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OBSTETRIC ULTRASOUND OET READING

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TEXT A: An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word “ultrasound”, in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20 weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

TEXT B: Abstract: Implementing a obstetric ultrasound training program in rural Africa
Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa. Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.
Results: The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.
Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

TEXT C: The Role of Obstetric Ultrasound in Low Resource Settings
Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle- and low-income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

TEXT D: “Entertainment” Ultrasound Examinations
It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of “entertainment”. In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.
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. alternative name for professionals who do ultrasound scan?
2. benefits of obstetric ultrasound scan?
3. benefits of three-dimensional ultrasound images?
4. places which recorded high maternal mortality?
5. who condemned non-diagnostic uses of ultrasound?
6 who conducted the study in rural Africa?
7 differences among countries regarding maternal mortality?



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 is the maximum frequency limit of diagnostic ultrasound?
9. What does ‘MDG’ stand for based on the information given in the texts?
10. How many participants were there in the study conducted in rural Africa?
11. What type of frequencies travel more into human body?
12. Which millennium development goal aim to reduce maternal mortality?
13. What is the alternate term for ultrasound scan?
14. What is the maternal mortality ratio in comparison with live births in developed nations?
15. How many transverse presentations were identified in the study conducted in rural Africa?



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. in a hinterland backdrop, which is assisted remotely is very practical.
17. The adverse bio-effects of ultrasound energy is a major brought up by the American Institute of Ultrasound in Medicine.
18. Advancements in is vital to eliminate the adverse outcomes of MCH globally.
19. can penetrate through skin and provide superior image quality.
20. The significance of is identified as essential, soon after the fetal period.



PART B. For questions 1-6, choose the answer (A, B or C)

1. This extract informs us that multidisciplinary care is
A. essential to tackle the increasing complexness of the residents care needs.
B. enhancing the resident’s quality of life to meet the needs of residents.
C. providing an integrated team approach by addressing the problems.
Multidisciplinary Care: Given the increasing complexity of the resident’s care needs combined with the call for a palliative approach to care delivery suggests that the adoption of a multi-disciplinary team approach to care planning and delivery is required. Multidisciplinary care is the vehicle for providing an integrated team approach to the provision of health care and this occurs when medical, nursing and allied health professionals consider all treatment options, including all of the potential benefits and disadvantages of treatment decisions, personal preferences of the resident and collaboratively develop an individual care plan that best meets the needs of each resident and their family. There is compelling evidence to suggest that a multi-disciplinary approach to care helps to enhance the resident’s quality of life by addressing the problems that are of most concern to the residents are addressed, reduces ambiguity around treatment and the goals of care, ensures that care decisions are based on best evidence-based practice.

2. What is being described in this section of the guidelines?
A. changes in protocols.
B. best practice protocols.
C. exceptions to the protocols.
Protected Health Information: Employees access our office via main entrance or employee entrance. Main entrance is locked after hours and is unlocked each morning at 8:00. The Office Manager has the key to both entrances and is responsible for unlocking main entrance each AM. Employee entrance is accessed only via key. Employees or service personal may gain entrance through the employee entrance by knocking on the door. All patients’ protected health information (PHI) regardless of its form, mechanism of transmission, or storage is to be kept confidential. Only individuals with a business need to know are allowed to view, read, or discuss any part of a patient’s PHI. An employee who violates this confidentiality policy will be subject to sanctions up to immediate termination. All employees are required to verify in writing that they have read and will comply with our policy regarding confidentiality of all forms of PHI. Employees whose job functions require access to our computer system will be given a secure, unique password to access the system.

3. The carcinogenicity potential should be assessed for
A. all medical devices with direct human contact.
B. reviewing the carcinogenicity of novel materials.
C. all medical devices with lasting human contact.
Carcinogenicity: Carcinogenicity potential should be evaluated for devices with permanent contact. This includes devices in contact with breached or compromised surfaces, as well as externally communicating and implanted devices. If novel materials are used to manufacture devices in contact with breached or compromised surfaces, externally communicating devices, or implant devices, we also recommend a review of the carcinogenicity literature. In the absence of experimentally derived carcinogenicity information, structure activity relationship modeling for these materials may be needed regardless of the duration of contact, to better understand the carcinogenicity potential for these materials. Because there are carcinogens that are not genotoxins and carcinogenesis is multifactorial, the assessment of carcinogenicity should not rely solely on genotoxicity information.


4. According to the extract, the best way to address the biocompatibility of a device is through
A. clinical testing
B. clinical studies
C. clinical experience
Clinical experience: Clinical experience should be considered in the overall benefit-risk profile for the device where the totality of the data available for the device may inform whether more testing is needed, or if any testing is needed at all. For example, clinical experience may be useful to mitigate problematic findings in an in vitro biocompatibility. In other cases, testing to address long-term biocompatibility endpoints may not be necessary if the patient’s life expectancy in the intended use population is limited. Generally, clinical studies are not sufficiently sensitive to identify biocompatibility concerns. Clinical or sub-clinical symptoms that result from the presence of a non- biocompatible material may not be identifiable, or may result in symptoms that are indistinguishable from the disease state such that the clinical data may not be informative to the biocompatibility evaluation. For example, blood vessel occlusion at the site of an implanted stent could be indicative of a toxic response to the stent materials or be related to damage to the stent during implantation.

5. Which is not an alternate term for a medical committee?
A. drug and medicine committee.
B. pharmacy and therapeutics committee.
C. medicine and therapeutics committee.
Drugs in Hospital: A hospital exists to provide diagnostic and curative services to patients. Pharmaceuticals are an integral part of patient care. Appropriate use of medicines in the hospital is a multidisciplinary responsibility shared by physicians, nurses, pharmacists, administrators, support personnel, and patients. A medical committee, sometimes called the drug and therapeutics committee, pharmacy and therapeutics committee, or the medicine and therapeutics committee, is responsible for approving policies and procedures and monitoring practices to promote safe and effective medicine use. The pharmacy department, under the direction of a qualified pharmacist, should be responsible for controlling the distribution of medicines and promoting their safe use. This task is challenging because medicines are prescribed by physicians, administered by nurses, and stored throughout the hospital. The control of narcotics is of particular concern in the hospital setting and requires a systematic approach for the prevention and detection of abuse.

6. What point does the extract make about known genotoxins?
A. can assume a positive result for the devices containing genotoxic materials.
B. cannot absolutely negate the negative results for other device components.
C. overall benefit-risk determined by device indication and human exposure.
Genotoxicity: Genotoxicity testing may be waived if chemical characterization of device extracts and literature references indicate that all components have been adequately tested for genotoxicity. Genotoxicity testing may not be informative for devices containing materials already known to be genotoxic assumed to be due to the known genotoxin. Thus, a second genotoxin from another source may be overlooked. If genotoxicity testing is performed, a negative result should be interpreted as a negative for the other device components or interaction products, but does not necessarily negate the risk of the known genotoxin. Chemical characterization may be needed to demonstrate to what extent the genotoxin is released from the device. For known genotoxins, the overall benefit-risk determination will depend on the device indication and human exposure. Genotoxicity testing is requested when the genotoxicity profile has not been adequately established.


PART C. TEXT 1: EYE DAMAGES IN DIVERS Choose (A, B, C or D)

An investigation of the circulation of blood in the eyes of divers has produced the strongest evidence yet that tissue damage is caused by diving is more common and more severe than previously thought. Researchers from Moorefield’s Eye Hospital in London and Maurice Cross of the Diving Diseases Research Centre in Plymouth examined the retinas of 80 divers of varying experience. The researchers found evidence of damage in nearly half the divers. Although the damage tended to increase with diving experience some of the divers developed it within two years of diving. The study is the first evidence of damage to the eye tissue in amateur divers and it suggests for the first time that a career in diving almost inevitably leads to damage of the 26 professional divers studied all had abnormal retinas. None of the divers taking part in the study had visual problems as a result of their damaged retinas but Bird said that he “would not be surprised to find divers whose damage has progressed far enough to affect their vision”.

Evidence has mounted during recent years to show that exposure to pressure during diving subtly damages the central nervous system. Doctors believe that the damage is due to obstruction in the flow of blood through the tissues. People who take up diving as a sport know they are at risk of getting “the bends” or an air embolism, but if they follow the correct procedures the risk is very low. All professional divers know they also run the risk of bone necrosis. About 5 per cent of them develop small dead patches in their bones. Active professional divers have the bones of their thighs and upper arms x-rayed as part of their annual medical examination. Doctors have been concerned that if diving caused dead patches to appear on bones, other tissues may be suffering a similar fate. Their concern increased in the early 2000s, when detailed neurological examinations and tests of the memory and reactions of experienced professional divers suggested that some of them might have slight damage to the brain and spinal cord.

Then, in 2006, nuclear magnetic resonance imaging revealed small areas of damage in the brains of apparently healthy North Sea divers. The following year Ian Calder, a pathologist at the London Hospital in the city’s East End, published the results of a postmortem study of eleven professional divers. Seven of them had areas of damage in the spinal cord that had not been detected while the divers were alive. The samples were too small for researchers in the studies to draw conclusions as to how common such damage might be. The fact that few divers are currently complaining of neurological symptoms does not mean that they will not experience problems later in life. There is a great deal of extra capacity in the nervous system of young people that begins to diminish in middle age. Most people who have dived deeper than 50 meters are still relatively young. Deeper diving did not become common until the mid-1970s when drilling for offshore oil began in the deeper water of the North Sea. Over the same period recreational diving became more popular and the amateur divers began to go deeper.

In order to determine the size of the problem, the researchers needed a method of looking for the damage in a large sample of divers that did not involve surgery. The damage which occurs in the tissue of both the bones and the nerves of divers is similar. Minute areas of tissue had died, probably because they had been starved of blood, suggesting that capillaries that supplied blood to the areas had been blocked. The bone necrosis of divers closely resembles that seen in victims of sickle-cell anemia whose capillaries are temporarily blocked during a sickle-cell “crisis” when their red blood cells become too rigid to pass through. Sickle-cell disease damages the retina which doctors can see using the technique known as retinal angiography. The process involves injecting Fluorescein dye into the blood stream and photographing the back of the eye through the pupil. The technique can provide a detailed photograph of the two vascular systems supplying blood to their retina without causing too much discomfort to the patient.

The researchers used retinal angiography to assess the tissue damage in divers. The abnormalities that they detected in the angiograms of divers were very similar to those seen in sickle-cell disease. There was clear evidence of obstruction to the capillaries. The researchers suggested three mechanisms to explain how diving causes this obstruction. When divers come back to the surface air bubbles sometimes form in their veins and their lungs. If bubbles also form in the arteries, they would block the capillaries. Bubbles forming in the lungs trigger changes in the body’s clotting mechanism which could result in minute clots becoming trapped in the capillaries.
The third suggestion is that the mechanism might also be similar to that of sickle-cell disease. The pressure that divers experience at 30 meters causes their white blood cells to become rigid just as red blood cells do during a sickle-cell crisis. The researchers hope that clues to the cause of the obstruction will come from investigations into the individual differences between divers. Some of the divers studied had relatively little damage even though they had been diving for many years and done a great deal of deep diving. On the other hand, a few inexperienced divers had quite extensive damage.


7. According to the article,
A. low blood pressure can cause eye problems in divers.
B. diving is becoming more and more dangerous.
C. eyes can be severely harmed as a result of diving.
D. many divers experience approximately 50% vision loss.
8. The study suggests that
A. divers should have at least two years of experience..
B. experienced divers can avoid the risk of eye damage.
C. professional divers are more careful than amateur divers.
D. none of the above.
9. Damage to the retina is caused by
A. obstructions to blood circulation.
B. loss of pigment in the epithelium.
C. pressure on the central nervous system.
D. all of the above.
10. Approximately 5 per cent of professional divers
A. develop bone necrosis.
B. have annual bone x-rays.
C. get the ‘bends’.
D. are nervous when diving.
11. All of the following were used by doctors to examine the health of practicing divers except
A. nuclear magnetic resonance imaging.
B. post-mortem examinations.
C. memory tests and reaction tests.
D. neurological examinations.
12. Which of the following statements is true according to the article?
A. Small dead patches always develop in divers’ bones.
B. Brain damage is common among North Sea divers.
C. Neurological problems may not be immediately apparent.
D. Spinal cord damage in divers is easily detected.
13. Which of the following is not true according to the article?
A. Sickle-cell anemia is a common disease among divers.
B. Neurological and bone tissue damage are similar.
C. Tissue damage of diver’s results from blockage of blood.
D. Researchers avoided the use of surgery in their investigations.
14. Retinal angiography
A. involves the injection of fluoroscein dye into the pupil.
B. provides graphic information about blood supply to retinas.
C. causes considerable discomfort to the patient.
D. none of the above.





