
in a bottle on the table in front of her. A cable rose from the top of her head, connecting her to
a robot arm, but her gaze never wavered as she mentally guided the robot arm, which was
opposite her, to close its grippers around the bottle, then slowly lift the vessel towards her
mouth. Only when she finally managed to take a sip did her face relax. This example illustrates
the strides being taken in brain-controlled prosthetics. But Hutchinson's focused stare also
illustrates the one crucial feature still missing from prosthetics. Her eyes could tell her where the
arm was, but she couldn't feel what it was doing.

Prosthetics researchers are now trying to create prosthetics that can 'feel'. It's a daunting
task: the researchers have managed to read signals from the brain; now they must write
information into the nervous system. Touch encompasses a complicated mix of information
- everything from the soft prickliness of wool to the slipping of a sweaty soft-drink can. The
sensations arise from a host of receptors in the skin, which detect texture, vibration, pain,
temperature and shape, as well as from receptors in the muscles, joints and tendons that
contribute to 'proprioception' - the sense of where a limb is in space. Prosthetics are being
outfitted with sensors that can gather many of these sensations, but the challenge is to get the
resulting signals flowing to the correct part of the brain.

For people who have had limbs amputated, the obvious way to achieve that is to route the
signals into the remaining nerves in the stump, the part of the limb left after amputation. Ken
Horch, a neuroprosthetics researcher, has done just that by threading electrodes into the
nerves in stumps then stimulating them with a tiny current, so that patients felt like their fingers
were moving or being touched. The technique can even allow patients to distinguish basic
features of objects: a man who had lost his lower arms was able to determine the difference
between blocks made of wood or foam rubber by using a sensor-equipped prosthetic hand.
He correctly identified the objects' size and softness more than twice as often as would have
been expected by chance. Information about force and finger position was delivered from the
prosthetic to a computer, which prompted stimulation of electrodes implanted in his upper-arm
nerves.

As promising as this result was, researchers will probably need to stimulate hundreds or
thousands of nerve fibres to create complex sensations, and they'll need to keep the devices
working for many years if they are to minimise the number of surgeries required to replace
them as they wear out. To get around this, some researchers are instead trying to give
patients sensory feedback by touching their skin. The technique was discovered by accident
by researcher Todd Kuiken. The idea was to rewire arm nerves that used to serve the hand,
for example, to muscles in other parts of the body. When the patient thought about closing his
or her hand, the newly targeted muscle would contract and generate an electric signal, driving
movement of the prosthetic.
However, this technique won't work for stroke patients like Cathy Hutchinson. So some
researchers are skipping directly to the brain. In principle, this should be straightforward.
Because signals from specific parts of the body go to specific parts of the brain, scientists
should be able to create sensations of touch or proprioception in the limb by directly activating
the neurons that normally receive those signals. However, with electrical stimulation, all neurons
close to the electrode's tip are activated indiscriminately, so 'even if I had the sharpest needle in
the Universe, that could create unintended effects', says Arto Nurmikko, a neuroengineer. For
example, an attempt to create sensation in one finger might produce sensation in other parts of
the hand as well, he says.

Nurmikko and other researchers are therefore using light, in place of electricity, to activate
highly specific groups of neurons and recreate a sense of touch. They trained a monkey to
remove its hand from a pad when it vibrated. When the team then stimulated the part of its
brain that receives tactile information from the hand with a light source implanted in its skull, the
monkey lifted its hand off the pad about 90% of the time. The use of such techniques in humans
is still probably 10-20 years away, but it is a promising strategy.

Even if such techniques can be made to work, it's unclear how closely they will approximate
natural sensations. Tingles, pokes and vibrations are still a far cry from the complicated
sensations that we feel when closing a hand over an apple, or running a finger along a table's
edge. But patients don't need a perfect sense of touch, says Douglas Weber, a bioengineer.
Simply having enough feedback to improve their control of grasp could help people to perform
tasks such as picking up a glass of water, he explains. He goes on to say that patients who
wear cochlear implants, for example, are often happy to regain enough hearing to hold a phone
conversation, even if they're still unable to distinguish musical subtleties.
Text 2: Questions 15-22

15. What do we learn about the experiment Cathy Hutchinson took part in?

@ It required intense concentration.

@ It failed to achieve what it had set out to do.

@ It could be done more quickly given practice.

@ It was the first time that it had been attempted.

16. The task facing researchers is described as 'daunting' because

@ signals from the brain can be misunderstood.

@ it is hard to link muscle receptors with each other.

@ some aspects of touch are too difficult to reproduce.

@ the connections between sensors and the brain need to be exact.

17. What is said about the experiment done on the patient in the third paragraph?

@ There was statistical evidence that it was successful.

@ It enabled the patient to have a wide range of feeling.

@ Its success depended on when amputation had taken place.

@ It required the use of a specially developed computer program.

18. What drawback does the writer mention in the fourth paragraph?

@ The devices have a high failure rate.

@ Patients might have to undergo too many operations.

@ It would only be possible to create rather simple sensations.

@ The research into the new technique hasn't been rigorous enough.
19. What point is made in the fifth paragraph?

@ Severed nerves may be able to be reconnected.

@ More research needs to be done on stroke victims.

@ Scientists' previous ideas about the brain have been overturned.

@ It is difficult for scientists to pinpoint precise areas with an electrode.

20. What do we learn about the experiment that made use of light?

@ It can easily be replicated in humans.

@ It worked as well as could be expected.

@ It may have more potential than electrical stimulation.

@ It required more complex surgery than previous experiments.

21. In the final paragraph, the writer uses the phrase 'a far cry from' to underline

@ how much more there is to achieve.

@ how complex experiments have become.

@ the need to reduce people's expectations.

@ the differences between types of artificial sensation.

22. Why does Weber give the example of a cochlear implant?

@ to underline the need for a similar breakthrough in prosthetics

@ to illustrate the fact that some sensation is better than none

@ to highlight the advances made in other areas of medicine

@ to demonstrate the ability of the body to relearn skills

END OF READING TEST

THIS BOOKLET WILL BE COLLECTED
Reading sub-test
Answer Key - Part A
READING SUB-TEST-ANSWER KEY

PART A: QUESTIONS 1-20

1 B

2 A

3 c
4 A

5 D

6 A

7 organic matter

8 foreign bodies

9 compound

10 6/six hours

11 systemic sepsis

12 immuno(-)suppressed

13 antibiotics

14 (in) (the) jaw

15 broken bones

16 (a) bite reflex

17 5/five (times)

18 (a) booster dose OR booster doses

19 twenty-three/23 gauge

20 crying
Reading sub-test
Answer Key - Parts B & C
READING SUB-TEST-ANSWER KEY

PART B: QUESTIONS 1-6

1 B there is severe leakage from the wound.

2 A encourage participation in the scheme.

3 A data about patient errors may be incomplete.

4 B There are several ways of ensuring that the ventilator is working effectively.

5 c the patients most likely to suffer complications.

6 B to draw conclusions from the results of cleaning audits

PART C: QUESTIONS 7-14

7 c lacks any form of convincing proof of its value as a treatment.

8 A surprise at people's willingness to put their trust in it.

9 B the key attraction of the approach for patients.

10 B frequently result from a patient's treatment preferences.

11 c the way that homeopathic remedies endanger more than just the user

12 D the way positive results can be achieved despite people's doubts.

13 A prepared to accept that homeopathy may depend on psychological factors.

the motivation behind the desire for homeopathy to gain scientific

14 D
acceptance

PART C: QUESTIONS 15-22

15 A It required intense concentration.

16 D the connections between sensors and the brain need to be exact.

17 A There was statistical evidence that it was successful.

18 B Patients might have to undergo too many operations.

19 D It is difficult for scientists to pinpoint precise areas with an electrode.

20 c It may have more potential than electrical stimulation.

21 A how much more there is to achieve.

22 B to illustrate the fact that some sensation is better than none

 READING TEST:06
OCCUPATIONAL ENGLISH TEST

READING SUB-TEST - TEXT BOOKLET: PART A

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
MIDDLE NAMES: Passport Photo

PROFESSION:
VENUE:
TEST DATE:

CANDIDATE DECLARATION
By signing this, you agree not to disclose or use in any way (other than to take the test) or assist any other person to disclose or use any OET
test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice
or information, you may be disqualified and your results may not be issued at the sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
malpractice, their personal details and details of the investigation may be passed to a third party where required.

www.occupationalenglishtest.org
©Cambridge Boxhill Language Assessment -ABN 51 988 559 414

[CANDIDATE NO.] READING TEXT BOOKLET PART A 01/04

 Necrotizing Fasciitis (NF): Texts

Text A
Necrotizing fasciitis (NF) is a severe, rare, potentially lethal soft tissue infection that develops
in the scrotum and perineum, the abdominal wall, or the extremities. The infection progresses
rapidly, and septic shock may ensue; hence, the mortality rate is high (median mortality
32.2%). NF is classified into four types, depending on microbiological findings.

