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Ganglion Cyst OET Reading

May 16, 2024 jomon Leave a comment

TEXT 1 What is a ganglion cyst?

A ganglion cyst is a collection of synovial fluid in a sac, on or near tendon sheaths and joint capsules. They usually appear on the on the dorsal aspect of hands, fingers and wrists, and can also occur on the feet, ankles and knees. The cyst can range from the size of a pea to the size of a golf ball. The size of a ganglion may increase over time, especially if it near a joint where there are frequent repetitive movements.

About 65% of ganglia of the wrist and hand are dorsal wrist ganglia, followed by the volar wrist ganglion constituting about 20 to 25% of ganglia. Flexor tendon sheath ganglia and mucous cysts arising from the dorsal distal interphalangeal joint make up the remaining 10 to 15%.

Ganglion cysts look and feel like a smooth lump under the skin and the wall of the ganglion is smooth, fibrous, and of variable thickness. The cyst is filled with clear gelatinous, sticky, or mucoid fluid of high viscosity. The fluid in the cyst is sometimes almost pure hyaluronic acid. The cyst is attached to the tendon or joint by a pedicle (stalk).

The cause of them is not known, however it is thought they may be caused by tiny tears in the covering of a tendon or joint. Ganglion cysts are benign and appear in isolation. Around 30 to 50 per cent of ganglion cysts resolve spontaneously without medical intervention, though this can take many years.

Ganglia constitute about 60% of all chronic soft-tissue swellings affecting the hand and wrist. They usually develop spontaneously in adults aged 20 to 50, with a female: male preponderance of 3:1.People who have wear-and-tear arthritis in the finger joints closest to their fingernails are at higher risk of developing ganglion cysts near those joints. Joints or tendons that have been injured in the past are more likely to develop ganglion cysts.

TEXT 2: Diagnosing a ganglion cyst

Ganglia are evident on examination even if they cannot be seen by the naked eye. It is important that cysts are examined by a doctor because there is another type of ganglion on the dorsal wrist that occurs in people with rheumatoid arthritis. A doctor can easily differentiate between them because a rheumatoid cyst is soft and irregular in appearance. Also, a person with rheumatoid arthritis will also have proliferative rheumatoid extensor tenosynovitis.

Most ganglion cysts do not cause symptoms, but the main symptoms people experience are a noticeable swelling or lump. The lump is able to change its size, including going away completely only to return. The lump is usually soft and immobile. In some cases, the lump is painful and aching, particularly those at the base of fingers. The ache and pain is made worse by moving any nearby joints. The affected tendon may cause a sensation of muscular weakness. The back of the hands and wrists are most commonly affected.

A medical examination is generally all that is needed to confirm diagnosis but other tests could include: Aspirating some of the fluid with a syringe An ultrasound to determine if the ganglion is solid or fluid filled X-ray and/or magnetic resonance imaging may be needed if the cyst cannot be seen.

TEXT 3 Passive treatment options for a ganglion cyst

If a cyst is not causing any problems, a passive “watch and wait” approach is recommended. This means the cyst is monitored and action only taken if it increases to a point where it causes symptoms. However, even if there are no symptoms some people prefer treatment for cosmetic reasons.

Temporarily immobilising the joints around a cyst may both slow down the rate at which the cyst grows and reduce the size of the cyst. This may release the pressure on nerves, relieving pain. If a person knows what activity is the likely cause such as starting to play an instrument or using a new piece of equipment, it may be helpful to stop or modify this activity.

Simple over the counter pain relievers and/or anti-inflammatory medications may be required to alleviate pain. In some cases, modifying shoes or how they are laced can relieve the pain associated with ganglion cysts on ankles or feet.

A traditional old home remedy for a ganglion cyst consisted hitting the cyst with the Bible. Thumping a cyst with any heavy object is not recommended because the force of the blow can damage surrounding structures in the hand or foot.

TEXT 4

Another self-help approach is to try and “pop” the cyst by puncturing it with a needle. This is unlikely to be effective and can lead to infection.

Some people advocate herbal remedies that have anti-inflammatory properties such as turmeric and ginger. The true cause of ganglion cysts is not known but they are a bulge in the lining of a structure. This means it is unlikely to be part of the inflammatory process

Active treatment options for ganglion cysts.

If a cyst is causing problems, a needle aspiration performed by a qualified doctor. This simple procedure is carried out in the GP surgery or hospital outpatients department. It involves drawing the liquid contents of the cysts out of the sac via the syringe.

Needle aspiration is usually the first active treatment option offered for ganglion cysts as it is less invasive than surgery. However, nonsurgical treatment fails in about 40 to 70% of patients, necessitating surgical excision.

The cyst may be surgically removed using either open or keyhole approaches.

In open surgery the surgeon makes a medium-sized cut, usually about 5cm (2in) long, over the site of the affected joint or tendon. The sac is removed at the pedicle to reduce recurrence.

Keyhole surgery is often used if the ganglion cyst is near, or in a joint. Smaller incisions are made and a tiny camera called an arthroscope is used by the surgeon to look inside the joint and then pass instruments through the incision to remove the cyst. Excision can be done via arthroscopic or standard open surgery. Recurrence rates after surgical excision are about 5 to 15%.

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 The ratio of ganglion cysts between sexes? ___________________

2 The primary dynamic way of removing ganglion cysts? ________________

3 The investigations that may be done to confirm someone has a ganglion cyst? ___________________

4 How keeping the affected area immobile for a time can reduce the effect of a ganglion cyst? _____________

5 Another type of ganglion cyst that can develop at the wrist? ____________

6 The role the bible used to play in managing ganglion cysts? _____________

7 The contents of a ganglion cyst? ___________________

Questions 8-14 Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.

8 Where ganglion cysts are usually seen? ___________________

9 What percentage of ganglion cysts come back after a surgical excision? ___________________

10 Are ganglion cysts more common in men or women? ___________________

11 What can changing shoes achieve for people with ganglion cysts in lower limbs? ___________________ 12 What are the two main complaints people with a ganglion cyst have? ___________________

13 What type of cysts develop from the fingers? ___________________

14 What is often the first invasive treatment option offered for ganglion cysts? ___________________

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, numbers or both.

15 An______________ shows if the ganglion is solid or not.

16 ___________ganglia and mucous cysts in the DIP joints account for a small number of all ganglion cysts.

17 No one really knows why ganglion cysts develop but there is a____ in the membrane around a structure 18 A surgeon can look into a ganglion cyst around a joint with an arthroscope and then_________ through an additional small cut in the skin to get rid of the cyst.

19 A ganglion cyst on a tendon on can lead to a cause a feeling of___________________ weakness.

20 Needle aspiration involves pulling the__________ of the cysts out of the sac with a needle and syringe.

PART B

TEXT 1 What Nurses Need to Know About Celiac Disease and Gluten Sensitivity

Gluten is the group name for two proteins, gliadin and glutenin, which are primarily derived from wheat, barley, rye and triticale. These proteins are responsible for the bonding of particles, giving food its shape. When gluten is consumed, those with an allergy experience an immune response which attacks the small intestine. Once the villi of the small intestine are damaged, nutrients cannot be properly absorbed. While some people may be asymptomatic throughout their lifetime, many experience at least some symptoms.

Recent research shows there is no evidence to support an increased risk of celiac disease when infants are introduced to gluten at an early age (less than 4 months). However, delayed introduction (more than 7 months) to gluten may be associated with an increased risk.

Question 1) What does the article say about the causes of celiac disease?

a) It can provoke damage to the small intestine

b) It could be linked to children’s diets

c) Normally, children don’t suffer from celiac disease

TEXT 2 Aspirin Guidelines

Aspirin should be taken with, or straight after, a meal or snack. This helps to reduce the risk of any stomach irritation. Gastro-resistant tablets (also called enteric-coated or EC tablets) can be taken before food as these have a special coating which will help to protect the stomach from irritation. Gastro-resistant tablets should be swallowed whole, they must not be crushed or chewed. If the patient is using indigestion remedies, aspirin in this form must not be taken for at least two hours before and the two hours after they are used. This is because the antacid in the remedy can affect the way the coating on these tablets works. Melt-in-the-mouth (orodispersible) tablets should be placed on the tongue and allowed to dissolve.

Question 2) What do these guidelines say about when to take aspirin?

a) Aspirin taken close to meal times can irritate the stomach lining

b) Some types of aspirin have special indications

c) It can be taken in combination with indigestion remedies

TEXT 3 Assessing the Need for a Peripheral Intravenous Cannula

Many cannulas are left in without orders for intravenous fluids or medications. Some patients end up with two, three, or even more concurrent cannulas, despite only needing one in most cases. They are often left in ‘just in case’ they might be needed. But any catheter leads directly to the bloodstream and can be a source of infection. The need for the cannula must be constantly reassessed.

When a cannula is inserted, a flashback of blood in the chamber confirms it is in the vein. Flushing the cannula with 0.9% saline before and after intravenous medications reduces admixture of medicines and decreases the risk of blockage.

Question 3) What does this article say about the use of cannulas?

a) Cannula usage should be reviewed regularly

b) In most cases, concurrent cannula use is justified

c) Cannulas can be left in place so long as they are flushed with a 0.9% saline solution

TEXT 4 Description of the ‘SecurAcath’ Device

SecurAcath’ is a single-use device to secure percutaneous catheters in position on the skin. It is intended for use in adults and children who need a central venous

catheter which is a long, thin, flexible tube that is inserted into a vein through the skin.

‘SecurAcath’ has two parts, a base and cover. The base is made up of two foldable metal legs and two securement feet. The feet are placed under the skin at the catheter insertion site and unfolded to make a subcutaneous anchor. The cover then attaches to the catheter shaft and holds it in place when it is clipped onto the base. The device stays in place as long as the catheter is needed and can be lifted off the skin to allow cleaning of the insertion site.

Question 4) How should the ‘SecurAcath’ device be used?

a) The feet can be repositioned in order to clip them to the base

b) It should be correctly assembled before attaching the cover

c) The flexible tube should be inserted into a vein first

TEXT 5 Assessment of Colorectal Polyps During Colonoscopy

Colorectal polyps are small growths on the inner lining of the colon. Polyps are not usually cancerous, most are hyperplastic polyps with a low risk of cancer. However, some (known as adenomatous polyps) will eventually turn into cancer if left untreated. Detecting and removing adenomas during colonoscopy has been shown to decrease the later development of colorectal cancers. However, removal of any polyps by polypectomy may have adverse effects such as bleeding and perforation of the bowel.

It can take three weeks for a person to get the examination results for polyps that were removed during colonoscopy, and they may feel anxious during this waiting period. Using virtual chromoendoscopy technologies may allow real-time differentiation of adenomas and hyperplastic colorectal polyps during colonoscopy, which could lead to quicker results. Question

5) What does the article tell us about colonoscopies?

a) Colonoscopy and polypectomy procedures are thought to be risk-free

b) Virtual chromoendoscopy technology could speed up the process

c) Most hyperplastic polyps become cancerous if left untreated

TEXT 6 Osteomyelitis After Traumatic Knee Injury

A 56-year-old woman was admitted to a hospital for the treatment of osteomyelitis following a traumatic knee injury. She received the antibiotic Gentamicin in accordance with the hospital’s usual protocol. Kinetics, blood drug levels, and renal function were monitored, and dosage recommendations were made. However, a permanent vestibulopathy (or balance disorder) resulted from the antibiotic.