PART C. TEXT 2: PLUMBISM

Paragraph 1: Plumbism is the technical term for lead poisoning, which represent a diseased condition, produced by the absorption of lead, common among workers in this metal or in its compounds, as among painters, typesetters, etc. Lead is a metal which is toxic to humans when ingested or inhaled. When lead enters the bloodstream, whether the route of entry is the lungs or the gastrointestinal tract, it is distributed to the tissues and organs of the body, including the brain, liver and kidneys. In the long term, lead is stored in the teeth and bones. Although it is excreted gradually (mostly in the urine, but also in feces, sweat, hair and nails), repeated exposure and absorption results in an accumulation of lead in the body. Cumulative doses of lead over time can result in chronic lead poisoning, while acute lead toxicity may be observed in cases of short-term, high-dose exposures.

Paragraph 2: A naturally occurring element, lead may be dispersed by natural processes such as erosion, volcanic eruptions and forest fires. Overwhelmingly, however, hazardous human exposure to lead is due to its release into the environment through industrial processes, and to the widespread use of lead-containing products, most notoriously petrol, paints, and plumbing and building materials. Many everyday household items including adhesives, batteries, ceramics, glassware and children’s toys may also contain lead, particularly if manufactured in the twentieth century. Other items that have traditionally contained lead include bullets and radiation shields. Industrial sources of lead contamination of soil, water and air include mining and smelting of lead and lead- containing ore, car manufacture and combustion of large quantities of fuels such as coal in the generation of electricity. The leading cause of lead poisoning among adults is occupational exposure, particularly for those working in the industries previously mentioned.

Paragraph 3: To alleviate the incidence of environmental exposure due to contact with building materials and other products containing lead, industry guidelines and government legislation have been introduced in many countries: drinking water is no longer prone to lead contamination where alternatives to lead pipes and lead-soldered fittings, roofs and water tanks are required in new houses; maximum allowable lead content in domestic paint is now specified in a growing number of jurisdictions; and the last two decades or so have seen leaded petrol banned in most countries around the world. However, exposure to lead particles is still a significant health risk due to the lingering contamination of soil and dust from past fuel emissions, from continuing industrial exposure, and from contact with older lead-based products still in use.

Paragraph 4: Even small quantities of lead taken into the body are considered hazardous to human health. Adverse systemic effects can extend to the neurological, cardiovascular, gastrointestinal and renal. Damage caused by lead poisoning is known to be irreversible in some cases, such as severe neuro-behavioral impairment resulting from acute intoxication. However, health outcomes are influenced by the timing, duration and amount of exposure (or dosage), and by how much accumulation has occurred. Among the available biological markers of lead dose, blood lead levels provide a more accurate measure if there has been recent exposure to lead, while levels of lead in bone, measuring stored lead, are more accurate indicators of accumulation.

Paragraph 5: Among the most vulnerable to lead exposure and its effects are children under the age of six. Where lead is present in soil, dust, paint or toys, young children are at an increased risk of ingesting lead, as they may touch lead- based or contaminated materials with their fingers and mouths. A child’s body is also more susceptible to lead absorption -it has been estimated that a child’s body can absorb 50% of lead particles on exposure compared with only 10% for an adult’s. The likely health effects for young children are even more dire considering the vulnerability of the developing brain to permanent disadvantage as a result of the neurotoxicity of lead. Intelligence quota (IQ) deficit has been linked to neuro-toxic effects in children with lead blood levels as low as five micrograms per deciliter (5µg/dL). Less research has been conducted on the effects of lead exposure during prenatal development but, because lead is able to cross the blood brain barrier and the placenta, the risk of significant harm to the brain and to the developing fetus is a key concern. One study in Mexico led researchers to conclude that fetal neurodevelopment is adversely affected by lead exposure and particularly so during the first trimester of pregnancy.

Paragraph 6: Studies suggest that chronic lead toxicity in individuals could change behavior and cognitive function and even trigger psychosocial disturbances that contribute to aggressive behavior. One study observed a significant decline in rates of violent crime throughout the 1990s in the United States, a country where the use of leaded petrol was phased out during the 1970s. The researchers hypothesized that this change in crime rate is attributable to a reduction of childhood exposure to lead in the decades prior to the 1990s. Studies like this one, which documents an association between childhood lead exposure and criminal behavior in adults, are supported by findings that some adolescent criminals have blood lead levels quadrupling the average among teenagers. Despite these alarming health effects, the World Health Organization has described lead poisoning as a completely preventable disease.


15. Based on the first paragraph, lead
A. is excreted completely from the human body.
B. accumulates mainly in the lungs and intestines.
C. can be taken into the body through the skin.
D. moves about the body via blood circulation.
16. Which is the most likely source of lead poisoning in humans?
A. Exposure in the workplace.
B. A contaminated water supply.
C. Common household items.
D. Medical imaging procedures.
17. Legislation in many countries has resulted in
A. lead pipes being replaced in all housing.
B. petrol being produced without added lead.
C. the use of leaded paint being made illegal.
D. drinking water being guaranteed lead free.
18. The third paragraph describes
A. measures taken to reduce levels of lead in the environment.
B. the elimination of lead contamination in some countries.
C. twenty years of legislation restricting the use of lead.
D. difficulties in removing lead from construction sites.
19. The effects of lead in a person’s body
A. are not easy to observe.
B. cannot be reversed.
C. sometimes cause death.
D. depend on several factors.
20. The preferred method for measuring lead levels in the body depends on
A. how old the person is.
B. how sick the person is.
C. how intense the exposure was.
D. how long ago the exposure was.
21. Young children are at greater risk of lead poisoning than adults due to
A. the continuing presence of lead in children’s toys.
B. their more frequent exposure to contaminated materials.
C. a higher capacity for lead absorption into their bodies.
D. the increased retention of lead in developing brains.
22. In sixth paragraph research links a fall in incidents of violent crime to
A. environmental changes during the 1990s.
B. reduced exposure to lead in the workplace.
C. behavioral changes from lead poisoning.
D. the widespread use of unleaded petrol.


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MANAGEMENT OF BURNS OET READING

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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
• Underlying tissue may appear pale or blackened
• Remaining skin may be dry and white, brown or black with no blisters
• Healing associated with considerable contraction and scarring.
3 Mixed depth burns: 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 be based on the burn thickness at any specific site.

Text B
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


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


TEXT D. ADULT ANALGESIC GUIDELINES
The following table provides recommended short term (<72 hours) oral analgesia guidelines for the 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 Pain Score 1 – 3Moderate Pain Pain Score 4 – 6Severe Pain Pain Score 7 – 10
Recommended analgesia:Recommended analgesia in addition to column 1:Recommended analgesia in addition to column 1 & 2:
Paracetamol 1g 4 x dailyTramadol 50 – 100mg 4 x dailyStrong opioids Oxycontin SR 10mg (2 x daily)
And if needed: Naproxen 250mg 2 x dailyIf above unsuccessful: Endone (immediate release oxycodone) 5 – 10mg (2 – 4 hourly)  Endone, 2 – 4 hourly as needed
 Review in 72 hoursReview 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)

Questions 1-5. 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. In which text can you find information about
1 age-related considerations for initial treatment of burns injuries?
2 the risks involved in certain treatments?
3 when to start thinking about specialist treatment options?
4 treatment informed by patient self-assessment?
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.
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.
13 You should apply ointments containing _________________________to all deeper burns.


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 In the case of mixed depth burns, what factor determines the local treatment to give?
15 What is the maximum number of tries recommended for attaching a drip at the scene of a burn’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?



PART B. Choose the correct option: A, B or C.

1. Doctors are advised to break patient confidentiality if
A. failure to do so would put other people in danger.
B. they inform the patient of their intention in advance.
C. a patient refuses to disclose information relevant to their care.
PATIENT CONFIDENTIALITY: 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 to provide good care.
However, faced with a situation in which a patient’s refusal to consent to disclosure leaves others 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.

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.

TRANSFER OF PATIENTS:
1.15
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:
• 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;
• the receiving ward, with support from critical care if required, can deliver the agreed plan.
1.16
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 recovery. The information should be tailored to individual circumstances. If they agree, their family and carers should be involved.

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.
Memo
To: Hospital staff
Re: Nutrition screening
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 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.
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 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.



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.

Stock requisitioning
If stock levels of a medicine are low, the nurse should firstly liaise directly with their ward-based team to 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
(e.g., the ward medicines requisition book); however, these should not be relied on if ward stock is urgently needed.
“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 sent to the pharmacy department.
Wards/clinical areas using Mediwell 365 cabinets will have orders transmitted automatically to Pharmacy
on a daily basis, as stock is used.

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.

6.2 Intensive Care Unit (ICU)
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 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.
6.2.3 We encourage collaborative patient-centred care. However, the ICU is defined as a closed unit. 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.

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



PART C. For questions 7-22, choose the answer (A, B, C or D)

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

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. 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 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 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.



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.
8. In the second paragraph, what point is made about food intolerances?
A. Scientists continue to disagree about their root causes.
B. The symptoms are indistinguishable from those of allergies.
C. They can have an unpredictable impact on the person affected.
D. The distinction between them and allergies is not widely appreciated.
9. The phrase ‘via a different biological mechanism’ in the third paragraph explains
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.
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.
12. What does the phrase ‘this rule’ in the fifth paragraph refer to?
A. the likelihood of having an inherited allergy to certain foods
B. the type of diet in which food allergies more commonly occur
C. the degree of contact with allergens needed to trigger a reaction
D. the order of events most commonly found prior to allergic attacks
13. What does the sixth paragraph suggest about the transference of allergies between mother and child?
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.



PART C. 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 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- 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 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 and diabetes.

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

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

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


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
16. When the writer uses the word ‘cost’ in the second paragraph she is referring to
A. overwhelming evidence.
B. placental insufficiency.
C. viable pregnancy.
D. reduced growth.
17. In the third paragraph, what does the author suggest about the work of the international research
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
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.
20. In the sixth paragraph, what is suggested about the inhabitants of La Paz?
A. The altitude affects all socio-economic groups in a similar way.
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.
D. Poorer residents have a genetic advantage over those with higher incomes.
21. The purpose of the information in the sixth paragraph is to provide
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

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LYMPHOEDEMA OET READING

1 Comment

TEXT A: Phenotyping childhood lymphoedema: Primary lymphoedema is chronic oedema caused by a developmental abnormality of the lymphatic system and is the most common type seen in the paediatric population. In primary lymphoedema, fluid accumulates due to either abnormal function or structure of the lymphatic system. In most cases, oedema will be present from birth but in some cases, although the lymphatic abnormality is presumed to be present congenitally, the swelling does not develop until sometime later. It is thought that the lymphatic system normally functions at about 10% capacity and it is presumed that this functional redundancy allows homeostasis to be maintained for some time in this group of patients. A population prevalence of 1.33 per 1000 for all ages has been reported but it is acknowledged that this is probably an under estimation of the true burden of disease. A specific prevalence figure for primary lymphoedema in the paediatric population has been estimated at 1.15 per 100,000 population, but these numbers are based on those attending a single US clinic. A female preponderance (M:F ± 1:3) is documented, although this may represent ascertainment bias. Primary impairment of the lymphatic drainage system will begin surfacing due to a non-syndromic mendelian condition or as majorly because of other undefined disorder.

TEXT B. Milroy disease: Milroy disease is congenital onset lymphoedema which, although rarely, transform limbs to the nth degree or portion below the knee to the toe partially but is not reported to affect the arms. Males and females are affected equally. In males, hydroceles are common, affecting up to 30% of those carrying the altered gene. Other characteristic clinical findings include upslanting `ski-jump` toenails and prominent large calibre veins in the legs, most commonly the great (long) saphenous veins. The causative gene was first located on chromosome 5q in 1998 and subsequently numerous causative mutations in the VEGFR3 gene have been described. In those individuals not conforming to the Milroy phenotype, molecular testing of VEGFR3 is not warranted. Inheritance of Milroy disease is autosomal dominant with a penetrance of approximately 85%. This is going to be troublesome for sure as there will be 50% children that might get it from parents who are carrying the genes. De novo mutations have been reported so a family history is not mandatory. For this reason, it is always worthwhile testing the parents of an affected child before calculating recurrence risks.