Table 1

Classification of responsible pathogens according to type of infection

Microbiological Pathogens Site of infection Co-morbidities

type
Type 1 Obligate and facultative Trunk and perineum Diabetes mellitus
(polymicrobial) anaerobes

Type 2 Beta-hemolytic streptococcus Limbs

(monomicrobial) A

Type 3 Clostridium species Limbs, trunk and Trauma

Gram-negative bacteria perineum
Seafood
Vibrios spp. consumption (for
Aeromonas hydrophila Aeromonas)

Type4 Candida spp. Limbs, trunk, Im mu no-

perineum suppression
Zygomycetes

Text B
Antibiotic treatment for NF
Type 1
• Initial treatment includes ampicillin or ampicillin-sulbactam combined with metronidazole
or clindamycin.
• Broad gram-negative coverage is necessary as an initial empirical therapy for patients
who have recently been treated with antibiotics, or been hospitalized. In such cases,
antibiotics such as ampicillin-sulbactam, piperacillin-tazobactam, ticarcillin-clavulanate
acid, third or fourth generation cephalosporins, or carbapenems are used, and at a higher
dosage.
Type2
• First or second generation of cephalosporins are used for the coverage of methicillin-
sensitive Staphylococcus aureus (MSSA).
0 MRSA tends to be covered by vancomycin, or daptomycin and linezolid in cases where
S. aureus is resistant to vancomycin.
Type3
• NF should be managed with clindamycin and penicillin, which kill the Clostridium species.
• If Vibrio infection is suspected, the early use of tetracyclines (including doxycycline and
minocycline) and third-generation cephalosporins is crucial for the survival of the patient,
since these antibiotics have been shown to reduce the mortality rate drastically.
Type4
• Can be treated with amphotericin B or fluoroconazoles, but the results of this treatment
are generally disappointing.
Antibiotics should be administered for up to 5 days after local signs and symptoms have
resolved. The mean duration of antibiotic therapy for NF is 4-6weeks.
TextC
Supportive care in an ICU is critical to NF survival. This involves fluid resuscitation, cardiac
monitoring, aggressive wound care, and adequate nutritional support. Patients with NF are in a
catabolic state and require increased caloric intake to combat infection. This can be delivered
orally or via nasogastric tube, peg tube, or intravenous hyperalimentation. This should begin
immediately (within the first 24 hours of hospitalization). Prompt and aggressive support
has been shown to lower complication rates. Baseline and repeated monitoring of albumin,
prealbumin, transferrin, blood urea nitrogen, and triglycerides should be performed to ensure the
patient is receiving adequate nutrition.
Wound care is also an important concern. Advanced wound dressings have replaced wet-to-dry
dressings. These dressings promote granulation tissue formation and speed healing. Advanced
wound dressings may lend to healing or prepare the wound bed for grafting. A healthy wound
bed increases the chances of split-thickness skin graft take. Vacuum-assisted closure (VAC) was
recently reported to be effective in a patient whose cardiac status was too precarious to undergo
a long surgical reconstruction operation. With the VAC., the patient's wound decreased in size,
and the VAC was thought to aid in local management of infection and improve granulation
tissue.

Text D
Advice to give the patient before discharge
• Help arrange the patient's aftercare, including home health care and instruction regarding
wound management, social services to promote adjustment to lifestyle changes and
financial concerns, and physical therapy sessions to help rebuild strength and promote the
return to optimal physical health.
• The life-threatening nature of NF, scarring caused by the disease, and in some cases the
need for limb amputation can alter the patient's attitude and viewpoint, so be sure to take a
holistic approach when dealing with the patient and family.

Remind the diabetic patient to

• control blood glucose levels, keeping the glycated haemoglobin (HbAlc) level to 7% or less.
• keep needles capped until use and not to reuse needles.
• clean the skin thoroughly before blood glucose testing or insulin in..,jection, and to use
alcohol pads to clean the area afterward.

END OF PART A
THIS TEXT BOOKLET WILL BE COLLECTED
~eJET
OCCUPATIONAL ENGLISH TEST

READING SUB-TEST - QUESTION PAPER: PART A

CANDIDATE NUMBER:

LAST NAME:

FIRST NAME:

MIDDLE NAMES: Passport Photo

PROFESSION:

VENUE:

TEST DATE:

CANDIDATE DECLARATION
By signing this, you agree not to disclose or use in any way (other than to take the test) or assist any other person to disclose or use any OET
test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice
or information, you may be disqualified and your results may not be issued at the sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
malpractice, their personal details and details of the investigation may be passed to a third party where required.

TIME: 15 MINUTES

INSTRUCTIONS TO CANDIDATES
DO NOT open this Question Paper or the Text Booklet until you are told to do so.
Write your answers on the spaces provided on this Question Paper.

You must answer the questions within the 15-minute time limit.
One mark will be granted for each correct answer.

Answer ALL questions. Marks are NOT deducted for incorrect answers.

At the end of the 15 minutes, hand in this Question Paper and the Text Booklet.

DO NOT remove OET material from the test room.

www.occupationalenglishtest.org
© Cambridge Boxhill Language Assessment - ABN 51 988 559 414
[CANDIDATE NO.] READING QUESTION PAPER PART A 01/04
 Part A

TIME: 15 minutes

• 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.

 Necrotizing Fasciitis (NF): Questions

Questions 1-7

For each question, 1-7, decide which text (A, B, C or D) the information comes from. You
may use any letter more than once.

In which text can you find information about

1 the drug treatment required?

2 which parts of the body can be affected?

3 the various ways calories can be introduced?

4 who to contact to help the patient after they leave

hospital?

5 what kind of dressing to use?

6 how long to give drug therapy to the patient?

7 what advice to give the patient regarding needle use?

Questions 8-14

Complete each of the sentences, 8-14, with a word or short phrase from one of the texts. Each
answer may include words, numbers or both.

Patients at increased risk of tetanus:

8 Which two drugs can you use to treat the clostridium species of pathogen?

9 Which common metabolic condition may occur with NF?

1O What complication can a patient suffer from if NF isn't treated quickly enough?

11 What procedure can you use with a wound if the patient can't be operated on?
 12 What should the patient be told to use to clean an injection site?

13 Which two drugs can be used if you can't use vancomycin?

14 What kind of infection should you use tetracyclines for?

Questions 15-20

Answer each of the questions, 15-20, with a word or short phrase from one of the texts. Each
answer may include words, numbers or both.

15 The average proportion of patients who die as a result of contracting NF is

16 Patients who have eaten _ _ _ _ _ _ _ _ _ _ _ may be infected with

Aeromonas hydrophilia.

17 Patients with Type 2 infection usually present with infected

18 Type 1 NF is also known as _ _ _ _ _ _ _ _ _ __

19 The patient needs to be aware of the need to keep glycated haemoglobin levels
lower than _ _ _ _ _ _ _ _ _ __

20 The patient will need a course of _ _ _ _ _ _ _ _ _ _ _ to regain fitness

levels after returning home.

END OF PART A
THIS QUESTION PAPER WILL BE COLLECTED
OCCUPATIONAL ENGLISH TEST

READING SUB-TEST - QUESTION PAPER: PARTS B & C

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[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 01116
 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 answer (A, B or C) which you think fits best according to the text.

1. The policy document tells us that

stop dates aren't relevant in all circumstances.

® anyone using EPMA can disregard the request for a stop date.

prescribers must know in advance of prescribing what the stop date should
@ be.

Prescribing stop dates

Prescribers should write a review date or a stop date on the electronic prescribing system
EPMA or the medicine chart for each antimicrobial agent prescribed. On the EPMA, there
is a forced entry for stop dates on oral antimicrobials. There is not a forced stop date on
EPMA for IV antimicrobial treatment - if the prescriber knows how long the course of
IV should be, then the stop date can be filled in. If not known, then a review should be
added to the additional information, e.g. 'review after 48 hrs'. If the prescriber decides
treatment needs to continue beyond the stop date or course length indicated, then it is their
responsibility to amend the chart. In critical care, it has been agreed that the routine use of
review/stop dates on the charts is not always appropriate.
2. The guidelines inform us that personalised equipment for radiotherapy

@ is advisable for all patients.

@ improves precision during radiation.

@ needs to be tested at the first consultation.