During the case investigation, the patient testified that she experienced “roaring” in her ears while hospitalized. (The roaring is a form of tinnitus) She further testified that she was not ambulatory; she was restricted to bed rest. No staff member inquired about unusual ear symptoms or told her to report such symptoms. Consequently, a lawsuit was brought against the hospital, specifically against the pharmacists. Question 6) What went wrong in the treatment of the 56-year-old woman?

a) The woman was infected by vestibulopathy while in hospital

b) The correct dosage was not balanced

c) Staff members failed to take note of the woman’s symptoms

PART C TEXT 1

Many adult hospital inpatients need intravenous (IV) fluid therapy to prevent or correct problems with their fluid and/or electrolyte status. Deciding on the optimal amount and composition of IV fluids to be administered and the best rate at which to give them can be a difficult and complex task, and decisions must be based on careful assessment of the patient’s individual needs.

Errors in prescribing IV fluids and electrolytes are particularly likely in emergency departments, acute admission units, and general medical and surgical wards rather than in operating theatres and critical care units. Surveys have shown that many staff who prescribe IV fluids know neither the likely fluid and electrolyte needs of individual patients, nor the specific composition of the many choices of IV fluids available to them. Standards of recording and monitoring IV fluid and electrolyte therapy may also be poor in these settings. IV fluid management in hospital is often delegated to the most junior medical staff who frequently lack the relevant experience and may have received little or no specific training on the subject.

The ‘National Confidential Enquiry into Perioperative Deaths’ report in 1999 highlighted that a significant number of hospitalised patients were dying as a result of infusion of too much or too little fluid. The report recommended that fluid prescribing should be given the same status as drug prescribing. Although mismanagement of fluid therapy is rarely reported as being responsible for patient harm, it is likely that as many as one in five patients on IV fluids and electrolytes suffer complications or morbidity due to their inappropriate administration.

There is also considerable debate about the best IV fluids to use (particularly for more seriously ill or injured patients), resulting in wide variation in clinical practice. Many reasons underlie the ongoing debate, but most revolve around difficulties in interpretation of both trial evidence and clinical experience. For example, many accepted practices of IV fluid prescribing were developed for historical reasons rather than through clinical trials. Trials cannot easily be included in meta-analyses because they examine varied outcome measures in heterogeneous groups, comparing not only different types of fluid with different electrolyte content, but also different volumes and rates of administration. In addition, most trials have been undertaken in operating theatres and critical care units rather than admission units or general and elderly care settings. Hence, there is a clear need for guidance on IV fluid therapy for general areas of hospital practice, covering both the prescription and monitoring of IV fluid and electrolyte therapy, and the training and educational needs of all hospital staff involved in IV fluid management.

The aim of these guidelines is to help prescribers understand the physiological principles that underpin fluid prescribing the pathophysiological changes that affect fluid balance in disease states and the indications for IV fluid therapy. In developing the guidelines, it was necessary to limit the scope by excluding patient groups with more specialised fluid prescribing needs. It is important to emphasise that the recommendations do not apply to patients under 16 years, pregnant women, and those with severe liver or renal disease, diabetes or burns. They also do not apply to patients needing inotropes and those on intensive monitoring, and so they have less relevance to intensive care settings and patients during surgical anaesthesia. Patients with traumatic brain injury (including patients needing neurosurgery) are also excluded. The scope of the guidelines does not cover the practical aspects of administration (as opposed to the prescription) of IV fluids. It is hoped that these guidelines will lead to better fluid prescribing in hospitalised patients, reduce morbidity and mortality, and lead to better patient outcomes.

The guidelines will assume that prescribers will use a drug’s summary of product characteristics to inform decisions made with individual patients. All patients continuing to receive IV fluids need regular monitoring. This should initially include at least daily reassessments of clinical fluid status, laboratory values (urea, creatinine and electrolytes) and fluid balance charts, along with weight measurement twice weekly. It is important to remember that patients receiving IV fluid therapy to address replacement or redistribution problems may need more frequent monitoring. Additional monitoring of urinary sodium may be helpful in patients with high-volume gastrointestinal losses. Patients on longer-term IV fluid therapy whose condition is stable may be monitored less frequently, although decisions to reduce monitoring frequency should be detailed in their IV fluid management plan. Clear incidents of fluid mismanagement (for example, unnecessarily prolonged dehydration or inadvertent fluid overload due to IV fluid therapy) should be reported through standard critical incident reporting to encourage improved training and practice (see Consequences of fluid mismanagement to be reported as critical incidents).

Questions 7-14

7) What does the first paragraph tell us about intravenous (IV) fluid therapy?
a) Most patients receive a standard composition of fluids
b) Electrolyte status should be kept at the optimal level
c) It is not easy to decide on the correct volume and speed of delivery of fluids
d) It is difficult to correct problems
8) What have surveys shown about intravenous (IV) fluid therapy?
a) There is often a lack of information about correct dosage
b) Sometimes, staff mixed up electrolyte fluids with standard IV fluids
c) Intravenous (IV) fluid therapy should be delegated to junior medical staff
d) Mistakes made in operating theatres were often fatal
9) What did the 1999 report highlight?
a) A small number of patients died because they were prescribed the wrong medication
b) Around 20% of patients experience problems due to incorrect IV fluid therapy
c) Some hospitals fail to report deaths due to mismanaged procedures
d) Not all Perioperative deaths could be linked to IV fluid therapy
10) What does the fourth paragraph tell us about IV fluid therapy?
a) Seriously ill patients generally need more fluids that injured patients
b) There are historical reasons to prolong the use of IV fluid therapy
c) The best IV fluids are more expensive
d) Not everyone agrees on the most suitable fluids to use
11) Why is it difficult to perform meta-analyses of trials?
a) There are not enough qualified analysts
b) Trials usually don’t take place in different healthcare settings
c) The volume of data is too great to analyse
d) More hospital staff need training before the trials take place
12) What do we learn about the scope of the guidelines in the fifth paragraph?
a) The guidelines are not appropriate for all types of patients
b) Patients needing inotropes and those on intensive monitoring were included for historical reasons
c) Pathophysiological patients were excluded because they cannot be given IV fluid therapy
d) The guidelines only apply to men (that is to say, adult male patients)
13) According the sixth paragraph, how often should clinical fluid status be reassessed?
a) Twice a day or more frequently
b) Once every 24 hours
c) Twice a week
d) Never – routine reassessment can be monitored by machine
14) What should be done in the case of fluid mismanagement?
a) Additional monitoring should be carried out
b) Rehydration should be prolonged
c) Information about occurrences should be conveyed to the appropriate authorities
d) The person or persons involved should be criticised

PART C TEXT 2

A CT scan is a specialised X-ray test. It can give quite clear pictures of the inside of your body. In particular, it can give good pictures of soft tissues of the body which do not show on ordinary X-ray pictures. CT stands for computerised tomography. It is sometimes called a CAT scan. CAT stands for Computerised Axial Tomography. The CT scanner looks like a giant thick ring. Within the wall of the scanner there is an X-ray source. Opposite the X-ray source, on the other side of the ring, are X-ray detectors. You lie on a couch which slides into the centre of the ring until the part of the body to be scanned is within the ring. The X-ray machine within the ring rotates around your body. As it rotates around, the X-ray machine emits thin beams of X-rays through your body, which are detected by the X-ray detectors.

The detectors detect the strength of the X-ray beam that has passed through your body. The denser the tissue, the less X-rays pass through. The X-ray detectors feed this information into a computer. Different types of tissue with different densities show up as a picture on the computer monitor, in different colours or shades of grey. So, in effect, a picture is created by the computer of a slice (cross-section) of a thin section of your body.

As the couch moves slowly through the ring, the X-ray beam passes through the next section of your body. So, several cross-sectional pictures of the part of your body being investigated are made by the computer. Newer scanners can even produce 3-dimensional pictures from the data received from the various slices of
the part of the body being scanned.

A CT scan can be performed on any section of the head or body. It can give clear pictures of bones. It also gives clear pictures of soft tissues, which an ordinary X-ray test cannot show, such as muscles, organs, large blood vessels, the brain and nerves. The most commonly performed CT scan is of the brain to determine the cause of a stroke, or to assess serious head injuries.

Usually, very little preparation is necessary. It depends on which part of your body is to be scanned. You will be given instructions by the CT department according to the scan to be done. As a general rule, you will need to remove any metal objects from your body, such as jewellery, hair clips, etc. It is best not to wear clothes with metal zips or studs. You may be asked not to eat or drink for a few hours before your scan, depending on the part of your body to be scanned.

The CT scan itself is painless. You cannot see or feel X-rays. You will be asked to stay as still as possible, as otherwise the scan pictures may be blurred. Conventional CT scans can take between 5-30 minutes, depending on which part of the body is being scanned. More modern CT scans (helical CT scans) take less than a minute and also use less radiation.

As the scan uses X-rays, other people should not be in the same room. The operator controls the movement of the couch and scanner from behind a screen or in a separate control room so that they are protected from repeated exposure to X-rays. However, communication is usually possible via an intercom, and you will be observed at all times on a monitor. Some people feel a little anxious or claustrophobic in the scanner room when they are on their own. You can return to your normal activities as soon as the scan is over. The pictures from the scan are studied by an X-ray doctor (radiologist) who sends a report to the doctor who requested the scan.

CT scans use X-rays, which are a type of radiation. Exposure to large doses of radiation is linked to developing cancer or leukaemia – often many years later. The dose of X-ray radiation needed for a CT scan is much more than for a single X-ray picture but is still generally quite a low dose. The risk of harm from the dose of radiation used in CT scanning is thought to be very small but it is not totally without risk. As a rule, the higher the dose of radiation, the greater the risk. So, for example, the larger the part of the body scanned, the greater the radiation dose. And, repeat CT scans over time cause an overall increase of dose. Various studies have aimed to estimate the risk of developing cancer or leukaemia following a CT scan. In general, the risk is small. In many situations, the benefit of a CT scan greatly outweighs the risk.