TEXT C. Lymphoedema distichiasis: Lymphoedema distichiasis syndrome is a very unusual, not-so-arcane, dominantly inherited condition for which the underlying genetic cause was identified by Fang et al. Almost all individuals with lymphoedema distichiasis syndrome have mutations in FOXC2. This condition is the association of primary, pubertal, or post-pubertal, onset lymphoedema with aberrant eyelashes arising from the Meibomian glands in the eyelids. Other associations include; cleft palate, congenital heart disease, varicose veins and ptosis. Half of affected individuals will have clinically evident varicose veins from an early age, while 100% have venous abnormalities when assessed by ultrasound scanning. A lymphoscintigram showing lymph reflux will necessitate the diagnosis of lymphoedema distichiasis. If distichiasis is not present in the patient or a family member, the chance of finding a mutation in the causative gene, FOXC2, is extremely unlikely. As distichiasis can be difficult to see, slit lamp examination by an ophthalmologist is advised wherever possible. Due to the increased risk of both cleft palate and congenital heart disease, additional pre-natal scans may be recommended for a fetus at risk of inheriting the condition.

TEXT D. Case Study: A 29-year-old woman with a history of renal cysts, hypertension and lymphoedema distichiasis syndrome, was referred to ophthalmology, with bilateral blurred vision, hyperaemia and ocular pain, developed over months. The patient had no positive family history for lymphoedema-distichiasis or other diseases. Clinical examination revealed stunted height (144 cm), neck webbing, bilateral and asymmetric lymphoedema, bilateral distichiasis and keratitis. Other ocular manifestations of lymphoedema-distichiasis, such as ptosis and strabismus, were excluded through ophthalmological examination.
The patient`s symptoms regressed with bilateral electrolysis of the abnormal follicles after unsuccessful attempts at epilation and follicle removal using an argon laser. Lymphoedema-distichiasis syndrome is a rare condition, associated with diminished quality of life, being linked with chronic keratitis, conjunctivitis and photophobia in 75% of cases.
Distichiasis, which may be present at birth, is observed in 94% of affected individuals. The FOXC 2 gene is the only gene in which mutations are known to cause lymphoedema distichiasis syndrome. Its protein has a role in a variety of developmental processes, such as formation of veins, lungs, eyes, kidneys, urinary tract, cardiovascular system and lymphatic vessels. Any pathogenic variant of this gene could lead to varicose veins, absence of lymphatic valves, lymphoedema, and cardiovascular and kidney malformations.
The patient did not have a family history for this syndrome. For this reason, lymphoedema-distichiasis syndrome in this case was a probable phenotypic manifestation of a de novo mutation in the FOXC 2 gene.



Questions 1-7. For each question, 1-7, decide which text (A, B, C or D) the information comes from. In which text can you find information about;
1. A rare disease condition, peculiarly begins at very early age.
2 .Diagnosis is based on the presence of primary lymphoedema and distichiasis.
3. Disorder is passed down (inherited) through families.
4. A condition characterized by an excess of watery fluid collecting in the cavities or tissues of the body.
5. It can be said that approximately 75% of affected individuals have an affected parent.
6. No proper statistics are available.
7. Classically affects lower half of the legs only.

Questions 8-14. Answer each of the questions, 8-14, with a word or short phrase from one of the texts.
8. What can occur as a part of more complex syndromic disorder? ______________
9. What is suggestive of a diagnosis of lymphoedema distichiasis? ______________
10. Which syndrome is inherited in an autosomal dominant manner? ______________
11. What is that Greek Word which may mean “Two Rows?” ______________
12. What is the percentage of recurrence risk for family members if one of the parents carries the gene?
13. Which Greek or Latin Word may mean “From The Beginning? ______________
14. Which syndrome can also present with cardiac abnormalities? ______________


QUESTIONS 15-20. Complete each of the sentences, 15-20, with a word or short phrase from one of the texts
15. ______________________ is possible even with more definitive treatment.
16. ______________________ are known to be affecting many of those with modified gene.
17. In absence of distichiasis, it could be difficult to find ______________ in the causative gene.
18. Conservative management of ______________is with lubrication or epilation.
19. ______________________ may not surface itself in an apparent way.
20. It is advisable that ____________shall undergo testing as this can minimize risk of transfer of genes



PART B. For questions 1-6, choose the answer (A, B or C)

1. As per information given in the table, to define NAFLD;
A. Evidence of hepatic steatosis both by histology and imaging is required.
B. Secondary causes of hepatic fat accumulation needed to be taken into consideration.
C. Monogenic hereditary disorder gets revealed.
NAFLD: In the majority of patients, NAFLD is commonly associated with metabolic comorbidities such as obesity, diabetes mellitus, and dyslipidemia. NAFLD can be categorized histologically into nonalcoholic fatty liver (NAFL) or non-alcoholic steatohepatitis. NAFL is defined as the presence of 5% HS without evidence of hepatocellular injury in the form of hepatocyte ballooning (e.g., ballooning), with or without any fibrosis. A not-so common form of monogenic disorder but the underlying genetic defect is expressed.

2. The notice is giving more information about;
A. Signs and symptoms.
B. Problems that might occur due to CMV.
C. The contagious nature of the virus.
Infected babies may have health problems that are apparent at birth or may develop later during infancy or childhood. Although not fully understood, it is possible for CMV to cause the death of a baby during pregnancy (pregnancy loss). Some babies may have signs of a congenital CMV infection at birth. These signs include:
• Premature birth, Liver, lung and spleen problems,
• Small size at birth, Small head size, and Seizures.
Babies with congenital CMV infection at birth may have long-term health
problems, such as: Hearing loss, Vision loss, Intellectual disability, Small head size etc.

3. What is right about risks, specific to Laparoscopic Splenectomy?
A. Swelling on the stomach.
B. May damage lungs completely.
C. Blood vessels may rupture.
Risks Involved: Injury to the tail of the pancreas, resulting in a collection of fluid in the abdomen that may require a further operation or drainage procedures. Bleeding from the blood vessels that flow to the spleen requiring a return to the operating theatre. Significant distention of the stomach that may lead to a large vomit. Occasionally some of this vomit may be inhaled into the lungs and cause life threatening pneumonia. This is why a tube will be placed via your nose into the stomach for the first day after the operation.
Splenunculi. Many people have tiny `extra` spleens. After the spleen is removed, they may grow and patients with blood diseases may have a recurrence of their
disease. This may require further surgery. Because the spleen is very close to the lung, collapse of the left lung, to some measure, is quite common after splenectomy. A physiotherapist will work with you to prevent this. It is very common to have a slight fever on the first 1 ± 2 days after the operation because of this lung collapse.



4. The report stresses more on;
A. Shows relatively small for GA
B. Mothers who had consultations more than three times outnumbered those who had consultations only twice or thrice.
C. Widespread prevalent of the infection.
The majority of the NB had adequate intrauterine growth (67.9%), while 26.9% were small for gestational age (SGA) and 5.2% were large for gestational age. Maternal age varied from 14 to 48 years (mean 25.8±7.3 years). More than 80% of the population of recently delivered mothers were married or had a stable relationship. Two hundred and thirty-seven (94.8%) of the 250 mothers had received some prenatal, with 175 attending four or more consultations and 62 from one to three.

5. The manual gives information about;
A. Asystole threshold rate
B. Detection rate
C. ECG operations
All ventricular fibrillation (VF) and ventricular tachycardia (VT) rhythms at or above this rate will be classified as shockable. All rhythms below this rate will be classified as non-shockable. This rate is programmable between 120 bpm (beats per minute) and 240 bpm via MDLink Software by the Medical Director. The default Detection Rate is 160 bpm
The asystole baseline-to-peak threshold is set at 0.08 mV. ECG rhythms at or below 0.08 mV will be classified as asystole and will not be shockable. The AED will detect noise artifacts in the ECG. Noise could be introduced by excessive moving of the patient or electronic noise from external sources like cellular and radio telephones. When noise is detected, the AED will issue the prompt “ANALYSIS INTERRUPTED. STOP PATIENT MOTION” to warn the operator. The AED will then proceed to reanalyze the rhythm and continue with the rescue.

6. What does the word sepsis mean?
A. Life-threatening complication arising due to infection.
B. Indicates release of chemicals into the bloodstream to fight the infection.
C. Higher death risk arising due to infection
Pediatric Trauma: The field has made major advances in the areas of sepsis, lung injury, traumatic brain injury and postoperative care. The pediatric intensive’s role in the Trauma Events is to give steady care during cardiorespiratory or multi-organ failure or recuperation from surgical medications or a traumatic injury that happens to an infant, child or adolescent. It manages the medicinal consideration of infants, children, and teenagers, and as far as possible as a rule ranges from birth up to 18 years old. It is a zone inside a healing center, spends significant time in the consideration of critically ill infants and children. The risk of death for injured children is significantly lower when care is provided in pediatric trauma, which focuses as opposed than non-pediatric trauma which is incorporated into the Critical Care Meetings.



PART C. TEXT1. For questions 7-22, choose the answer (A, B, C or D)
SEBORRHEIC ECZEMA
Seborrheic eczema, also known as seborrheic dermatitis, is a very common skin condition that causes redness often asymmetrically, scaly patches, and dandruff. It most often affects the scalp in an expeditious manner. It may, sometimes, begin to flourish in oily areas of the body, such as the face, upper chest, and back. It is hard to say how it may expand or who may get it – adults, children or newborn babies. When infants develop this condition, it`s known as crib cap; it typically develops within the first few weeks of life and gradually disappears over several weeks or months. The exact cause of seborrheic eczema isn`t known. However, doctors believe there are two main factors that can contribute to the development of the condition. The first factor is an overproduction of oil. An excess amount of oil in the skin might act as an irritant, causing the skin to become red and greasy. The second contributing factor is Malassezia, which is a type of fungus that`s naturally found in the skin`s oils. It can, sometimes, burgeon abnormally, causing the skin to secrete more oil than usual; the increased production of oil can lead to seborrheic eczema.

The condition might also develop in infants due to hormonal changes that occur in the mother during pregnancy. The fluctuating hormone levels are believed to stimulate the infant`s oil glands, leading to an overproduction of oil that may provoke this condition, begin to peeve the skin. Seborrheic eczema is a long-term skin condition that requires ongoing treatment. However, developing a good skin care routine and learning to recognize and eliminate triggers can help you manage the condition effectively. The symptoms of seborrheic eczema are often aggravated by various factors, including stress, change of seasons, and heavy alcohol use. The types of symptoms that thrive enormously can vary from person-to-person. It`s also possible for symptoms to occur in different parts of the body.

Seborrheic eczema tends to develop in oily areas of the body. It most often affects the scalp, but it can also occur in the following areas: in and around the ears, on the eyebrows, on the nose, on the back, on the upper portion of the chest etc. Seborrheic eczema has a distinct appearance and set of symptoms: skin develops scaly patches that flake off; the patches may be white or yellowish in color (this problem is commonly known as dandruff and it can occur in the scalp, hair, eyebrows, or beard); skin in the affected area tends to be greasy and oily; skin in the affected area may be red; skin in the affected area may be itchy; hair loss may occur in the affected area.

Doctors aren`t exactly sure why some people develop seborrheic eczema while others don`t. However, it does appear that it develops more quickly if a close family member has it. Other factors that contribute to its growth may include: obesity, fatigue, poor skin care, stress, environmental factors, such as pollution, the presence of other skin issues, such as acne etc. The symptoms are similar to those of other skin conditions, including rosacea. To make an accurate diagnosis, a doctor will perform a physical examination and carefully inspect the affected areas. The doctor may also want to perform a biopsy before making a diagnosis. During this procedure, the doctor will scrape off skin cells from the affected area; these samples will then be sent to a laboratory for analysis. The results will help to rule out other conditions that may be causing symptoms.

The doctor will likely recommend the patients to try some home remedies before considering medical treatments. Dandruff shampoos are frequently used to treat seborrheic eczema on the scalp; they usually need to be used every day for optimal results and it is important to follow all instructions on the bottle carefully. Other home treatments that may help manage seborrheic eczema include: using over-the counter (OTC) antifungal and anti-itch creams; using hypoallergenic soap and detergent; thoroughly rinsing soap and shampoo off the skin and scalp; shaving off a moustache or beard; and wearing loose cotton clothing to avoid skin irritation.

