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TUBERCULOSIS OET Reading

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TEXT A Background: In New York City, the incidence of tuberculosis has more than doubled during the past decade. We examined the incidence of tuberculosis and the acquired immune deficiency syndrome (AIDS) and the rate of death from all cause in a very high-risk group – indigent subject who abuse drugs, alcohol, or both. Methods: In 2009 we began to study prospectively a cohort of welfare applicants and recipients 18 to64 years of age who abused or alcohol. The incidence rate of tuberculosis, AIDS, and death for this group were ascertained through vital records and New York City’s tuberculosis and AIDS registries.

TEXT B: RESULTS. The cohort was followed for eight years. Of the 858 subjects;
• tuberculosis developed in 47 (5.5 percent),
• 84 (9.8 percent) were given a diagnosis of AIDS, and
• 183 (21.3 percent) died.
The rates of incidence per 100,000 person- years were
• 744 for tuberculosis, • 1323 for AIDS, and., • 2842 for death.
In this group of welfare clients,
• the rate of newly diagnosed tuberculosis was 14.8 times that of the age matched general population of New York City;
• the rate of AIDS-was 10.0 times as high; • the death rate was 5.2 times as high.
• no significant difference in the rate of new cases of tuberculosis between subjects with positive skin tests and those with negative skin tests at examination in 2009.

TEXT C. Deaths in the cohort: There were 183 deaths in the cohort during follow-up (21.3 percent) of the subjects, a rate of 2842 deaths per 100,000 person-years, 5.2 times that of the age-matched general population. Causes of death – Table 3


TEXT D: Conclusions
• Of the 47 subjects with tuberculosis, 21 (44.7 percent) died before the end of 2017;
• 12 (57.1 percent) of those who died also had AIDS.
• Of 15 persons with both tuberculosis and AIDS, 12 (80.0 percent) died before the end of 2017 and 8 died before completing anti-TB therapy.
• Of the 84 study subjects with AIDS, 68 (81.0 percent) died before the end of 2017.

For each question, 1-7, decide which text (A, B, C or D) the information comes from
1. what was the percentage of deaths caused by diabetes in the study group?
2. what was the rate of incidence per 100,000 person per years for tuberculosis?
3. name the city where the study was conducted?
4. how the incidence rates of diseases and death for the study group were ascertained?
5. how many died before the end of 2017 without completing anti-TB therapy?
6. what was the average age of subjects died due to other causes in the study group?
7. how many years the cohort was followed?
Questions 8-13. Answer each of the questions, 8-13, with a word or short phrase from one of the texts.
8. How many of the study subjects with only AIDS died before the end of 2017?
9. In how many of the study subjects wound was the cause of death?
10. What was the age limits of the study subjects?
11. When did the study begin?
12. What was the total number of deaths in the study group?
13. What was the percentage of deaths caused by respiratory arrest in the study group?

Questions 14-20. Complete each of the sentences, 14-20, with a word or short phrase.


14. The study shows that number of the incidence of tuberculosis in New York City has more than _____________during the past decade.
15. In conclusion, 12 of those who died had both AIDS and ____________
16. In the cohort during follow-up of the subjects, rate of deaths was 5.2 times that of the _______________ general population.
17. In the group of welfare clients, the rate of ________________ was 10.0 times as high.
18. The study was conducted among _____________ who abuse drugs, alcohol, or both.
19. ___________ subjects died suffering from coronary artery disease.
20. There were ______________ subjects in the study group.

PART B


Incubators for Infant: The general principle is that air is processed before it reaches baby. An electric fan draws room air through a bacterial filter which removes dust and bacteria. The filtered air flows over an electric heating element. The filtered and heated air then passes over a water tank where it is moistened. It then flows on to the incubator canopy. The incubator canopy is slightly pressurized. This allows expired carbon dioxide to pass back into the room via the vent holes and most of the air to be re-circulated. It also prevents unfiltered air entering the system.
1. The extract informs us that the incubators
A. is likely to circulate most of the air again.
B. may not work correctly in close proximity to some other devices.
C. prevents filtered air entering the system.

Nebulizers: A nebulizer is a device used to administer medication in the farm of a mist inhaled into the lungs. Nebulizers are commonly used for treatment of cystic fibrosis, asthma and other respiratory diseases. The reason for using a nebulizer for medicine to be administered directly to the lungs is that small aerosol droplets can penetrate into the narrow branches of the lower airways. Large droplets would be absorbed by the mouth cavity, where the clinical effect would be low. The common technical principle for all nebulizers is to use oxygen, compressed air or ultrasonic power as means to break up medical solutions or suspensions into small aerosol droplets.
2. The notice is giving information about
A: ways of checking that a nebulizer has been placed correctly1<
B. how the use of nebulizer is authorised.
C. why nebulizer is being used.

Oxygen Concentrators: Atmospheric air consists of approximately 80% nitrogen and 20% oxygen. An oxygen concentrator uses air as a source of oxygen by separating these two components. It utilizes the property of zeolite granules to selectively absorb nitrogen from compressed air. Atmospheric air is gathered, filtered and raised to a pressure of 20 pounds per square inch (psi) by a compressor. The compressed air is then introduced into one of the canisters containing zeolite granules where nitrogen is selectively absorbed leaving the residual oxygen available for patient use. After about 20 seconds the supply of compressed air is automatically diverted to the second canister where the process is repeated enabling the output of oxygen to continue uninterrupted.
3. What does this manual tell us about zeolite granules?
A. leave residual oxygen for patient use
B. selectively absorb nitrogen from air
C. absorb only nitrogen from compressed air

Arterial blood pressure: The arterial blood pressure (BP) is connected with the force-, which is exerted by the blood volume on the walls of the arteries. The level of BP is dependent on two factors: the heart minute ejection volume and the elasticity of arterial walls. Other factors affecting BP include: the volume’ and viscosity of the blood, body position and emotional state. The BP at the top of pulse wave (due to the constriction of heart ventricles) is called systolic BP, whereas the respective one during the diastole is called diastolic BP. The difference between systolic and diastolic BP is defined as amplitude or pulse pressure.
4. Which is the main factor behind BP level?
A. the heart minute rejection volume
B. volume and viscosity of the blood
C. elasticity of the arterial wall

Basic Life Support: Basic Life Support means saving lives by maintaining airway, supplying ventilation (rescue breathing by blowing air to the victim’s mouth) and supplying circulation (external cardiac massage – chest compressions) performed without additional equipment. It is the first step in cardio­ pulmonary resuscitation (CPR) that should be initiated by bystanders and continued until qualified help arrives. Next step is Advanced Life Support (ALS), which is performed by medical services. People with cardiac arrest (CA) need immediate CPR. First aid means BLS that is started by witnesses before the emergency service arrival and is the key action in achieving patient survival.
5. What does this manual tell us about cardio-pulmonary resuscitatio?
A. should be initiated by bystanders
B. should be initiated immediately only for cardiac arrest
C. should be performed by medical services

Types of surgical threads: Materials, which the threads are made of, are divided into absorbable and non- absorbable ones or natural and synthetic sutures. Non-absorbable sutures are applied on the skin and in septic wounds. Absorbable threads, depending on their structure are divided into monofilament, polifilament, braided, plaits, coated and uncoated ones. Time of their absorbing is varied and depends on material properties; it can take from 14 days to 6 months. Absorbing progresses due to enzymatic disintegration and hydrolysis.
6. What does this extract from a handbook tell us about absorbable threads?
A. absorbing progresses due to enzymatic integration and hydrolysis7
B. absorbing time is varied and depends on material properties
C. are divided into monofilament, polifilament, braided; plaits and uncoated ones

PART C TEXT 1.