Questions 15-22
15) What advantage does a CT scan give over a standard X-ray?
a) It emits less radiation
b) It can take pictures of bones and soft tissues
c) It is quieter and uses less electricity
d) The patient can lie down during the scan
16) What can be seen on a CT scan result?
a) Tissue thicknesses and densities can be shown using different colours
b) The computer displays the date, time and patient’s name on the result
c) When this article was written, CT scans could only show shades of grey on the results
d) Cross-dimensional attributes are shown on the results in colour or shades of grey
17) What does the third paragraph tell us about the CT scans?
a) Usually, more than one picture is obtained
b) 3-dimensional pictures provide more information that standard cross-sectional pictures
c) The CT ring can be programmed to move the coach slowly
d) Images and scans can be stored on computers for up to a year
18) What type of scan is carried out most frequently?
a) Scans of the head and neck b) Scans of the chest and upper body
c) Whole body scans
d) Scans of the head only
19) What should you wear for your CT scan?
a) Clothing that is free of any metal
b) A standard hospital gown
c) There are usually no restrictions on clothing
d) Some scans require an absence of clothing
20) What can influence the clarity of CT images?
a) Temperature
b) Movement
c) Radiation levels
d) Levels of pain or discomfort
21) What does the article say about the number of people in the CT room?
a) A Only the operator will be with you in the CT room
b) You can ask for one or two people to stay with you during the scan
c) You can only be accompanied if you feel anxious or claustrophobic
d) You will be alone in the CT room
22) What does the last paragraph say about the levels of risk?
a) Generally, the risks are not as significant as the potential advantages
b) Some people have developed cancer or leukaemia after a CT scan
c) CT scanners pose a lower risk than standard X-ray machines
d) There is a high risk of cancer if you have a large body

View answers – Ganglion Cyst

OET READING TESTS

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Tobacco Smoking OET Reading

May 15, 2024 jomon Leave a comment

PART A

TEXT 1:Tobacco Smoking Statistics from the Australian Institute of Health and Welfare

Tobacco smoking is the single most important preventable cause of ill health and death in Australia. Tobacco smoke contains over 7,000 chemicals, of which over 70, cause cancer. Lung cancer, chronic obstructive airways disease and coronary heart disease are the 3 main diseases linked to tobacco smoking.

Smoking-related diseases killed 14,900 Australians in the financial year 2004–05. This equals 40 preventable deaths every day. Smoking resulted in over 750,000 days spent in hospital and cost $670 million in hospital costs in the financial year 2004–05.

Smoking kills more men than women – 9,700 men compared to 5,200 women. Cancer is the number one cause of tobacco-related death in men (57 per cent) and women (51 per cent), with lung cancer accounting for around 75 per cent and 72 per cent of cancers for men and women respectively. Lung cancer currently causes the most cancer deaths in Australia and this is due mainly to smoking.

The trend for tobacco smoking is dropping with 12% of people aged 14 and older smoking daily in 2016, which is a 24% reduction since 1991. The number of young people who start smoking is also reducing. In 2010, the average age when 14–24 year-olds smoked their first full cigarette was 14.2, but it was 16.3 in 2016. In 1995, 31% of adults smoked in a home where there were dependent children. In 2016, this was down to just 2.8%.

TEXT 2 Why do people smoke?

Cigarettes contain nicotine which does not cause the health issues linked to cigarette smoking but is highly addictive. In small amounts, nicotine causes pleasant feelings which makes the smoker want more. It does not take long before the time between cigarettes gets less, because the smoker is keen to get the pleasant feelings they had before. When a person becomes addicted to nicotine they soon start to have bad

feelings like being irritated and edgy when they are ready for another boost of nicotine.

Most smokers started when they were teens and those who have friends and/or parents who smoke are more likely to start smoking than those who don’t.

The tobacco industry spends billions of dollars each year to create and market their products that show smoking as exciting, glamorous, and safe. Tobacco use is also shown in video games, online, and on TV. Movies showing smokers are another big influence and studies show that young people who repeatedly see smoking in movies are more likely to start smoking.

Widespread advertising, price breaks, and other promotions for cigarettes have been big influences in the past but now many governments are bringing in a lot of ways to reduce the number of people who smoke.

In Australia, the government:

•does not allow cigarette advertising

•has had cigarettes moved to covered cupboards so they cannot be seen in places like dairies, petrol stations and supermarkets

•has gradually increased the amount of tax added to a packet of cigarettes

TEXT 3 Stopping smoking is not easy

Common symptoms people have when they stop smoking include:

•Cravings for nicotine which may be strong at first but they

usually only last a few minutes

• restlessness and trouble concentrating or sleeping

• irritability, anger, anxiety, depression

• increase in appetite and weight gain

Less common symptoms include:

• cold symptoms such as coughing, sore throat and sneezing

• constipation

• dizziness or light-headedness

• mouth ulcers.

The benefits of quitting smoking are:

• immediate health benefits

• a dramatic reduction the risk of smoking-related diseases

Statistics include:

• Quitting before 30 years of age reduces the risk of lung cancer by 90 per cent

• After 15 years of being a non-smoker, the risk of stroke is reduced to that of a person who has never smoked

• Within two to five years of quitting, there is a large drop in the risk of heart attack and stroke

TEXT 4. Different support to stop smoking in Australia

• ‘Cold turkey’ is giving up smoking suddenly, without using medications.

• The prescription medications, bupropion (Zyban) and varenicline (Champix) which reduce withdrawal symptoms from nicotine.

• Nicotine replacement therapy including patches, gum and lozenges.

• QuitCoach is an online tool developed to assist in quitting smoking.

• Quitline is a telephone service available to smokers who want to quit.

• Acupuncture involves treatment by applying needles or surgical staples to different parts of the body.

• Hypnotherapy has not been shown to increase the likelihood of quitting in the long term, although counselling or other treatments that may be offered with it can be helpful to some smokers

E-Cigarettes/ Vaping are increasingly being used instead of traditional cigarettes. However, there is limited evidence available on their quality, safety, efficacy for smoking cessation or harm reduction, and the risks they pose to population health.

In March 2015, the Chief Executive Officer (CEO) of Australia’s National Health and Medical Research Council (NHMRC) issued a statement stating that: “there is currently insufficient evidence to conclude whether e-cigarettes can benefit smokers in quitting, or about the extent of their potential harms. It is recommended that health authorities act to minimise harm until evidence of safety, quality and efficacy can be produced”. 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 E-cigarettes and their role in stopping smoking? __________________

2 Statistics about smoking in Australia? __________________

3 The benefits of quitting smoking? __________________

4 The different support to stop smoking in Australia? _____________

5 The addictive features of nicotine? __________________

6 The 3 main diseases linked to tobacco smoking? __________________

7 The common symptoms people have when they stop smoking? __________________

Questions 8-14 Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.

8 What bad feelings might a person have when they are ready for another boost of nicotine? ________

9 What therapy includes patches, gum and lozenges? __________________

10 How old is a person if their risk of lung cancer reduces by 90 per cent if they stop smoking? _______

11 What percentage of adults smoked in a home where there were dependent children in 2016?

12 Who does not allow cigarette advertising? __________________

13 Who should act to minimise harm until evidence of safety, quality and efficacy of e-cigarettes can be produced__________________

14 Young people are more likely to start smoking if they see what repeatedly? __________________ 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, numbers or both.

15 12% of people aged 14 and older smoked daily in 2016, which is a___________reduction since 1991

16 Common symptoms of nicotine withdrawal include_________________and depression

17 Cigarettes contain nicotine which does not cause the___linked to cigarette smoking but is highly addictive. 18 Smoking kills more_________________

19 The prescription medications, bupropion (Zyban) and varenicline (Champix) which reduce__from nicotine. 20 The Government in Australia has_________________the amount of tax added to a packet of cigarettes.

PART B

TEXT 1 The MIST Therapy system for the promotion of wound healing

The MIST Therapy system shows potential to enhance the healing of chronic, ‘hard-to-heal’, complex wounds, compared with standard methods of wound management. If this potential is substantiated, then MIST could offer advantages to both patients and the hospitals.

However, comparative research has yet to be carried out. Further investigation is necessary to reduce uncertainty about the outcomes of patients with chronic, ‘hard-to-heal’, complex wounds treated by the MIST Therapy system compared with those treated by standard methods of wound care. This research should define the types and chronicity of wounds being treated and the details of other treatments being used. It should report healing rates, durations of treatment (including debridement) needed to achieve healing, and quality of life measures (including quality of life if wounds heal only partially).

Question 1) Why should further research be carried out on the MIST Therapy system?

a) To investigate the range of wounds that this system can help to treat

b) To make sure that it offers improvements over the usual treatment option

c) To discover if this system can avoid deleterious outcomes for chronic wounds

TEXT 2 Assessing Risk and Prevention

Falls and fall-related injuries are a common and serious problem for older people. People aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 45% of people older than 80 falling at least once a year. The human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and mortality. Falling also affects the family members and carers of people who fall.

All people aged 65 or older are covered by all guideline recommendations as they have the highest risk of falling. According to the guideline recommendations, all

people 65 or older who are admitted to hospital should be considered for a multifactorial assessment for their risk of falling during their hospital stay.

Question 2) What does the article tell us about the risk of falling?

a) People over 65 need extra facilities to help them avoid falls

b) More people over 65 fall in hospital environments compared with other places

c) Only a minority of people over 65 fall at least once a year

TEXT 3 Dealing With Hazmat

One of the most challenging aspects of providing emergency medical care is attending to patients who have been contaminated with hazardous materials. HAZMAT is a term used to describe incidents involving hazardous materials or specialized teams who deal with these incidents. Hazardous materials are defined as substances that have the potential to harm a person or the environment upon contact. These can be gases, liquids, or solids and include radioactive and chemical materials.

The potential for exposure to hazardous materials in the United States is significant. More than 60,000 chemicals are produced annually in the United States, of which the US Department of Transportation considers approximately 2000 hazardous. More than 4 billion tons of chemicals are transported yearly by surface, air, or water routes.

Question 3) According to this article, what is HAZMAT?

a) Liquid, gaseous or solid materials that are bad for the environment

b) Events where harmful substances are released and the groups that deal with the aftermath

c) Toxic chemicals that are transported by water, land or air.

TEXT 4 How Does Blood Clot?

Within seconds of a blood vessel cut, the damaged tissue causes platelets to become ‘sticky’ and gather together around the cut. These ‘activated’ platelets and the damaged tissue release chemicals which react with other chemicals and proteins in the plasma, called clotting factors. A complex series of reactions involving these clotting factors then occurs rapidly. Each reaction triggers the next reaction and this process is known as a cascade.

The final chemical reaction is to convert a clotting agent called fibrinogen into thin strands of a solid protein called fibrin. The strands of fibrin form a meshwork and trap blood cells which form into a solid clot.

Question 4) According to this article, what is a cascade?

a) A series of events

b) The process that occurs when platelets become sticky

c) The reaction that precedes the formation of fibrin

TEXT 5 At the onset of a migraine attack, the patient should be given a full dose of painkiller. For an adult this means 900 mg aspirin (usually three 300 mg tablets) or 1000 mg of paracetamol (usually two 500 mg tablets). This dose can be repeated every four hours if necessary. Soluble tablets have the advantage of being absorbed more quickly than solid tablets.

Codeine and medicines containing codeine, such as co-codamol, are not recommended for the treatment of migraine. This is because codeine can make feeling sick (nausea) and being sick (vomiting) worse, which can aggravate the migraine. They are also more likely than paracetamol or aspirin to cause a condition called medication-overuse headache if they are used frequently.

Question 5) What do we learn about migraine treatment from this article?

a) Paracetamol doses should not exceed 1000mg

b) Aspirin can cause nausea and/or vomiting

c) Codeine can provoke conditions other than migraine

TEXT 6 Not all patients can independently move or position themselves in bed and their immobility may be due to a wide range of factors. Positioning patients in good body alignment and changing position regularly are essential aspects of nursing practice. It is vital to provide meticulous care to patients who must remain in bed. Healthcare givers’ measures should ensure to preserve the joints, bones and skeletal muscles and must be carried out for all patients who require bed rest.

