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 thickness | Intraocular pressure | Intraocular pressure + Central corneal thickness | Predictor 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?
- used to provide flow through an intravenous catheter
- 80% of hospitalized patients receive parenteral infusion devices
- 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
- state the factors that led to the expanding biomedical use of laser technology
- give valid reasons for the increase in the biomedical use of lasers in surgery
- 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
- the circumstances for prescribing the infant monitor by the doctor
- why infants shouldn’t be discharged from the hospital with infant monitor
- 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?
- It is a physiological reaction of the patient to stress. •
- It is only a local response of the patient to stress.
- 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
- benefits of rinses to patients using suitable solutions.
- solutions less suitable should not be applied to wounds.
- 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
- help maximize efficiency of healing process.
- 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?
- Zagury’s experiments have been controversial before.
- An inquiry found obvious irregularities in Zagury’ s work.
- ANRS is to re-evaluate Zagury’s tests.
- Zagury’s intention had been to increase patients’ immune systems with proteins.
Q2. The preparation which the patients received
- had been accidentally infected with a form of the vaccinia virus.
- was made from white blood cells which had been manufactured in the laboratory.
- had been stored in formaldehyde,
- contained laboratory-treated white blood cells which had been taken from them.
Q3. According to the article, vaccinia _
- is potentially lethal for all humans.
- has been used to fight both cowpox and smallpox all around the world.
- can be dangerous in people who have abnormal immune systems.
- in none of the above.
Q4. Jean-Claude Guillaume _
- was also a member of Zagury’s team.
- examined one of the patients who had been referred to him by Zagury’ s team.
- informed the Chicago Tribune about the results of the tests on the tissue samples.
- was/did none of the above.
Q5. Which of the following people does NOT work with Zagury?
- Odile Picard.
- Luc Montalgnier.
- Robert Gallo.
- None of the above works with Zagury.
Q6. It is FALSE that findings at the Pasteur institute —
- were ignored by Zagury’s team.
- did not lead to intervention by the National institutes of Health.
- showed that intravenous injections were not good for patients with weaker immune systems.
- 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?
- Fourteen
- Nineteen
- Twenty eight
- Thirty three ‘
Q8. Which of the following statements best describes the initial condition of the people who took part in the trial?
- Fewer than half of them had AIDS
- Half of them had AIDS
- 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 _
- many people have poor eyesight at retirement age.
- sight problems of the aged are often treatable.
- cataract and glaucoma are the inevitable results of growing older.
- few sight problems of the elderly are potentially damaging.
Q2. According to paragraph 2, cataracts _
- may affect about half the population of Australians aged over 64.
- may occur in about 4-5% of Australians aged over 64.
- are directly related to smoking and alcohol consumption in old age.
- are the cause of more than 50% of visual impairments.
Q3. According to paragraph 3, age-related macular degeneration (AMD)
- responds well to early treatment. ,’;
- affects 1in 5 of people aged 65-74.
- is a new disease which originated in the USA.
- causes a significant amount of sight loss in the elderly.
Q4. According to paragraph 3, the detection of glaucoma _
- generally occurs too late for treatment to be effective.
- is strongly associated with ethnic and genetic factors.
- must occur early to enable effective treatment.
- generally occurs before optic nerve damage is very advanced.
QS. Statistics in paragraph 4 indicate that _
- existing eye care services are not fully utilised by the elderly.
- GPs are generally aware of their patients’ sight difficulties.
- most of the elderly in the USA receive adequate eye treatment.
- only 40% of the visually impaired visit an opthalmologist.
Q6. According to paragraph 4, which one of the following statements is true?
- Many elderly people believe that eyesight problems cannot be treated effectively.
- Elderly people with chronic diseases are more likely to have poor eyesight.
- The facilities for eye treatments are not always readily available.
- 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 _
- wealthier people use health services more often than poorer people.
- poorer people use health services more regularly than wealthier people.
- poorer people deliberately avoid having their eye sight examined.
- poorer people have less access to the range of available eye care services.
Q8. According to paragraph 6, in Australia in the year 2031 _
- about one tenth of the country’s population will be elderly.
- about one third of the country’s population will be elderly.
- the proportion of people over 65 will be twice the present proportion.
- the number of visually impaired will be twice the present number.
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Glaucoma
PART A:
1. C
2. D
3. B
4. A
5. B
6. D
7. A
8. Secondary glaucoma
9. $4.3 billion
10. .07
11. Over 146,000
12. $342 million
13. 50%
14. Optic nerve
15. An 8-fold
16. Acute glaucoma
17. Cortisone
18. Indigenous population
19. Chronic glaucoma
20. Eye drops
PART B:
1. A
2. A
3. A
4. A
5. A
6. C
PART C (TEXT 01):
1. B
2. D
3. C
4. D
5. B
6. A
7. B
8. D
PART C (TEXT 02):
1. B
2. B
3. D
4. C
5. A
6. B
7. D
8. C