Guidelines: Radiotherapy Simulation Planning Appointment

The initial appointment may also be referred to as the Simulation Appointment. During
this appointment you will discuss your patient's medical history and treatment options,
and agree on a radiotherapy treatment plan. The first step is usually to take a CT scan of
the area requiring treatment. The patient will meet the radiation oncologist, their registrar
and radiation therapists. A decision will be made regarding the best and most comfortable
position for treatment, and this will be replicated daily for the duration of the treatment.
Depending on the area of the body to be treated, personalised equipment such as a face
mask may be used to stabilise the patient's position. This equipment helps keep the patient
comfortable and still during the treatment and makes the treatment more accurate.
3. The purpose of these instructions is to explain how to

@ monitor an ECG reading.

@ position electrodes correctly.

@ handle an animal during an ECG procedure.

CT200CV Veterinarian Electrocardiograph User Manual

Animal connections
Good electrode connection is the most important factor in recording a high quality ECG. By
following a few basic steps, consistent, clean recordings can be achieved.

1. Shave a patch on each forelimb of the animal at the contact site.

2. Clean the electrode sites with an alcohol swab or sterilising agent.

3. Attach clips to the ECG leads.

4. Place a small amount of ECG electrode gel on the metal electrode of the limb strap or

adapter clip.

5. Pinch skin on animal and place clips on the shaved skin area of the animal being
tested. The animal must be kept still.

6. Check the LCD display for a constant heart reading.

7. If there is no heart reading, you have a contact problem with one or more of the leads.

8. Recheck the leads and reapply the clips to the shaven skin of the animal.
4. The group known as 'impatient patients' are more likely to continue with a course of
prescribed medication if

@ their treatment can be completed over a reduced period of time.

@ it is possible to link their treatment with a financial advantage.

@ its short-term benefits are explained to them.

Medication adherence and impatient patients

A recent article addressed the behaviour of people who have a 'taste for the present
rather than the future'. It proposed that these so-called 'impatient patients' are unlikely
to adhere to medications that require use over an extended period. The article proposes
that, an 'impatience genotype' exists and that assessing these patients' view of the future
while stressing the immediate advantages of adherence may improve adherence rates
more than emphasizing potentially distant complications. The authors suggest that rather
than attempting to change the character of those who are 'impatient', it may be wise to
ascertain the patient's individual priorities, particularly as they relate to immediate gains.
For example, while advising an 'impatient' patient with diabetes, stressing improvement
in visual acuity rather than avoidance of retinopathy may result in greater medication
adherence rates. Additionally, linking the cost of frequently changing prescription lenses
when visual acuity fluctuates with glycemic levels may sometimes provide the patient with
an immediate financial motivation for improving adherence.
5. The memo reminds nursing staff to avoid

@ x-raying a patient unless pH readings exceed 5.5.

@ the use of a particular method of testing pH levels.

@ reliance on pH testing in patients taking acid-inhibiting medication.

Checking the position of a nasogastric tube

It is essential to confirm the position of the tube in the stomach by one of the following:
• Testing pH of aspirate: gastric placement is indicated by a pH of less than 4, but
may increase to between pH 4-6 if the patient is receiving acid-inhibiting drugs.
Blue litmus paper is insufficiently sensitive to adequately distinguish between
levels of acidity of aspirate.
• X-rays: will only confirm position at the time the X-ray is carried out. The tube may
have moved by the time the patient has returned to the ward. In the absence of a
positive aspirate test, where pH readings are more than 5.5, or in a patient who
is unconscious or on a ventilator, an X-ray must be obtained to confirm the initial
position of the nasogastric tube.
6. This extract informs us that

@ the amount of oxytocin given will depend on how the patient reacts.

@ the patient will go into labour as soon as oxytocin is administered.

@ the staff should inspect the oxytocin pump before use.

Extract from guidelines: Oxytocin

1 Oxytocin Dosage and Administration

Parenteral drug products should be inspected visually for particulate matter and
discoloration prior to administration, whenever solution and container permit. Dosage of
Oxytocin is determined by the uterine response. The dosage information below is based
upon various regimens and indications in general use.

1.1 Induction or Stimulation of Labour

Intravenous infusion (drip method) is the only acceptable method of administration for
the induction or stimulation of labour. Accurate control of the rate of infusion flow is
essential. An infusion pump or other such device and frequent monitoring of strength of
contractions and foetal heart rate are necessary for the safe administration of Oxytocin
for the induction or stimulation of labour. If uterine contractions become too powerful, the
infusion can be abruptly stopped, and oxytocic stimulation of the uterine musculature will
soon wane.
 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 according to the text.

Text 1 : Phobia pills

An irrational fear, or phobia, can cause the heart to pound and the pulse to race. It can
lead to a full-blown panic attack - and yet the sufferer is not in any real peril. All it takes
is a glimpse of, for example, a spider's web for the mind and body to race into panicked
overdrive. These fears are difficult to conquer, largely because, although there are no
treatment guidelines specifically about phobias, the traditional way of helping the sufferer
is to expose them to the fear numerous times. Through the cumulative effect of these
experiences, sufferers should eventually feel an increasing sense of control over their
phobia. For some people, the process is too protracted, but there may be a short cut. Drugs
that work to boost learning may help someone with a phobia to 'detrain' their brain, losing
the fearful associations that fuel the panic.

The brain's extraordinary ability to store new memories and forge associations is so well
celebrated that its dark side is often disregarded. A feeling of contentment is easily evoked
when we see a photo of loved ones, though the memory may sometimes be more idealised
than exact. In the case of a phobia, however, a nasty experience with, say, spiders, that
once triggered a panicked reaction, leads the feelings to resurge whenever the relevant
cue is seen again. The current approach is exposure therapy, which uses a process called
extinction learning. This involves people being gradually exposed to whatever triggers
their phobia until they feel at ease with it. As the individual becomes more comfortable with
each situation, the brain automatically creates a new memory - one that links the cue with
reduced feelings of anxiety, rather than the sensations that mark the onset of a panic attack.

Unfortunately, while it is relatively easy to create a fear-based memory, expunging that

fear is more complicated. Each exposure trial will involve a certain degree of distress in
the patient, and although the process is carefully managed throughout to limit this, some
psychotherapists have concluded that the treatment is unethical. Neuroscientists have been
looking for new ways to speed up extinction learning for that same reason.

One such avenue is the use of 'cognitive enhancers' such as a drug called 0-cycloserine or
DCS. DCS slots into part of the brain's 'NMDA receptor' and seems to modulate the neurons'
ability to adjust their signalling in response to events. This tuning of a neuron's firing is
thought to be one of the key ways the brain stores memories, and, at very low doses, DCS
appears to boost that process, improving our ability to learn. In 2004, a team from Emory
University in Atlanta, USA, tested whether DCS could also help people with phobias. A pilot
trial was conducted on 28 people undergoing specific exposure therapy for acrophobia - a
fear of heights. Results showed that those given a small amount of DCS alongside their
regular therapy were able to reduce their phobia to a greater extent than those given a
placebo. Since then, other groups have replicated the finding in further trials.
For people undergoing exposure therapy, achieving just one of the steps on the long
journey to overcoming their fears requires considerable perseverance, says Cristian Sirbu,
a behavioural scientist and psychologist. Thanks to improvement being so slow, patients -
often already anxious - tend to feel they have failed. But Sirbu thinks that DCS may make it
possible to tackle the problem in a single 3-hour session, which is enough for the patient to
make real headway and to leave with a feeling of satisfaction. However, some people have
misgivings about this approach, claiming that as it doesn't directly undo the fearful response
which is deep-seated in the memory, there is a very real risk of relapse.

Rather than simply attempting to overlay the fearful associations with new ones, Merel Kindt
at the University of Amsterdam is instead trying to alter the associations at source. Kindt's
studies into anxiety disorders are based on the idea that memories are not only vulnerable
to alteration when they're first laid down, but, of key importance, also at later retrieval. This
allows for memories to be 'updated', and these amended memories are re-consolidated by
the effect of proteins which alter synaptic responses, thereby maintaining the strength of
feeling associated with the original memory. Kindt's team has produced encouraging results
with arachnophobic patients by giving them propranolol, a well-known and well-tolerated
beta-blocker drug, while they looked at spiders. This blocked the effects of norepinephrine
in the brain, disrupting the way the memory was put back into storage after being retrieved,
as part of the process of reconsolidation. Participants reported that while they still don't like
spiders, they were able to approach them. Kindt reports that the benefit was still there three
months after the test ended.
Text 1: Questions 7-14

In the first paragraph, the writer says that conventional management of phobias
7.
can be problematic because of

@ the lasting psychological effects of the treatment.