Positions in which patients are placed, methods of moving and turning should all be based on the principles of maintaining the musculoskeletal system in proper alignment. In addition, the health care provider must also use good body mechanics when moving and turning patients to preserve his or her own musculoskeletal system from injury.

Question 6) What information does the article give us about positioning patients?

a) Healthcare givers should position immobile patients in accordance with the doctor’s instructions

b) Positioning patients is a fundamental part of a nurse’s job

c) Improper musculoskeletal manipulation can lead to immobility

PART C TEXT 1

Once the preserve of hippies and activists, veganism has now hit the mainstream. Forgoing meat, dairy and eggs is more popular than ever. While it’s positive that people are taking a more ethically-conscious approach to food shopping, what nutrients could vegetarians and vegans put themselves at risk of losing out on? And how can you approach animal-free consumption in a healthy way?

Generally, people choose to be vegetarian or vegan for ethical reasons or because they want to improve their health. A vegan diet is usually low in saturated fats and rich in fruit and vegetables. ‘Meat-free Monday’ is a UK campaign, launched by Paul McCartney in 2009, to encourage people to reduce their environmental impact and improve their health by having at least one meat-free day each week. More and more people are realising this is far more manageable than they first thought. When you stop thinking a meal needs meat to be complete, vegetarian options start to look a lot more appealing.

If you’ve decided to give up meat and have vowed to eat more vegetables, that’s a good first step. But vegetarians and vegans do have to be careful they’re not missing out on nutrients most easily found in meat and dairy sources. Protein is one of them. Protein builds and repairs tissues and is a building block of bone, muscles, skin and blood. It isn’t stored in your body, so you need to make sure you’re getting enough from your diet.

Unfortunately for vegetarians, meat is a rich source of this macronutrient. “Whilst many plant-based foods contain protein too, they may not contain protein in the correct balance that the body needs. Therefore, vegetarians need to make sure they eat a combination of foods to achieve the right protein balance,” says Dr Jan Sambrook, a doctor who specialises in nutrition. Luckily, you can also find protein in grains, pulses and dairy products. “If you eat any two of these, the protein will balance,” reveals Sambrook. “This doesn’t necessarily need to be within a single meal, as was previously thought. Examples of protein-balanced meals include cereal with milk, or baked potato with beans and cheese.”

A balanced vegetarian or vegan diet generally gives you plenty of vitamins. But if you’re not sure, there are some foods to look out for when it comes to specific nutrients. “Vitamin A is found in eggs and dairy products. A different form of the vitamin, called beta carotene, is found in dark green leafy vegetables and in coloured fruits and vegetables such as mango, carrots and red peppers,” explains Sambrook. Vitamin D, ‘the sunshine vitamin’, is also really important. It helps your body absorb calcium and is also needed for our muscles to work properly. More recently, vitamin D deficiency has been associated with numerous conditions, from heart disease, to dementia and multiple sclerosis. “Vitamin D is mainly made in our skin by the action of sunlight. However, it is also found in dairy products, mushrooms and in fortified cereals and margarine,” says Sambrook. “Oily fish and eggs are also among the top dietary sources of vitamin D, so if you’re adopting a vegan diet you’re less likely to be getting enough.”

Most of the minerals we need are found in a wide variety of foods and anyone eating a balanced diet can obtain enough of them. However, vegetarians and vegans must make sure they’re getting enough calcium and iron. Recently, the National Osteoporosis Society (NOS) warned that the popularity of ‘clean eating’ and other diets where major foods groups are cut out is setting young people up for a future of weak bones. “Without urgent action being taken to encourage young adults to incorporate all food groups into their diets and avoid particular ‘clean eating’ regimes, we are facing a future where broken bones will become just the norm,” said Susan Lanham-New, a nutrition professor and clinical advisor to the NOS.

Vegans, who normally don’t consume dairy products, may find it challenging to obtain calcium in their diet. “Calcium is, however, also present in leafy green vegetables, dried figs, almonds, oranges, sesame seeds, seaweed and some types of bean,” reveals Sambrook. She explains that if non-dairy calcium is eaten with a source of vitamin D, this will help the body absorb it.

You need iron in order for your blood to carry oxygen around your body. If you don’t get enough, you become anaemic. Whether we like it or not, red meat is the richest dietary source of iron. But there are a few meat-free sources too. “Vegetarian sources of iron include pulses such as chickpeas and lentils, sprouted seeds and beans, breakfast cereals and bread. Spinach is famous for containing iron, but it is also found in other green leafy vegetables such as broccoli and kale,” explains Sambrook. She adds that your body can absorb iron from food more easily if it is eaten with vitamin C.

Questions 7-14
7) The first paragraph implies that
a) Becoming a vegan is an ethical choice

b) Hippies and activists have always been vegan

c) Food-shopping for animal-free products is essential for vegans

d) Being a vegan has potential drawbacks

8) Paul McCartney’s 2009 campaign

a) Helped the number of people who understand that meat-free cooking is possible to increase

b) Was designed to help the environment for animals

c) Showed that vegetarian meals can be more attractive than meals prepared with meat

d) Was aimed at reducing saturated fats in processed food

9) What do we learn about protein in the third paragraph?

a) The human body only has a small reserve of protein

b) Without protein, bones and muscle tissues may build more slowly

c) Levels of protein in your body need to be replenished regularly d) It is not possible to find protein in meat-free diets

10) According to the fourth paragraph, how can vegans and vegetarians consume the right kinds of protein?

a) They should stick to basic food groups, such as grains or pulses

b) They should have a mixture of food types

c) They should eat vegetables that contain the same macronutrients as dairy products

d) They can enhance their diet by taking food supplements

11) What does the fifth paragraph tell us about vitamin deficiency?

a) Vegans can get enough vitamin D from sunlight on their skin

b) Coloured fruits and vegetables are good sources of vitamin D

c) Incidence of heart disease, dementia and multiple sclerosis among vegetarians is the same as among vegans

d) Vegans have a higher than normal risk of vitamin

D deficiency

12) What is the National Osteoporosis Society (NOS) concerned about?

a) Young people can cut themselves

b) More vegetarians and vegans will develop Osteoporosis

c) There may be a rise in a specific type of injury

d) Some people are not eating enough clean food

13) What does ‘it’ (the last word of the seventh paragraph) refer to?

a) Calcium

b) Vitamin D

c) Vitamin A

d) Protein

14) What does the last paragraph say about iron?

a) Vitamin C and iron consumed together is good for iron absorption

b) Vegans should consider eating red meat

c) You can become anaemic if you don’t eat enough vegetables

d) For oxygen-carrying blood cells, vitamin C is more important than iron

PART C TEXT 2

Jennifer Millar keeps rubbish bags and hand sanitizer near her tent, and she regularly pours water mixed with hydrogen peroxide on the pavement nearby. Keeping herself and the patch of concrete she calls home clean is her top priority. But this homeless encampment near a Hollywood freeway slip road is often littered with needles and rubbish. Rats occasionally run through, and Millar fears the consequences. “I worry about all those diseases,” said Millar, 43, who said she has been homeless most of her life.

Infectious diseases, including some that ravaged populations in the Middle Ages, are resurging in California and around the country and are hitting homeless populations especially hard. Los Angeles recently experienced an outbreak of typhus in city centre streets, a disease spread by infected fleas on rats and other animals. Officials briefly closed part of the City Hall after reporting that rodents had invaded the building. Hepatitis A, also spread primarily through faeces, has infected more than 1,000 people in Southern California in the past two years. The disease also has erupted in New Mexico, Ohio and Kentucky, primarily among people who are homeless or use drugs.

Public health officials and politicians are using terms like “disaster” and “public health crisis” to describe the outbreaks, and they warn that these diseases can easily jump beyond the homeless population. “Our homeless crisis is increasingly becoming a public health crisis,” California Governor Gavin Newsom said in his State of the State speech in February, citing outbreaks of hepatitis A, syphilis and typhus in Los Angeles.

Those infectious diseases are not limited to homeless populations, Newsom warned. “Even someone who believes they are protected from these infections may not be.” At least one Los Angeles city employee said she contracted typhus in the City Hall last fall. And San Diego County officials warned in 2017 that diners at a four-star restaurant were at risk of hepatitis A. Last month, the state announced an outbreak of typhus in Los Angeles city centre that infected nine people, six of whom were homeless. After city workers said they saw rodent droppings in City Hall, Los Angeles City Council President Herb Wesson briefly shut down his office and called for an investigation.

The infections around the country are not a surprise, given the lack of attention to housing and health care for the homeless and the dearth of bathrooms and places to wash hands, said Dr. Jeffrey Duchin, the health officer for Seattle, Washington State. “It’s a public health disaster,” he said. In his area, Duchin said, he has seen shigellosis, trench fever and skin infections among homeless populations.

In New York City, where more of the homeless population lives in shelters rather than on the streets, there have not been the same outbreaks of hepatitis A and typhus, said Dr. Kelly Doran, an emergency medicine physician and assistant professor at NYU School of Medicine. But Doran said different infections occur in shelters, including tuberculosis, a disease that spreads through the air and typically infects the lungs. These diseases sometimes get the “medieval” moniker because people in that era lived in squalid conditions without clean water or sewage treatment. People living on the streets or in homeless shelters are vulnerable to such outbreaks because their weakened immune systems are worsened by stress, malnutrition and sleep deprivation. Many also have mental illness and substance abuse disorders, which can make it harder for them to stay healthy or get health care.

One recent February afternoon, Community Clinic physician assistant Negeen Farmand walked through homeless encampments in Hollywood carrying a backpack with medical supplies. She stopped to talk to a man sweeping the sidewalks. He said he sees “everything and anything” in the gutters and hopes he doesn’t get sick. “To get these people to come into a clinic is a big thing,” she said. “A lot of them are distrustful of the health care system.” On another day, 53-year-old Karen Mitchell waited to get treated for a persistent cough by St. John’s mobile health clinic. She also needed a tuberculosis test, as required by the shelter where she was living. Mitchell, who said she developed alcoholism after a career in pharmaceutical sales, said she has contracted pneumonia from germs from other shelter residents. “Everyone is always sick, no matter what precautions they take.”

During the hepatitis A outbreak, public health officials administered widespread vaccinations, cleaned the streets with bleach and water and installed hand-washing stations and portable toilets near high concentrations of homeless people. But health officials and homeless advocates said more needs to be done, including helping people access medical and behavioural health care and affordable housing. “It really is unconscionable,” said Bobby Watts, CEO of the National Homeless Council, a policy and advocacy organization. “These are all preventable diseases.”

Questions 15-22

15) What is the most important thing for Jennifer Miller?

a) Avoiding diseases

b) Sanitizing her immediate environment

c) Finding a permanent home

d) Stopping rats and other rodents

16) What does the second paragraph tell us about Hepatitis A?

a) The recent outbreak was not confined to California

b) Hepatitis A is transmitted by fleas on rats and other animals

c) More than 1000 contracted the disease through sharing dirty needles

d) Some people in the City Hall now have Hepatitis A.

