ATTEMPT THE TEST – ANGINA PECTORIS

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Text A
Cardiovascular disease is the leading cause of death in the United States for men and women of all racial and ethnic groups. Angina pectoris is a clinical syndrome usually characterized by episodes or paroxysms of pain or pressure in the anterior chest. The cause is insufficient coronary blood flow, resulting in a decreased oxygen supply when there is increased myocardial demand for oxygen in response to physical exertion or emotional stress.

Text B – Risk factors
a. Family history
b. Increasing age, particularly women
c. Gender: men; women, especially after menopause (estrogen seems to provide some protection)
d. Race; risk appears higher in African-Americans
e. Cigarette smoking contributes to vasoconstriction, platelet activation, arterial smooth muscle cell proliferation, and reduced oxygen availability
f. Hypertension; widened QRS complex (bundle branch block)
g. Hyperlipidemia: increased total cholesterol; increased LDL (high: 130 to150 mg/dL; very high: 160 mg/dL or more); increased ratio of total cholesterol or LDL to HDL; low HDL (less than 40 mg/dL); HDL greater than 60 mg/dL seems to help protect against coronary artery disease (CAD); increased triglycerides (high:200 to 499 mg/dL; very high: 500 mg/dL or more)
h. Obesity (particularly abdominal obesity)
i. Sedentary lifestyle (contributes to obesity and reduced HDL)
j. Type 2 diabetes
k. Stress; an innate, competitive, aggressive type A personality seems less important than amount of stress and client’s psychologic response)
l. Metabolic syndrome: cluster of signs including hyperlipidemia, low HDL level, abdominal obesity, increased BP, insulin resistance, increased levels of C-reactive protein, and increased fibrinogen level
Text C

Text D
Management of acute MI
A. Improvement of perfusion
(1) Administration of aspirin immediately
(2) Beta blockers or angiotensin II receptor blockers for left ventricular systolic dysfunction (LVSD)
(3) Thrombolytic therapy within 30 minutes of arrival; anticoagulants
(4) IV nitroglycerin
(5) ACEIs
(6) Anti-dysrhythmics to maintain cardiac function
(7) PCI within 90 minutes of arrival at emergency department
(8) Intraaortic balloon pump that inflates during diastole and deflates during systole to decrease cardiac workload by decreasing after load and increasing myocardial perfusion for cardiogenic shock
(9) Aspirin, beta blocker, and possible antilipidemic prescribed at discharge
B. Promotion of comfort and rest
(1) Analgesics (e.g., IV morphine) to reduce pain, anxiety, and cardiac Work load by decreasing preload and after load
(2) Oxygen to improve tissue oxygenation
(3) Maintenance of bed or chair rest to decrease oxygen tissue demands
(4) Diet therapy: 2g sodium diet or clear liquids, depending on presence of nausea

PART A TIME: 15 minutes
• Look at the four texts, A – D, in the separate Text Booklet
• For each question, 1-20, look through the texts, A-d, to find the relevant information.
• Write your answers on the spaces provided in this Question Paper.
• Answer all the questions within the 15-minute time limit.
ANGINA PECTORIS
1. How to assess chest pain? ………………………………………………………………….
2. The major cause of angina pectoris ……………………………………………………..
3. Metabolic syndrome may also contribute to angina …………….……
4. It is required to take ECG for patients with chest pain……………………
5. How acute MI can be managed? …………………………………
6. Importance of pain medications in management of chest pain………………….
7. Greater levels of high-density lipoprotein in the body protects from cardiac illness………………

Questions 8-14
Answer each of the questions, 8-4, with a word or short phrase from one of the texts. Each answer may include words, number of the both. Your answers should be correctly spelled.
8. What is the main symptom of angina pectoris?
9. What contributes to obesity and reduced HDL?
10. Which is the leading cause of death in the US for both the genders?
11. What should be administered within half an hour of arrival of client with angina?
12. What should be avoided if the client exhibits chest pain which is angina unlikely?
13. What is recommended in order to reduce oxygen tissue demands?
14. What is the next step involved in the angina assessment protocol, if the client’s resting ECG is normal?