Targeting two important risk factors for cardiovascular disease and other major risk factors that can be lowered by modification, treatment or control


Paragraph 1: (ARA) – It’s well known that the prevalence of diabetes is on the rise. According to the Centers for Disease Control and Prevention (CDC), about 23.6 million, or nearly 8 percent of people in the United States, have diabetes, and 1.6 million new cases are diagnosed each year in people aged 20 and older. Type 2 diabetes is the most common form, accounting for about 90 to 95 percent of those diagnosed, and occurs when the body either does not produce enough insulin or does not respond to insulin.

Paragraph 2: But something that many people may not know is that in addition to having diabetes, 70 percent of adult with type 2 diabetes also have high LDL cholesterol (LDL-C), the “bad” cholesterol that can cause build-up in the arteries, greatly increasing their risk for cardiovascular disease. Cholesterol is needed for the body to function normally, but when there is too much LDL-C in the bloodstream, it is deposited in arteries, including those of the heart, which can limit blood flow and lead to heart disease.

Paragraph 3: The American Diabetes Association (ADA) and the American College of Cardiology (ACC) emphasize that it is critical to control both cholesterol and blood sugar levels. The ADA recommends that patients with type 2 diabetes aim for an A1C level which reflects your average blood sugar level for the past two to three months, of less than 7 percent. The National Cholesterol Education Program (NCEP) ATP 111 recommends that patients with type 2 diabetes target an LDL-C goal of less than 100 mg/dL.

Paragraph 4: Treating these two diseases can take a combination of efforts, including a healthy diet and increased exercise. Medications are also sometimes needed. While there are many drugs approved by the U.S. Food and Drug Administration (FDA) to treat type 2 diabetes and others available to lower LDL-C, a drug called Welchol (colesevelam HCI) is the first and only medication approved as an adjunct to diet and exercise to reduce both A1C in adults with type 2 diabetes and LDL-C in adults with elevated cholesterol.t
Welchol addresses both of these chronic health conditions with one medication and offers the convenience of two formulations, Welchol tablets and Welchol for Oral Suspension. Welchol can be taken alone or with other cholesterol lowering medications known as statins and can be added to other anti-diabetic medications (metformin, sulfonylureas, or insulin).

Paragraph 5: “For patients with type 2 diabetes and high LDL cholesterol, it is important to manage both conditions,” said Yehuda Handelsman, MD, FACP, FACE, Medical Director of the Metabolic Institute of America in Tarzana, Calif. “Welchol reduces these two risk factors for cardiovascular disease in adults with type 2 diabetes by significantly lowering A1C and LDL-C or ‘bad’ cholesterol, providing a unique therapeutic option.” It is important to note that the affect of Welchol on cardiovascular morbidity and mortality has not been determined.

Paragraph 6: What are the major uncontrollable risk factors for coronary heart disease? The American Heart Association has identified several risk factors for coronary heart disease. Some of them can be modified, treated or controlled, and some can’t. The more risk factors a person has, the greater the chance that he or she will develop heart disease. Also, the greater the level of each risk factor, the greater the risk. For example, a person with a total cholesterol of 300 mg/dL has a greater risk than someone with a total cholesterol of 240 mg/dL, even though all people with a total cholesterol of 240 or higher are considered high risk.

Paragraph 7: Increasing age – About 82% of people who die of coronary heart disease are 65 or older.
Male sex (gender) – The lifetime risk of developing CHD after age 40 is 49% for men and 32% for women. The incidence of CHD in women lags behind men I years for total CHD and by 20 years for more serious clinical events such as sudden death.

Paragraph 8: Heredity (including Race)- Children of parents with heart disease are more likely to develop it themselves. African Americans have more severe high blood pressure than Caucasians and a higher risk of heart disease. Heart· disease is also higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This is partly due to higher rates of obesity and diabetes. Most people with a strong family history of heart disease have one or more other risk factors. Just as you can’t control your age, sex and race, you can’t control your family history. Therefore, it’s even more important to treat and control any other risk factors you have.

Paragraph 9: Other major risk factors that can be lowered by modification, treatment or control. Tobacco smoke – Smokers’ risk of developing CHD is two to four times that nonsmokers. Smokers who have a heart attack are more likely to die and die suddenly (within an hour) than nonsmokers. Cigarette smoking also acts with other risk factors to greatly increase the risk for coronary heart disease. People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke), but their risk isn’t as great as cigarette smokers’. Constant exposure to other people’s smoke – called environmental tobacco smoke, secondhand smoke or passive smoking – increases the risk of heart disease even for nonsmokers.

Paragraph 10: High blood cholesterol levels – The risk of coronary heart disease rises as blood cholesterol levels increase. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more. A person’s cholesterol level is also affected by age, sex, heredity and diet.
High blood pressure – High blood pressure increases the heart’s workload, causing the heart to enlarge and weaken over time. It also increases the risk of stroke, heart attack, kidney failure and heart failure. When high blood pressure exists with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke increases several times.

Paragraph 11: Physical inactivity-An inactive lifestyle is a risk factor for coronary heart disease. Regular, moderate-to-vigorous physical activity is important in preventing heart and blood vessel disease.
Obesity and overweight – People who have excess body fat – especially if a lot of it is in the waist area – are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases the strain on the heart, raises blood pressure and blood cholesterol and triglyceride levels, and lowers HDL (good) cholesterol levels. It can also make diabetes more likely to develop. Many obese and overweight people have difficulty losing weight. If you can lose as little as 10 to 20 pounds, you can help lower your heart disease risk.

Paragraph 12: Diabetes mellitus – Diabetes seriously increases the risk of developing cardiovascular disease. Even when glucose levels are under control, diabetes greatly increases the risk of heart disease and stroke. From two-thirds to three-quarters people with diabetes die of some form of heart or blood vessel disease.

Paragraph 13: What other factors contribute to heart disease risk? Stress – Individual response to stress may be a contributing factor. Some scientists have noted a relationship between coronary heart disease risk and stress in a person’s life, their health behaviors and socioeconomic status. These factors may affect established risk factors. For example, people under stress may overeat, start smoking or smoke more than they otherwise would.

Paragraph 14: Excessive alcohol intake – Drinking too much alcohol can raise blood pressure, cause heart failure and lead to stroke. It can contribute to high triglycerides, cancer and other diseases, and produce irregular heartbeats. It also contributes to obesity, alcoholism, suicide and accidents. The risk of heart disease in people who drink moderate amounts of alcohol (an average of one drink for women or two drinks for men per day) is lower than in nondrinkers. One drink is defined as 1-1/2 fluid ounces (fl oz) of 80-proof spirits (such as bourbon, Scotch, vodka, gin, etc.), 1 fl oz of 100- proof spirits, 4 fl oz of wine, or 12 fl oz of beer. It’s not recommended that nondrinkers start using alcohol or that drinkers increase their intake.

