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TEXT-A. Special warnings and precautions for use: If you are receiving medical treatment, are asthmatic, allergic to aspirin or have or have had a stomach ulcer, seek your doctor’s advice before taking this product.
The product labelling will include “Do not give to children aged under 16 years unless on the advice of a doctor”. There is a possible association between aspirin and Reye’s Syndrome when given to children. Reye’s Syndrome is a very rare disease which affects the brain and liver and can be fatal. For this reason, aspirin should not be given to children aged under 16 years unless specifically indicated (e.g. for Kawasaki’s disease).
Interaction with other medicinal products and other forms of interaction:
Aspirin may enhance the effects of anticoagulants and inhibit the effects of uricosurics. Experimental data suggest that ibuprofen may inhibit the effect of low dose aspirin on platelet aggregation when they are dosed concomitantly. However, the limitations of these data and the uncertainties regarding extrapolation of ex-vivo data to the clinical situation imply that no firm conclusions can be made for regular ibuprofen use, and no clinically relevant effect is considered to be likely for occasional ibuprofen use.
Overdose
Salicylate poisoning is usually associated with plasma concentrations >350 mg/L (2.5 mmol/L). Most adult deaths occur in patients whose concentrations exceed 700 mg/L (5.1 mmol/L). Single doses less than 100 mg/kg are unlikely to cause serious poisoning.

TEXT-B. Symptoms
Common features include vomiting, dehydration, tinnitus, vertigo, deafness, sweating, warm extremities with bounding pulses, increased respiratory rate and hyperventilation. Some degree of acid-base disturbance is present in most cases.
A mixed respiratory alkalosis and metabolic acidosis with normal or high arterial pH (normal or reduced hydrogen ion concentration) is usual in adults and children over the age of four years. In children aged four years or less, a dominant metabolic acidosis with low arterial pH (raised hydrogen ion concentration) is common. Acidosis may increase salicylate transfer across the blood brain barrier.
Uncommon features include haematemesis, hyperpyrexia, hypoglycaemia, hypokalaemia, thrombocytopaenia, increased INR/PTR, intravascular coagulation, renal failure and non-cardiac pulmonary oedema.
Central nervous system features including confusion, disorientation, coma and convulsions are less common in adults than in children.
Management
Give activated charcoal if an adult presents within one hour of ingestion of more than 250 mg/kg. The plasma salicylate concentration should be measured, although the severity of poisoning cannot be determined from this alone and the clinical and biochemical features must be taken into account. Elimination is increased by urinary alkalinisation, which is achieved by the administration of 1.26% sodium bicarbonate. The urine pH should be monitored. Correct metabolic acidosis with intravenous 8.4% sodium bicarbonate (first check serum potassium). Forced diuresis should not be used since it does not enhance salicylate excretion and may cause pulmonary oedema.
Haemodialysis is the treatment of choice for severe poisoning and should be considered in patients with plasma salicylate concentrations >700 mg/L (5.1 mmol/L), or lower concentrations associated with severe clinical or metabolic features. Patients under ten years or over 70 have increased risk of salicylate toxicity and may require dialysis at an earlier stage.

TEXT-C. Treatment
Antiemetic. 5-HT3 receptor antagonists are most effective as antiemetics. Examples:
o Kytril (granisetron HCl), 10 μg/kg IV over 5 minutes in adults and (PEDS) children 2 years and older
o Zofran (ondansetron), 8 mg IV over 15 minutes (PEDS: > 2 years 0.15 mg/kg)
o Anzemet (dolasetron), 100 mg IV over 30 seconds (PEDS: > 2 years 1.8 mg/kg)
Correct Acidosis: Sodium bicarbonate is frequently required to treat acidemia and to promote salicylate elimination by the kidneys. To correct metabolic acidosis caused by salicylate intoxication, administer 0.5 to 1.0 mEq/kg/IV bolus over 2 minutes and repeat as needed to maintain a blood pH of 7.4 to 7.5.