Questions 15-20
Complete each of the sentences, 15- 20, with a word or short phrase from one of the texts. Each answer may include words, number or both. Your answers should be correctly spelled
15. …………………….. should be administered within one and half hour of arrival.
16. Beta blockers or angiotensin II receptor blockers to be administered for…………………..
17. The risk of angina appears higher in…………………
18. ………………………is used to reduce cardiac workload which works by decreasing after load and increasing myocardial perfusion.
19. ……………………….. contributes to vasoconstriction and platelet activation
20. ……………………….. sodium diet or clear liquids are recommended depending on presence of nausea

Part B
In this part of the test, there are six short extracts relating to the work of health professionals. For questions 1-6, choose answer (A, B, or C) which you think fits best according to the text.

1) Living will-2
1. According to the paragraph, a living will covers certain situation, except,
a. during the need of resuscitation, ventilation and dialysis
b. to receive only pain medication
c. when there is no life threatening injury is present
1. A living will addresses many of the medical procedures common in life- threatening situations, such as resuscitation via electric shock, ventilation and dialysis. One can choose to allow some of these procedures or none of them. One can also indicate whether he or she wishes to donate his or her organs and tissues after death. Even if he or she refuses life-sustaining care, he or she can express the desire to receive pain medication throughout his or her final hours.
In most states, one can extend his or her living will to cover situations where he or she has no brain activity or where doctors expect him or her to remain unconscious for the rest of his or her life, even if a terminal illness or life-threatening injury isn’t present. Because these situations can occur to any person at any age, it’s a good idea for all adults to have a living will.

2. The passage says regarding suprapubic catheter that
a. It is better than indwelling catheters
b. It is preferred for short-term urinary drainage
c. It may cause damage to the urethra, if it is not secured with sutures or tape
2. Suprapubic catheter
A suprapubic catheter may be used for long-term continuous urinary drainage. This type of catheter is surgically inserted through a small incision above the pubic area. Suprapubic bladder drainage diverts urine from the urethra when injury, stricture, prostatic obstruction, or gynecologic or abdominal surgery has compromised the flow of urine through the urethra. A suprapubic catheter is often preferred over indwelling urethral catheters for long-term urinary drainage. Suprapubic catheters are associated with decreased risk of contamination with organisms from fecal material, elimination of damage to the urethra, a higher rate of patient satisfaction, and lower risk of catheter-associated urinary tract infections. The drainage tube is secured with sutures or tape. Care of the patient with a suprapubic catheter includes skin care around the insertion site; care of the drainage tubing and drainage bag is the same as for an indwelling catheter.

3. Evaluation of breast cancer by using PET/CT scan
a. provides accurate results than the PET scan alone
b. to be compared with PET or CT scan alone
c. has been receiving no attention because it’s results to be compared with the PET or CT scan alone.
3. The Role of PET/CT for Evaluating Breast Cancer
Positron emission tomography combined with computed tomography (PET/CT) has been receiving increasing attention during the recent years for making the diagnosis, for determining the staging and for the follow-up of various malignancies. The PET/CT findings of 58 breast cancer patients (age range: 34 79 years old, mean age: 50 years) were retrospectively compared with the PET or CT scans alone. PET/CT was found to be better than PET or CT alone for detecting small tumors or multiple metastases, for accurately localizing lymph node metastasis and for monitoring the response to chemotherapy in breast cancer patients.

4. The purpose of the guidelines is;
a. To conduct competitions in environmental health, between the health care providers regarding management of pediatric asthma
b. Merge environmental management of asthma with child health care
c. To provide environmental instructions to the patients
4. Extract from “Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers”
These guidelines are aimed at integrating environmental management of asthma into pediatric health care. These documents outline competencies in environmental health relevant to pediatric asthma that should be mastered by health care providers, and outlines the environmental interventions that should be communicated to patients. The guidelines contain three components: Competencies (Competencias en Espanol): An outline of the knowledge and skills that health care providers and health professional students should master and demonstrate in order to incorporate management of environmental asthma triggers into pediatric practice. Environmental History Form: A quick, user-friendly document that can be used as an intake tool to help determine pediated patients’ environmental asthma triggers. Environmental Intervention Guidelines: Follow-up questions and intervention solutions to environmental asthma triggers.