Q1. According to paragraph 1 of the article states that
a. Diabetes has stabilised
b. 1.6 million people aged 20 and older have diabetes
c. Type 2 diabetes is the most common
d. Type 2 diabetes occurs when there is an over-production of insulin
Q2. In addition to having diabetes
a. 30% of adult with Type 2 diabetes do not have high counts of low-density lipids
b. 70% of adults with Type 2 diabetes do have high counts of low-density lipids
c. Too many LDLs in the bloodstream go straight to the heart
d. LDLs in the bloodstream cannot hinder blood flow
Q3. According to the ADA and the ACC
a. Both blood sugar levels and cholesterol levels need to be controlled if diabetes is avoided
b. Blood sugar levels need to be controlled if diabetes is to be avoided
c. ACA believes less than7% average blood sugar level over a one-month period indicates diabetes risk
d. The NCEP does not recommend Type 2 diabetics aim for less than 100 mg/dL of low-density lipids
Q4. Welchol, a drug to lower the level of LDLs in the blood
a. has not been approved by the U.S. FDA
b. Welchol must be taken with other statins
c. Welchol should not be added to medications such as metformin, sulfonylureas or insulin.
d. Welchol needs to be taken together with a healthy diet and an exercise program to reduce A1C in Type 2 diabetics and LDL-C in adults with elevated cholesterol levels.
Q5. Welchol’s effect on cardiovascular morbidity and mortality…
a. is supported by the evidence b. has not been positively established
c. has been positively established d. none of the above
Q6. Some risk factors can be controlled, or lowered; some cannot be controlled: such as advancing age, one’s gender, and one’s genetic inheritance. However, there are some major risk factors that can be lowered by modifying one’s lifestyle – or by medical intervention. Risk factors such as—–
a. high blood pressure b. high cholesterol levels c. obesity d. all of the above
Q7. The article states that stress
a. causes overeating and/or habitual smoking
b. does not interact with lifestyle and socioeconomic status
c. depends on how one reacts to it
d. may depend on how one reacts to it
Q8. Alcohol contributes to heart failure and strokes;
a. if you drink very less amount
b. moderate alcohol intake leads to less risk of heart disease
c. but not contribute to high triglycerides
d. is not a factor in developing cancer

PART C. TEXT 2. FLUORIDE


Paragraph 1: Globalization has provoked changes in many facets of human life, particularly in diet. Trends in the development of dental caries in population have traditionally followed developmental patterns where, as economies grow and populations have access to a wider variety of food products as a result of more income and trade, the rate of tooth decay begins to increase. As countries become wealthier, there is a trend to greater preference for a more “western” diet, high m carbohydrates and refined sugars. Rapid globalization of many economies has accelerated this process. These dietaries have a substantial impact on diseases such as diabetes and dental caries.

Paragraph 2: The cariogenic potential of diet emerges in areas where fluoride supplementation is inadequate. Dental caries is a global health problem and has a significant negative impact on quality of life, economic productivity, adult and children’s general health and development. Untreated dental caries in pre-school children is associated with poorer quality of life, pain and discomfort, and difficulties in ingesting food that can result in failure to gain weight and impaired cognitive development. Since low-income countries cannot afford dental restorative treatment and in general the poor are most vulnerable to the impacts of illness, they should be afforded a greater degree of protection.

Paragraph 3: By WHO estimates, one third of the world’s population have inadequate access to needed medicines primarily because they cannot afford them. Despite the inclusion of sodium fluoride in the World Health Organization’s Essential Medicines Model List, the global availability and accessibility of fluoride for the prevention of dental caries remains a global problem. The optimal use of fluoride is an essential and basic public health strategy in the prevention and control of dental caries, the most common non­ communicable disease on the planet. Although a whole range of effective fluoride vehicles are available for fluoride use (drinking water, salt, milk, varnish, etc.), the most widely used method for maintaining a constant low level of fluoride in the oral environment is fluoride toothpaste.

Paragraph 4: More recently, the decline in dental caries amongst school children in Nepal has been attributed to improved access to affordable fluoride toothpaste. For many low-income nations, fluoride toothpaste is probably the only realistic population strategy for the control and prevention of dental caries since cheaper alternatives such as water or salt fluoridation are not feasible due to poor infrastructure and limited financial and technological resources. The use of topical fluoride e.g., in the form of varnish or gels for dental caries prevention is similarly impractical since it relies on repeated applications of fluoride by trained personnel on an individual basis and therefore in terms of cost cannot be considered as part of a population based preventive strategy.

Paragraph 5: The use of fluoride toothpaste is largely dependent upon its socio-cultural integration in personal oral hygiene habits, availability and the ability of individuals to purchase and use it on a regular basis. The price of fluoride toothpaste is believed to be too high in some developing countries and this might impede equitable access. In a survey conducted at a hospital dental clinic in Lagos, Nigeria 32.5% of the respondents reported that the cost of toothpaste influenced their choice of brands and 54% also reported that the taste of toothpastes influenced their choice.

Paragraph 6: Taxes and tariffs on fluoride toothpaste can also significantly contribute to high prices, lower demand and inequity since they target the poor. Toothpastes are u; classified as a’ cosmetic product and as such often highly taxed by governments. For example, various taxes such as excise tax, VAT, local taxes as well as taxation on the ingredients and packaging contribute to 25% of the retail cost of toothpaste in Ne and India, and 50% of the retail price in Burkina Faso. WHO continues to recommend the removal taxes and tariffs on fluoride toothpastes. Any lost revenue can be rest by higher taxes on sugar and high sugar containing foods, which are common risk factors for dental caries, coronary heart disease, diabetes and obesity.

Paragraph 7: The production of toothpaste within a country has the potential to make fluoride toothpaste more affordable than imported products. In Nepal, fluoride toothpaste was limited to expensive imported products. However, due to successful advocacy locally manufactured fluoride toothpaste, the least expensive locally manufactured fluoride toothpaste is now 170 times less costly than the most expensive imported Philippines, local manufacturers are able to satisfy consumer preferences and compete against multinationals by discounting the price of toothpaste by as much as 55% against global brands; and typically receive a 40% profit margin compared to 70% for multinational producers.

Paragraph 8: In view of the current extremely inequitable use of fluoride throughout countries and regions, all efforts to make fluoride and fluoride toothpaste affordable and accessible must be intensified. As a first step to addressing the issue of affordability of fluoride toothpaste in the poorer countries in-depth country studies should be undertaken to analyze the price of toothpaste in the context of the country economies.
Q1. Which of the following would be the most appropriate heading for the paragraph 1?

a. High sugar intake and increasing tooth decay
b. Globalisation, dietary changes and declining dental health
c. Dietary changes in developing nations
d. Negative health effects of a western diet
Q2. Which of the following is not mentioned as a negative effect of untreated dental caries in pre-school children?
a. Decreased mental alertness b. Troubling chewing and swallowing food
c. Lower life quality d. Reduced physical development
Q3. According to paragraph 3, which of the following statement is correct?
a. Dental caries is the most contagious disease on earth.
b. Fluoride in drinking water is effective but rarely used
c. Fluoride is too expensive for a large proportion of the global population.
d. Fluoride toothpaste is widely used by 2/3 of the world’s population.
Q4. Fluoride toothpaste is considered the most effective strategy to reduce dental caries in low-income countries because___
a. it is the most affordable.
b. topical fluoride is unavailable.
c. it does not require expensive infrastructure or training.
d. it was effective in Nepal.
Q5. Which of the following is closest in meaning to the word impede?
a. stop b. prevent c. hinder d. postpone
Q6. Regarding the issue of taxation in paragraph 6 which of the following statements is most correct?
a. Income tax rates are higher in Burkina Faso than India or Nepal.
b. WHO recommends that tax on toothpaste be reduced.
c. Governments would like to reduce tax on toothpastes but can’t as it is classified as a cosmetic.
d. WHO suggests taxing products with a high sugar content instead of toothpastes.
Q7. Which of the following is closest in meaning to the _word advocacy?
a. marketing b. demand c. development d. support
Q8. Statistics in paragraph 7 indicate that….
a. local products can’t compete with global products and make a profit at the same time.”
b. Philippine produced toothpaste is profitable while being less than half the price of global brands.
c. in Nepal, fluoride toothpaste is limited to imported products which are very expensive
d. toothpaste produced in the Philippines has a higher profit margin than internationally produced toothpaste.