17) What problem did California Governor Gavin Newsom highlight?

a) Hepatitis A, syphilis and typhus have jumped into the homeless population

b) Politicians are not doing enough to stop the outbreak

c) The health situation in his state (California) is now a ‘disaster’

d) There is a link between public health and homelessness

18) What statistic is given in the fourth paragraph?

a) Four percent of restaurants were at risk of hepatitis A

b) Two thirds of typhus cases in Los Angeles city centre concerned people living on the streets

c) Nine out of ten people are concerned about the crisis

d) Ninety percent of people believe they are protected from these infections

19) What does Dr. Jeffrey Duchin think?

a) The infections are surprising b) There are insufficient washing facilities

c) Shigellosis and trench fever have disastrous consequences

d) More houses should be built for the homeless

20) What does the sixth paragraph help us to understand?

a) The conditions in New York shelters are worse than those in Los Angeles

b) Tuberculosis infections could be due to poor sewage treatment

c) Homeless people are more susceptible to these diseases for a number of reasons

d) The pathology of these diseases has not changed since medieval times

21) What problem does Karen Mitchell have?

a) She has a chronic cough

b) She lost her job in pharmaceutical sales

c) She has to go to a new shelter

d) She has tuberculosis

22) In the final paragraph, what else needs to be done?

a) A Install more portable toilets and hand-washing stations

b) B Prevent more diseases

c) C Give free health care to homeless people

d) D Give assistance to people who want medical help or an inexpensive place to live.

View answers- Tobacco Smoking

OET READING TESTS

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The use of feeding tubes in paediatrics: OET reading

May 9, 2024 jomon Leave a comment

In which text can you find information about
1. the risks of feeding a child via a nasogastric tube?
2. calculating the length of tube that will be required for a patient?
3. when alternative forms of feeding may be more appropriate than nasogastric?
4. who to consult over a patient’s liquid food requirements?
5. the outward appearance of the tubes?
6. knowing when it is safe to go ahead with the use of a tube for feeding?
7. how regularly different kinds of tubes need replacing?

Questions 8-15. Answer each of the questions, 8-15, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.

8. What type of tube should you use for patients who need nasogastric feeding for an extended period?
9. What should you apply to a feeding tube to make it easier to insert?
10. What should you use to keep the tube in place temporarily?
11. What equipment should you use initially to aspirate a feeding tube?
12. If initial aspiration of the feeding tube is unsuccessful, how long should you wait before trying again?
13. How should you position a patient during a second attempt to obtain aspirate?
14. If aspirate exceeds pH 5.5, where should you take the patient to confirm the position of the tube?
15. What device allows for the delivery of feeds via the small bowel?

Questions 16-20. Complete each of the sentences, 16-20, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.
16. If a feeding tube isn’t straight when you unwrap it, you should it.
17. Patients are more likely to experience long-term feeding via a tube.
18. If you need to give the patient a standard liquid feed, the tube to use is in size.
19. You must take out the feeding tube at once if the patient is coughing badly or is experiencing
20. If a child is receiving ___________ via a feeding tube, you should replace the feed bottle after four hours.

Text A

Paediatric nasogastric tube use
Nasogastric is the most common route for enteral feeding. It is particularly useful in the short term, and when it is necessary to avoid a surgical procedure to insert a gastrostomy device. However, in the long term, gastrostomy feeding may be more suitable.
Issues associated with paediatric nasogastric tube feeding include:
• The procedure for inserting the tube is traumatic for the majority of children.
• The tube ls very noticeable.
• Patients are likely to pull out the tube making regular re-insertion necessary.
• Aspiration, if the tube is incorrectly placed.
• Increased risk of gastro-esophageal reflux with prolonged use.
• Damage to the skin on the face.

Text B

Inserting the nasogastric tube
All tubes must be radio opaque throughout their length and have externally visible markings.
1. Wide bore:
– for short-term use only.
– should be changed every seven days.
– range of sizes for paediatric use is 6 Fr to 10 Fr.
2. Fine bore:
– for long-term use.
– should be changed every 30 days.
In general, tube sizes of 6 Fr are used for standard feeds, and 7-10 Fr for higher density and fibre feeds. Tubes come in a range of lengths, usually 55cm, 75cm or 85cm.
Wash and dry hands thoroughly. Place all the equipment needed on a clean tray.
• Find the most appropriate position for the child, depending on age and/or ability to co operate. Older children may be able to sit upright with head support. Younger children may sit on a parent’s lap. Infants may be wrapped in a sheet or blanket.
• Check the tube is intact then stretch it to remove any shape retained from being packaged.
• Measure from the tip of the nose to the bottom of the ear lobe, then from the ear lobe to xiphisternum. The length of tube can be marked with indelible pen or a note taken of the measurement marks on the tube (for neonates: measure from the nose to ear and then to the halfway point between xiphisternum and umbilicus).
• Lubricate the end of the tube using a water-based lubricant.
• Gently pass the tube into the child’s nostril, advancing·1along the floor of the nasopharynx to the oropharynx. Ask the child to swallow a little water, or offer a younger child their soother, to assist passage of the tube down the oesophagus. Never advance the tube against resistance.
• If the child shows signs of breathlessness or severe coughing,
• remove the tube immediately.
Lightly secure the tube with tape until the position has been checked

Text C

Text D:

Administering feeds/fluid via a feeding tube
Feeds are ordered through a referral to the dietitian.
When feeding directly into the small bowel, feeds must be delivered continuously via a feeding pump. The small bowel cannot hold large volumes of feed.
Feed bottles must be changed every six hours, or every four hours for expressed breast milk.
Under no circumstances should the feed be decanted from the container in which it is sent up from the special feeds unit.
All feeds should be monitored and recorded hourly using a fluid balance chart. If oral feeding is appropriate, this must also be recorded.
The child should be measured and weighed before feeding commences and then twice weekly.
The use of this feeding method should be re-assessed, evaluated and recorded daily.

View answers – The use of feeding tubes in paediatrics

OET READING TESTS

AUTISM SPECTRUM DISORDER. OET Reading

May 4, 2024 jomon Leave a comment

AUTISM SPECTRUM DISORDER.

Text A. Autism Spectrum Disorder: Autism Spectrum Disorder {ASD) develops in early childhood. Recent population analysis indicates that the number of cases of ASD is increasing in many countries, particularly in technologically developed countries. The U.S. Center for Disease Control research claims that, in some states, one of every 68 children {one of 42 boys) has a diagnosis of the ASD, a 30% increase from 2012 {IACC Strategic Plan for Autism Spectrum Disorder Research, 2013.

Multiple dysfunctional reflex patterns are characteristic in two separate groups of children diagnosed with autism: 1) those whose patterns were immature or pathological and severely dysfunctional from birth, and 2) those that developed normally but regressed into autism at age 2 or 3 unexpectedly. Reflexes of these children may have been delayed and immature, but not noted by specialists or parents. Their nerve system, possibly, was not resilient enough to cope with the stress that they experienced. Alternatively, their reflexes might not have matured and have caused the asynchronicity in their brain function development on both cortical and extrapyramidal levels resulting in neurodevelopmental disorders beginning around 2 years of age. An initially mild unrecognized problem can lead to more complicated deficits with age.

Text B: Individuals diagnosed with ASD show a chronic lack of sensory motor integration and delay of skills concerning the early motor milestones. They show a wide range of immature reflex patterns such as Hands Pulling, Hands Supporting, Hands Grasp, Crawling, Asymmetrical Tonic Neck Reflex, Symmetrical Tonic Neck Reflex, Babkin Palmomental, Ocular-Vestibular, and other patterns. The MNRI program utilizes non-invasive intervention to support the development of the neuro-sensory-motor aspects of those reflex patterns through specific techniques and procedures that allow restoration of links between reflex circuit components and the protection function of a reflex to normalize their over-freezing and fight or flight reactions seen, for example, in tactile defensiveness or deprivation. Thus, the MNRI program works particularly with the autonomic nervous system – its sympathetic and parasympathetic processes.

Text C: Disharmony in muscular system development and lack of regulation for muscle tone beginning in children with ASD in their infancy results in impulsive reactions that often turns into permanent physical characteristics and behaviors as they grow older. For example, impulsivity may lead to poor ability for goal setting, poor focus and following instructions, deficient inner control, hyperactivity, disorganized and chaotic behavior, and irritability and impatience. Lack of muscle tone regulation may later result in challenges in motor programming and control, planning, and thus lead to poor motor-cognitive- behavior coordination. This poor regulation is caused by a lack of balance in the excitation and inhibition processes in the reflex circuits, including improper connectivity between alpha and gamma motor neurons. Clinical observations show that the disharmony and lack of proper regulation in muscle tone in children with ASD are seen mainly in: Hypertonic muscles in the posterior dorsal plane of the body {along the spinal column – sacrospinalis, thoracic longus, trapezius) and with the opposite hypotonic abdominal muscles and diaphragm negatively affects development of postural control. The child with ASD, in an attempt to release tension caused by this disproportion of muscle tone in the back and front of their body, may often display reactivity in behavior and impulsive movements triggering balance/equilibrium mechanisms {balancing reflex pattern), resulting in a state of being overstimulated.

Text D: Problems in visual and auditory perception systems:

The eyes of children diagnosed with ASD show a restless state or lack of mobility and dilated pupils. They usually have a limited, narrow visual span, poor visual attention and focus, and hyperactive peripheral vision. Their eye movements appear to freeze or jump rapidly in saccades. Many children with ASD demonstrate an addictive tendency for computers and cell phones with compulsive repetition of the same image, object, or program, often watching it at a very close range. The child with ASD becomes over-focused, which over-stimulates their vestibular system and static balance. The Pupillary Reflex in these children may become hypersensitive, overstimulating the sympathetic system, with either over-reactive or hypoactive motor activity. The visual system of children diagnosed with ASD copes poorly with this visual chaos which leads to a visual processing disorder. A Bonding response in infants is seen from their first months after birth. Bonding as a behavior trait matures during their first years of life. Almost every child with ASD assessed presented signs of inadequate bonding – lack of attachment, tactile and interactivity defensiveness, a tendency for self-isolation, a poor imitation, and poor learning of verbal communication. When bonding is immature, there are problems with visual contact, focusing on the face/eyes of their mother and other adults and poor emotional communication, inability to adequately smile, and poor labeling of the objects in their environment.

PART A -QUESTIONS AND ANSWER SHEET. 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. Represents the resistance to passive movement of a joint. Answer

2. Associated with pupillary function. Answer

3. Utilization of information and clinical experience from neurodevelopment in different ways. Answer

4. Development of autism. Answer

5. Possibility of development of strange characteristics as one grows. Answer

6. Not existing or occurring at the same time with respect to movements or reactions. Answer

7. Primitive reflex that normally emerges during the first year of an infant’s life. Answer

Questions 8-14. Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may include words, numbers or both. Your answers should be correctly spelt.

8. What MNRI will operate with? Answer

9. How eye movements may appear? Answer

10. What is the term which defines activation of the vestibular system which causes eye movement? Answer

11. What is related to tendency to act on a whim, displaying behaviour characterized by little or no forethought, reflection? Answer

12. What is the term used to define healthy stress? Answer

13. What is known to be activated as a result of turning the head to one side? Answer

14. What is the impact visual chaos of the children with ASD? Answer

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, numbers or both. Your answers should be correctly spelt.