TEXT 1: QUESTIONS 7-14

7. According to paragraph 1, seborrheic eczema is;
A. Common among adults
B. Common among children
C. Common among newborn babies
D. Still a mystery to doctors
8 In paragraph 1, which medically-suitable word or phrase would mean growing or developing more in infection?
A. Asymmetrical
B. Burgeon
C. Flourish
D. Expand
9. According to paragraph 2, which one of the following statements is true about seborrheic eczema?
A. Infants may get this disease from their parents.
B. This disease occurs due to secretion of excess of oil by the oil glands, during pregnancy.
C. There is no specific treatment available for this disease.
D. This disease can spread to various parts of the body as well.
10. According to paragraph 2, which word would mean: to make a bad situation worse?
A. Provoke
B. Peeve
C. Aggravate
D. Thrive
11. Paragraph 3 talks more about ………
A. How the disease affects body parts.
B. How the symptoms develop.
C. How it can spread to other body areas.
D. Affected areas and symptoms.
12. In paragraph 3, flake off may mean.
A. to begin to fall
B. to come off a surface in small, thin pieces
C. to become more obvious
D. to begin to develop, usually on the surface
13. The most suitable heading for paragraph 4 is …………
A. Common symptoms of seborrheic eczema
B. Common symptoms and risk factors for eczema
C. Who is at risk for seborrheic eczema?
D. How is seborrheic eczema examined?
14. The most suitable heading for paragraph 5 is?
A. Treatment options for seborrheic eczema
B. Cost-effective management of seborrheic eczema
C. Common treatment procedures for home-based patients
D. How can you treat seborrheic eczema at home?

PART C. TEXT 2: FIBROMYALGIA

Fibromyalgia is a long-term or chronic disorder. It`s associated with widespread pain in the muscles and bones, areas of tenderness, and general fatigue. Symptoms like these are considered subjective. The lack of reproducible, objective tests for this disorder plays a role in some doctors questioning the disorder altogether.
Although it`s more widely accepted in medical circles now than previously, some doctors and researchers don`t consider fibromyalgia a de facto condition. This can increase risk of depression, which stems from a struggle in gaining acceptance for painful symptoms.

Researchers are closer to understanding fibromyalgia, so the stigma that surrounds the condition is disappearing. In the past, many doctors worried that people could use this undetectable pain as an excuse to seek out prescription pain medication. Doctors are now finding that lifestyle changes may be better than medication in treating and managing this condition. The more that doctors begin to accept this diagnosis, the more likely the medical community is to explore effective ways of treating fibromyalgia.

Fibromyalgia is often associated with areas of tenderness, which are called trigger points or tender points. These are places on your body where even light pressure can cause pain. Today, these points are rarely used to diagnose fibromyalgia. Instead, they may be used as one way for doctors to narrow their list of possible diagnoses. The pain caused by these trigger points can also be described as a constant dull ache affecting many areas of your body. If you were to experience this pain for at least three months, doctors may consider this a symptom of fibromyalgia. People with this disorder may also experience: fatigue, trouble sleeping, sleeping for long periods of time without feeling rested, headaches, depression etc.

A person used to be diagnosed with fibromyalgia if they had widespread pain and tenderness in at least 11 of the known 18 trigger points. Doctors would check to see how many of these points were painful by pressing firmly on them. Trigger points are no longer the focus of diagnosis for fibromyalgia. Instead, doctors may make a diagnosis if you report widespread pain for more than three months and have no diagnosable medical condition that can explain the pain. Medical researchers and doctors don`t know what causes fibromyalgia. However, thanks to decades of research, they`re close to understanding factors that may work together to cause it which include: Infections: Prior illnesses may trigger fibromyalgia or make symptoms of the condition worse. Fibromyalgia often runs in families. If you have a family member with this condition, your risk for developing it is higher.

Researchers think certain genetic mutations may play a role in this condition; those genes haven`t yet been identified. People who experience physical or emotional trauma may develop fibromyalgia. The condition has been linked with posttraumatic stress disorder. Like trauma, stress can create long-reaching effects your body deals with for months and years. Stress has been linked to hormonal disturbances that could contribute to fibromyalgia. Doctors also don`t fully understand the factors that cause people to experience the chronic widespread pain associated with the condition. Some theories suggest it may be that the brain lowers the pain threshold. Although the causes are unclear, fibromyalgia flare-ups can be the result of stress, physical trauma, or an unrelated systemic illness like the flu. It`s believed the brain and nervous system may garble or overreact to normal pain signals. This incorrect interpretation could be due to an imbalance in brain chemicals.

TEXT 2: QUESTIONS 15-22

15. In paragraph 1, what does the word subjective mean?
A. Something that requires fact
B. Illusory
C. Not easy to understand and explain
D. D Something that can`t be determined or measured by tests

16. According to paragraph 1, what do some doctors feel about fibromyalgia?
A. It is a serious condition
B. It is a condition that is difficult to examine
C. It is a condition that is not real
D. It is a condition which every patient finds difficult to accept

17. According to paragraph 2, which one of the following statements is true?
A. Doctors of the 21st century know more about this condition.
B. Doctors believe change in lifestyle can be more effective in managing the condition.
C. Doctors are still finding effective ways of treating this condition.
D. Researchers are working on developing new drugs for the treatment of this condition.

18. The most suitable heading for paragraph 3 is ………
A. What are the symptoms of fibromyalgia?
B. Trigger points are significant in the diagnosis of fibromyalgia.
C. The causal agents of fibromyalgia.
D. Common and uncommon symptoms of fibromyalgia.

19. The most suitable heading for paragraph 4.
A. Role of genetic mutation in fibromyalgia.
B. What are trigger points?
C. What causes fibromyalgia?
D. About trigger points and causal agents of fibromyalgia.

20. According to paragraph 4, which one of the following statements is true?
A. Doctors first check trigger points to identify the problem of fibromyalgia.
B. Fibromyalgia is a genetic disorder
C. Fibromyalgia is hard to detect
D. Doctors in the 21st century know more about how fibromyalgia occurs

21. According to paragraph 4, which one of the following statements is true?
A. Fibromyalgia is common among people who suffer from emotional trauma.
B. Stress is also one of the factors that often leads to fibromyalgia.
C. People who suffered long-term illness can develop fibromyalgia.
D. none of the above

22. The most suitable heading for paragraph 5 is.
A. Genetic Disorder
B. Who are at risk of developing fibromyalgia?
C. how fibromyalgia is caused?
D. common disease-growth indicators

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JUNIOR SPORTS INJURIES OET READING

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TEXT A. Title: Patters of injury in US high school sports: A review. OBJECTIVES: to characterize the risk of injury associated with 10 popular high school sports by c 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 rosters for football, wrestling, baseball, field hockey, softball, girls’ volleyball, boy’s or girls’ basketball, and boy’s or girls’ soccer.

MEASUREMENTS: Injuries and opportunities for injury 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 1nost 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 concuss10n.

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 1-7. For each question, 1-7, decide which text (A, B, C or D) the information comes from. 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? _____________

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.

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, numbers or both.

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____________________

Part B. For questions 1-6, choose the answer (A, B or C)

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.

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

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.

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.

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.

3.      The email is reminding  staff that log book  should not

A. contain the frequency  of  procedures perf armed

B. have any personal  details of  patients

C. have  any unique  identifiers of patients

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.

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

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.

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

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.

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

Part C. TEXT 1. Choose the answer (A, B, C or D) Swine Flu Found in Birds

Paragraph 1: Last week the H1N1 virus was found in turkeys on farms in Chile. The UN now says poultry f arms 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.

Paragraph 2: 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.”

Paragraph 3: 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.

Paragraph 4: 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 H5Nl bird flu in flocks in Chile. However, Dr Lubroth said: “In Southeast Asia there is a lot of the (H5Nl) virus circulating in poultry. “The introduction of H1N1 in these populations would be of greater concern.”

Paragraph 5: Colin Butter from the UK’s Institute  of  Animal Health agrees. “We hope it is  a rare event and we must mo!1,itor 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.”

Paragraph 6: 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.”

Paragraph 7: 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.

Paragraph 8:  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.

Paragraph 9: 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.

Paragraph 10:  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.

Paragraph 11:   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 Northerri Hemisphere countries need to brace for a second wave of H1N1 as their  winter  approaches.

Paragraph 12:  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.

Paragraph 13:  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.

QUESTIONS:

Q1. 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

Q2. 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.

Q3. 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.

Q4. 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

Q5. Which statement best describes the opinion of the representative from the Institute of  Animal Health?

a.) He doesn’t 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.

Q6. 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.

Q7. 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.

Q8. 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.  Choose the answer (A, B, C or D) Alzheimer Disease

Paragraph 1: 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 f eel good-particularly if the activity is both challenging and successfully completed.

Paragraph 2: 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.

Paragraph 3:  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 f our 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.

Paragraph 4: 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 .

Paragraph 5: 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 ref er 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.

Paragraph 6: 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 straight forward techniques, such as concentrating, or taking notes, or putting objects in the same- place each time so that they won’t be   lost.

Paragraph 7: 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.”

QUESTIONS

Q1. 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

Q2. In paragraph  2, the author expresses the opinion that    …….

a.  Mentally stimulating activities may off er 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

Q3. 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

Q4. 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

Q5. 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

Q6. 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

Q7. 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

Q8. 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

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HEADACHE OET READING

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TEXT A: Headaches are one of the most common medical complaints; most people experience them at some point in their life. They can affect anyone regardless of age, race, and gender.

  • A headache can be a sign of stress or emotional distress, or it can result from a medical disorder, such as migraine or high blood pressure, anxiety, or depression. It can lead to other problems. People with chronic migraine headaches, for example, may find it hard to attend work or school regularly.
  • Primary headaches: Primary headaches are stand-alone illnesses caused directly by the over activity of, or problems with, structures in the head that are pain-sensitive.
  • This includes the blood vessels, muscles, and nerves of the head and neck. They may also result from changes in chemical activity in the brain. Common primary headaches include migraines, cluster headaches, and tension headaches.
  • Secondary headaches: Secondary headaches are symptoms that happen when another condition stimulates the pain-sensitive nerves of the head. In other words, the headache symptoms can be attributed to another cause.

A wide range of different factors can cause secondary headaches. These include:

  • alcohol-induced hangover
  • brain tumor
  • blood clots
  • bleeding in or around the brain
  • “brain freeze,” or ice-cream headaches

TEXT B: Diagnosis: Have chronic or recurrent headaches, conduct physical and neurological exams, then try to pinpoint the type and cause of your headaches using these approaches:

Your pain description: One can learn a lot about your headaches from a description of your pain. Be sure to include these details:

  • Pain characteristics. Does your pain pulsate? Or is it constant and dull? Sharp or stabbing?
  • Pain intensity. A good indicator of the severity of your headache is how much you’re able to function while you have it. Are you able to work? Do your headaches wake you or prevent you from sleeping?
  • Pain location. Do you feel pain all over your head, on only one side of your head, or just on your forehead or behind your eyes?

Imaging tests: For unusual or complicated headaches, prescribe may order tests to rule out serious causes of head pain, such as a tumor. Two common tests used to image your brain include:

  • Magnetic resonance imaging (MRI). An MRI scan combines a magnetic field, radio waves and computer technology to produce clear images.
  • Computerized tomography (CT). A CT scan is a diagnostic imaging procedure that uses a series of computer-directed X-rays to provide a comprehensive view of your brain.

TEXT C: American College of Radiology Recommendations for Neuroimaging in Patients with Headache

CLINICAL FEATURESRECOMMENDED IMAGING MODALITY
Headache in immunocompromised patientsMRI of the head with and without contrast media
Headache in patients older than 60 years with suspected temporal arteritisMRI of the head with and without contrast media
Headache with suspected meningitisCT or MRI of the head without contrast media
Severe headache in pregnancyCT or MRI of the head without contrast media
Severe unilateral headache caused by possible dissection of the carotid or arterial arteriesMRI of the head with and without contrast media, MRA of the head and neck, or CTA of the head and neck
Sudden onset or severe headache; worst headache of the patient’s lifeCT of the head without contrast media; CTA of the head with contrast media, MRA of the head with or without contrast media, or MRI of the head without contrast media

CT = computed tomography; CTA = computed tomographic angiography; MRA = magnetic resonance
angiography: MR/ = magnetic resonance imaging.