5. While dispensing dangerous drugs
a. RN must document the preparation and performance time
b. RN must follow the written drug dispersing procedure as well as nurse protocol
c. Pharmacist and physician may need to sign the procedure
5. Subject: DISPENSING DANGEROUS DRUGS
RNs are authorized to dispense dangerous drugs only under the following conditions: The dispensing is in accordance with a written drug dispensing procedure and under the authority of an order issued in conformity with a nurse protocol. There must be documented preparation and performance (i.e., ability to perform) specific to dispensing dangerous drugs based on a written dispensing procedure. Documentation should include that each RN has read and understands the drug dispensing procedure. A copy of the drug dispensing procedure must be accessible in each of the specific settings where RNs dispense under nurse protocols and be available upon request. The procedure must be signed by the pharmacist and physician who have established it.

6. A metabotropic receptors
a. form an ion channel pore
b. are coupled with G-proteins
c. are directly linked with ion channels on the plasma membrane
6.A metabotropic receptor
A metabotropic receptor is a type of membrane receptor of eukaryotic cells that acts through a second messenger. It may be located at the surface of the cell or in vesicles. Based on their structural and functional characteristics, the neurotransmitter receptor can be classified into two broad categories: metabotropic and ionotropic receptors. Ionotropic receptors form an ion channel pore. In contrast, metabotropic receptors are indirectly linked with ion channels on the plasma membrane of the cell through signal transduction mechanisms, often G proteins. Hence, G protein-coupled receptors are inherently metabotropic. Other examples of metabotropic receptors include tyrosine kinases and guanylyl cyclase receptors. Both receptor types are activated by specific neurotransmitters. When an ionotropic receptor is activated, it opens a channel that allows ions such as Na+, K+, or Cl− to flow. In contrast, when a metabotropic receptor is activated, a series of intracellular events are triggered that can also result in ion channels opening or other intracellular events, but involve a range of second messenger chemicals

Part C
In this part of the test, there are two tests about different aspects of health care. For questions 7 – 22, choose the answer (A, B, C , or D) which you think fits best according to the text

Text 1: Ebola Virus and Marburg Virus

The Ebola virus and Marburg virus are related viruses that cause hemorrhagic fevers — illnesses marked by severe bleeding (hemorrhage), organ failure and, in many cases, death. Both the Ebola virus and Marburg virus are native to Africa, where sporadic outbreaks have occurred for decades.

The Ebola virus and Marburg virus both live in animal hosts, and humans can contract the viruses from infected animals. After the initial transmission, the viruses can spread from person to person through contact with bodily fluids or contaminated needles.

No drug has been approved to treat the Ebola virus or Marburg virus. People diagnosed with the Ebola or Marburg virus receive supportive care and treatment for complications. Scientists are coming closer to developing vaccines for these deadly diseases.

In both the Ebola virus and Marburg virus, signs and symptoms typically begin abruptly within the first five to 10 days of infection. Early signs and symptoms include: fever, severe headaches, joint and muscle aches, chills, sore throat and weakness. Over time, symptoms become increasingly severe and may include: nausea and vomiting, diarrhea (may be bloody), red eyes, raised rash, chest pain and coughing, stomach pain, severe weight loss, bleeding from the nose, mouth, rectum, eyes and ears.

Ebola virus has been found in African monkeys, chimps and other nonhuman primates. A milder strain of Ebola has been discovered in monkeys and pigs in the Philippines. The Marburg virus has been found in monkeys, chimps and fruit bats in Africa.

The virus can be transmitted to humans by exposure to an infected animal’s bodily fluids, including blood. Butchering or eating infected animals can spread the viruses; scientists who have operated on infected animals as part of their research have also contracted the virus.