View answers – TUBERCULOSIS

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TUBERCULOSIS OET Reading answers

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Text A

01. c

ut. 6

03. A

04. A

05. D

06. c

07. B

08. 58

09. 3

10. 18 TO 64 years

11.2009

1.2. 183

13.1,.1%

14. Doubieci

15. Tuberculosis

16. Age – matched

17. AIDS

18. lndigent subject

19. 10

20.858

Text B

U1. A

42. c

03. c

04. c

05. A

06. B

Text c(Part 01)

01. c

02. B

03. A

04. D

05. B

06. D

07. D

08. B

Text c (Part 02)

01. B

02. A

03. c

04. c

0s. c

06. D

07. D

08. B

TUBERCULOSIS OET Reading

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ANGINA PECTORIS OET Reading

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

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


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

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

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

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

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

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

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

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

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

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

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

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

Text 1: Ebola Virus and Marburg Virus


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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text 1: Questions 7-14


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

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

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

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

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

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

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

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

Text 2: A Chronic Disease – Atopic Dermatitis

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

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

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

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

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

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

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

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

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

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

Text 2: Questions 15 to 22

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

View answers – ANGINA PECTORIS

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ANGINA PECTORIS OET Reading answers

1 Comment

1 C
2 A
3 B
4 C
5 D
6 D
7 B
8 CHEST PAIN
9 SEDENTARY LIFESTLYE
10 CARDIOVASCULAR DISEASE
11 THARRUBOLYTIC THERAPY / ANTICOAGULANTS
12 UNNECESSARY TESTS.
13 BEDREST/CHAIR REST
14 EXERCIRE ECG
15 PIC
16 LVSD
17 AFRICAN – AMERICAN
18 INTRAORTIC BALLON PUMP
19 CIGERETTE SMOKING
20 2G

READING SUB – TEST – ANSWER KEY LIVING WILL -2
1. C
2. A
3. A
4. B
5. B
6. B
PART C: QUESTIONS 7-14 Ebola Virus and Marburg Virus
7. C
8. D
9. B
10. D
11. D
12. C
13. A
14. B
PART C: QUESTIONS 15-22. A Chronic Disease – Atopic Dermatitis
15. C
16. D
17. D
18. B
19. A
20. A
21. C
22. C

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Attempt the test again – ANGINA PECTORIS

TREATMENT OF FRACTURES OET READING ANSWERS

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Part A – Answer key 1 – 7 

1: D

2: B

3: D

4: C

5: A

6: A

7: C 

Part A – Answer key 8 – 14

8: Pre-emptive analgesia

9: After healing

10: Pain

11: Sling

12: Internal fixation

13: medications knowledge

14: Closed manipulation 

Part A – Answer key

15 – 20 15: DVT

16: mal-union

17: several injuries

18: useful sensation

19: fat embolism

20: fractured bone 

Reading part B – answer key 

Questions 1-6 

1: Wall sphygmomanometer

2: Indications for using the Powerheart AED G3

3: NAFLD is more prevalent in Middle East.

4: Impact Of Delirium On ICU Patient

5: Gestational age is taken as an important factor for the study conducted.

6: The device will analyze ECG and can make shock deliverance simple. 

Reading test – part C – answer key 

Text 1 – Answer key 7 – 14 

7: How OIC occurs? 8: Lead to intestinal movement 9: Impact of OIC on life 10: Opioid Tolerance and OIC 11: None of the above 12: Nonpharmacologic management of OIC. 13: Use of laxative can certainly be decreased. 14: Role of the advanced practice nurse in OIC. 

Text 2 – Answer key 15 – 22

15: Vaccines implemented have changed lives of people across the globe.

16: MMR is an example of effective combined vaccine.

17: Immunogenicity of the prepared vaccines.

18: Antigen role

19: Antigen competition

20: Combined vaccines often produce different results.

21 : Various combinations bring in various results.

22: Combined vaccine helps with retaining immunogenicity. 

Treatment of fractures – oet reading

OET READING TESTS

GLAUCOMA OET reading

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TEXT A: Description: Glaucoma is the name given to as group of eye disease in which the optic nerve at the back of the eye is slowly destroyed. In most people this damage is due to an increased pressure inside the eye – a result of blockage of the circulation of adequous, or its drainage. In other patients, the damage may because by poor blood supply to the vital optic nerve fibbers weakness in the structure of the nerve, and or a problem in the health of the nerve fibers themselves. Over 146000 Australians have been diagnosed with glaucoma. While it is more common as people age, it can occur at any age. Glucoma is also far less common in the indigenous population.

Symptoms: Chronic glaucoma is the common type. It has no symptoms  until eyesight  is lost at  a later stage.

Prognosis: Damage progresses very slowly and destroys vision gradually, starting with the   side vision. One eye covers for the other, and the person remains unaware of any problem until a majority of nerve fibers  have been damages, and  a large part of vision has been  destroyed.  This damage is irreversible.

Treatment: Although there is no cure for glaucoma it can usually be controlled and further loss of sight either prevented or at least slowed down. Treatments include: Eyedrops – these are the most common form of treatment and must be used regularly. Laser (laser trabeculoplasty) – this is performed when eye drops do not stop deterioration in the field of vision. Surgery (trabeculectomy) – this is performed usually after eye drops and laser have failed to control the eye pressure. A new channel for the fluid to leave the eye is created. Treatment can save remaining vision but it does not improve eye sight.

Text B.      Table 1: Study of  eye pressure  and corneal thickness  as predictors of Glaucoma                         
lntraocular pressure (IOP) Central corneal thickness (CCT) and Glaucoma  correlations.

Central corneal thicknessIntraocular pressureIntraocular pressure + Central corneal thicknessPredictor of development of glaucoma (r2)
thickness of 555 microns or less  .36*
thickness of more than 5BB microns  -.13*
 pressure of less than 21 mmHg .38*
 pressure of more than 22 mmHg .07*  
*power >.05   Thickness less than 555and pressure less than 21 mmHg-.49*

Text C. Other forms of Glaucoma.        •

  • Low-tension or normal tension glaucoma. Occasionally optic nerve damage can occur in people  with so-called normal  eye  pressure.
  • Acute  (angle-closure)  glaucoma. Acute  glaucoma  is when  the pressure inside the eye rapidly increases due to the iris blocking the drain. An attack of acute glaucoma is often severe. People suff er pain, nausea, blurred vision and redness of the eye.     /
  • Congenital glaucoma. This is a rare form of glaucoma caused by an abnormal drainage system. It can exist at birth or develop later.
  • Secondary glaucomas. These glaucomas can develop because of other disorders of the eye such as injuries, cataracts, eye inflammation. The use of steroids (cortisone) has a tendency to raise eye pressure; therefore, pressures  should be  checked  frequently when  steroids are used.

Text D: Overview  of  Glaucoma Facts: Glaucoma  is the leading  cause  of  irreversible blindness worldwide. One in 10 Australians over 80 will develop glaucoma.

• First degree relatives of glaucoma patients have an 8-fold increased risk of developing  the disease.

  • At present,  50% of  people  with glaucoma in Australia  are undiagnosed.
  • Australian  health  care cost of  glaucoma in 2017 was $342  million.
  • The total annual cost of  glaucoma  in 2017 was  $1.9 billion.
  • The total cost is expected to increase to $4.3 billion by 2025.
  • The dynamic model of the economic impact of glaucoma enables cost­effectiveness comparison of various interventions to inform policy development.