TEXT D: Treatment

Some people with tension headaches don’t seek medical attention and try to treat the pain on their own. Unfortunately, repeated use of over-the-counter (OTC) pain relievers can actually cause another type of headache, overuse headaches.

Acute medications: A variety of medications, both OTC and prescription, are available to reduce the pain of a headache, including:

  • Pain relievers. Simple OTC pain relievers are usually the first line of treatment for reducing headache pain. These include the drugs aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve). Prescription medications include naproxen (Naprosyn), indomethacin (Indocin) and ketorolac (Ketorolac Tromethamine).
  • Combination medications. Aspirin or acetaminophen or both are often combined with caffeine or a sedative drug in a single medication. Combination drugs may be more effective than are single- ingredient pain relievers. Many combination drugs are available OTC.
  • Triptans and narcotics. For people who experience both migraines and episodic tension headaches, a triptan can effectively relieve the pain of both headaches. Opiates, or narcotics, are rarely used because of their side effects and potential for dependency.

Preventive  medications: Preventive medications may include:

  • Tricyclic antidepressants. Tricyclic antidepressants, including amitriptyline and protriptyline, are the most commonly used medications to prevent tension headaches. Side effects of these medications may include constipation, drowsiness and dry mouth.
  • Other antidepressants. There also is some evidence to support the use of the antidepressants venlafaxine (Effexor XR) and mirtazapine (Remeron).
  • Anticonvulsants and muscle relaxants. Other medications that may prevent tension headaches include anticonvulsants, such as topiramate (Topamax). More study is needed.

Questions 1-7. Headache: Questions

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. What leads to another headache? _______________

2. Signs that a patient may have headache _______________

3. How to decide which clinical scanning is for headache _______________

4. Alternative medications for Acute medications _______________

5. Other conditions which are associated with headache? _______________

6. Types of headaches _______________

7. What to consider while suggesting scanning _______________

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.

8. Repeated uses of OTC pain relievers can cause ____________
9. If a pregnant woman is suffering from severe headache, which imaging modality is recommended________?
10. An MRI Scan imaging is the combination of radio waves, magnetic field and ____________to generate clear images.
11. What should be recommended to a patient suffering from migraine and tensional headaches _____?
12. Blood clots in brain may induce headaches.
13. If an old age patient is suspected arthritis, ____________ to be referred to confirm.
14. Migraines, cluster headaches, and tension headaches are __________

Questions 15-20. Answer each of the following questions, 15-20, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.
15. Which two examinations are necessary in assessing a patient suffering from chronic headache?
16. Which drugs are used for headaches in the first line of treatment?
17. Which scan that you would prescribe to patient, to comprehensive brain view?
18. What to consider while diagnosing a patient?
19. Combination drugs may be more effective in relieving pain compared to?
20. Which antidepressants usage will lead to constipation, drowsiness and dry mouth?

PART B. For questions 1-6, choose the answer (A, B or C) which you think fits best according to the text.

1. What should be ideal to maintain for protection from blurred vision?
A. Protective goggles
B. Amsler grid
C. Safety measure
Patient Education Guidelines: Patients should be instructed to return if visual acuity decreases. Signs of decreased central visual acuity may include central blurred vision, difficulty in depth perception, and distortion of lines and objects.
Families and patients will benefit from using an Amsler grid to detect early changes in asymptomatic but high-risk individuals. More emphasis should be placed on safety measures to avoid trauma even if trivial. Protective goggles are useful for young patients who participate in sports.

2. The purpose of this instructions is to explain how to
A. deal with Ovarian Cancer
B. estimate the extent of Ovarian Cancer
C. find out the source of origin for Ovarian Cancer.
Extract from manual: Practice Essentials.
• Ovarian cancer is the most common cause of cancer death from gynecologic tumors in the United States. Malignant ovarian lesions include primary lesions arising from normal structures within the ovary and secondary lesions from cancers arising elsewhere in the body. Primary lesions include epithelial ovarian carcinoma (70% of all ovarian malignancies). Current research suggests that the majority of these originate from the fallopian tubes.
• Stromal tumors of the ovary include germ-cell tumors, sex-cord stromal tumors, and other more rare types. Metastases to the ovaries are relatively frequent; common sources are tumors in the endometrium, breast, colon, stomach, and cervix.

3. What does this information tell us about?
A. How does a Breathalyzer Work
B. How it checks breathe rate
C. Guidelines to use breathalyzer.
Breathlyzer: The breathalyzer or intoxilyzer is a modified IR spectrometer. When you blow into the intoxilyzers, the breath you expire passes into a sample chamber and if you have been drinking then so will some of the alcohol that has passed from your blood to your breath. In the case of the Lion Intoxilyzer 6000, produced by Lion Labs, the machine starts sampling the breath immediately as it starts to enter the chamber and does so 37 times per second. The machine continues to monitor this until you blow a consecutive reading for 3 seconds. This is so that it is taking the reading from the deep lung air, where the greatest concentration of alcohol is. Once this is achieved, the machine will register that a satisfactory sample has been taken. It will then purge itself and move to the next stage (either a second sample or a calibration check)



4. The purpose of this manual is to explain about
A. The much care that an equipment user needs to take
B. To consider this while maintaining cardiac monitors only
C. Its short term benefits
User manual: Elecronic Diagnostic Equipment: There are many items of equipment in a hospital that use electronics for operation. The maintenance of such equipment is a task for specialised and trained staff. However, regular inspection and cleaning will help such equipment last for a long time and deliver safe function. These are tasks that the equipment user can carry out and should be done regularly, as laid out on the checklists on the next pages. The types of equipment that might be included in this category are for instance audiometers, blood gas analyzers, cardiac monitors, cryoprobes, infusion pumps and stimulators. The steps in this section can also be applied to most laboratory equipment, although it should be noted that the WHO publication Maintenance Manual for Laboratory Equipment deals with these in much better detail.

5. What do you understand form the manual extract?
A. It is used in pre-risk estimation across the state.
D. This will help you to report adverse situation
E. Requirements to use PSRP
Patient Safety Reporting Program: The Patient Safety Reporting Program (PSRP) collects, analyzes, and shares non- identifiable information about why adverse events and near misses occur, and what facilities are doing to prevent similar events. When you contribute information to PSRP for analysis, it is protected and confidential. Your information can be aggregated with similar organizations across the state to identify patterns of risk and actions to eliminate patient safety hazards. What You Need to Use PSRP
To use PSRP: Your facility must be a PSRP participant. You must have a PSRP account.

6. The purpose of this email is
A. To refer the recent changes in healthcare
B. To explain the reasons for why the Older are not treated satisfactorily.
C. To remind the duties that overcome difficulty at operation.
Email to Group Staff: You might think that helping an older adult get to the hospital is as simple as dropping them off at “Admitting” and allowing the hospital staff to take care of the rest. Think again. Older patients desperately need your help because hospital risks are at an all-time high; even a short stay can be fraught with medical errors, medication mistakes, falls, infectious diseases and a host of other life-threatening events for elderly in the hospital.
• Hospital medical staff wants the very best medical care for your older loved one, but they are under tremendous pressure. Few can overcome patient overload, a nationwide nursing shortage and a developing physician shortage. Many hospitals in Australia are suffering from financial duress, rendering them unable to accommodate the many needs and vulnerabilities of older adults.
• Enter the patient advocate. You as a family member or good friend must monitor older
• patients’ medical care and provide support during a hospital stay to minimize hospital risks.



PART C. TEXT: 1. For questions 7- 22, choose the answer (A, B, C or D)
WHAT IS DEPRESSION?

At one point or another most people talk of feeling depressed, but there’s a big difference between ‘feeling blue’ and clinical depression. Churchill described it as a black dog lurking behind him, while comedic genius Spike Milligan said his depression was both a blessing and a curse.

In the last decade there has been a significant effort to boost public awareness of mood disorders – especially depression – and provide support for those affected by the illness. In reality, depression is more akin to a feeling of numbness than a feeling of sadness. While it can be triggered by a particular event like loss of a job or a loved one, it can also come on for no apparent reason. It’s unfortunate that we use the same word for two different things – a low mood, and a diagnosable illness. It means people often fail to recognise the symptoms of depression, and don’t get treatment for it. At its worst, severe depression can end in suicide.

In reality, everyone is vulnerable to depression: in Australia one in four women and one in six men will experience an episode of clinical depression during their lifetime, and an estimated 6 per cent of Australian adults are affected by a depressive illness. Depression is caused or triggered by genes, biology, psychology, personality, life events … “it’s an incredibly complex condition”. Family and twin studies have shown that some depressions can have a genetic component. If someone in your immediate family has been diagnosed with depression or bipolar disorder (manic depression), you are two to three times more likely to have a similar diagnosis yourself. Twin studies have found that genetics increase the risk of developing clinical depression by roughly 40 per cent.

Certain medical conditions can also increase the likelihood of depression. For example, having an under-active thyroid gland can contribute to depression, and research shows that people who’ve had a heart attack, stroke, cancer, or diabetes, for example, have higher than average rates of depression. Some prescription medications can increase the risk of depression. Depression is also more likely if you are female, are under stress or experience a stressful life event such as the death of a loved one, a relationship ending or losing a job. A history of abuse or childhood deprivation can also predispose people to depression.

People who are prone to worrying and feeling anxious, the extremely shy, those who engage in negative self-talk or people who are extremely sensitive are all more likely to experience depression. Often those with a tendency to set unrealistic goals and exhibit certain kinds of perfectionism also have also been associated with an increased risk of depression, particularly in the face of work or school related stressors. One area of recent controversy around the diagnosis of clinical depression is related to grief that follows the recent death of a loved one.

In previous versions of what is considered to be the ‘psychiatry bible’, there was a ‘bereavement exclusion’, which recommended that clinicians not diagnose major depression in an individual who had experienced the death of a loved one in the previous two months. The argument was that normal grieving could present as depression and be misdiagnosed. However, in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the expert committee decided to remove the ‘bereavement exclusion’, arguing that it may have resulted in major depression being overlooked in these grieving individuals.

While everyone grieves differently, and grief shares many of the same features as depression, the expert committee behind the DSM-5 identified some key features separating them. “In grief, painful feelings come in waves, often intermixed with positive memories of the deceased; in depression, mood and ideation are almost constantly negative,” they write. “In grief, self-esteem is usually preserved; in MDD, corrosive feelings of worthlessness and self-loathing are common.” With regards to the underlying biology of depression, previous theories focused around the idea of low levels of neurotransmitters.

Today, researchers believe that the brain changes which accompany depression may be even more fundamental, and that altered levels of neurotransmitters reflect these changes. There is evidence that the structure of brain cells can be altered with stress and depression, with the result that their functioning is affected.
This would explain why people often complain of poor concentration and memory when depressed. However, the good news is that treatments, including antidepressant medications and electroconvulsive therapy, can reverse these changes, causing brain cells to grow back to their healthy states.



QUESTIONS 7-14

7. What does the word “It” refers to?
A. Feeling blue
B. Clinical depression
C. The big difference
D. Time point

8. Why the author compared the depression to several situations?
A. Probably he was confused in comparing
B. He feels it may be triggered by several reasons
C. Used to express multiple prongs of depression.
D. Unable to define a proper form, instead he used.

9. In the third paragraph, the narrator used the words “it’s an incredibly complex condition” to express
A. to express author view on depression
B. to formulate a proposal to tackle depression
C. the undermine the factors responsible for causing depression
D. to show relation among several factors which triggers depression

10. Who are most likely prone to depression?
A. Males
B. Females
C. People who have had heart attack
D. People under high stress

11. What does the word unrealistic defines?
A. Impractical
B. Theoretical
C. Practical
D. Sensible

12. Why does the expert committee decided to remove the ‘bereavement exclusion’ from DSM-5?
A. This is missing in the grieving individuals.
B. To refrain from heavy definitions and complexities in defining
C. To mobilize themselves to meet strict criteria in assessing
D. To verify that theirs stand suits to concurrent needs

13. According to narrator, what is usually preserved in grief?
A. Positive memories
B. Self-esteem
C. Corrosive feelings
D. Self-loathing

14. Who does the word “their” refers to?
A. People
B. Brain cells
C. Researchers
D. Patients



PART C. TEXT: 2 ADHD

It’s one of the most common disorders of childhood, affecting an estimated 3 to 5 per cent of Australian schoolchildren, but few topics in children’s health arouse more controversy than Attention Deficit/Hyperactivity Disorder – or ADHD. Formerly known as Attention Deficit Disorder or ADD, ADHD is characterised by difficulties staying focused and paying attention, ‘problem’ behaviour and hyperactivity. ADHD is three times more common in boys than in girls, and symptoms usually emerge before the child starts school.