Infected people typically don’t become contagious until they develop symptoms. Family members are often infected as they care for sick relatives or prepare the dead for burial. Medical personnel can be infected if they don’t use protective gear such as surgical masks and latex gloves. Medical centers in Africa are often so poor that they must reuse needles and syringes and some of the worst Ebola epidemics have occurred because contaminated injection equipment wasn’t sterilized between uses. There’s no evidence that the Ebola virus or Marburg virus can be spread via insect bites.

Ebola and Marburg hemorrhagic fevers are difficult to diagnose because many of the early signs and symptoms resemble those of other infectious diseases, such as typhoid and malaria. But if doctors suspect that you have been exposed to the Ebola virus or Marburg virus, they use laboratory tests that can identify the viruses within a few days.

Most people with Ebola or Marburg hemorrhagic fever have high concentrations of the virus in their blood. Blood tests known as enzyme-linked immunosorbent assay ’(ELISA)’ and reverse transcriptase polymerase chain reaction ‘(PCR)’ can detect specific genes or the virus or antibodies to them.

No antiviral medications have proved effective in treating Ebola virus or Marburg virus infection. As a result, treatment consists of supportive hospital care. This includes providing fluids, maintaining adequate blood pressure, replacing blood loss and treating any other infections that develop.

As with other infectious diseases, one of the most important preventive measures for Ebola virus and Marburg virus is frequent hand-washing. Use soap and water, or use alcohol-based hand rubs containing at least 60 percent alcohol when soap and water aren’t available. In developing countries, wild animals, including nonhuman primates, are sold in local markets. Avoid buying or eating any of these animals.

In particular, caregivers should avoid contact with the person’s body fluids and tissues, including blood, semen, vaginal secretions and saliva. People with Ebola or Marburg are most contagious in the later stages of the disease.

If you’re a health care worker, wear protective clothing — such as gloves, masks, gowns and eye shields. Keep infected people isolated from others. Carefully disinfect and dispose of needles and other instruments. Injection needles and syringes should not be reused.

Scientists are working on a variety of vaccines that would protect people from Ebola or Marburg viruses. Some of the results have been promising, but further testing is needed.

Text 1: Questions 7-14

7. The Ebola and Marburg Viruses are native to
A. America
B. Japan
C . Africa
D. China

8. According to the passage(s), the Ebola and Marburg viruses
A. spread from person to person only
B. spread from animals to humans
C. spread from animals to animals
D. spread person to person after initial transmission from the infected animals

9. One of these statements is true, according to the information given in the passage(s)
A. scientists have developed vaccines for the treatment of Ebola and Marburg diseases
B. scientists are closer to developing an effective vaccine for the treatment
C. it is not possible to fight the diseases caused by Ebola and Marburg
D. scientists have discovered the causes of the transmission of the viruses from animal to human

10. Symptoms are typically seen within
A. five days
B. ten days
C. five to seven days
D. five to ten days

11. In the Philippines, Ebola was discovered in
A. chimpanzees
B. human primates
C. non-human primates
D. monkeys

12. Most known Ebola diseases occur due to
A. contamination
B. bodily fluids
C. contaminated needles and syringes
D. none

13. People with hemorrhagic fever show
A. high number of viruses in their blood
B. low concentrations of virus
C. high concentrations of antibodies
D. low concentrations of antibodies

10. As a health care worker, you
A. should keep infected people totally isolated from others
B. should not reuse needles and syringes for the second time
C. should wear clothing such as gowns and eye shields
D. none of the above

Text 2: A Chronic Disease – Atopic Dermatitis

Atopic dermatitis is a common chronic skin disease. It is also called atopic eczema. ‘Atopic’ is a term used to describe allergic conditions such as asthma and hay fever. Both dermatitis and eczema mean inflammation of the skin. People with atopic dermatitis tend to have dry, itchy and easily irritated skin. They may have times when their skin is clear and other times when they have rash.