15. The term is used to describe a rapid movement of the eye between fixation points.

16. Generally, in newly born babies will be at very early stages.

17. What synchronizes hands, neck, and jaw is

18. In many of the cases, reflex in affected children may turn out to be more .

19. Almost all of the children with ASD show various signs of .

20. The complexities in can be the result of the regulation changes in muscle tone.

READING SUB-TEST : PART B. Questions 1-6

1. What this notice talks about?

A. AIDS-related deaths dropped by more than 50%

B. AIDS-related deaths increased more significantly

C. Efforts that can lead to curbing AIDS in various countries.

UNAIDS Programme Coordinating Board

The 31st UNAIDS Programme Coordinating Board {PCB) meeting took place in Geneva from 11-13 June 2018. There were more than 700 000 less new HIV infections estimated globally in 2016 than in 2001. The road from 2.5 million new HIV infections in 2011 to zero new HIV infections is a long one and significant efforts are required to accelerate HIV prevention programmes. Sustained investments for access to antiretroviral therapy by donors and national governments have led to record numbers of lives being saved in the past six years.

In 2011 more than half a million fewer people died from AIDS-related illnesses than six years earlier. It’s a dramatic turning point. Numbers can quantify, but alone cannot express the impact of each averted death on the whole community, including its children. The number of people dying from AIDS-related causes began to decline in the mid-2000s because of scaled up antiretroviral therapy and the steady decline in HIV incidence since the peak of the epidemic in 1997. In 2011, this decline continued, with evidence showing that the drop in the number of people dying from AIDS-related causes is accelerating in several countries.

2. The given notice explains the procedure of;

A. Use of radix Sophorae samples.

B. Ultrasonic treatment – obtaining radix.

C. Preparing radix Sophorae tonkinensis samples.

Radix Sophorae tonkinensis: Radix Sophorae tonkinensis was crushed and screened, then taking screened powder (approximately 0.5 g) gain a respective weight, denoted M. Trichloromethane-methanol- ammonia (40:10:1) was used to dispose of the radix Sophorae tonkinensis samples for 30 min, and all samples were subsequently obtained from organic solvent extraction with 30 min ultrasonic treatment. All disposed of samples were filtered, then 10 ml of filtrate was measured to recover solvents to dry under decompression at 38°C to obtain the residue, the residue was diluted by methanol, then transferred to a 10 ml volumetric flask. After mixing and filtering with 0.45 µm filter membrane, Radix Sophorae samples were obtained. The blank groups were treated as the samples but without radix Sophorae tonkinensis.

3. What is correct about Torcetrapib?

A. It is known to enhance health.

B. Trials performed produced negative results.

C. The drug did not get approved completely as the project was dropped in the middle.

Short note on Torcetrapib: Torcetrapib, which has been in development since the early 1990s, was supposed to raise so-called good cholesterol, and cardiologists had hoped it would reduce the buildup of plaques in blood vessels that can cause heart attacks. This drug actually caused an increase in deaths and heart problems. Eighty-two people had died so far in a clinical trial, versus 51 people in the same trial who had not taken it. The GABR company gave up the project incurring a claimed loss of $1 billion investment and not much hue and cry was raised on the deaths of the study subjects as this was the doing of a billionaire giant manufacturer.In case of trials or experiments, if a single death is noticed with the use of UD, a big hue and cry would be raised.

4. The table shows

A. Comparison of Type A, B, C and G and H drugs and their resistance quality.

B. Type A is known to produce more adverse reactions than all the others present in the table.

C. A total of 200 cases have been reported with respect to adverse reaction.

Drug Adverse Reactions

Type of ADR	Number ADRS	Percentage {%)
Type-A	96	103.7
Type-B	69	56.79
Type-C	23	28.39
Type G	8	7.4
Type H	4	3.7
Total	200	200

5. The notice clearly explains

A. Clinical trials using Vitamin B12.

B. Advantages of B12.

C. Study performed with focus on B12 usage.

Vitamin B12: Vitamin B12 is produced by the liver and is involved in several biochemical metabolic reactions. It promotes the repair of damaged skin mucous membranes and vascular endothelial cells, reduces spasm and occlusion of blood vessels, improves local blood flow and prevents the deterioration of wound infection. In addition, it reduces the excitability of pain fibers C and AG, leading to an analgesic effect. Vitamin B12 injections to the skin in the radiation field benefit the wound by reducing irritation and pain, preventing rupture and enhancing new epithelial resistance to radiation, thereby promoting healing of the skin.

Chen et al used a vitamin B12 solution to treat radiation-induced moist dermatitis. The cure rate at 10 days was 100%, which was significantly different from the control group.

6. What is correct about the given table?

A. The age wise male patients population ranges from 4.

B. 18.18 patients were in the age group of 50-70 years.

C. 32.72 patients were in the age group of 50-60 years.

Age wise distribution of male patients showing percentage of distribution.

Age in years	Male patients	Age in years	Female patients
20-30	4 (7.27)	20-30	0 (0)
30-40	54 (98.18)	30-40	32 (71.11)
40-50	24 (43.63)	40-50	38
50-60	18	50-60	10
60-70	10	60-70	6 (13.32)
Total	110 (110)	70-80	4 (8.88)
Total	90 (9

READING SUB-TEST : PART C In this part of the test, there are two texts about different aspects of healthcare.For questions 7-22, choose the answer {A, B, C or D) which you think fits best according to the text. Write your answers on the separate Answer Sheet

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.

The 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 the Ebola virus or Marburg virus infections. 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 the 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 bodily fluids and tissues, including blood, semen, vaginal secretions and saliva. People with Ebola or Marburg are most contagious during the later stages of the disease. If you’re a healthcare 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. What is right about 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. Symptoms are typically seen within;

A. Five days

B. Ten days

C. Five to seven days

D. Five to ten days

10. In the Philippines, Ebola was discovered in;

A. Chimpanzees

B. Human primates

C. Non-human primates

D. Monkeys

11. Most known Ebola diseases occur due to;

A. Contamination

B. Bodily fluids

C. Contaminated needles and syringes

D. None

12. 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

13. Pick one of the best preventive measures stated in the passage here;

A. Hand cleaning with medicinal soap.

B. Use of alcohol-based hand rubs, containing at least 60% alcohol, in absence of water & soap.

C. Only use of soap.

D. Avoiding direct contact with patients is a necessity.

14. As a healthcare worker, you should;

A. Keep infected people totally isolated from others.

B. Not reuse needles and syringes for the second time.

C. 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”.

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 healthcare 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 healthcare 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 healthcare 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 immunomodulators, tar products, anti-infectives and 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 a 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 15-22

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 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, avoiding allergens is;

A. Easy

B. Difficult

C. Sometimes easy and sometimes difficult

D. Can 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. Topical steroids are available in these forms:

A. Gel tubes

B. Ointments

C. lotions

D. Ointments, creams, lotions and gels.

View answers: AUTISM SPECTRUM DISORDER

OET READING TESTS

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SEDATION OET READING ANSWERS

March 21, 2024 jomon Leave a comment

1) A
2) D
3) A
4) B
5) C
6) A
7) B
8) benzodiazepines
9) Minimal sedation and analgesia
10) emergency intubation.
11) fracture reduction.
12) Phencyclidines
13) Nitrous oxide
14) 5mg
15) intravenous route
16) response
17) verbal commands
18) seizure disorders/epilepsy
19) carbon dioxide
20) reversal agent

Part B.

C
B
B
B
A
A

Part C.1

7 d

8 d

9 c

10 b

11 b

12 a

13 b

14 a

15 с

16 a

17 c

18 b

19 a

20 d

21 c

22 a

SEDATION OET READING

OET READING TESTS

Rheumatoid arthritis OET Reading

March 15, 2024 jomon Leave a comment

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Rheumatoid arthritis OET Reading answers

March 15, 2024 jomon Leave a comment

1.C

2 .D

3.A

4.B

5.A

6.C

7.B

8. chemokines

9. Th17 cytokines

10. wide variation in anti-SSA prevalence across different RA populations.

11. Anti SSA

12.CXCL10

13. serum chemokines

14. relation between RF seropositivity & CXCL10 levels

15. Serum Chemokine

16.3-16%

17. Seropositivity

18. Cxcl10 And Cxcl13

19. Anti- Ssa In Aa

20.Cxcl10

Reading test – Part B: Answer Key

1. Steps to improving interpersonal communication with patients.
2 is associated with various anomalies.
3. Can have a detrimental effect on elderly people.
4. Future course of action.
5. The majority of patients remained hospitalized for 5 days or more
6. The majority of the patients were females.

Reading test – Part C: Answer Key
Text 1 – Answer key 7 – 14
7. Affects a higher number of men than women.
8. Arthritis in its final stage.
9. Rebuilding of bone is accelerated.
10. Lower back pain, loss of hearing and discomfort.
11. Correct Answer Is: Pagets disease, is both heritable and inheritable.
12. Increase is indicative of the development of the bone at a rapid speed.
13. Should be taken only during the morning.
14. Correct Answer Is: Surgery can get rid of Pagets disease.

PART C. Text 2 – Answer key 15 – 22
15. Benign and malignant
16. When harmful tumors invade and destroy other healthy tissues of the body.
17. Exocrine gland
18. Exocrine gland
19. Cancerous tissues in the pancreas
20. Genetic mutations
21. Pesticides, dyes and chemicals used for refining metals
22. Pulmonary edema and enlargement of the gallbladder

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Rheumatoid arthritis OET Reading

OET READING TESTS

SEDATION OET reading

March 10, 2024 jomon Leave a comment

Text A: Procedural sedation and analgesia for adults in the emergency department
Patients in the emergency department often need to undergo painful, distressing or unpleasant diagnostic and therapeutic procedures as part of their care. Various combinations of analgesic, sedative and anaesthetic agents are commonly used for the procedural sedation of adults in the emergency department.

Although combinations of benzodiazepines and opioids have generally been used for procedural sedation, evidence for the use of other sedatives is emerging and is supported by guidelines based on randomised trials and observational studies. Patients in pain should be provided with analgesia before proceeding to more general sedation. The intravenous route is generally the most predictable and reliable method of administration for most agents.

Local factors, including availability, familiarity, and clinical experience will affect drug choice, as will safety, effectiveness, and cost factors. There may also be cost savings associated with providing sedation in the emergency department for procedures that can be performed safely in either the emergency department or the operating theatre.

Text B: Levels of sedation as described by the American Society of Anesthesiologists
Non-dissociative sedation
• Minimal sedation and analgesia: essentially mild anxiolysis or pain control. Patients respond normally to verbal commands. Example of appropriate use: changing burns dressings
• Moderate sedation and analgesia: patients are sleepy but also aroused by voice or light touch. Example of appropriate use: direct current cardioversion
• Deep sedation and analgesia: patients require painful stimuli to evoke a purposeful response. Airway or ventilator support may be needed. Example of appropriate use: major joint reduction
• General anesthesia: patient has no purposeful response to even repeated painful stimuli. Airway and ventilator support is usually required. Cardiovascular function may also be impaired. Example of appropriate use: not appropriate for general use in the emergency department except during emergency intubation.

Dissociative sedation: Dissociative sedation is described as a trance-like cataleptic state characterised by profound analgesia and amnesia, with retention of protective airway reflexes, spontaneous respirations, and cardiopulmonary stability. Example of appropriate use: fracture reduction.