Skeptics may dismiss the condition as being nothing more than childhood exuberance and energy, but child behaviour experts have longed acknowledged that ADHD represents behaviour well outside the youthful norm. There is on-going debate about the best diagnostic criteria for ADHD, especially now that it is recognised that in a significant number of people, childhood ADHD can persist into adulthood. The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) has been revised to include diagnostic criteria not only for children, but also for adolescents and adults.

Another aspect of the controversy is that ADHD is usually treated with a class of drugs – psychostimulants – that are considered addictive and dangerous in adults (although it is also argued that this is high dose related, and less likely to occur with oral medications, because of slow absorption). However, those who have lived their lives with ADHD, or with an affected child, say that accurate diagnosis and treatment of the disorder has transformed their lives, enabling them to function normally. It’s one of the most common disorders of childhood, affecting an estimated 3 to 5 per cent of Australian schoolchildren, but few topics in children’s health arouse more controversy than Attention Deficit/Hyperactivity Disorder – or ADHD.

A diagnosis of ADHD is usually made by a paediatrician or child psychiatrist, who will take a detailed developmental history from the parents. The specialist will also talk to the child, and assess their functioning in a range of environments, such as home and school. Sometimes the child’s teacher will also be asked to fill in a questionnaire.

It is important that the specialist is able to rule out other factors or undiagnosed conditions that might be responsible for the symptoms, for example, middle-ear infections causing hearing problems, or significant life events, such as a divorce, that might be affecting the child. Doctors should take a careful history of the child’s family and social background to see whether things like upbringing and parental factors are the cause of the symptoms before a diagnosis of ADHD is made. It shouldn’t be made after a single session with the child.

For a positive diagnosis the symptoms need to have lasted for at least six months, started before the child was seven, and be causing problems at home and school. Children must present with at least six symptoms from either (or both) the inattention group of criteria and the hyperactivity and impulsivity criteria, while older adolescents and adults (over age 17 years) must present with five for a diagnosis of ADHD to be made.

Because all two- to three-year-olds (and many four- and five-year-olds) are impulsive and inattentive, the symptoms must be shown to slow the child’s ability to learn, socialise or function before an ADHD diagnosis is given. Deciding whether a child has the characteristics of ADHD can be very subjective. There’s no sign of physical abnormality in these children, and there is no test to prove that a child has the condition.

However, in 2013, US regulators approved the first brain wave test for attention deficit hyperactivity disorder for children age six to 17 years. The new test, known as the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, measures electrical impulses given off by neurons in the brain. It can help confirm an ADHD diagnosis or help decide if further treatment should focus on other medical or behavioural conditions that produce symptoms similar to ADHD. ADHD may also overlap with other conditions, such as oppositional behaviour and with a learning disability. The latter may need an educational assessment and remediation.


Pediatricians may differ in how often they will diagnose ADHD, and sometimes it will come down to which pediatrician or child psychiatrist the child sees as to whether the diagnosis of ADHD is made. It can help parents to do some research on the condition, through reading books and evidence-based articles online, talking to experts or attending workshops, before accepting the diagnosis.



Questions 15-22

15. What was the author’s view on ADHD from the first paragraph?
A. ADHD is not a severe disorder to afraid
B. It is the most common disorder in teens
C. It is identified with learning difficulties in children
D. It is less frequent in boys

16. Why does the need for the best diagnostic criteria for ADHD aroused?
A. Because of criticism by skeptics
B. The nature of ADHD
C. Prevalence of ADHD in large number of children
D. Based on samples collected from research

17. What do you understand from the third paragraph?
A. ADHD is less likely to impact children mental status
B. ADHD is not been treated as a dangerous disorder
C. The impact of other child disorders will undermine ADHD
D. No appropriate diagnosis and treatment for ADHD is available

18. Who will do the primary diagnosis of ADHD in children?
A. Paediatrician
B. child’s teacher
C. specialist
D. parents

19. Why doctors shouldn’t be made determination of ADHD after a single session with the child?
A. It cannot be determined with some symptoms
B. ADHD determination requires through study over child’s behaviour and other social aspects
C. May be are of other symptoms unidentified with ADHD
D. Unable to determine the impacts of early determination of ADHD

20. What do you understand from the last sentence in the 7th paragraph?
A. It doesn’t include many other aspects of determining ADHD
B. It focuses mainly on analyzing the impact of ADHD
C. No appropriate test for diagnosis of ADHD
D. Abnormal behaviour of children is essential in determining ADHD

21. What does the word “it” in the 8th paragraph refers to?
A. NEBA system
B. Electric impulses
C. Hyperactivity
D. Neurons

22. Who does the word “they” refers to?
A. Teachers
B. Children
C. Pediatricians
D. Child Specialists


VIEW ANSWER KEYSOET READINGOET SPEAKINGOET ROLE PLAYSOET LETTER WRITINGOET LISTENING

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GLAUCOMA OET READING TEST

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TEXT A: Description: Glaucoma is the name given to as group of eye disease in which the optic nerve at the back of the eye is slowly destroyed. In most people this damage is due to an increased pressure inside the eye – a result of blockage of the circulation of adequous, or its drainage. In other patients, the damage may because by poor blood supply to the vital optic nerve fibbers weakness in the structure of the nerve, and or a problem in the health of the nerve fibers themselves. Over 146000 Australians have been diagnosed with glaucoma. While it is more common as people age, it can occur at any age. Glucoma is also far less common in the indigenous population.

Symptoms: Chronic glaucoma is the common type. It has no symptoms  until eyesight  is lost at  a later stage.

Prognosis: Damage progresses very slowly and destroys vision gradually, starting with the   side vision. One eye covers for the other, and the person remains unaware of any problem until a majority of nerve fibers  have been damages, and  a large part of vision has been  destroyed.  This damage is irreversible.

Treatment: Although there is no cure for glaucoma it can usually be controlled and further loss of sight either prevented or at least slowed down. Treatments include: Eyedrops – these are the most common form of treatment and must be used regularly. Laser (laser trabeculoplasty) – this is performed when eye drops do not stop deterioration in the field of vision. Surgery (trabeculectomy) – this is performed usually after eye drops and laser have failed to control the eye pressure. A new channel for the fluid to leave the eye is created. Treatment can save remaining vision but it does not improve eye sight.

Text B.      Table 1: Study of  eye pressure  and corneal thickness  as predictors of Glaucoma                         
lntraocular pressure (IOP) Central corneal thickness (CCT) and Glaucoma  correlations.

Central corneal thicknessIntraocular pressureIntraocular pressure + Central corneal thicknessPredictor of development of glaucoma (r2)
thickness of 555 microns or less  .36*
thickness of more than 5BB microns  -.13*
 pressure of less than 21 mmHg .38*
 pressure of more than 22 mmHg .07*  
*power >.05   Thickness less than 555and pressure less than 21 mmHg-.49*

Text C. Other forms of Glaucoma.        •

  • Low-tension or normal tension glaucoma. Occasionally optic nerve damage can occur in people  with so-called normal  eye  pressure.
  • Acute  (angle-closure)  glaucoma. Acute  glaucoma  is when  the pressure inside the eye rapidly increases due to the iris blocking the drain. An attack of acute glaucoma is often severe. People suff er pain, nausea, blurred vision and redness of the eye.     /
  • Congenital glaucoma. This is a rare form of glaucoma caused by an abnormal drainage system. It can exist at birth or develop later.
  • Secondary glaucomas. These glaucomas can develop because of other disorders of the eye such as injuries, cataracts, eye inflammation. The use of steroids (cortisone) has a tendency to raise eye pressure; therefore, pressures  should be  checked  frequently when  steroids are used.

Text D: Overview  of  Glaucoma Facts: Glaucoma  is the leading  cause  of  irreversible blindness worldwide. One in 10 Australians over 80 will develop glaucoma.

• First degree relatives of glaucoma patients have an 8-fold increased risk of developing  the disease.

  • At present,  50% of  people  with glaucoma in Australia  are undiagnosed.
  • Australian  health  care cost of  glaucoma in 2017 was $342  million.
  • The total annual cost of  glaucoma  in 2017 was  $1.9 billion.
  • The total cost is expected to increase to $4.3 billion by 2025.
  • The dynamic model of the economic impact of glaucoma enables cost­effectiveness comparison of various interventions to inform policy development.

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. which is the rare form of glaucoma?  

2. what is the leading cause of irreversible blindness in the world?

3. what has the highest value for the predictor of development of glaucoma?

4. which is the most common form of glaucoma?? __

5. what has the lowest value for the predictor of development of glaucoma?

6. what was the total annual cost of glaucoma in 2017? __

7. what is the most common form of treatment for glaucoma? __

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, numbers or both.

8. Which form of glaucoma can develop due to eye inflammation?

9. What is the predicted total cost of glaucoma in 2025?

10. What is the predictor of development of glaucoma for intraocular pressure more than 22 mmHg?

11. How many Australians have been diagnosed with glaucoma?

12. What was the Australian health care cost of glaucoma in 2017?

13. what is the current percentage of undiagnosed glaucoma patients in Australia?

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, numbers or both.

14. Glaucoma is a group of eye diseases in which the________ is slowly destroyed

15. First degree relatives of glaucoma patients have _________ increased risk of developing the disease.

16. ______can cause pain, nausea, blurred vision and redness of the eye.

17. Steroids such as _______has a tendency to raise eye pressure.

18. Glaucoma is far less common in the_______

19. ________has no symptoms until eyesight is lost at a later stage.

20. Laser trabeculoplasty is performed when _______ don’t stop deterioration in the field of vision.

Part B.

Parenteral  Infusion Devices: Intravenous (IV) and intraarterial access routes provide an effective pathway for the delivery  of  fluid, blood,  and medicants  to a patient’s vital  organs. Consequently, about 80% of hospitalized patients receive infusion therapy. A variety of devices can be used to provide  flow through  an intravenous catheter. An intravenous delivery system typically consists of three major components:  (1) fluid or drug reservoir,  (2) catheter  system for transferring the fluid or drug from the reservoir into the vasculature  through a   venipuncture,  and (3) device for regulation  and/or  generating  flow.

1. What  does this extract tell us about parenteral infusion devices?

  1. used  to provide  flow through  an intravenous catheter
  2. 80% of hospitalized  patients receive parenteral  infusion   devices
  3. provide an effective pathway  for the delivery of fluid,   blood

Biomedical  Lasers: Three important factors have led to the expanding biomedical use of laser technology, particularly in surgery. These factors are: (1) the increasing understanding of the wave-length  selective interaction  and associated  effects of ultraviolet-  infrared  (UV-IR) radiation with biologic tissues,  including those of acute damage and long-term healing, (2) the rapidly increasing availability of lasers emitting (essentially monochromatically) at those wave­ lengths that  are strongly  absorbed by  molecular  species within  tissues, and (3) the availability of both optical fiber and lens technologies as well as of endoscopic technologies for delivery of the laser radiation to the often remote internal treatment site.

2. The purpose  of  these notes about Biomedical  Lasers is to

  1. state the factors that led to the expanding biomedical use of laser technology
  2. give valid reasons  for the increase in the biomedical use of lasers   in surgery
  3. recommend an alternate for ultraviolet- infrared (UV-IR) radiation in biomedical use

Infant Monitor: Many infants are being monitored in the home using  apnea monitors because they have been identified with breathing problems. These include newborn premature babies who have apnea of prematurity, siblings of babies who have died of sudden infant death syndrome, or infants who have had an apparent life-threatening episode related to lack of adequate respiration. Rather than keeping infants in the hospital for a problem that they may soon outgrow, doctors often discharge them from the hospital with an infant apnea monitor that measures the duration of breathing pauses and heart rate and sounds an alarm if either parameter crosses limits prescribed by the doctor.