TEXT-D. Medications
Activated charcoal: To prevent more absorption, the doctor may give activated charcoal to absorb the salicylate from the stomach. A laxative may be given with the activated charcoal to move the mixture through the gastrointestinal system more rapidly. People who have been severely poisoned may be given repeated doses of activated charcoal.
IV fluids: Dehydration occurs early in aspirin poisoning. To correct dehydration, the doctor will start an IV to provide fluids. The doctor will also work to correct imbalances in the body’s blood chemistries.
Alkaline diuresis: This is a way to reduce the amount of salicylate in the body. Alkaline diuresis is the process of giving a person who has been poisoned compounds that alter the chemistry of the blood and urine in a way that allows the kidneys to remove more salicylate. Specifically, sodium bicarbonate is given via IV to make the blood and urine less acidic (more alkaline). This encourages the kidneys to capture more salicylate that can leave the body through the urine. Sometimes, other compounds, such as potassium, also have to be given to help with this process.
Reading test – 04. Part – A Question paper
Questions 1-7. Aspirin overdose: For each question, 1-7, decide which text (A, B, C or D) the information comes from. You may use any letter more than once. In which text can you find information about?
1. The various symptoms of a patients who have taken too much aspirin
2. Steps need to be taken while treatment
3. What medicines are necessary for treatment
4. How to decide the overdose of a drug
5. What precautions do we need to take to keep children safe? ________
6. Types of treatments for aspirin overdose
7. What to consider in treatment management
8. The number of other products that are associated with aspirin

Questions 8-14. Complete each of the sentences, 8-14, with a word or short phrase from one of the texts.
9. Sodium bicarbonate is given via______________ to make the blood and urine more alkaline.
10. We need to take into consideration of ______________ and ______________ factor, while defining the severity of overdose poising.
11. If you are suffering from asthma you need to contact____________________ before taking aspirin.
12. ______________ antagonistic are used for treating over poising.
13. Patients under ten years or more than 70 have expanded danger of______________ and may require dialysis at a prior stage.
14. Dehydration occurs in the______________ stage of poisoning.
15. ______________ may inhibit the effect of low dose aspirin.
Questions 15-20. Answer each of the following questions, 15-20, with a word or short phrase from one of the texts.
16. The drug that will enhance the effects of anticoagulants and inhibit the effects of uricosurics is______________
17. What method will reduce salicylate level in the body? ______________
18. Which chemical compound is required to treat acidemia? ______________
19. What will be provided primarily, if a patient presents with over ingestion of aspirin? ______________
20. What do you need to take to control dehydration? ______________

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

1. What are these guidelines for?
A. Improving patient safety at hospitals
B. Promoting appropriate use of email at practice
C. Generating impression among staff and with patients

Mail Etiquette Guidelines: Most people know it only takes a few seconds to make an impression, and most first impressions are difficult to change. What most people may not realize is that this rule doesn’t just apply to person-to-person meetings.
“We are in the age of computers, and e-mail is a huge way of communication, so that could be the first way of meeting a patient,” says Hendersonville, N.C.-based Darlene Das, president of etiquette consulting company Today’s Etiquette, and a trained surgical technician who specializes in medical practice etiquette.
When it comes to communicating with patients, and even with fellow staff, making a good impression is just the first of many reasons your written — or typed — words are so important. Come across as too cutesy, grammatically inept, impolite, or inappropriate, and your e-mails could offend colleagues or turn off patients from your practice.
Whether communicating with colleagues or patients face-to-face or via e-mail, the same age-old etiquette rules apply. You need to be polite, professional, and friendly. But because of electronic communication’s unique qualities, there are additional considerations, from using proper grammar to observing formalities.

2. As per the extract, what is the main topic of selection?
A. Small practices
B. Large practices
C. Individual doctor

Extract from manual: Some patients prefer the intimacy of a small practice. The advantages include getting to know all the staff and usually less bureaucracy. Other patients prefer large-practices that offer the convenience of many specialties under one roof. Ultimately, who your individual doctor is matters more than the practice he or she is working for. But different practices have different vibes, though you may not be able to sense this until you are actually a patient.
Another option these days — though much more expensive — is the “direct primary care” model (sometimes known as “concierge” medicine). In this type of practice, you pay an annual retainer fee but get longer visits and easier access to your doctors.

3. What does this information tell us about?
A. Many people are travelling farther distances to get cure
B. Most people are preferring to get cared at best hospitals
C. Significant Medicare patients are suffering from heart attack

Extract from blog: There’s an exceedingly simple way to get better health care: Choose a better hospital. A recent study shows that many patients have already done so, driving up the market shares of higher-quality hospitals.
A great deal of the decrease in deaths from heart attacks over the past two decades can be attributed to specific medical technologies like stents and drugs that break open arterial blood clots. But a study by health economists at Harvard, M.I.T., Columbia and the University of Chicago showed that heart attack survival gains from patients selecting better hospitals were significant, about half as large as those from breakthrough technologies. That’s a big improvement for nothing more than driving a bit farther to a higher-quality hospital. Because more Medicare patients went to higher-quality hospitals for heart attacks between 1996 and 2008, overall chances of survival increased by one percentage point, according to the study. To receive care at a hospital with a one-percentage-point gain in survival rate or a one-percentage-point decrease in readmission rate, a heart attack patient travelled 1.8 or 1.1 miles farther, respectively. The investigators also found survival gains for heart failure and pneumonia, but with far less of a difference, about 0.21 and 0.10 percentage points.