Text C: Drug administration: General principles
International consensus guidelines recommend that minimal sedation – for example, with 50% nitrous oxide oxygen blend – can be administered by a single physician or nurse practitioner with current life support certification anywhere in the emergency department. Guidelines recommend that for moderate and dissociative sedation using intravenous agents, a physician should be present to administer the sedative, in addition to the practitioner carrying out the procedure.
For moderate sedation, resuscitation room facilities are recommended, with continuous cardiac and oxygen saturation monitoring, non-invasive blood-pressure monitoring, and consideration of capnography (monitoring of the concentration or partial pressure of carbon dioxide in the respiratory gases).
During deep sedation, capnography is recommended, and competent personnel should be present to provide cardiopulmonary rescue in terms of advanced airway management and advanced life support.
Text D: Drugs used for procedural sedation and analgesia in adults in the emergency department

Class	Drug	Dosage	Advantages	Cautions
Opioids	Fentanyl Morphine Remifentanil	0.5-1 µg/kg over 2 mins 50-100 µg/kg then 0.8-1 mg/h 0.025-0.1 µg/kg/ min	Short acting analgesic; reversal agent (naloxone) available Reversal agent (naloxone); prolonged analgesic Ultra-short acting; no solid organ involved in metabolic clearance	May cause apnoea, respiratory depression, bradycardia, dysphoria, muscle rigidity, nausea and vomiting Slow onset and peak effect time; less reliable Difficult to use without an infusion pump
Benzodiazepines	Midazolam	Small doses of	Minimal effect on	No analgesic effect; may
		0.02-0.03 mg/kg	respiration; reversal agent	cause hypotension
		until clinical effect	(flumazenil)
		achieved; repeat
		dosing of 0.5-1 mg
		with total dose ::;
		5mg
Volatile agents	Nitrous oxide	50% nitrous oxide – 50% oxygen mixture	Rapid onset and recovery; cardiovascular and respiratory stability	Acute tolerance may develop; specialised equipment needed
Propofol	Propofol	Infusion of 100	Rapid onset; short-acting;	May cause rapidly
		µg/kg/min for 3-5	anticonvulsant properties	deepening sedation, airway
		min then reduce		obstruction, hypotension
		to-50 µg/kg/min
Phencyclidines	Ketamine	0.2-0.5 mg/kg over 2-3 min	Rapid onset; short-acting; potent analgesic even at low doses; cardiovascular stability	Avoid in patients with history of psychosis; may cause nausea and vomiting
Etomidate	Etomidate	0.1-0.15 mg/kg may re-administer	Rapid onset; short-acting; cardiovascular stability	May cause pain on injection, nausea, vomiting; caution when using in patients with seizure disorders/epilepsy – may induce seizures

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 the point at which any necessary pain relief should be given?
2 the benefits and drawbacks of specific classes of drugs?
3 financial considerations when making decisions about sedation?
4 typical procedures carried out under various sedation levels?
5 measures to be taken to ensure a patient’s stability under sedation?
6 reference to research into alternative sedative agents?
7 patients’ levels of sensory awareness when sedated?
Questions 8-14. Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.
8 What class of drug is traditionally administered together with opioids for the purpose of procedural sedation?
9 What level of sedation is appropriate for changing burns dressings?
10 What is the only emergency department procedure for which it is appropriate to use general anaesthesia?
11 What procedure may be carried out under dissociative sedation?
12 What class of drugs is unsuitable for patients who have a history of psychosis?
13 What opioid drug should be administered using specific equipment?
14 What is the maximum overall dose of Midazolam which should be given?

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, numbers or both.
15 The majority of sedative drugs are administered via the _______________
16 General anaesthesia is the one form of sedation under which patients may have reduced_______________
17 Patients under minimal sedation will react if they are given _______________
18 Care should be taken when administering Etomidate to patients who are likely to have ______________
19 It may be helpful to use capnography to keep track of patients _____________ levels during moderate sedation.
20 Fentanyl, Morphine and Midozolam each have a ______________ , which is used to cancel out the effects of the drug.

END OF PART A. THIS QUESTION PAPER WILL BE COLLECTED

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. The manual states that the wheelchair should not be used
A. inside buildings.
B. without supervision.
C. on any uneven surfaces.

Manual extract: Kuschall ultra-light wheelchair:
Intended use: The active wheelchair is propelled manually and should only be used for independent or assisted transport of a disabled patient with mobility difficulties. In the absence of an assistant, it should only be operated by patients who are physically and mentally able to do so safely (e.g., to propel themselves, steer, brake, etc.). Even where restricted to indoor use, the wheelchair is only suitable for use on level ground and accessible terrain. This active wheelchair needs to be prescribed and fit to the individual patient’s specific health condition. Any other or incorrect use could lead hazardous situations to arise.

2. These guidelines contain instructions for staff who
A. need to screen patients for MRSA.
B. are likely to put patients at risk from MRSA.
C. intend to treat patients who are infected with MRSA.
MRSA Screening guidelines: It may be necessary to screen staff if there is an outbreak of MRSA within a ward or department. Results will normally be available within three days, although occasionally additional tests need to be done in the laboratory. Staff found to have MRSA will be given advice by the Department of Occupational Health regarding treatment. Even minor skin sepsis or skin diseases such as eczema, psoriasis or dermatitis amongst staff can result in widespread dissemination of staphylococci. If a ward has an MRSA problem, staff with any of these conditions (colonised or infected) must contact Occupational Health promptly, so that they can be screened for MRSA carriage. Small cuts and/or abrasions must always be covered with a waterproof plaster. Staff with infected lesions must not have direct contact with patients and must contact Occupational Health.

3. The main point of the notice is that hospital staff
A. need to be aware of the relative risks of various bodily fluids.
B. should regard all bodily fluids as potentially infectious.
C. must review procedures for handling bodily fluids.
Infection prevention: Infection control measures are intended to protect patients, hospital workers and others in the healthcare setting. While infection prevention is most commonly associated with preventing HIV transmission, these procedures also guard against other blood borne pathogens, such as hepatitis Band C, syphilis and Chagas disease. They should be considered standard practice since an outbreak of enteric illness can easily occur in a crowded hospital.

Infection prevention depends upon a system of practices in which all blood and bodily fluids, including cerebrospinal fluid, sputum and semen, are considered to be infectious. All such fluids from all people are treated with the same degree of caution, so no judgement is required about the potential infectivity of a particular specimen. Hand washing, the use of barrier protection such as gloves and aprons, the safe handling and disposal of ‘sharps’ and medical waste and proper disinfection, cleaning and sterilisation are all part of creating a safe hospital.

4. What do nursing staff have to do?
A. train the patient how to control their condition with the use of an insulin pump
B. determine whether the patient is capable of using an insulin pump appropriately
C. evaluate the effectiveness of an insulin pump as a long-term means of treatment.
Extract from staff guidelines: Insulin pumps: Many patients with diabetes self-medicate using an insulin pump. If you’re caring for a hospitalised patient with an insulin pump, assess their ability to manage self-care while in the hospital. Patients using pump therapy must possess good diabetes self-management skills. They must also have a willingness to monitor their blood glucose frequently and record blood glucose readings, carbohydrate intake, insulin boluses, and exercise. Besides assessing the patient’s physical and mental status, review and record pump-specific information, such as the pump’s make and model. Also assess the type of insulin being delivered and the date when the infusion site was changed last. Assess the patient’s level of consciousness and cognitive status. If the patient doesn’t seem competent to operate the device, notify the healthcare provider and document your findings.

5. The extract states that abnormalities in babies born to mothers who took salbutamol are
A. relatively infrequent.
B. clearly unrelated to its use.
C. caused by a combination of drugs.
Extract from a monograph: Salbutamol Sulphate Inhalation Aerosol:
Pregnant women: Salbutamol has been in widespread use for many years in humans without apparent ill consequence. However, there are no adequate and well controlled studies in pregnant women and there is little published evidence of its safety in the early stages of human pregnancy. Administration of any drug to pregnant women should only be considered if the anticipated benefits to the expectant woman are greater than any possible risks to the foetus.

During worldwide marketing experience, rare cases of various congenital anomalies, including cleft palate and limb defects, have been reported in the offspring of patients being treated with salbutamol. Some of the mothers were taking multiple medications during their pregnancies. Because no consistent pattern of defects can be discerned, a relationship with salbutamol use cannot be established.

6. What is the purpose of this extract?
A. to present the advantages and disadvantages of particular procedures
B. to question the effectiveness of certain ways of removing non-viable tissue
C. to explain which methods are appropriate for dealing with which types of wounds
Extract from a textbook: debridement: Debridement is the removal of non-viable tissue from the wound bed to encourage wound healing. Sharp debridement is a very quick method, but should only be carried out by a competent practitioner, and may not be appropriate for all patients. Autolytic debridement is often used before other methods of debridement. Products that can be used to facilitate autolytic debridement include hydrogels, hydrocolloids, cadexomer iodine and honey. Hydrosurgery systems combine lavage with sharp debridement and provide a safe and effective technique, which can be used in the ward environment. This has been shown to precisely target damaged and necrotic tissue and is associated with a reduced procedure time. Ultrasonic assisted debridement is a relatively painless method of removing non-viable tissue and has been shown to be effective in reducing bacterial burden, with earlier transition to secondary procedures. However, these last two methods are potentially expensive and equipment may not always be available.

PART C
In this part of the test, there are two texts about different aspects of healthcare. For questions 7-22, choose the answer (A, B, C or D) which you think fits best according to the text.

Text 1: Cardiovascular benefits of exercise

Cardiovascular disease (CVD) is the leading cause of death for both men and women in the United States. According to the American Heart Association (AHA), by the year 2030, the prevalence of cardiovascular disease in the USA is expected to increase by 9.9%, and the prevalence of both heart failure and stroke is expected to increase by approximately 25%. Worldwide, it is projected that CVD will be responsible for over 25 million deaths per year by 2025. And yet, although several risk factors are non-modifiable (age, male gender, race, and family history), the majority of contributing factors are amenable to intervention. These include elevated blood pressure, high cholesterol, smoking, obesity, diet and excess stress. Aspirin taken in low doses among high risk groups is also recommended for its cardiovascular benefits.

One modifiable behaviour with major therapeutic implications for CVD is inactivity. Inactive or sedentary behaviour has been associated with numerous health conditions and a review of several studies has confirmed that prolonged total sedentary time (measured objectively via an accelerometer) has a particularly adverse relationship with cardiovascular risk factors, disease, and mortality outcomes. The cardiovascular effects of leisure time physical activity are compelling and well documented. Adequate physical leisure activities like walking, swimming, cycling, or stair climbing done regularly have been shown to reduce type 2 diabetes, some cancers, falls, fractures, and depression. Improvements in physical function and weight management have also been shown, along with increases in cognitive function, quality of life, and life expectancy.

Several occupational studies have shown adequate physical activity in the workplace also provides benefits. Seat-bound bus drivers in London experienced more coronary heart disease than mobile conductors working on the same buses, as do office-based postal workers compared to their colleagues delivering mail on foot. The AHA recommends that all Americans invest in at least 30 minutes a day of physical activity on most days of the week. In the face of such unambiguous evidence, however, most healthy adults, apparently by choice it must be assumed, remain sedentary.