Questions 1-7. For each question, 1-7, decide which text (A, B, C or D) the information comes from. You may use any letter more than once. In which text can you find information about:

1. which is the rare form of glaucoma?  

2. what is the leading cause of irreversible blindness in the world?

3. what has the highest value for the predictor of development of glaucoma?

4. which is the most common form of glaucoma?? __

5. what has the lowest value for the predictor of development of glaucoma?

6. what was the total annual cost of glaucoma in 2017? __

7. what is the most common form of treatment for glaucoma? __

Questions 8-13. Answer each of the questions, 8-13, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.

8. Which form of glaucoma can develop due to eye inflammation?

9. What is the predicted total cost of glaucoma in 2025?

10. What is the predictor of development of glaucoma for intraocular pressure more than 22 mmHg?

11. How many Australians have been diagnosed with glaucoma?

12. What was the Australian health care cost of glaucoma in 2017?

13. what is the current percentage of undiagnosed glaucoma patients in Australia?

Questions 14-20. Complete each of the sentences, 14-20, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.

14. Glaucoma is a group of eye diseases in which the________ is slowly destroyed

15. First degree relatives of glaucoma patients have _________ increased risk of developing the disease.

16. ______can cause pain, nausea, blurred vision and redness of the eye.

17. Steroids such as _______has a tendency to raise eye pressure.

18. Glaucoma is far less common in the_______

19. ________has no symptoms until eyesight is lost at a later stage.

20. Laser trabeculoplasty is performed when _______ don’t stop deterioration in the field of vision.

Part B.

Parenteral  Infusion Devices: Intravenous (IV) and intraarterial access routes provide an effective pathway for the delivery  of  fluid, blood,  and medicants  to a patient’s vital  organs. Consequently, about 80% of hospitalized patients receive infusion therapy. A variety of devices can be used to provide  flow through  an intravenous catheter. An intravenous delivery system typically consists of three major components:  (1) fluid or drug reservoir,  (2) catheter  system for transferring the fluid or drug from the reservoir into the vasculature  through a   venipuncture,  and (3) device for regulation  and/or  generating  flow.

1. What  does this extract tell us about parenteral infusion devices?

  1. used  to provide  flow through  an intravenous catheter
  2. 80% of hospitalized  patients receive parenteral  infusion   devices
  3. provide an effective pathway  for the delivery of fluid,   blood

Biomedical  Lasers: Three important factors have led to the expanding biomedical use of laser technology, particularly in surgery. These factors are: (1) the increasing understanding of the wave-length  selective interaction  and associated  effects of ultraviolet-  infrared  (UV-IR) radiation with biologic tissues,  including those of acute damage and long-term healing, (2) the rapidly increasing availability of lasers emitting (essentially monochromatically) at those wave­ lengths that  are strongly  absorbed by  molecular  species within  tissues, and (3) the availability of both optical fiber and lens technologies as well as of endoscopic technologies for delivery of the laser radiation to the often remote internal treatment site.

2. The purpose  of  these notes about Biomedical  Lasers is to

  1. state the factors that led to the expanding biomedical use of laser technology
  2. give valid reasons  for the increase in the biomedical use of lasers   in surgery
  3. recommend an alternate for ultraviolet- infrared (UV-IR) radiation in biomedical use

Infant Monitor: Many infants are being monitored in the home using  apnea monitors because they have been identified with breathing problems. These include newborn premature babies who have apnea of prematurity, siblings of babies who have died of sudden infant death syndrome, or infants who have had an apparent life-threatening episode related to lack of adequate respiration. Rather than keeping infants in the hospital for a problem that they may soon outgrow, doctors often discharge them from the hospital with an infant apnea monitor that measures the duration of breathing pauses and heart rate and sounds an alarm if either parameter crosses limits prescribed by the doctor.

3. The notice is giving information about

  1. the circumstances  for prescribing  the infant monitor  by  the doctor
  2. why  infants shouldn’t be  discharged  from the hospital with infant  monitor
  3. why infants unidentified with breathing problems need infant monitor

Postoperative complications: Surgery and  anesthesia  are stressful events for the patient. The patient   handles stress in accordance with their overall condition, the nature of the surgery and associated diseases. Post-traumatic stress disorder (stress  syndrome)  can be expected in all patients  following surgery. This is an  overall and local response of the organism to stress and its effort to cope with the strain. It is a physiological reaction of the organism to stress, which in the worst-case scenario can become a pathological  or a post-operative complication.

4. What  does this extract tell us about post-traumatic  stress   disorder?

  1. It is a physiological reaction of the patient to stress. •
  2. It is only a local response of the patient to stress.
  3. It can definitely turn into a post-operative    complication.

Rinses: These are prescribed when redressing necrotic, infected wounds. The rinse, · especially with antiseptic solution for clean, granulating and epithelizing wounds is not substantiated. The wound rinse helps to dean the wound of early leaching residues, coatings, necrotic tissue, pus, blood dots, toxins or residues of bacterial biofilm. Rinsing a colonized chronic wound reduces the existing microbial population.

Solutions suitable for application to wounds: Prontosan solution, Ostenisept, Dermacin,  DebsriEcaSan

Less suitable solutions: Betadin,  Braunol,  saline,  Permanganate

Solutions not suitable for application to wounds: Chloramin, Persteril, Rivanol, Jodisol.

5. The email is reminding  staff that  the

  1. benefits  of  rinses to patients  using suitable solutions.
  2. solutions less suitable should not be  applied to   wounds.
  3. epithelizing  wounds  should be rinsed  with  antiseptic solution.

Drains and drainage systems: Drains are used to drain physiological or pathological  fluids from the  body. The use of drains and drainage systems in surgery significantly affects the overall healing process. The accumulated fluid can endanger the whole body as it has a mechanical and toxic effect on the surrounding 4ssue and is a breeding ground for microorganisms.  Drains are used to drain fluids from body cavities, organs, wounds and surgical wounds (e.g. blood, wound secretion, bile, intestinal contents, pus etc.) and air (chest drainage).

6. The purpose  of  these notes  about drains and drainage  systems is to

  1. help maximize  efficiency of healing  process.
  2. give  guidance  on certain medical procedures.
  • avoid accumulation  of  fluid in body cavities.

Part C Text 1. Choose the answer (A, B, C or D) AIDS deaths blamed on immune therapy

Paragraph 1: THE DEATHS of three patients during trials of an experimental immune therapy for people with AIDS have renewed controversy over experiments carried out by the French scientist Daniel Zagury. The affair has also   highlighted shortcomings in the system of checks and controls over clinical research. The French health minister, Bruno Durieux, recently announced that  an inquiry had cleared Zagury and his team at the Pierre and Marie Curie University  in Paris of  alleged irregularities in the way they conducted tests of   a potential vaccine and an experimental immune therapy in patients at the Saint-Antoine Hospital  (This Week,  13 April). But Durieux  made  no mention of  three deaths which the inquiry had  reported.

Paragraph 2: Following revelations about the circumstances in which the patients died, Durieux has now announced a new assessment of the tests to be undertaken by ANRS, the national agency for AIDS research. Last July, Zagury and his colleagues reported in a letter to The Lancer  (vol 336, p  179)  a trial on patients with AIDS or AIDS-related complex. The patients received a preparation based on proteins from HIV that was designed to boost their immune  systems.