@ the time required to identify the cause of the phobia.

@ the limited choice of therapies available to professionals.

@ the need for the phobia to be confronted repeatedly over time.

In the second paragraph, the writer uses the phrase 'dark side' to reinforce the
8.
idea that

@ memories of agreeable events tend to be inaccurate.

@ positive memories can be negatively distorted over time.

@ unhappy memories are often more detailed than happy ones.

@ unpleasant memories are aroused in response to certain prompts.

9. In the second paragraph, extinction learning is explained as a process which

@ makes use of an innate function of the brain.

@ encourages patients to analyse their particular fears.

@ shows patients how to react when having a panic attack.

@ focuses on a previously little-understood part of the brain.

10. What does the phrase 'for that same reason' refer to?

@ the anxiety that patients feel during therapy

@ complaints from patients who feel unsupported

@ the conflicting ethical concerns of neuroscientists

@ psychotherapists who take on unsuitable patients

11. In the fourth paragraph, we learn that the drug called DCS

@ is unsafe to use except in small quantities.

@ helps to control only certain types of phobias.

@ affects how neurons in the brain react to stimuli.

@ increases the emotional impact of certain events.

12. In the fifth paragraph, some critics believe that one drawback of using DCS is that

@ its benefits are likely to be of limited duration.

@ it is only helpful for certain types of personality.

@ few patients are likely to complete the course of treatment.

@ patients feel discouraged by their apparent lack of progress.

In the final paragraph, we learn that Kindt's studies into anxiety disorders focused
13.
on how

@ proteins can affect memory retrieval.

@ memories are superimposed on each other.

@ negative memories can be reduced in frequency.

@ the emotional force of a memory is naturally retained.

14. The writer suggests that propranolol may

@ not offer a permanent solution for patients' phobias.

@ increase patients' tolerance of key triggers.

@ produce some beneficial side-effects.

@ be inappropriate for certain phobias.

Text 2: Challenging medical thinking on placebos

Dr Damien Finniss, Associate Professor at Sydney University's Pain Management and

Research Institute, was previously a physiotherapist. He regularly treated football players
during training sessions using therapeutic ultrasound. 'One particular session', Finniss
explains, 'I treated five or six athletes. I'd treat them for five or ten minutes and they'd say,
"I feel much better" and run back onto the field. But at the end of the session, I realised the
ultrasound wasn't on.' It was a light bulb moment that set Finniss on the path to becoming a
leading researcher on the placebo effect.

Used to treat depression, psoriasis and Parkinson's, to name but a few, placebos have
an image problem among medics. For years, the thinking has been that a placebo is
useless unless the doctor convinces the patient that it's a genuine treatment - problematic
for a profession that promotes informed consent. However, a new study casts doubt on
this assumption and, along with a swathe of research showing some remarkable results
with placebos, raises questions about whether they should now enter the mainstream as
legitimate prescription items. The study examined five trials in which participants were told
they were getting a placebo, and the conclusion was that doing so honestly can work.

'If the evidence is there, I don't see the harm in openly administering a placebo,' says Ben
Colagiuri, a researcher at the University of Sydney. Colagiuri recently published a meta-
analysis of thirteen studies which concluded that placebo sleeping pills, whose genuine
counterparts notch up nearly three million prescriptions in Australia annually, significantly
improve sleep quality. The use of placebos could therefore reduce medical costs and the
burden of disease in terms of adverse reactions.

But the placebo effect isn't just about fake treatments. It's about raising patients' expectations
of a positive result; something which also occurs with real drugs. Finniss cites the 'open-
hidden' effect, whereby an analgesic can be twice as effective if the patient knows they're
getting it, compared to receiving it unknowingly. 'Treatment is always part medical and part
ritual,' says Finniss. This includes the austere consulting room and even the doctor's clothing.
But behind the performance of healing is some strong science. Simply believing an analgesic
will work activates the same brain regions as the genuine drug. 'Part of the outcome of what
we do is the way we interact with patients,' says Finniss.

That interaction is also the focus of Colagiuri's research. He's looking into the 'nocebo'
effect, when a patient's pessimism about a treatment becomes self-fulfilling. 'If you give a
placebo, and warn only 50% of the patients about side effects, those you warn report more
side effects,' says Colagiuri. He's aiming to reverse that by exploiting the psychology of
food packaging. Products are labelled '98% fat-free' rather than '2% fat' because positive
reference to the word 'fat' puts consumers off. Colagiuri is deploying similar tactics. A drug
with a 30% chance of causing a side effect can be reframed as having a 70% chance of not
causing it. 'You're giving the same information, but framing it a way that minimises negative
expectations,' says Colagiuri.
There is also a body of research showing that a placebo can produce a genuine biological
response that could affect the disease process itself. It can be traced back to a study from the
1970s, when psychologist Robert Ader was trying to condition taste-aversion in rats. He gave
them a saccharine drink whilst simultaneously injecting Cytoxan, an immune-suppressant
which causes nausea. The rats learned to hate the drink due to the nausea. But as Ader
continued giving it to them, without Cytoxan, they began to die from infection. Their immune
system had 'learned' to fail by repeated pairing of the drink with Cytoxan. Professor Andrea
Evers of Leiden University is running a study that capitalises on this conditioning effect and
may benefit patients with rheumatoid arthritis, which causes the immune system to attack the
joints. Evers' patients are given the immunosuppressant methotrexate, but instead of always
receiving the same dose, they get a higher dose followed by a lower one. The theory is that
the higher dose will cause the body to link the medication with a damped-down immune
system. The lower dose will then work because the body has 'learned' to curb immunity as a
placebo response to taking the drug. Evers hopes it will mean effective drug regimes that use
lower doses with fewer side effects.

The medical profession, however, remains less than enthusiastic about placebos. 'I'm one
of two researchers in the country who speak on placebos, and I've been invited to lecture at
just one university,' says Finniss. According to Charlotte Blease, a philosopher of science, this
antipathy may go to the core of what it means to be a doctor. 'Medical education is largely
about biomedical facts. 'Softer' sciences, such as psychology, get marginalised because it's
the hard stuff that's associated with what it means to be a doctor.' The result, says Blease,
is a large, placebo-shaped hole in the medical curriculum. 'There's a great deal of medical
illiteracy about the placebo effect ... it's the science behind the art of medicine. Doctors need
training in that.'
Text 2: Questions 15-22

15. A football training session sparked Dr Finniss' interest in the placebo effect because

@ he saw for himself how it could work in practice.

@ he took the opportunity to try out a theory about it.

@ he made a discovery about how it works with groups.

@ he realised he was more interested in research than treatment.

The writer suggests that doctors should be more willing to prescribe placebos now
16.
because

@ research indicates that they are effective even without deceit.

@ recent studies are more reliable than those conducted in the past.

@ they have been accepted as a treatment by many in the profession.

@ they have been shown to relieve symptoms in a wide range of conditions.

17. What is suggested about sleeping pills by the use of the verb 'notch up'?

@ they may have negative results

@ they could easily be replaced

@ they are extremely effective

@ they are very widely used

18. What point does the writer make in the fourth paragraph?

@ The way a treatment is presented is significant even if it is a placebo.

The method by which a drug is administered is more important than its

® content.

The theatrical side of medicine should not be allowed to detract from the
@ science.

The outcome of a placebo treatment is affected by whether the doctor

® believes in it.
19. In researching side effects, Colagiuri aims to

@ discover whether placebos can cause them.

@ reduce the number of people who experience them.

@ make information about them more accessible to patients.

@ investigate whether pessimistic patients are more likely to suffer from them.

20. What does the word '!!' in the sixth paragraph refer to?

@ a placebo treatment

@ the disease process itself

@ a growing body of research

@ a genuine biological response

21. What does the writer tell us about Ader's and Evers' studies?

® Both involve gradually reducing the dosage of a drug.

® Evers is exploiting a response which Ader discovered by chance.

@ Both examine the side effects caused by immunosuppressant drugs.

Evers is investigating whether the human immune system reacts to placebos as

® Ader's rats did.

22. According to Charlotte Blease, placebos are omitted from medical training because

@ there are so many practical subjects which need to be covered.

@ those who train doctors do not believe that they work.

@ they can be administered without specialist training.

@ their effect is more psychological than physical.