3. The notice is giving information about

  1. the circumstances  for prescribing  the infant monitor  by  the doctor
  2. why  infants shouldn’t be  discharged  from the hospital with infant  monitor
  3. why infants unidentified with breathing problems need infant monitor

Postoperative complications: Surgery and  anesthesia  are stressful events for the patient. The patient   handles stress in accordance with their overall condition, the nature of the surgery and associated diseases. Post-traumatic stress disorder (stress  syndrome)  can be expected in all patients  following surgery. This is an  overall and local response of the organism to stress and its effort to cope with the strain. It is a physiological reaction of the organism to stress, which in the worst-case scenario can become a pathological  or a post-operative complication.

4. What  does this extract tell us about post-traumatic  stress   disorder?

  1. It is a physiological reaction of the patient to stress. •
  2. It is only a local response of the patient to stress.
  3. It can definitely turn into a post-operative    complication.

Rinses: These are prescribed when redressing necrotic, infected wounds. The rinse, · especially with antiseptic solution for clean, granulating and epithelizing wounds is not substantiated. The wound rinse helps to dean the wound of early leaching residues, coatings, necrotic tissue, pus, blood dots, toxins or residues of bacterial biofilm. Rinsing a colonized chronic wound reduces the existing microbial population.

Solutions suitable for application to wounds: Prontosan solution, Ostenisept, Dermacin,  DebsriEcaSan

Less suitable solutions: Betadin,  Braunol,  saline,  Permanganate

Solutions not suitable for application to wounds: Chloramin, Persteril, Rivanol, Jodisol.

5. The email is reminding  staff that  the

  1. benefits  of  rinses to patients  using suitable solutions.
  2. solutions less suitable should not be  applied to   wounds.
  3. epithelizing  wounds  should be rinsed  with  antiseptic solution.

Drains and drainage systems: Drains are used to drain physiological or pathological  fluids from the  body. The use of drains and drainage systems in surgery significantly affects the overall healing process. The accumulated fluid can endanger the whole body as it has a mechanical and toxic effect on the surrounding 4ssue and is a breeding ground for microorganisms.  Drains are used to drain fluids from body cavities, organs, wounds and surgical wounds (e.g. blood, wound secretion, bile, intestinal contents, pus etc.) and air (chest drainage).

6. The purpose  of  these notes  about drains and drainage  systems is to

  1. help maximize  efficiency of healing  process.
  2. give  guidance  on certain medical procedures.
  • avoid accumulation  of  fluid in body cavities.

Part C Text 1. Choose the answer (A, B, C or D) AIDS deaths blamed on immune therapy

Paragraph 1: THE DEATHS of three patients during trials of an experimental immune therapy for people with AIDS have renewed controversy over experiments carried out by the French scientist Daniel Zagury. The affair has also   highlighted shortcomings in the system of checks and controls over clinical research. The French health minister, Bruno Durieux, recently announced that  an inquiry had cleared Zagury and his team at the Pierre and Marie Curie University  in Paris of  alleged irregularities in the way they conducted tests of   a potential vaccine and an experimental immune therapy in patients at the Saint-Antoine Hospital  (This Week,  13 April). But Durieux  made  no mention of  three deaths which the inquiry had  reported.

Paragraph 2: Following revelations about the circumstances in which the patients died, Durieux has now announced a new assessment of the tests to be undertaken by ANRS, the national agency for AIDS research. Last July, Zagury and his colleagues reported in a letter to The Lancer  (vol 336, p  179)  a trial on patients with AIDS or AIDS-related complex. The patients received a preparation based on proteins from HIV that was designed to boost their immune  systems.

Paragraph 3: The preparation  was made from samples of  the patients’  own white blood  cells, purified and cultured in the laboratory. The researchers had infected the white blood cells with a genetically engineered form of the vaccinia virus that had  genes from HIV inserted into its DNA. The vaccinia, or cowpox, virus, had  first been  inactivated with  formaldehyde,  said the researchers.  Last week, the Chicago Tribune and Le Monde alleged that at least two of the deaths were caused by vaccinia disease, a rare complication of infection with vaccinia virus. Vaccinia is harmless in healthy people and has been used in its live form as the vaccine against smallpox worldwide. But, in people whose immune systems are suppressed, the virus can ‘occasionally spread rapidly in the body and kill.

Paragraph 4: A Paris dermatologist, Jean-Claude Guillaume, said that when he warned Zagury’s team that he was convinced one of their patients had contracted vaccinia disease “the response was that this was not possible” because the vaccinia had been inactivated. Shortly before his death, the patient had consulted  Guillaume  about large, rubbery  lesions  across his abdomen. Guillaume  consulted  a colleague, Jean-Claude  Roujeau,  about the rare disease. Roujeau told the Chicago Tribune that his tests on the tissue samples taken from two patients before they died had detected vaccinia virus in their skin cells.

Paragraph 5: The Saint-Antoine team’s postmortem tests did not reveal vaccinia. Odile Picard, who is in charge of administering the treatment, says there were three possible causes of death – vaccinia disease, herpes or a toxic reaction to the procedure used to prepare white blood cells before injecting them into patients. Zagury, however, insisted that “nothing allows us to affirm it [was vaccinia]. It could have been herpes or Kaposi’s sarcoma”. The tests are continuing, he says.

Paragraph 6: Luc Montagnier, co-discoverer of HIV, called for an immediate halt to the experiments. He says that intravenous injections could lead to generalised vaccinia disease. His team at the Pasteur Institute has already shown in laboratory tests that vaccinia virus maybe dangerous if the immune system is unable to resist it. The findings at the Pasteur Institute were apparently unknown to Zagury’s team, which works with Montagnier’s rival, the researcher  Robert Gallo. Gallo’s collaboration with  Zagury has been  suspended by the National Institutes of Health in the US because of alleged irregularities.

Paragraph 7: Zagury and his team have also denied charges that they covered up the deaths, which are not mentioned in their report in The Lancet. “They were not covered up,” Picard said. “They were accepted [into the trial] on compassionate grounds.” The Lancet report concerns 28 patients. 14 who were treated  and  14  controls who  were not  able to receive  the treatment.

Picard says that five other patients were also treated with the preparation but were not compared with the  controls. Their T4 cell counts had fallen too low to be comparable with the control group, so they were  excluded  from the  study and not mentioned  in its  report.

Paragraph 8: AIDS patients are particularly  vulnerable to infection. Furthermore, the French ethics council had specified that volunteers should be chosen because “their state was so advanced it excluded  treatment with AZT”. At least some of the patients were being treated with AZT at the same time as immune therapy. The council had also asked to be informed of the results of the trials case by case, but had not been told of the deaths. The geneticist Andre Boue, a member of the council, said: “The ethics council does not have judicial powers;  we are not the fraud  squad.”

Paragraph 9: The director  of the -AIDS research  agency ANRS, Jean-Paul  Levy, is concerned that all the controversy may lead to a crisis of public confidence  but laid the blame firmly at the door of the media where “excessive praise is followed by  excessive rejection”.  Levy, who had still heard nothing, “even   informally” from the health ministry the day after Durieux told parliament  that ANRS would assess immune therapy trials, said he wanted to study the problems  “in depth, but not in the atmosphere  of  a  tribunal”.

Paragraph 10: ANRS has a panel of experts in therapeutic trials, which, says Levy, “might seek international contacts to obtain a broad consensus” on the issues  involved. The research agency’s r-ole is to carry out a purely scientific evaluation, not to assess whether there was a breach of ethical guidelines, according to Levy. “If the government called on us to examine this case, we could act very quickly,” said Philippe Lucas of  the ethics   council.      

                           

Q1. “Which of the following is FALSE?

  1. Zagury’s  experiments have been  controversial  before.
  2. An inquiry found obvious irregularities in Zagury’ s work.
  3. ANRS  is to re-evaluate  Zagury’s tests.
  4. Zagury’s intention  had been to increase patients’  immune  systems   with proteins.

Q2. The preparation which the patients received

  1. had been  accidentally  infected with  a form of the vaccinia  virus.
  2. was made from white blood cells which had been manufactured in the laboratory.
  3. had been stored in formaldehyde,
  4. contained laboratory-treated white blood cells which had been taken from them.

Q3. According to the article, vaccinia   _

  1. is potentially  lethal for all humans.
  2. has been used to fight both  cowpox  and smallpox  all around the  world.
  3. can be dangerous  in people  who have  abnormal  immune systems.
  4. in none of the  above.

Q4. Jean-Claude Guillaume         _

  1. was  also a member  of  Zagury’s team.
  2. examined one of the patients who had been referred to him by Zagury’ s team.
  3. informed the Chicago Tribune about the results of the tests on the tissue samples.
  4. was/did none  of the above.

Q5. Which  of  the following people  does NOT work with  Zagury?

  1. Odile Picard.
  2. Luc Montalgnier.
  3. Robert Gallo.
  4. None  of  the above works with Zagury.

Q6. It is FALSE that findings at the Pasteur institute —

  1. were ignored by Zagury’s team.
  2. did not lead to intervention  by the National  institutes of   Health.
  3. showed that intravenous injections were not good for patients with weaker immune systems.
  4. led to Zagury’s team  keeping  quiet about the patients who had   died.

Q7. How many people  were injected with the preparation  in the   trial?

  1. Fourteen 
  2. Nineteen
  3. Twenty eight
  4. Thirty three ‘

Q8. Which of the following statements best describes the initial condition of the people who took part in the   trial?

  1. Fewer than half  of them had  AIDS
  2. Half  of them had AIDS
  3. Most of them had  AIDS
  • All of them had  AIDS

Part C. TEXT 2.

Going blind in Australia

Paragraph 1: Australians  are living longer and so face increasing levels of visual  impairment. When we look at the problem  of visual impairment and the  elderly, there are three main issues. First, most impaired people retire with relatively  “normal” eyesight, with no more than presbyopia,  which  is  common in most people over 45 years of age. Second, those with visual impairment do have eye disease and are not merely suffering from “old age”. Third, almost all the major ocular disorders affecting the older population,  such as cataract, glaucoma and age-related macular degeneration (AMD), are progressive and if untreated will cause visual impairment and eventual blindness.

Paragraph 2: Cataract accounts for nearly half  of  all blindness  and remains the  most prevalent cause of blindness worldwide. In Australia, we do not know how prevalent cataract is, but it was estimated in 1979 to affect the vision of 43 persons per thousand over the age of 64 years. Although some risk factors for cataract have been identified, such as ultraviolet radiation, cigarette  smoking and alcohol consumption, there is no proven means of preventing the development of most age-related or senile cataract. However cataract blindness can be delayed or cured if diagnosis is early and therapy, including_ surgery,  is accessible.

Paragraph 3: AMD is the leading cause of new cases of blindness in those over 65. In the United States, it affects 8-1 1%  of those aged 65-74, and 20% of those over  75 years. In Australia, the prevalence of AMD is presently unknown but could be similar to that in the USA…Unlike cataract, the treatment  possibilities  for AMD are Hmited. Glaucoma is the third major cause  of vision loss in the elderly. This insidious disease is often undetected until optic nerve damage is far advanced. While risk factors for glaucoma,  such as  ethnicity and family history, are known, these associations are poorly understood. With early detection, glaucoma can be controlled medically or surgically.

Paragraph 4: While older people use a large percentage  of  eye services, many more may   not have access to, or may underutilise, these services. In the United  States  33% of the elderly in Baltimore had ocular pathology requiring further investigation or intervention. In the UK, only half the visually impaired in London were known by their doctors to have visual problems, and 40% of  those visually impaired in the city of Canterbury had never visited an ophthalmologist. The reasons for people underutilising eye care services are, first, that many elderly people believe that poor vision is inevitable or untreatable.  Second, many  of  the visually  impaired  have  other  chronic disease and may neglect their eyesight. Third, hospital resources and rehabilitation centres in the community are limited and, finally, social factors play a role.

Paragraph 5: People in lower socioeconomic groups are more likely to delay seeking treatment; they also use fewer preventive, early intervention and screening services, and fewer rehabilitation and after-care services. The poor use more health services, but their use is episodic, and often involves hospital casualty departments or general medical services, where eyes are not routinely examined. In addition, the costs of services are great deterrent for those with lower incomes who are less likely to have private health insurance. For example, surgery is the most effective means of treatment for cataract, and timely medical care is required for glaucoma and AMD. However, in December 1991, the proportion of the Australian  population  covered by private health insurance was 42%. Less than 38% had supplementary  insurance cover. With 46% of category 1(urgent) patients waiting for more than 30 days for elective eye surgery in the public system, and 54% of category 2 (semi-urgent) patients waiting for more than three months, cost appears to be a barrier to appropriate and adequate  care.