The cardiovascular beneficial effects of regular exercise for patients with a high risk of coronary disease have also been well documented. Leisure time exercise reduced cardiovascular mortality during a 16-year follow-up study of men in the high risk category. In the Honolulu Heart Study, elderly men walking more than 1.5 miles per day similarly reduced their risk of coronary disease. Such people engaging in regular exercise have also demonstrated other CVD benefits including decreased rate of strokes and improvement in erectile dysfunction. There is also evidence of an up to 3-year increase in lifespan in these groups.

Among patients with experience of heart failure, regular physical activity has also been found to help improve angina-free activity, prevent heart attacks, and result in decreased death rates. It also improves physical endurance in patients with peripheral artery disease. Exercise programs carried out under supervision such as cardiac rehabilitation in patients who have undergone percutaneous coronary interventions or heart valve surgery, who are transplantation candidates or recipients, or who have peripheral arterial disease result in significant short- and long-term CVD benefits.

Since data indicate that cardiovascular disease begins early in life, physical interventions such as regular exercise should be started early for optimum effect. The US Department of Health and Human Services for Young People wisely recommends that high school students achieve a minimum target of 60 minutes of daily exercise. This may be best achieved via a mandated curriculum. Subsequent transition from high school to college is associated with a steep decline in physical activity. Provision of convenient and adequate exercise time as well as free or inexpensive college credits for documented workout periods could potentially enhance participation. Time spent on leisure time physical activity decreases further with entry into the workforce. Free health club memberships and paid supervised exercise time could help promote a continuing exercise regimen. Government sponsored subsidies to employers incorporating such exercise programs can help decrease the anticipated future cardiovascular disease burden in this population.

General physicians can play an important role in counselling patients and promoting exercise. Although barriers such as lack of time and patient non-compliance exist, medical reviews support the effectiveness of physician counselling, both in the short term and long term. The good news is that the percentage of adults engaging in exercise regimes on the advice of US physicians has increased from 22.6% to 32.4% in the last decade. The empowerment of physicians, with training sessions and adequate reimbursement for their services, will further increase this percentage and ensure long-term adherence to such programmes. Given that risk factors for CVD are consistent throughout the world, reducing its burden will not only improve the quality of life, but will increase the lifespan for millions of humans worldwide, not to mention saving billions of health-related dollars.

Text 1: Questions 7-14

7. In the first paragraph, what point does the writer make about CVD?
A. Measures to treat CVD have failed to contain its spread.
B. There is potential for reducing overall incidence of CVD.
C. Effective CVD treatment depends on patient co-operation.
D. Genetic factors are likely to play a greater role in controlling CVD.

8. In the second paragraph, what does the writer say about inactivity?
A. Its role in the development of CVD varies greatly from person to person.
B. Its level of risk lies mainly in the overall amount of time spent inactive.
C. Its true impact has only become known with advances in technology.
D. Its long-term effects are exacerbated by certain medical conditions.

9. The writer mentions London bus drivers in order to
A. demonstrate the value of a certain piece of medical advice.
B. stress the need for more research into health and safety issues.
C. show how important free-time activities may be to particular groups.
D. emphasise the importance of working environment to long-term health.

10. The phrase ‘apparently by choice’ in the third paragraph suggests the writer
A. believes that health education has failed the public.
B. remains unsure of the motivations of certain people.
C. thinks that people resent interference with their lifestyles.
D. recognises that the rights of individuals take priority in health issues.

11. In the fourth paragraph, what does the writer suggest about taking up regular exercise?
A. Its benefits are most dramatic amongst patients with pre-existing conditions.
B. It has more significant effects when combined with other behavioural changes.
C. Its value in reducing the risks of CVD is restricted to one particular age group.
D. It is always possible for a patient to benefit from making such alterations to lifestyle.

12. The writer says ‘short- and long-term CVD benefits’ derive from
A. long distance walking.
B. better cardiac procedures.
C. organised physical activity.
D. treatment of arterial diseases.

13. The writer supports official exercise guidelines for US high school students because
A. it is likely to have more than just health benefits for them.
B. they are rarely self-motivated in terms of physical activity.
C. it is improbable they will take up exercise as they get older.
D. they will gain the maximum long-term benefits from such exercise.

14. What does the writer suggest about general physicians promoting exercise?
A. Patients are more likely to adopt effective methods under their guidance.
B. They are generally seen as positive role models by patients.
C. There are insufficient incentives for further development.
D. It may not be the best use of their time.

PART C. TEXT 2: POWER OF PLACEBO

Ted Kaptchuk is a Professor of Medicine at Harvard Medical School. For the last 15 years, he and fellow researchers have been studying the placebo effect- something that, before the 1990s, was seen simply as a thorn in medicine’s side. To prove a medicine is effective, pharmaceutical companies must show not only that their drug has the desired effects, but that the effects are significantly greater than those of a placebo control group. However, both groups often show healing results. Kaptchuk’s innovative studies were among the first to study the placebo effect in clinical trials and tease apart its separate components. He identified such variables as patients’ reporting bias (a conscious or unconscious desire to please researchers), patients simply responding to doctors’ attention, the different methods of placebo delivery and symptoms subsiding without treatment – the inevitable trajectory of most chronic ailments.

Kaptchuk’s first randomised clinical drug trial involved 270 participants who were hoping to alleviate severe arm pain such as carpal tunnel syndrome or tendonitis. Half the subjects were instructed to take pain-reducing pills while the other half were told they’d be receiving acupuncture treatment. But just two weeks into the trial, about a third of participants – regardless of whether they’d had pills or acupuncture – started to complain of terrible side effects. They reported things like extreme fatigue and nightmarish levels of pain. Curiously though, these side effects were exactly what the researchers had warned patients about before they started treatment. But more astounding was that the majority of participants – in other words the remaining two-thirds – reported real relief, particularly those in the acupuncture group. This seemed amazing, as no-one had ever proved the superior effect of acupuncture over standard painkillers. But Kaptchuk’s team hadn’t proved it either. The ‘acupuncture’ needles were in fact retractable shams that never pierced the skin and the painkillers were actually pills made of corn starch. This study wasn’t aimed at comparing two treatments. It was deliberately designed to compare two fakes.

Kaptchuk’s needle/pill experiment shows that the methods of placebo administration are as important as the administration itself. It’s a valuable insight for any health professional: patients’ feelings and beliefs matter, and the ways physicians present treatments to patients can significantly affect their health. This is the one finding from placebo research that doctors can apply to their practice immediately. Others such as sham acupuncture, pills or other fake interventions are nowhere near ready for clinical application.
Using placebo in this way requires deceit, which falls foul of several major pillars of medical ethics, including patient autonomy and informed consent.

Years of considering this problem led Kaptchuk to his next clinical experiment: what if he simply told people they were taking placebos? This time his team compared two groups of 18S sufferers. One group received no treatment. The other patients were told they’d be taking fake, inert drugs (from bottles labelled ‘placebo pills’) and told also, at some length, that placebos often have healing effects. The study’s results shocked the investigators themselves: even patients who knew they were taking placebos described real improvement, reporting twice as much symptom relief as the no-treatment group. It hints at a possible future in which clinicians cajole the mind into healing itself and the body – without the drugs that can be more of a problem than those they purport to solve.

But to really change minds in mainstream medicine, researchers have to show biological evidence – a feat achieved only in the last decade through imaging technology such as positron emission tomography (PET) scans and functional magnetic resonance imaging (MRI). Kaptchuk’s team has shown with these technologies that placebo treatments affect the areas of the brain that modulate pain reception. ‘It’s those advances in “hard science”‘, said one of Kaptchuk’s researchers, ‘that have given placebo research a legitimacy it never enjoyed before’. This new visibility has encouraged not only research funds but also interest from healthcare organisations and pharmaceutical companies. As private hospitals in the US run by healthcare companies increasingly reward doctors for maintaining patients’ health (rather than for the number of procedures they perform), research like Kaptchuk’s becomes increasingly attractive and the funding follows.

Another biological study showed that patients with a certain variation of a gene linked to the release of dopamine were more likely to respond to sham acupuncture than patients with a different variation – findings that could change the way pharmaceutical companies conduct drug trials. Companies spend millions of dollars and often decades testing drugs; every drug must outperform placebos if it is to be marketed. If drug companies could preselect people who have a low predisposition for placebo response, this could seriously reduce the size, cost and duration of clinical trials, bringing cheaper drugs to the market years earlier than before.

Text 2: Questions 15-22

15. The phrase ‘a thorn in medicine’s side’ highlights the way that the placebo effect
A. varies from one trial to another.
B. affects certain patients more than others.
C. increases when researchers begin to study it.
D. complicates the process of testing new drugs.

16. In the first paragraph, it’s suggested that part of the placebo effect in trials is due to
A. the way health problems often improve naturally.
B. researchers unintentionally amplifying small effects.
C. patients’ responses sometimes being misinterpreted.
D. doctors treating patients in the control group differently.

17. The results of the trial described in the second paragraph suggest that
A. surprising findings are often overturned by further studies.
B. simulated acupuncture is just as effective as the real thing.
C. patients’ expectations may influence their response to treatment.
D. it’s easy to underestimate the negative effect of most treatments.

18. According to the writer, what should health professionals learn from Kaptchuk’s studies?
A. The use of placebos is justifiable in some settings.
B. The more information patients are given the better.
C. Patients value clarity and honesty above clinical skill.
D. Dealing with patients’ perceptions can improve outcomes.
19. What is suggested about conventional treatments in the fourth paragraph?

A. Patients would sometimes be better off without them.
B. They often relieve symptoms without curing the disease.
C. They may not work if patients do not know what they are.
D. Insufficient attention is given to developing effective ones.

20. What does the phrase ‘This new visibility’ refer to?
A. improvements in the design of placebo studies
B. the increasing acceptance of placebo research
C. innovations in the technology used in placebo studies
D. the willingness of placebo researchers to admit mistakes

21. In the fifth paragraph, it is suggested that Kaptchuk’s research may ultimately benefit from
A. the financial success of drug companies.
B. a change in the way that doctors are paid.
C. the increasing number of patients being treated.
D. improved monitoring of patients by healthcare providers.

22. According to the final paragraph, it would be advantageous for companies to be able to use genetic testing to
A. understand why some patients don’t respond to a particular drug.
B. choose participants for trials who will benefit most from them.
C. find out which placebos induce the greatest response.
D. exclude certain individuals from their drug trials.

END OF READING TEST. THIS BOOKLET WILL BE COLLECTED

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JUNIOR SPORTS INJURIES OET Reading answers

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Part A

1. c

2. B

3. D

4. c

5. B

6. A

7. D

8. SERIOUS HEAD INJURIES

9. Protective head gear

10. Volleyball

11. Knee injuries

12. Do not further damage

13. Custom fabricated mouth guards

14. Recreational activities

15. Re-injury

16. Protective wrist guard

17. Soccer

18. Medical clearance

19. An appropriate qualified person

20. The female athlete

Part B

1. A

2. A

3. B

4. A

5. B

6. C

Part C (01)

1. B

2. C

3. B

4. A

5. B

6. C

7. D

8. A

Part C (02)

1. C

2. A

3. B

4. D

5. A

6. D

7. A

8. C

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