END OF READING TEST

THIS BOOKLET WILL BE COLLECTED
READING SUB-TEST-ANSWER KEY

PART A: QUESTIONS 1-20

1 B

2 A

3 c
4 D

5 c
6 B

7 D

8 clindamycin (and) penicillin

9 diabetes mellitus

10 septic shock

11 VACI vacuum-assisted closure

12 alcohol pads

13 daptomycin (and) linezolid

14 vibrio (infection)

15 32.2%

16 seafood

17 limbs

18 polymicrobial

19 7%

20 physical therapy
Reading sub-test
Answer Key - Parts B & C
READING SUB-TEST-ANSWER KEY

PART B: QUESTIONS 1-6

1 A stop dates aren't relevant in all circumstances.

2 B improves precision during radiation.

3 B position electrodes correctly.

4 c its short-term benefits are explained to them.

5 B the use of a particular method of testing pH levels.

6 A the amount of oxytocin given will depend on how the patient reacts.

PART C: QUESTIONS 7-14

7 D the need for the phobia to be confronted repeatedly over time.

8 D unpleasant memories are aroused in response to certain prompts.

9 A makes use of an innate function of the brain.

10 A the anxiety that patients feel during therapy

11 c affects how neurons in the brain react to stimuli.

12 A its benefits are likely to be of limited duration.

13 D the emotional force of a memory is naturally retained.

14 B increase patients' tolerance of key triggers.

PART C: QUESTIONS 15-22

15 A he saw for himself how it could work in practice.

16 A research indicates that they are effective even without deceit.

17 D they are very widely used

18 A The way a treatment is presented is significant even if it is a placebo.

19 B reduce the number of people who experience them.

20 c a growing body of research

21 B Evers is exploiting a response which Ader discovered by chance.

22 D their effect is more psychological than physical.

READING SUB-TEST – TEXT BOOKLET: PART A
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
MIDDLE NAMES: Passport Photo

PROFESSION: Candidate details and photo will be printed here.

VENUE:
TEST DATE:

CANDIDATE DECLARATION
By signing this, you agree not to disclose or use in any way (other than to take the test) or assist any other person to disclose or use any OET
test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice
or information, you may be disqualified and your results may not be issued at the sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
malpractice, their personal details and details of the investigation may be passed to a third party where required.

CANDIDATE SIGNATURE:

INSTRUCTIONS TO CANDIDATES
You must NOT remove OET material from the test room.

PRACTICE TEST 3 153

 Necrotizing Fasciitis (NF): Texts
Text A
Necrotizing fasciitis (NF) is a severe, rare, potentially lethal soft tissue infection that develops
in the scrotum and perineum, the abdominal wall, or the extremities. The infection progresses
rapidly, and septic shock may ensue; hence, the mortality rate is high (median mortality
32.2%). NF is classified into four types, depending on microbiological findings.

Table 1

Classification of responsible pathogens according to type of infection

Microbiological Pathogens Site of infection Co-morbidities

type
Type 1 Obligate and facultative Trunk and perineum Diabetes mellitus
(polymicrobial) anaerobes

Type 2 Beta-hemolytic streptococcus Limbs

(monomicrobial) A

Type 3 Clostridium species Limbs, trunk and Trauma

Gram-negative bacteria perineum
Seafood
Vibrios spp. consumption (for
Aeromonas hydrophila Aeromonas)

Type 4 Candida spp. Limbs, trunk, Immuno-

perineum suppression
Zygomycetes

Text B
Antibiotic treatment for NF
Type 1
• Initial treatment includes ampicillin or ampicillin–sulbactam combined with metronidazole
or clindamycin.
• Broad gram-negative coverage is necessary as an initial empirical therapy for patients
who have recently been treated with antibiotics, or been hospitalized. In such cases,
antibiotics such as ampicillin–sulbactam, piperacillin–tazobactam, ticarcillin–clavulanate
acid, third or fourth generation cephalosporins, or carbapenems are used, and at a higher
dosage.
Type 2
• First or second generation of cephalosporins are used for the coverage of methicillin-
sensitive Staphylococcus aureus (MSSA).
• MRSA tends to be covered by vancomycin, or daptomycin and linezolid in cases where
S. aureus is resistant to vancomycin.
Type 3
• NF should be managed with clindamycin and penicillin, which kill the Clostridium species.
• If Vibrio infection is suspected, the early use of tetracyclines (including doxycycline and
minocycline) and third-generation cephalosporins is crucial for the survival of the patient,
since these antibiotics have been shown to reduce the mortality rate drastically.
Type 4
• Can be treated with amphotericin B or fluoroconazoles, but the results of this treatment
are generally disappointing.
Antibiotics should be administered for up to 5 days after local signs and symptoms have
resolved. The mean duration of antibiotic therapy for NF is 4–6 weeks.

154 PRACTICE TEST 3

Text C
Supportive care in an ICU is critical to NF survival. This involves fluid resuscitation, cardiac
monitoring, aggressive wound care, and adequate nutritional support. Patients with NF are in a
catabolic state and require increased caloric intake to combat infection. This can be delivered
orally or via nasogastric tube, peg tube, or intravenous hyperalimentation. This should begin
immediately (within the first 24 hours of hospitalization). Prompt and aggressive support
has been shown to lower complication rates. Baseline and repeated monitoring of albumin,
prealbumin, transferrin, blood urea nitrogen, and triglycerides should be performed to ensure the
patient is receiving adequate nutrition.
Wound care is also an important concern. Advanced wound dressings have replaced wet-to-dry
dressings. These dressings promote granulation tissue formation and speed healing. Advanced
wound dressings may lend to healing or prepare the wound bed for grafting. A healthy wound
bed increases the chances of split-thickness skin graft take. Vacuum-assisted closure (VAC) was
recently reported to be effective in a patient whose cardiac status was too precarious to undergo
a long surgical reconstruction operation. With the VAC., the patient’s wound decreased in size,
and the VAC was thought to aid in local management of infection and improve granulation
tissue.

Text D
Advice to give the patient before discharge
• Help arrange the patient’s aftercare, including home health care and instruction regarding
wound management, social services to promote adjustment to lifestyle changes and
financial concerns, and physical therapy sessions to help rebuild strength and promote the
return to optimal physical health.
• The life-threatening nature of NF, scarring caused by the disease, and in some cases the
need for limb amputation can alter the patient’s attitude and viewpoint, so be sure to take a
holistic approach when dealing with the patient and family.

Remind the diabetic patient to

• control blood glucose levels, keeping the glycated haemoglobin (HbAlc) level to 7% or less.
• keep needles capped until use and not to reuse needles.
• clean the skin thoroughly before blood glucose testing or insulin in¬jection, and to use
alcohol pads to clean the area afterward.

END OF PART A
THIS TEXT BOOKLET WILL BE COLLECTED

PRACTICE TEST 3 155

 Part A
TIME: 15 minutes

• 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.

PRACTICE TEST 3 157

 Necrotizing Fasciitis (NF): Questions

Questions 1-7

For each question, 1-7, decide which text (A, B, C or D) the information comes from. You
may use any letter more than once.

In which text can you find information about

1 the drug treatment required?

2 which parts of the body can be affected?

3 the various ways calories can be introduced?

4 who to contact to help the patient after they leave

hospital?

5 what kind of dressing to use?

6 how long to give drug therapy to the patient?

7 what advice to give the patient regarding needle use?

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, numbers or both.

8 Which two drugs can you use to treat the clostridium species of pathogen?

9 Which common metabolic condition may occur with NF?

10 What complication can a patient suffer from if NF isn’t treated quickly enough?

11 What procedure can you use with a wound if the patient can’t be operated on?

158 PRACTICE TEST 3

 12 What should the patient be told to use to clean an injection site?

13 Which two drugs can be used if you can’t use vancomycin?

14 What kind of infection should you use tetracyclines for?

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, numbers or both.

15 The average proportion of patients who die as a result of contracting NF is

16 Patients who have eaten may be infected with

Aeromonas hydrophilia.

17 Patients with Type 2 infection usually present with infected

.

18 Type 1 NF is also known as .

19 The patient needs to be aware of the need to keep glycated haemoglobin levels
lower than .

20 The patient will need a course of to regain fitness

levels after returning home.

END OF PART A
THIS QUESTION PAPER WILL BE COLLECTED

PRACTICE TEST 3 159

 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 answer (A, B or C) which you think fits best according to the text.

1. The policy document tells us that

A stop dates aren’t relevant in all circumstances.

B anyone using EPMA can disregard the request for a stop date.

C prescribers must know in advance of prescribing what the stop date should
be.

Prescribing stop dates

Prescribers should write a review date or a stop date on the electronic prescribing system
EPMA or the medicine chart for each antimicrobial agent prescribed. On the EPMA, there
is a forced entry for stop dates on oral antimicrobials. There is not a forced stop date on
EPMA for IV antimicrobial treatment – if the prescriber knows how long the course of
IV should be, then the stop date can be filled in. If not known, then a review should be
added to the additional information, e.g. ‘review after 48 hrs’. If the prescriber decides
treatment needs to continue beyond the stop date or course length indicated, then it is their
responsibility to amend the chart. In critical care, it has been agreed that the routine use of
review/stop dates on the charts is not always appropriate.