Paragraph 3: The preparation  was made from samples of  the patients’  own white blood  cells, purified and cultured in the laboratory. The researchers had infected the white blood cells with a genetically engineered form of the vaccinia virus that had  genes from HIV inserted into its DNA. The vaccinia, or cowpox, virus, had  first been  inactivated with  formaldehyde,  said the researchers.  Last week, the Chicago Tribune and Le Monde alleged that at least two of the deaths were caused by vaccinia disease, a rare complication of infection with vaccinia virus. Vaccinia is harmless in healthy people and has been used in its live form as the vaccine against smallpox worldwide. But, in people whose immune systems are suppressed, the virus can ‘occasionally spread rapidly in the body and kill.

Paragraph 4: A Paris dermatologist, Jean-Claude Guillaume, said that when he warned Zagury’s team that he was convinced one of their patients had contracted vaccinia disease “the response was that this was not possible” because the vaccinia had been inactivated. Shortly before his death, the patient had consulted  Guillaume  about large, rubbery  lesions  across his abdomen. Guillaume  consulted  a colleague, Jean-Claude  Roujeau,  about the rare disease. Roujeau told the Chicago Tribune that his tests on the tissue samples taken from two patients before they died had detected vaccinia virus in their skin cells.

Paragraph 5: The Saint-Antoine team’s postmortem tests did not reveal vaccinia. Odile Picard, who is in charge of administering the treatment, says there were three possible causes of death – vaccinia disease, herpes or a toxic reaction to the procedure used to prepare white blood cells before injecting them into patients. Zagury, however, insisted that “nothing allows us to affirm it [was vaccinia]. It could have been herpes or Kaposi’s sarcoma”. The tests are continuing, he says.

Paragraph 6: Luc Montagnier, co-discoverer of HIV, called for an immediate halt to the experiments. He says that intravenous injections could lead to generalised vaccinia disease. His team at the Pasteur Institute has already shown in laboratory tests that vaccinia virus maybe dangerous if the immune system is unable to resist it. The findings at the Pasteur Institute were apparently unknown to Zagury’s team, which works with Montagnier’s rival, the researcher  Robert Gallo. Gallo’s collaboration with  Zagury has been  suspended by the National Institutes of Health in the US because of alleged irregularities.

Paragraph 7: Zagury and his team have also denied charges that they covered up the deaths, which are not mentioned in their report in The Lancet. “They were not covered up,” Picard said. “They were accepted [into the trial] on compassionate grounds.” The Lancet report concerns 28 patients. 14 who were treated  and  14  controls who  were not  able to receive  the treatment.

Picard says that five other patients were also treated with the preparation but were not compared with the  controls. Their T4 cell counts had fallen too low to be comparable with the control group, so they were  excluded  from the  study and not mentioned  in its  report.

Paragraph 8: AIDS patients are particularly  vulnerable to infection. Furthermore, the French ethics council had specified that volunteers should be chosen because “their state was so advanced it excluded  treatment with AZT”. At least some of the patients were being treated with AZT at the same time as immune therapy. The council had also asked to be informed of the results of the trials case by case, but had not been told of the deaths. The geneticist Andre Boue, a member of the council, said: “The ethics council does not have judicial powers;  we are not the fraud  squad.”

Paragraph 9: The director  of the -AIDS research  agency ANRS, Jean-Paul  Levy, is concerned that all the controversy may lead to a crisis of public confidence  but laid the blame firmly at the door of the media where “excessive praise is followed by  excessive rejection”.  Levy, who had still heard nothing, “even   informally” from the health ministry the day after Durieux told parliament  that ANRS would assess immune therapy trials, said he wanted to study the problems  “in depth, but not in the atmosphere  of  a  tribunal”.

Paragraph 10: ANRS has a panel of experts in therapeutic trials, which, says Levy, “might seek international contacts to obtain a broad consensus” on the issues  involved. The research agency’s r-ole is to carry out a purely scientific evaluation, not to assess whether there was a breach of ethical guidelines, according to Levy. “If the government called on us to examine this case, we could act very quickly,” said Philippe Lucas of  the ethics   council.                                 

Q1. “Which of the following is FALSE?

  1. Zagury’s  experiments have been  controversial  before.
  2. An inquiry found obvious irregularities in Zagury’ s work.
  3. ANRS  is to re-evaluate  Zagury’s tests.
  4. Zagury’s intention  had been to increase patients’  immune  systems   with proteins.

Q2. The preparation which the patients received

  1. had been  accidentally  infected with  a form of the vaccinia  virus.
  2. was made from white blood cells which had been manufactured in the laboratory.
  3. had been stored in formaldehyde,
  4. contained laboratory-treated white blood cells which had been taken from them.

Q3. According to the article, vaccinia   _

  1. is potentially  lethal for all humans.
  2. has been used to fight both  cowpox  and smallpox  all around the  world.
  3. can be dangerous  in people  who have  abnormal  immune systems.
  4. in none of the  above.

Q4. Jean-Claude Guillaume         _

  1. was  also a member  of  Zagury’s team.
  2. examined one of the patients who had been referred to him by Zagury’ s team.
  3. informed the Chicago Tribune about the results of the tests on the tissue samples.
  4. was/did none  of the above.

Q5. Which  of  the following people  does NOT work with  Zagury?

  1. Odile Picard.
  2. Luc Montalgnier.
  3. Robert Gallo.
  4. None  of  the above works with Zagury.

Q6. It is FALSE that findings at the Pasteur institute —

  1. were ignored by Zagury’s team.
  2. did not lead to intervention  by the National  institutes of   Health.
  3. showed that intravenous injections were not good for patients with weaker immune systems.
  4. led to Zagury’s team  keeping  quiet about the patients who had   died.

Q7. How many people  were injected with the preparation  in the   trial?

  1. Fourteen 
  2. Nineteen
  3. Twenty eight
  4. Thirty three ‘

Q8. Which of the following statements best describes the initial condition of the people who took part in the   trial?

  1. Fewer than half  of them had  AIDS
  2. Half  of them had AIDS
  3. Most of them had  AIDS
  • All of them had  AIDS

Part C. TEXT 2.

Going blind in Australia

Paragraph 1: Australians  are living longer and so face increasing levels of visual  impairment. When we look at the problem  of visual impairment and the  elderly, there are three main issues. First, most impaired people retire with relatively  “normal” eyesight, with no more than presbyopia,  which  is  common in most people over 45 years of age. Second, those with visual impairment do have eye disease and are not merely suffering from “old age”. Third, almost all the major ocular disorders affecting the older population,  such as cataract, glaucoma and age-related macular degeneration (AMD), are progressive and if untreated will cause visual impairment and eventual blindness.

Paragraph 2: Cataract accounts for nearly half  of  all blindness  and remains the  most prevalent cause of blindness worldwide. In Australia, we do not know how prevalent cataract is, but it was estimated in 1979 to affect the vision of 43 persons per thousand over the age of 64 years. Although some risk factors for cataract have been identified, such as ultraviolet radiation, cigarette  smoking and alcohol consumption, there is no proven means of preventing the development of most age-related or senile cataract. However cataract blindness can be delayed or cured if diagnosis is early and therapy, including_ surgery,  is accessible.

Paragraph 3: AMD is the leading cause of new cases of blindness in those over 65. In the United States, it affects 8-1 1%  of those aged 65-74, and 20% of those over  75 years. In Australia, the prevalence of AMD is presently unknown but could be similar to that in the USA…Unlike cataract, the treatment  possibilities  for AMD are Hmited. Glaucoma is the third major cause  of vision loss in the elderly. This insidious disease is often undetected until optic nerve damage is far advanced. While risk factors for glaucoma,  such as  ethnicity and family history, are known, these associations are poorly understood. With early detection, glaucoma can be controlled medically or surgically.