In infants and small children, the rash is often present on the skin around the knees and elbows and the cheeks. In teenagers and adults, the rash is often present in the creases of the wrists, elbows, knees or ankles, and on the face or neck.

Atopic dermatitis usually begins and ends during childhood, but some people continue to have the disease into adulthood. If you have ever had atopic dermatitis, you may have trouble with one or more of these: dry, sensitive skin, hand dermatitis and skin infections.

The exact cause of atopic dermatitis is unknown. Research suggests that atopic dermatitis and other atopic diseases are genetically determined; this means that you are more likely to have atopic dermatitis, food allergies, asthma and/or hay fever if your parents or other family members have ever had atopic dermatitis. These diseases may develop one after another over a period of years. This is called the ―atopic march.

Recognizing that a person with atopic dermatitis is at a higher risk of developing one of these diseases is important for parents, patients and health care providers. Knowing that a child with a slight wheeze has had a history of atopic dermatitis, for example makes it easier to diagnose the subtle onset of asthma. There are many things that make the itching and rash of atopic dermatitis worse. When you learn more about atopic dermatitis and how to avoid things that make it worse, you may be able to lead a healthier life.

If you have a reaction to something you touch, breathe or eat, you might have an allergy. Allergies can trigger or worsen your atopic dermatitis symptoms. Common causes of allergy are: dust mites, furry and feathered animals, cockroaches, pollen, mold, foods, chemicals.

Your health care provider may recommend allergy testing and food challenges to see if allergies worsen itching or rashes. Allergy testing may include skin testing, blood tests or patch tests. Many measures can be taken to avoid things to which you are allergic. Although many of the measures can be done for the entire home, the bedroom is the most important room to make skin friendly. Talking with health care provider about what measures you can take to avoid your allergens can be very beneficial.

Food allergies may be the cause of itching or rashes that occur immediately after eating, especially in children. Some common food allergens include milk, eggs, peanuts, wheat, nuts, soy and seafood. Most people are allergic to only one, two or at the most three foods. Be aware that diet restrictions can lead to poor nutrition and growth delay in babies and children. Talk with your health care provider about maintaining a well-balanced diet.

Emotions and stress do not cause atopic dermatitis, but they may bring on itching and scratching. Anger, frustration and embarrassment can cause flushing and itching. Day to day stresses as well as major stressful events can lead to or worsen the itch-scratch cycle. The medications used in atopic dermatitis include: Topical steroids, Topical immuno modulators, Tar products, Antiinfectives, Antihistamines.

Steroid medicines that are applied to the skin are called topical steroids. Topical steroids are drugs that fight inflammation. They are very helpful when rash is not well controlled. Topical steroids are available in many forms such as ointments, creams, lotions and gels. It is important to know that topical steroids are made in low to super potent strengths. Steroid pills or liquids, like prednisone, should be avoided because of side effects and because the rash often comes back after they are stopped.

Text 2: Questions 15 to 22

15. People with atopic dermatitis suffer from
A. hay fever
B. asthma
C. dry, itchy and irritated skin
D. rashes
16. In small children, a rash is seen
A. around elbows
B. on the face
C. on the neck
D. around the knees
17. People with atopic dermatitis have
A. dry skin
B. skin infections
C. hand dermatitis
D. all of the above
18. The term atopic in the passage 1 refers to
A. allergic diseases
B. asthma and hay fever
C. allergic conditions like hay fever
D. allergic conditions like asthma
19. can worsen dermatitis symptoms
A. allergies
B. pollen
C. dust
D. mold
20. According to the information given in the passage(s), avoiding allergens is
A. easy
B. difficult
C. sometimes easy and sometimes difficult
D. can’t say
21. Allergic conditions like asthma in patients who have had a history of atopic dermatitis can be easily diagnosed by health professionals, this statement is
A. out of the paragraphs given
B. false
C. true
D. can be true or can be false
22. According to information given, common food allergens can be in
A. milk, egg, fish
B. fish, nuts, soya been
C. nuts, eggs, wheat
D. milk, cereals, sea food

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