Paragraph 6: With the proportion of Australians aged 65 years and older expected to double from the present 11% to 21% by 2031, the cost to individuals and to society of poor sight will increase significantly if people do not have access to, or do not use, eye services. To help contain these costs, general practitioners can actively investigate the vision of all their older patients, ref er them earlier, and teach them self-care practices. In addition, the government, which is responsible to the taxpayer, must provide everyone with equal access to eye health care services. This may not be achieved merely by increasing expenditure – funds need to be directed towards prevention and health promotion, as well as treatment. Such strategies will make good economic sense if they stop older people going blind.

Q1. In paragraph 1, the author suggests that         _

  1. many people have poor eyesight at retirement  age.
  2. sight problems of the aged are often  treatable.
  3. cataract and glaucoma  are the inevitable results  of  growing  older.
  4. few sight problems  of  the elderly are potentially  damaging.

Q2. According to paragraph 2, cataracts       _

  1. may affect about half  the population  of  Australians  aged over 64.
  2. may occur in about 4-5% of Australians aged over 64.
  3. are directly related to smoking and alcohol consumption in old age.
  4. are the cause of more than  50% of visual   impairments.

Q3. According to paragraph 3, age-related macular degeneration (AMD)

  1. responds well to early treatment. ,’;
  2. affects 1in 5 of people  aged 65-74.
  3. is a new disease which  originated  in the USA.
  4. causes  a significant  amount  of sight loss in the elderly.

Q4. According to paragraph 3, the detection of glaucoma      _

  1. generally  occurs too late for treatment  to be  effective.
  2. is strongly associated  with  ethnic  and genetic factors.
  3. must  occur early to enable effective  treatment.
  4. generally occurs before optic nerve damage is very advanced.

QS. Statistics in paragraph 4 indicate that    _

  1. existing  eye care services are not fully utilised by the   elderly.
  2. GPs are generally  aware of  their  patients’  sight difficulties.
  3. most  of  the elderly in the USA receive  adequate  eye treatment.
  4. only 40% of  the visually  impaired visit  an opthalmologist.

Q6. According to paragraph 4, which one of the following statements is   true?

  1. Many elderly people believe that eyesight problems cannot be treated effectively.
  2. Elderly people with chronic diseases are more likely to have  poor eyesight.
  3. The facilities for eye treatments  are not always readily   available.
  4. Many elderly people think that deterioration of eyesight is a product of ageing.

Q7. In discussing social factors affecting the use of health services in paragraph 5, the author points out that _

  1. wealthier  people  use health  services more  often than poorer people.  
  2. poorer  people use health  services more regularly  than wealthier  people.
  3. poorer people deliberately avoid having their eye sight   examined.
  4. poorer  people have less access to the range of  available  eye care  services.

Q8. According to paragraph 6, in Australia in the year 2031   _

  1. about  one tenth  of  the country’s population  will be elderly.
  2. about one third  of  the  country’s population  will be elderly.
  3. the proportion  of people  over 65 will be twice the present proportion.
  4. the number  of visually impaired will be twice the present number.

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Mr Jonathon Singh OET letter

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Read the case notes below and complete the writing task which follows.

Notes:

Hospital: Flinders Medical Centre

Patient Details:

Name: Mr Jonathon Singh

Age: 63 years Address: 51 Parsons Road, Woodville West

Marital Status: married

NOK: Mrs Megan Singh ph 0433 917825

Admission date: 22/10/08

Discharge date: 26/10/08

Diagnosis: Carbon monoxide poisoning- home kerosene heater Past

Medical History:

Cataract surgery 12/5/99

Surgical repair for Prostate Hypertrophy 29/9/05

Psoriasis Constipation Impaired vision- glasses

Social History /Supports:Retired bank employee- Commonwealth Bank Lives with wife and adopted daughter- both overseas at present

Day 1- 22/10/08/ On examination: widely dilated pupils Unconscious Cold clammy skin, cherry red lips and skin Dyspnoea Physical examination. Assessed for head injury or other Precipitating factors causing coma- negative result. Blood test for blood sugar to ? diabetic coma- negative result.

Treatment: 0₂ Sats at 98% on 2 L/min via nasal specs Hyperbaric oxygenation Hourly assessment of vital signs Calm environment NG tube inserted for feeding Monitored for asphyxia Registrar visit 2pm Knees flexed using pillows Foot board to prevent foot drop Pressure Area Care: frequent change in position and back rub In- dwelling catheter Skin care for psoriasis

Observation:Patient comatose, but no other physical injuries. No asphyxia

Day 2- 23/10/08 Treatment:0₂ Sats at 98% on 2 L/min via nasal specs Hyperbaric oxygenation ceased at 1900 Hourly assessment of vital signs Calm environment NG tube Skin specialist assessment re psoriasis Skin care for psoriasis Foot board to prevent foot drop Pressure Area Care: frequent change in position and back rub. Skin intact IDC draining moderate amounts

Observation:Patient regained consciousness with right hemi-plegia 1800

Day 3- 24/10/08 Treatment: Assessment for consciousness GCS 14 but varies Hourly assessment of vital signs Calm environment Good ventilation NG tube removed- liquid diet per oral Mobility assessment Right sided weakness Speech affected, vision as per normal for this patient Small pillow placed on affected right side for prevention of adduction of arm Physiotherapist assessment and commencement of passive exercises Pressure Area Care: frequent change in position and back rub Removal of IDC

Observation:Level of consciousness with right-sided weakness. Comfortable, depressed and anxious re prognosis

Days 4- 25/10/08 Treatment:Assessment for conscious GCS 15 2 Hourly assessment of vital signs Physiotherapist visit- passive exercise continued Range of motion gradually increased Pressure Area Care: patient encouraged to move off sacrum as it is a little red Full ward diet and fluids

Observation:Patient mentally stable, but depressed. Making steady physical progress. Doctor has advised discharged tomorrow and further rehabilitation at The General Repatriation Hospital

Nursing Management: Provided comfortable stable environment Output, skin integrity, diet monitored Assistance in regaining physical health.

Discharge plans:Daily assessment and support from physiotherapist and possibly occupational therapist for increased mobility and physical ability Psychiatrist visits to be initiated regarding depression caused by loss of mobility and independence following the accident

Writing Task:Write a letter of referral to the Director, General Repatriation Hospital, Daw Park, using the information above.

In your answer:Expand the relevant case notes into complete sentences Do not use note form Use letter format. The body of the letter should be approximately 180-200 words.

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Mr Darwish Woods OET letter

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Occupational English Test: WRITING SUB-TEST: NURSING

TIME ALLOWED:            READING TIME: 5 MINUTES

WRITING TIME:             40 MINUTES

You are a Surgical Nurse in a post-operative ward. Your patient is ready for discharge today after CABG surgery.

Date:29/05/2021

Patient Details

Name: Mr Darwish Woods

Age: 77 years

Diagnosis: Coronary artery bypass graft

Family History

Married, carer for his wife (registered blind)

Daughter, married with children and lives overseas

Hobbles: Reading, cooking daily

Past History

Hypertension since 2011 (perindopril 1tab/daily)

High cholesterol since 2009 (atorvastatin 1 tab/dally)

Arthritis since 2007 (paracetamol 1 gm daily 4times

CAD (ECG, stress test, angiogram

Surgery: off pump CABG

23/05/2021

Admitted to hospital and underwent surgery on 24/05/2021 (graft from left leg)

Admitted in ICU for 24 hours

Administered IV antibiotics , analgesics and antithrombolytic agents

Chest tube insitu, drainage 20ml

Temp-37. 7C, PR-78/mt, RR-22/mt, Spo2-100°/o, BP-130/80 mm of Hg

Dressing in graft site

Provided elastic stockings and elevated leg for 24 hours

25/05/2021

Transferred to ward

Chest tube removed, wounds WNL

Complaints of pain over the chest and shoulder (administered Brufen)

Daily physiotherapy (deep breathing exercises, walking 4-5 mts 4times per day)

Exercise data sheet provided

Temp-37C, PR- 84/mt, RR-18/mt, BP-120/76 mm of Hg

29/05/2021

Ready for discharge (planned transfer to rehabilitation unit for 3 weeks) Follow up appointment:07/06/2021

Discharge instructions:

•          Assess wound over the chest and graft site

•          Dressing over the wound 2/weekly until sutures removed

•          Sutures removal after 2 weeks

•          Continue deep breathing exercises, walking 4-5 mts increase gradually

•          Avoid heavy lifting

•          Arrange carer and meals before discharge to home

WRITING TASK:

Using the information in the case notes, write a transfer letter to Ms Smith Brown, head of nursing, rehabilitation centre. Address this letter to Ms Brown, Head of Nursing, Brisbane OLD, Australia 4001.

In your answer:

•          Expand the relevant notes into complete sentences

•          Do not use note form

•          Use letter format

The body of the letter should be approximately 180-200 words.

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OET WRITING TASKS

Bill O’Riley OET letter

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TASK 82: Today’s Date: 09/09/12.

Notes: You are Lee Wong a registered nurse in the Coronary Care Unit, St Andrews Hospital Brisbane. Bill O’Riley is a patient in your care.

Patient Details:  Name: Bill O’Riley

DOB 12 January 1959                      

Address: 9476 Old Dam Road, Goondiwindi QLD 4390

Next of Kin Brother: Ernie O’Riley 72 Burke St, Cunnamulla QLD 4490

Admitted 2 September 2012; Diagnosis Obstructive coronary artery disease

Operation Coronary artery bipass grafts (x 4) on 4th September 2012

Social History: Never married. Lives alone in own home just outside Goondiwindi. Fencing contractor

Medical History: Smokes 20 cigarettes/day. Alcohol: 2 x 300ml bottles beer / day. Ht 170cm Wt 99kg

Usual diet: sausages, deep fried chips, eggs, MacDonalds. Allergic reaction to nuts

Nursing Management and Progress: Routine post operative recovery

Advised to cease smoking, reduce alcohol. Low fat diet. Walking well. Wounds healing well

Routine visit from Social Worker

Discharge Plan: Returning Home to Goondiwindi

Appointment made for follow up visit to local GP Dr. Avril Jensen 2pm 15/9/12

Local physiotherapist to continue rehabilitation exercise program

Writing Task: Mr. O’Riley has requested advice on low fat dietary guidelines and healthy simple recipes. Write a letter to the Community Information Section of the Heart Foundation, Gregory Terrace, Brisbane on the patient’s behalf. Use the relevant case notes to explain Mr. O’Riley’s situation and the information he needs. Include Medical History, Body Mass Index and lifestyle. Information should be sent to his home address.

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Joanna Andrew OET letter

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TASK 81: .  You are Joanna Andrew, a senior nurse working with the “Your Health Care Agency.” Stephen Mabel is the patient. Read the case notes below and complete the writing task which follows.

Name Stephen Mabel            

Address 8 Stuart Street, Perth, WA 6000

Phone 0422 678 144             

Date of Birth 18 June, 1972

Social Background: Married – Wife Sandra Mabel aged 39. Lives together Stephen Mabel works as an accountant in a company in Perth.

Medical History Faced Cerebrovascular accident (CVA) some 2 years ago. Agile, Mentally active, speech slightly slurred, complaining of severe illness, Walks with limp, impaired balance

12/7/2011: Felt extreme headache in the morning, fell off the stairs, badly injured right knee, GP requested Your Health Care Agency for daily visits, dressing and assisting in taking shower daily.

15/7/2011: Left leg knee – redressed, no infection noticed.

Stephen was able to walk little distances with help from his wife, Sandra. Complained of usual pain while walking, apart from this nothing and he is doing well.

19/7/2011: Kneed healed well.

Patient was suggested to walk, using walking sticks. Wife, Sandra, requested for more home visits in order to bring more improvement in his mobility.

WRITING TASK: Using the information given below in the case notes, write a letter to the Ms Physiotherapy Center 588 Hay Street Subiaco, ((08) 9388 2877) on behalf of the patient’s wife, Sandra, requesting a home visit to help her husband in walking properly.

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OET WRITING TASKS