PRACTICE TEST 3 161

 2. The guidelines inform us that personalised equipment for radiotherapy

A is advisable for all patients.

B improves precision during radiation.

C needs to be tested at the first consultation.

Guidelines: Radiotherapy Simulation Planning Appointment

The initial appointment may also be referred to as the Simulation Appointment. During
this appointment you will discuss your patient’s medical history and treatment options,
and agree on a radiotherapy treatment plan. The first step is usually to take a CT scan of
the area requiring treatment. The patient will meet the radiation oncologist, their registrar
and radiation therapists. A decision will be made regarding the best and most comfortable
position for treatment, and this will be replicated daily for the duration of the treatment.
Depending on the area of the body to be treated, personalised equipment such as a face
mask may be used to stabilise the patient’s position. This equipment helps keep the patient
comfortable and still during the treatment and makes the treatment more accurate.

162 PRACTICE TEST 3

3. The purpose of these instructions is to explain how to

A monitor an ECG reading.

B position electrodes correctly.

C handle an animal during an ECG procedure.

CT200CV Veterinarian Electrocardiograph User Manual

Animal connections
Good electrode connection is the most important factor in recording a high quality ECG. By
following a few basic steps, consistent, clean recordings can be achieved.

1. Shave a patch on each forelimb of the animal at the contact site.

2. Clean the electrode sites with an alcohol swab or sterilising agent.

3. Attach clips to the ECG leads.

4. Place a small amount of ECG electrode gel on the metal electrode of the limb strap or
adapter clip.

5. Pinch skin on animal and place clips on the shaved skin area of the animal being
tested. The animal must be kept still.

6. Check the LCD display for a constant heart reading.

7. If there is no heart reading, you have a contact problem with one or more of the leads.

8. Recheck the leads and reapply the clips to the shaven skin of the animal.

PRACTICE TEST 3 163

 4. The group known as ‘impatient patients’ are more likely to continue with a course of
prescribed medication if

A their treatment can be completed over a reduced period of time.

B it is possible to link their treatment with a financial advantage.

C its short-term benefits are explained to them.

Medication adherence and impatient patients

A recent article addressed the behaviour of people who have a ‘taste for the present
rather than the future’. It proposed that these so-called ‘impatient patients’ are unlikely
to adhere to medications that require use over an extended period. The article proposes
that, an ‘impatience genotype’ exists and that assessing these patients’ view of the future
while stressing the immediate advantages of adherence may improve adherence rates
more than emphasizing potentially distant complications. The authors suggest that rather
than attempting to change the character of those who are ‘impatient’, it may be wise to
ascertain the patient’s individual priorities, particularly as they relate to immediate gains.
For example, while advising an ‘impatient’ patient with diabetes, stressing improvement
in visual acuity rather than avoidance of retinopathy may result in greater medication
adherence rates. Additionally, linking the cost of frequently changing prescription lenses
when visual acuity fluctuates with glycemic levels may sometimes provide the patient with
an immediate financial motivation for improving adherence.

164 PRACTICE TEST 3

5. The memo reminds nursing staff to avoid

A x-raying a patient unless pH readings exceed 5.5.

B the use of a particular method of testing pH levels.

C reliance on pH testing in patients taking acid-inhibiting medication.

Checking the position of a nasogastric tube

It is essential to confirm the position of the tube in the stomach by one of the following:
• Testing pH of aspirate: gastric placement is indicated by a pH of less than 4, but
may increase to between pH 4-6 if the patient is receiving acid-inhibiting drugs.
Blue litmus paper is insufficiently sensitive to adequately distinguish between
levels of acidity of aspirate.
• X-rays: will only confirm position at the time the X-ray is carried out. The tube may
have moved by the time the patient has returned to the ward. In the absence of a
positive aspirate test, where pH readings are more than 5.5, or in a patient who
is unconscious or on a ventilator, an X-ray must be obtained to confirm the initial
position of the nasogastric tube.

PRACTICE TEST 3 165

 6. This extract informs us that

A the amount of oxytocin given will depend on how the patient reacts.

B the patient will go into labour as soon as oxytocin is administered.

C the staff should inspect the oxytocin pump before use.

Extract from guidelines: Oxytocin

1 Oxytocin Dosage and Administration

Parenteral drug products should be inspected visually for particulate matter and
discoloration prior to administration, whenever solution and container permit. Dosage of
Oxytocin is determined by the uterine response. The dosage information below is based
upon various regimens and indications in general use.

1.1 Induction or Stimulation of Labour

Intravenous infusion (drip method) is the only acceptable method of administration for
the induction or stimulation of labour. Accurate control of the rate of infusion flow is
essential. An infusion pump or other such device and frequent monitoring of strength of
contractions and foetal heart rate are necessary for the safe administration of Oxytocin
for the induction or stimulation of labour. If uterine contractions become too powerful, the
infusion can be abruptly stopped, and oxytocic stimulation of the uterine musculature will
soon wane.

166 PRACTICE TEST 3

 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 according to the text.

Text 1: Phobia pills

An irrational fear, or phobia, can cause the heart to pound and the pulse to race. It can
lead to a full-blown panic attack – and yet the sufferer is not in any real peril. All it takes
is a glimpse of, for example, a spider’s web for the mind and body to race into panicked
overdrive. These fears are difficult to conquer, largely because, although there are no
treatment guidelines specifically about phobias, the traditional way of helping the sufferer
is to expose them to the fear numerous times. Through the cumulative effect of these
experiences, sufferers should eventually feel an increasing sense of control over their
phobia. For some people, the process is too protracted, but there may be a short cut. Drugs
that work to boost learning may help someone with a phobia to ‘detrain’ their brain, losing
the fearful associations that fuel the panic.

The brain’s extraordinary ability to store new memories and forge associations is so well
celebrated that its dark side is often disregarded. A feeling of contentment is easily evoked
when we see a photo of loved ones, though the memory may sometimes be more idealised
than exact. In the case of a phobia, however, a nasty experience with, say, spiders, that
once triggered a panicked reaction, leads the feelings to resurge whenever the relevant
cue is seen again. The current approach is exposure therapy, which uses a process called
extinction learning. This involves people being gradually exposed to whatever triggers
their phobia until they feel at ease with it. As the individual becomes more comfortable with
each situation, the brain automatically creates a new memory – one that links the cue with
reduced feelings of anxiety, rather than the sensations that mark the onset of a panic attack.

Unfortunately, while it is relatively easy to create a fear-based memory, expunging that

fear is more complicated. Each exposure trial will involve a certain degree of distress in
the patient, and although the process is carefully managed throughout to limit this, some
psychotherapists have concluded that the treatment is unethical. Neuroscientists have been
looking for new ways to speed up extinction learning for that same reason.

One such avenue is the use of ‘cognitive enhancers’ such as a drug called D-cycloserine or
DCS. DCS slots into part of the brain’s ‘NMDA receptor’ and seems to modulate the neurons’
ability to adjust their signalling in response to events. This tuning of a neuron’s firing is
thought to be one of the key ways the brain stores memories, and, at very low doses, DCS
appears to boost that process, improving our ability to learn. In 2004, a team from Emory
University in Atlanta, USA, tested whether DCS could also help people with phobias. A pilot
trial was conducted on 28 people undergoing specific exposure therapy for acrophobia – a
fear of heights. Results showed that those given a small amount of DCS alongside their
regular therapy were able to reduce their phobia to a greater extent than those given a
placebo. Since then, other groups have replicated the finding in further trials.

PRACTICE TEST 3 167

 For people undergoing exposure therapy, achieving just one of the steps on the long
journey to overcoming their fears requires considerable perseverance, says Cristian Sirbu,
a behavioural scientist and psychologist. Thanks to improvement being so slow, patients –
often already anxious – tend to feel they have failed. But Sirbu thinks that DCS may make it
possible to tackle the problem in a single 3-hour session, which is enough for the patient to
make real headway and to leave with a feeling of satisfaction. However, some people have
misgivings about this approach, claiming that as it doesn’t directly undo the fearful response
which is deep-seated in the memory, there is a very real risk of relapse.