4. According to extract, prior to making a home visit, GPs must?
A. give his out-of-hours telephone number to local hospitals
B. respond appropriately for patient’s case
C. request the patient to come to hospital on the follow-up day.

Home visit guidelines: All doctors have an emergency service outside of normal surgery hours. Most surgeries have an answering machine message that refers you to out-of-hours telephone numbers or the NHS Direct helpline. The out-of-hours service is only for urgent medical problems that cannot wait until the next day to be treated. It’s usually based at a local medical centre or attached to a local hospital and is a co-operative manned by local GPs. When you phone the out-of-hours service, a nurse or GP will take your details and ask you about your symptoms. You’ll then be dealt with in one of three ways.
• You’ll be given telephone advice.
• You’ll be asked to come into the medical centre to see a doctor.
• A home visit will be arranged if you are too ill to leave your house.
If you’re seen out of hours, your doctor will be informed of any consultation you’ve had with another doctor.

5. What do you understand form the manual extract?
A. Physician assistants improve healthcare in rural areas
B. PA’s isolation is not ideal for better healthcare outcomes
C. Requirements need to meet for working in rural areas

I have been concerned with the maldistribution of rural health provider assets for decades. The situation is dire. The sad reality is that the number of physicians practicing in rural and medically underserved areas has been declining for decades. The reasons for this are complex. Practice in these areas is challenging from financial and quality of life perspectives. Many clinicians I know choose to work in metropolitan areas to find a “better life,” more opportunities, and more professional support.

The PAs I know who practice in rural and medically underserved areas tell me how much they love their work and their patients. They also express concerns about the isolation and the fatigue that comes with being the only provider in a small community with little professional support. It takes a special kind of clinician to work in this environment.

6. The purpose of this email is
A. To implement medical practice change without going broke or insane
B. To explain the reasons for why the new regulations affecting medical workforce
C. To remind the duties of medical professionals.

Email to Medical Staff:
To
All Medical Professionals, Commonwealth Medical Board, Liang Province.

Over the last several years, new regulations have become law affecting how doctors practice medicine. First came the Meaningful Use program, pushing doctors to purchase and implement EHRs. Then came updates to those rules, threatening doctors with financial penalties not only if they failed to incorporate an EHR into practice, but if it was not used in a meaningful way based on submitted data metrics (as determined by government officials).

Now, many practices and healthcare systems are scrambling to address the recently enacted MACRA laws (also known as Medicare’s Quality Payment Program). There is much discussion going on about how to avoid reimbursement reductions. It first comes down to how your practice is getting ready to take on the challenge.

Not all of us work for a hospital or large organization that has IT departments assigned specifically to that task. For many of us, especially in small and/or private practices, this is pretty much a do-it-yourself project.

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

I’d heard there was a new woman GP in town, so, at my doctor-husband’s urging, I booked an appointment for a routine check-up. I was feeling well and had no need to suspect anything was amiss. The GP detected nothing out of the ordinary and, with the exception of slightly elevated cholesterol levels, my blood tests came back normal. My GP told me to try to lower my cholesterol levels with diet and exercise and she’d see me again in six months. I embarked upon a calorie-controlled, low-fat diet and worked out most nights for 45 to 60 minutes on my treadmill and weights machine. I was feeling fit and healthy and was close to my ideal weight when the time arrived for my follow-up visit.

In preparation for the visit my husband organised repeat blood tests and sent a copy to my GP. The results arrived the following afternoon. Though my cholesterol had lowered from 5.6 mmol/L to 5.2 mmol/L, we were both surprised to see that my fasting blood glucose had gone from a perfectly normal 5.2 mmol/L to a perfectly diabetic 9.3 mmol/L. A follow-up fasting blood glucose, organised by my husband, confirmed I had diabetes.