Paragraph 4: While older people use a large percentage  of  eye services, many more may   not have access to, or may underutilise, these services. In the United  States  33% of the elderly in Baltimore had ocular pathology requiring further investigation or intervention. In the UK, only half the visually impaired in London were known by their doctors to have visual problems, and 40% of  those visually impaired in the city of Canterbury had never visited an ophthalmologist. The reasons for people underutilising eye care services are, first, that many elderly people believe that poor vision is inevitable or untreatable.  Second, many  of  the visually  impaired  have  other  chronic disease and may neglect their eyesight. Third, hospital resources and rehabilitation centres in the community are limited and, finally, social factors play a role.

Paragraph 5: People in lower socioeconomic groups are more likely to delay seeking treatment; they also use fewer preventive, early intervention and screening services, and fewer rehabilitation and after-care services. The poor use more health services, but their use is episodic, and often involves hospital casualty departments or general medical services, where eyes are not routinely examined. In addition, the costs of services are great deterrent for those with lower incomes who are less likely to have private health insurance. For example, surgery is the most effective means of treatment for cataract, and timely medical care is required for glaucoma and AMD. However, in December 1991, the proportion of the Australian  population  covered by private health insurance was 42%. Less than 38% had supplementary  insurance cover. With 46% of category 1(urgent) patients waiting for more than 30 days for elective eye surgery in the public system, and 54% of category 2 (semi-urgent) patients waiting for more than three months, cost appears to be a barrier to appropriate and adequate  care.

Paragraph 6: With the proportion of Australians aged 65 years and older expected to double from the present 11% to 21% by 2031, the cost to individuals and to society of poor sight will increase significantly if people do not have access to, or do not use, eye services. To help contain these costs, general practitioners can actively investigate the vision of all their older patients, ref er them earlier, and teach them self-care practices. In addition, the government, which is responsible to the taxpayer, must provide everyone with equal access to eye health care services. This may not be achieved merely by increasing expenditure – funds need to be directed towards prevention and health promotion, as well as treatment. Such strategies will make good economic sense if they stop older people going blind.

Q1. In paragraph 1, the author suggests that         _

  1. many people have poor eyesight at retirement  age.
  2. sight problems of the aged are often  treatable.
  3. cataract and glaucoma  are the inevitable results  of  growing  older.
  4. few sight problems  of  the elderly are potentially  damaging.

Q2. According to paragraph 2, cataracts       _

  1. may affect about half  the population  of  Australians  aged over 64.
  2. may occur in about 4-5% of Australians aged over 64.
  3. are directly related to smoking and alcohol consumption in old age.
  4. are the cause of more than  50% of visual   impairments.

Q3. According to paragraph 3, age-related macular degeneration (AMD)

  1. responds well to early treatment. ,’;
  2. affects 1in 5 of people  aged 65-74.
  3. is a new disease which  originated  in the USA.
  4. causes  a significant  amount  of sight loss in the elderly.

Q4. According to paragraph 3, the detection of glaucoma      _

  1. generally  occurs too late for treatment  to be  effective.
  2. is strongly associated  with  ethnic  and genetic factors.
  3. must  occur early to enable effective  treatment.
  4. generally occurs before optic nerve damage is very advanced.

QS. Statistics in paragraph 4 indicate that    _

  1. existing  eye care services are not fully utilised by the   elderly.
  2. GPs are generally  aware of  their  patients’  sight difficulties.
  3. most  of  the elderly in the USA receive  adequate  eye treatment.
  4. only 40% of  the visually  impaired visit  an opthalmologist.

Q6. According to paragraph 4, which one of the following statements is   true?

  1. Many elderly people believe that eyesight problems cannot be treated effectively.
  2. Elderly people with chronic diseases are more likely to have  poor eyesight.
  3. The facilities for eye treatments  are not always readily   available.
  4. Many elderly people think that deterioration of eyesight is a product of ageing.

Q7. In discussing social factors affecting the use of health services in paragraph 5, the author points out that _

  1. wealthier  people  use health  services more  often than poorer people.  
  2. poorer  people use health  services more regularly  than wealthier  people.
  3. poorer people deliberately avoid having their eye sight   examined.
  4. poorer  people have less access to the range of  available  eye care  services.

Q8. According to paragraph 6, in Australia in the year 2031   _

  1. about  one tenth  of  the country’s population  will be elderly.
  2. about one third  of  the  country’s population  will be elderly.
  3. the proportion  of people  over 65 will be twice the present proportion.
  4. the number  of visually impaired will be twice the present number.

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Glaucoma

PART A:

1.      C

2.      D

3.      B

4.      A

5.      B

6.      D

7.      A

8.      Secondary glaucoma

9.      $4.3 billion

10.    .07

11.    Over 146,000

12.    $342 million

13.    50%

14.    Optic nerve

15.    An 8-fold

16.    Acute glaucoma

17.    Cortisone

18.    Indigenous population

19.    Chronic glaucoma

20.    Eye drops

PART B:

1.      A

2.      A

3.      A

4.      A

5.      A

6.      C

PART C (TEXT 01):

1.      B

2.      D

3.      C

4.      D

5.      B

6.      A

7.      B

8.      D

PART C (TEXT 02):

1.      B

2.      B

3.      D

4.      C

5.      A

6.      B

7.      D

8.      C

GERIATRIC PHARMACOLOGY – OET Reading

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TEXT A: Changes in gastrointestinal function: The process of aging brings about changes in gastrointestinal function such as increase in gastric pH, deferment in process of expulsion of gastric, decreased motility, and decreased intestinal blood flow. The intake of substances that are actively transported from the intestinal lumen including some sugars, minerals and vitamins may therefore be decreased in elderly patients. Apart from the pathological or surgical alterations in gastrointestinal function such as gastrectomy, pyloric stenosis, pancreatitis, regional enteritis and concurrent administration of other drugs like cholestyramine and antacids may cause changes. Cholestyramine binds and decreases the effectiveness of many drugs including thiazides, anticoagulants, thyroxine, aspirin, PCM, and penicillin, while antacids decrease the efficiency of the process of taking in of drugs such as chlorpromazine, tetracycline, isoniazid.
Plasma protein concentrations may also be altered in elderly patients. Plasma albumin concentrations are causing less increase in free concentration of acidic drugs such as naproxen, phenytoin and warfarin. In contrast, the concentration of α1-acid glycoprotein may be increased in the presence of chronic diseases that frequently occur in the elderly population, potentially increasing the binding of drugs such as antidepressants, antipsychotic drugs and β-blockers, which are mainly bound to this protein.

TEXT B: Aging Factor: Body composition, plasma protein binding, and organ blood flow help in determining how effectively the drug is getting into every nook and corner. The total body water and lean body mass decreases, whereas, the body fat as a percentage of body weight increases with aging. The increased body fat is associated with the increase in volume of distribution of fat-soluble drugs such as the benzodiazepines, which leads to a more prolonged drug effect. Thus, it was demonstrated that the elimination half-life of diazepam was prolonged with age despite the fact that systemic clearance was unaltered. Change in organ blood flow with aging may also affect the rate of its efficient movement. In most of the cases, peripheral vascular resistance gets enhanced more and more. The same goes with the enhancement of the heart rate or cardiac output.

