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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 FEATURES	RECOMMENDED IMAGING MODALITY
Headache in immunocompromised patients	MRI of the head with and without contrast media
Headache in patients older than 60 years with suspected temporal arteritis	MRI of the head with and without contrast media
Headache with suspected meningitis	CT or MRI of the head without contrast media
Severe headache in pregnancy	CT or MRI of the head without contrast media
Severe unilateral headache caused by possible dissection of the carotid or arterial arteries	MRI 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 life	CT 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

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

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