A few days later my GP reaffirmed that I had type 2 diabetes and warned me of the complications if this was not treated correctly with a combination of diet, exercise and oral medication. “I wondered” how diet and exercise were going to save me, when previous dedication in this area had let me down so badly. The following week I dutifully attended a session with a diabetes dietitian. Of the six people at the clinic, I was the only one who had taken the fast lane to the dark side, everyone else was pre-diabetic. Along with our new healthy eating habits the dietitian recommended 30 minutes of brisk walking five times per week. I wanted to protest that I was already outdoing this, but sensed the futility of commenting.

Eager to avoid the threatened complications, I got stuck into the job at hand. I took my pills, cut my carbs, worked out and drew blood from my fingertips. Soon, I reached my ideal weight. But all of this did little or nothing to lower my blood sugars. Weekly they continued to rise.

Meanwhile, I carried a deep sense that part of the puzzle was missing. I became paranoid that some aspect of my lifestyle had contributed to this rapid progression, wondering if diet tonic water or my shampoo could be the hidden enemy. While I told myself that denial is one of the phases of grief and perhaps normal under the circumstances, I continued to obsess.

During one of my many sessions browsing diabetes sites on the internet, I found a site that stated that type 1 diabetes could, and did, occur in adults of any age. Many GPs were said to be unaware of this, passing it off as variant of type 2. People in this group were usually neither overweight nor sedentary. This type of diabetes was sometimes referred to as ‘latent autoimmune diabetes of adults’ (LADA) or ‘slow onset type 1’. The more I read about LADA, I became more convinced I was reading about myself. I mentioned it to my husband but he had not heard of it either, so for a while I dismissed it. I figured that if the general medical profession didn’t know about it, then it was probably some unfounded new age idea. I couldn’t let it go though, so kept reading about it. I learned that a blood test, measuring GAD antibodies could confirm type 1 diabetes. I wanted to have this test done so I pressed my husband to write out the pathology request. I was out the door with it like a bullet.

Two weeks later the results came back strongly positive. Perhaps most people would have been unsettled with such a result, but I simply felt relief. In one fell swoop, my questions had been answered. I now knew why there had been no pre-diabetes and why exercise and diet had not spared me. I was referred to an endocrinologist who confirmed type 1 diabetes, and who encouraged me to be proactive in my own treatment. Indeed, he confirmed what I’d already read – that starting insulin early might spare my remaining beta cells.

As flexibility is important to me, we agreed upon multiple daily injections consisting of long-acting insulin at night, and rapid acting insulin prior to meals. I’ve not looked back. Within 12 hours of my first shot I knew I was on the right path, as immediately I felt more energetic, less sleepy and generally more cheerful.

I’m glad I learned about it early as I’ve been fast-tracked to a treatment that works and in doing so, have avoided the frustration of taking medication more suited to type 2 diabetes. Though knowing my true type of diabetes may neither alter long-term treatment nor outcome, I feel at peace with my diagnosis and can now just get on with my life.

Questions 7-14
7. Why did the narrator decide to lose weight?
A. She felt bad on her overweight
B. Her husband wanted her to see slim
C. She thought of facing a severe health setback
D. On her GP’s advice
8. Why the narrator was shocked about the blood test results?
A. Probably she thought of checking her blood infections
B. The blood glucose levels reached extreme levels
C. The inappropriate blood test results of her health status
D. Because, it was come to her husband’s notice
9. In the third paragraph, the narrator used the words “I wondered” to
A. express her concern over the same diet plan
B. emphasized the doctor to assist her in reducing blood sugar
C. express anger on her old GP’s plan
D. to show relation among several factors which triggers depression
10. What do you understand about the narrator’s mental condition from the fourth paragraph?
A. She is irritated
B. She is feeling tensed
C. She is frustrated
D. She is disappointed
11. How come the narrator found LADA Test?
A. Her husband found it for her
B. Her first GP advised her to take it
C. She found it on reading a blog
D. One of her friends suggested her
12. Why did the narrator feel happy with the test results?
A. The test results obtained positively
B. The test results confirmed that she was attacked with low level diabetes
C. Her GP found that test is the bench mark to certify
D. She found the new test to diagnose diabetes
13. What made her to feel more energetic and less sleepy?
A. Her first injection dosage
B. Her husband’s support
C. After her GP motivation session
D. Wanted to show her strength to the society
14. What does the word “it” refers to?
A. Medicines
B. LADA
C. GP’s support
D. blog


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 is the author’s view on ADHD from the first paragraph?
A. ADHD is not a severe disorder to be 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’s 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 make 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 area 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 analysing 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. Paediatricians
D. Child Specialists

END OF PART B & C. End of the Reading Test.

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