Rather than simply attempting to overlay the fearful associations with new ones, Merel Kindt
at the University of Amsterdam is instead trying to alter the associations at source. Kindt’s
studies into anxiety disorders are based on the idea that memories are not only vulnerable
to alteration when they’re first laid down, but, of key importance, also at later retrieval. This
allows for memories to be ‘updated’, and these amended memories are re-consolidated by
the effect of proteins which alter synaptic responses, thereby maintaining the strength of
feeling associated with the original memory. Kindt’s team has produced encouraging results
with arachnophobic patients by giving them propranolol, a well-known and well-tolerated
beta-blocker drug, while they looked at spiders. This blocked the effects of norepinephrine
in the brain, disrupting the way the memory was put back into storage after being retrieved,
as part of the process of reconsolidation. Participants reported that while they still don’t like
spiders, they were able to approach them. Kindt reports that the benefit was still there three
months after the test ended.

168 PRACTICE TEST 3

Text 1: Questions 7-14

In the first paragraph, the writer says that conventional management of phobias
7.
can be problematic because of

A the lasting psychological effects of the treatment.

B the time required to identify the cause of the phobia.

C the limited choice of therapies available to professionals.

D the need for the phobia to be confronted repeatedly over time.

In the second paragraph, the writer uses the phrase ‘dark side’ to reinforce the
8.
idea that

A memories of agreeable events tend to be inaccurate.

B positive memories can be negatively distorted over time.

C unhappy memories are often more detailed than happy ones.

D unpleasant memories are aroused in response to certain prompts.

9. In the second paragraph, extinction learning is explained as a process which

A makes use of an innate function of the brain.

B encourages patients to analyse their particular fears.

C shows patients how to react when having a panic attack.

D focuses on a previously little-understood part of the brain.

10. What does the phrase ‘for that same reason’ refer to?

A the anxiety that patients feel during therapy

B complaints from patients who feel unsupported

C the conflicting ethical concerns of neuroscientists

D psychotherapists who take on unsuitable patients

PRACTICE TEST 3 169

 11. In the fourth paragraph, we learn that the drug called DCS

A is unsafe to use except in small quantities.

B helps to control only certain types of phobias.

C affects how neurons in the brain react to stimuli.

D increases the emotional impact of certain events.

12. In the fifth paragraph, some critics believe that one drawback of using DCS is that

A its benefits are likely to be of limited duration.

B it is only helpful for certain types of personality.

C few patients are likely to complete the course of treatment.

D patients feel discouraged by their apparent lack of progress.

In the final paragraph, we learn that Kindt’s studies into anxiety disorders focused
13.
on how

A proteins can affect memory retrieval.

B memories are superimposed on each other.

C negative memories can be reduced in frequency.

D the emotional force of a memory is naturally retained.

14. The writer suggests that propranolol may

A not offer a permanent solution for patients’ phobias.

B increase patients’ tolerance of key triggers.

C produce some beneficial side-effects.

D be inappropriate for certain phobias.

170 PRACTICE TEST 3

Text 2: Challenging medical thinking on placebos

Dr Damien Finniss, Associate Professor at Sydney University’s Pain Management and

Research Institute, was previously a physiotherapist. He regularly treated football players
during training sessions using therapeutic ultrasound. ‘One particular session’, Finniss
explains, ‘I treated five or six athletes. I’d treat them for five or ten minutes and they’d say,
“I feel much better” and run back onto the field. But at the end of the session, I realised the
ultrasound wasn’t on.’ It was a light bulb moment that set Finniss on the path to becoming a
leading researcher on the placebo effect.

Used to treat depression, psoriasis and Parkinson’s, to name but a few, placebos have
an image problem among medics. For years, the thinking has been that a placebo is
useless unless the doctor convinces the patient that it’s a genuine treatment – problematic
for a profession that promotes informed consent. However, a new study casts doubt on
this assumption and, along with a swathe of research showing some remarkable results
with placebos, raises questions about whether they should now enter the mainstream as
legitimate prescription items. The study examined five trials in which participants were told
they were getting a placebo, and the conclusion was that doing so honestly can work.

‘If the evidence is there, I don’t see the harm in openly administering a placebo,’ says Ben
Colagiuri, a researcher at the University of Sydney. Colagiuri recently published a meta-
analysis of thirteen studies which concluded that placebo sleeping pills, whose genuine
counterparts notch up nearly three million prescriptions in Australia annually, significantly
improve sleep quality. The use of placebos could therefore reduce medical costs and the
burden of disease in terms of adverse reactions.

But the placebo effect isn’t just about fake treatments. It’s about raising patients’ expectations
of a positive result; something which also occurs with real drugs. Finniss cites the ‘open-
hidden’ effect, whereby an analgesic can be twice as effective if the patient knows they’re
getting it, compared to receiving it unknowingly. ‘Treatment is always part medical and part
ritual,’ says Finniss. This includes the austere consulting room and even the doctor’s clothing.
But behind the performance of healing is some strong science. Simply believing an analgesic
will work activates the same brain regions as the genuine drug. ‘Part of the outcome of what
we do is the way we interact with patients,’ says Finniss.

That interaction is also the focus of Colagiuri’s research. He’s looking into the ‘nocebo’
effect, when a patient’s pessimism about a treatment becomes self-fulfilling. ‘If you give a
placebo, and warn only 50% of the patients about side effects, those you warn report more
side effects,’ says Colagiuri. He’s aiming to reverse that by exploiting the psychology of
food packaging. Products are labelled ‘98% fat-free’ rather than ‘2% fat’ because positive
reference to the word ‘fat’ puts consumers off. Colagiuri is deploying similar tactics. A drug
with a 30% chance of causing a side effect can be reframed as having a 70% chance of not
causing it. ‘You’re giving the same information, but framing it a way that minimises negative
expectations,’ says Colagiuri.

PRACTICE TEST 3 171

 There is also a body of research showing that a placebo can produce a genuine biological
response that could affect the disease process itself. It can be traced back to a study from the
1970s, when psychologist Robert Ader was trying to condition taste-aversion in rats. He gave
them a saccharine drink whilst simultaneously injecting Cytoxan, an immune-suppressant
which causes nausea. The rats learned to hate the drink due to the nausea. But as Ader
continued giving it to them, without Cytoxan, they began to die from infection. Their immune
system had ‘learned’ to fail by repeated pairing of the drink with Cytoxan. Professor Andrea
Evers of Leiden University is running a study that capitalises on this conditioning effect and
may benefit patients with rheumatoid arthritis, which causes the immune system to attack the
joints. Evers’ patients are given the immunosuppressant methotrexate, but instead of always
receiving the same dose, they get a higher dose followed by a lower one. The theory is that
the higher dose will cause the body to link the medication with a damped-down immune
system. The lower dose will then work because the body has ‘learned’ to curb immunity as a
placebo response to taking the drug. Evers hopes it will mean effective drug regimes that use
lower doses with fewer side effects.

The medical profession, however, remains less than enthusiastic about placebos. ‘I’m one
of two researchers in the country who speak on placebos, and I’ve been invited to lecture at
just one university,’ says Finniss. According to Charlotte Blease, a philosopher of science, this
antipathy may go to the core of what it means to be a doctor. ‘Medical education is largely
about biomedical facts. ‘Softer’ sciences, such as psychology, get marginalised because it’s
the hard stuff that’s associated with what it means to be a doctor.’ The result, says Blease,
is a large, placebo-shaped hole in the medical curriculum. ‘There’s a great deal of medical
illiteracy about the placebo effect ... it’s the science behind the art of medicine. Doctors need
training in that.’

172 PRACTICE TEST 3

Text 2: Questions 15-22

15. A football training session sparked Dr Finniss’ interest in the placebo effect because

A he saw for himself how it could work in practice.

B he took the opportunity to try out a theory about it.

C he made a discovery about how it works with groups.

D he realised he was more interested in research than treatment.

The writer suggests that doctors should be more willing to prescribe placebos now
16.
because

A research indicates that they are effective even without deceit.

B recent studies are more reliable than those conducted in the past.

C they have been accepted as a treatment by many in the profession.

D they have been shown to relieve symptoms in a wide range of conditions.

17. What is suggested about sleeping pills by the use of the verb ‘notch up’?

A they may have negative results

B they could easily be replaced

C they are extremely effective

D they are very widely used

18. What point does the writer make in the fourth paragraph?

A The way a treatment is presented is significant even if it is a placebo.

B The method by which a drug is administered is more important than its

content.

C The theatrical side of medicine should not be allowed to detract from the
science.

D The outcome of a placebo treatment is affected by whether the doctor

believes in it.

PRACTICE TEST 3 173

 19. In researching side effects, Colagiuri aims to

A discover whether placebos can cause them.

B reduce the number of people who experience them.

C make information about them more accessible to patients.

D investigate whether pessimistic patients are more likely to suffer from them.

20. What does the word ‘it’ in the sixth paragraph refer to?

A a placebo treatment

B the disease process itself

C a growing body of research

D a genuine biological response

21. What does the writer tell us about Ader’s and Evers’ studies?

A Both involve gradually reducing the dosage of a drug.

B Evers is exploiting a response which Ader discovered by chance.

C Both examine the side effects caused by immunosuppressant drugs.

D Evers is investigating whether the human immune system reacts to placebos as

Ader’s rats did.

22. According to Charlotte Blease, placebos are omitted from medical training because

A there are so many practical subjects which need to be covered.

B those who train doctors do not believe that they work.

C they can be administered without specialist training.

D their effect is more psychological than physical.

END OF READING TEST

THIS BOOKLET WILL BE COLLECTED

174 PRACTICE TEST 3

 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
according to the text. Write your answers on the separate Answer Sheet

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.
Part C -Text 2: Questions 15-22

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
Part A - Answer key 8 – 14
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
Part A - Answer key 15 – 20
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

Text 2 - Answer key 15 – 22

15. D, 16. A, 17. C, 18. D, 19. A, 20. B, 21. B, 22. D
 READING TEST 84
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 – 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
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
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
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 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

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 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
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
according to the text. Write your answers on the separate Answer Sheet

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.”

Part C -Text 1: Questions 7-14

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."

Part C -Text 2: Questions 15-22

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

END OF READING TEST, THIS BOOKLET WILL BE COLLECTED

Reading test 84 : Answer Key

Part A - Answer key 1 – 7

1. C

2. B

3. A

4. D

5. A
 6. C

7. B

Part A - Answer key 8 – 14

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

Part A - Answer key 15 – 20

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

Reading test - part B – answer key

1. C
2. A
3. B
4. B
5. C
6. C
Reading test - part C – answer key
Text 1 - Answer key 7 – 14

7. B
8. D
9. A
10. C
11. C
12. C
13. B
14. A
Text 2 - Answer key 15 – 22
15. D
16. A
17. C
18. D
19. C
20. B
21. C
22. A
 READING TEST 85
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 - 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
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

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.
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 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.

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
according to the text. Write your answers on the separate Answer Sheet

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.

Part C -Text 1: Questions 7-14

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.

Part C -Text 2: Questions 15-22

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.

END OF READING TEST, THIS BOOKLET WILL BE COLLECTED

Reading test 85 : Answer Key

Part A - Answer key 1 – 7

1. B
2. C
3. A
4. D
5. C
6. A
7. B
Part A - Answer key 8 – 14
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)

Part A - Answer key 15 – 20

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)

Reading test - part B – answer key

1. A
2. A
3. B
4. B
5. C
6. A
Reading test - part C – answer key
Text 1 - Answer key 7 – 14
7. A
8. C
9. B
10 D
11. A
12. C
13. B
14. D

Text 2 - Answer key 15 – 22

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
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 - 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
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

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
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. 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

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 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
_________________

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 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.

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
according to the text. Write your answers on the separate Answer Sheet

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.

Part C -Text 1: Questions 7-14

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”.
Part C -Text 2: Questions 15-22
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
END OF READING TEST, THIS BOOKLET WILL BE COLLECTED

Reading test 86 : Answer Key

Part A - Answer key 1 – 7

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

Part A - Answer key 8 – 14

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

Part A - Answer key 15 – 20

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

Text 2 - Answer key 15 – 22

15. d
16. b
17. b
18. b
19. c
20. c
21. d
22. d
 READING TEST 87
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 - 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
In which text can you find information about
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
____________

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.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.

4. The guidelines establish that the healthcare professional should

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.
 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
according to the text. Write your answers on the separate Answer Sheet

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.

Part C -Text 1: Questions 7-14

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.”
Part C -Text 2: Questions 15-22

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
END OF READING TEST, THIS BOOKLET WILL BE COLLECTED

Reading test 87 : Answer Key

Part A - Answer key 1 – 7

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

Part A - Answer key 8 – 14

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

Part A - Answer key 15 – 20

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

Text 2 - Answer key 15 – 22

15. c
16. a
17. b
18. d
19. a
20. d
21. a
22. c
 READING TEST 88
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 – 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
In which text can you find information about
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
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. 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

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. 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.
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 guidelines establish that the healthcare professional should
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.
 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
according to the text. Write your answers on the separate Answer Sheet

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.

Part C -Text 1: Questions 7-14

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
d) None of the above
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.

Part C -Text 2: Questions 15-22

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

END OF READING TEST, THIS BOOKLET WILL BE COLLECTED

Reading test 88 : Answer Key

Part A - Answer key 1 – 7

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

Part A - Answer key 8 – 14

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

Reading test - part B – answer key

1. C
2. B
3. C
4. B
5. A
6. C
Reading test - part C – answer key
Text 1 - Answer key 7 – 14

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

14. b

Text 2 - Answer key 15 – 22

15. c
16. d
17. a
18. a
19. b
20. c
21. a
22. c
 READING TEST 89
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 - 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
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

In which text can you find information about

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
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 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

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. 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

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. 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.
5. The notice is giving information about
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.

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
according to the text. Write your answers on the separate Answer Sheet

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.

Part C -Text 1: Questions 7-14

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.

Part C -Text 2: Questions 15-22

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

END OF READING TEST, THIS BOOKLET WILL BE COLLECTED

Reading test 89 : Answer Key

Part A - Answer key 1 – 7

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

Part A - Answer key 8 – 14

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

Part A - Answer key 15 – 20

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

Reading test - part B – answer key

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

Reading test - part C – answer key

Text 1 - Answer key 7 – 14
7. c
8. c
9. c
10. c
11. a
12. d
13. b
14. c

Text 2 - Answer key 15 – 22

15. a
16. b
17. b
18. b
19. d
20. c
21. a
22. b
 READING TEST 90
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 - 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
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

In which text can you find information about

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
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 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

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. 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.

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. 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.

2. The notice is giving information about

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°.

6. The guidelines establish that the healthcare professional should

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.

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 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.

Part C -Text 1: Questions 7-14

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
d) None of the above

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.

Part C -Text 2: Questions 15-22

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.

END OF READING TEST, THIS BOOKLET WILL BE COLLECTED

Reading test 90 : Answer Key

Part A - Answer key 1 – 7
1. B
2. C
3. D
4. C
5. B
6. A
7. C
Part A - Answer key 8 – 14
8. Alzheimer’s disease
9. INTERHEART
10. 24.2 million
11. sub-Saharan Africa
12. India and China
13. Europe
14. FDA-approved
Part A - Answer key 15 – 20
15. Latin America
16. Agitation
17. life expectancy
18. a cholinesterase inhibitor
19. aggressive
20. Demographic ageing
Reading test - part B – answer key
1. B
2. C
3. A
4. C
5. C
6. B
Reading test - part C – answer key
Text 1 - Answer key 7 – 14
7. b
8. c
9. b
10. c
11. a
12. a
13. c
14. c
Text 2 - Answer key 15 – 22
15. d
16. b
17. a
18. b
19. a
20. a
21. b
22. c
READING TEST 91
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 – 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
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

In which text can you find information about

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
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 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

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

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

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. 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.
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
according to the text. Write your answers on the separate Answer Sheet

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.

Part C -Text 1: Questions 7-14

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’’.

Part C -Text 2: Questions 15-22

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

END OF READING TEST, THIS BOOKLET WILL BE COLLECTED

Reading test 91 : Answer Key

Part A - Answer key 1 – 7

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

Part A - Answer key 8 – 14

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

Part A - Answer key 15 – 22

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

Reading test - part B – answer key

1. C
2. A
3. C
4. C
5. A
6. A
Reading test - part C – answer key
Text 1 - Answer key 7 – 14
7. C
8. A
9. A
10. D
11. B
12. B
13. B
14. C

Text 2 - Answer key 15 – 22

15. B
16. B
17. B
18. A
19. C
20. C
21. C
22. D
 READING TEST 92
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 - 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
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

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
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. 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

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 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.

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. 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.

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
according to the text. Write your answers on the separate Answer Sheet

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.

Part C -Text 1: Questions 7-14

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.

Part C -Text 2: Questions 15-22

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.

END OF READING TEST, THIS BOOKLET WILL BE COLLECTED

Reading test 92 : Answer Key

Part A - Answer key 1 – 7
1. B
2. C
3. D
4. A
5. D
6. A
7. D
Part A - Answer key 8 – 14
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
Part A - Answer key 15 – 20
15. tropical countries
16. not prolonged
17. small but significant
18. glucose
19. combined with
20. highly suited

Reading test - part B – answer key

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

Reading test - part C – answer key

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

Text 2 - Answer key 15 – 22

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