TEXT C. Hepatic Blood Flow: Hepatic blood flow and liver mass change in proportion to body weight decrease with aging. The rate of metabolism of many drugs by the cytochrome P450 enzyme system is decreased by 20- 40% with aging. Examples include theophylline, propranolol, nortriptyline, alfentanil, fentanyl, alprazolam, triazolam, diltiazem, verapamil, and levodopa. Many benzodiazepines are metabolized by microsomal enzyme to active metabolites, which are also eliminated by hepatic metabolism. Non-microsomal enzyme pathways may be less affected by age.
Example: Ethanol metabolism by alcohol dehydrogenase and isoniazid elimination by acetylation are unchanged in elderly patients. Concurrent drug administration, illness, genetics and environmental factors including smoking may have more significant effects on hepatic drug metabolism than age.

TEXT D. Toxicity In Drugs: Renal blood flow, glomerular filtration rate and tubular function all decline with aging. In addition to physiological decline in renal function, the elderly patient is particularly liable to renal impairment due to dehydration, congestive heart failure, hypotension and urinary retention, or to intrinsic renal involvement, e.g., diabetic nephropathy or pyelonephritis. As lean body mass decrease with aging, the serum creatinine level becomes a poor indicator of (and tends to overestimate) the creatinine clearance in older adults.
The Cockroft-Gault formula20 should be used to estimate creatinine clearance in older adults: Creatinine clearance = {140 – age) x weight (kg) / 72 X serum creatinine in mg/dl (For women multiplied by 0.85)
Drugs with significant toxicity that have diminished renal excretion with age include allopurinol, aminoglycosides, amantadine, lithium, digoxin, procainamide, chlorpropamide and cimetidine. These agents have reduced clearance, prolonged half-lives and increased steady-state concentrations if dosages are not adjusted for renal function.

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. In which text can you find information about;
1. Substance which is known to decrease absorption. Answer
2. Various factors are known to create an effect on how drug distribution is weakened. Answer _
3. Belongs to the class of medicines called digitalis glycosides Answer
4. With increase in age, various other health problems increase. Answer
5. Bioavailability and absorption. Answer
6. Drug distribution. Answer
7. Heart will pump less amount of blood through the circulatory system. 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 causes delay in gastric emptying? ______________
9. What can reduce effectiveness of blood thinners? ______________
10. One of the factors that lead to decrease in body fat is? ______________
11. How age can have its effect on cardiac output and peripheral vascular resistance? ______________
12. What is often stamp out by Hepatic metabolism? ______________
13. What can have major impact on hepatic drug metabolism? ______________
14. What cimetidine is known to be? ______________
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. In most of the patients, __________will often get transformed.
16. In most of the adults, the __________ will help signal the pathway for creatinine.
17. With steady increase in __________, there can be increase in volume of distribution of fat- soluble drugs.
18. __________ pathways may not show any kind of change though age increases.
19. Many of these substances, when they are not altered as needed, are recorded to be effective and known to enhance__________
20. __________is known to be very effective in curtailing down the absorption of drug.

PART B. For questions 1-6, choose the answer (A, B or C). Questions 1-6

1. The risk to the unborn baby may occur;
A. During the first half of the pregnancy.
B. When baby get primary infection through mother.
C. When infected with virus during first pregnancy.
CMV Infection: About one out of every 150 babies are born with a congenital CMV infection. However, only about one in five babies with a congenital CMV infection will be sick from the virus or will have long-term health problems.
If a woman is newly infected with CMV while pregnant, there is a risk that her unborn baby will also become infected (congenital CMV). Infected babies may, but not always, be born with a disability. Infection during one pregnancy does not increase the risk for subsequent pregnancies. However, if primary infection occurs, consideration should be given to wait for at least 12 months for next pregnancy. Studies conducted in Australia have shown that out of 1,000 live births, about 6 infants will have congenital CMV infection and 1-2 of those 6 infants (about 1 in 1000 infants overall) will have permanent disabilities of varying degree. These can include hearing loss, vision loss, small head size, cerebral palsy, developmental delay or intellectual disability, and in rare cases, death. Sometimes, the virus may be reactivated while a woman is pregnant but reactivation does not usually cause problems to the woman or to the fetus.

2. What is more related to defects?
A. SARS Co-V
B. MERS Co-V
C. Zika
Impact of re-emerging infectious diseases: New or re-emerging infectious diseases can have a huge impact on morbidity, mortality, and costs to the affected region, and pose a significant challenge to healthcare and public health systems. Multiple new diseases have been identified during the past twenty years, including severe acute respiratory syndrome coronavirus (SARS Co-V), Middle East respiratory syndrome coronavirus (MERS Co-V), and novel strains of avian and swine influenza. In addition, multiple existing infectious diseases have re-emerged or resurged, causing large outbreaks. Two recent examples include Zika and Ebola. The Zika virus has caused disease in more than 28 countries and is associated with severe natal deformity, such as microcephaly. The 2014 Ebola virus outbreak infected almost 30,000 individuals and resulted in more than 11,000 deaths worldwide.

3. The following manual talks about;
A. Digital blood pressure monitoring device.
B. Traditional blood pressure monitoring.
C. Accurate Blood Pressure Examination.
OMRON HEM-907XL Intellisense: Developed for the specific use in the clinical office setting and other health care environments, this device determines blood pressure by oscillometric measurement and displays systolic blood pressure, diastolic blood pressure, and pulse rate using an LCD digital monitor. It has the ability to automatically measure and store up to three sequential readings, and has a “hide” feature that hides measurements during acquisition. The pressure measurement range for this device is 0 to 280 mmHg. The OMRON is calibrated to the mercury manometer for routine quality assurance procedures.

4. What is known to have higher acoustical quality?
A. Littmann Cardioscope III
B. Littmann Classic II
C. A and B
Littmann Cardiology III stethoscope: The stethoscopes used for listening to Korotkoff sounds are Littmann Cardioscope III for adults and Littmann Classic II pediatric for children. They have a bell and diaphragm chest piece, and an acoustical rating by the manufacturer of 9 on a scale of 1-10, with a rating of 10 having the best acoustical attributes. The construction uses a single-lumen rubber tubing connection between the ear tubes and the chest piece. The ear tubes can be adjusted to fit the particular user at an anatomically correct angle, and the plastic ear covers come in different sizes allowing the user to match the best ear canal size to achieve an acoustically sealed ear fit. All parts of the stethoscope can be cleaned for use between SPs. The bell of the stethoscope is used to auscultate the Korotkoff sounds for blood pressure measurements.

5. Which word may indicate a plant a sapling?
A. Zygote
B. Blastocyst
C. Poppy
Implantation: Implantation takes place, when ovulation and fertilization occur. Implantation occurs in early stage of pregnancy when the fertilized egg (zygote) treks down the fallopian tube to the uterus and ascribes to the epithelium or uterine lining. It takes about 8 to 10 days for the fertilized egg to reaches to the uterus. During this time, it develops into a blastocyst through different stages of transformation instigation as a single cell dividing into 150 cells with an outer layer the trophoblastic, a fluid filled cavity the blastocoel, and a cluster of cells on the interior the inner cell mass. The tiny ball of cells is more or less like poppy generator. It attaches to the epithelium during 4th week of gestation. Once it firmly adheres, this’s called as an embryo. The embryo then again allocates into two parts, which will become the placenta and the fetus. An ultrasound done during the 5 to 6 weeks of gestation period that may show the amniotic sac and yolk sac, which are forming during this time. The amniotic sac is where baby will develop. The yolk sac will later be incorporated in a baby’s digestive tract. This ultrasound approves that implantation has taken place.

6. The given notice gives information about;
A. Women who are now more aware of health conditions.
B. Industry insights.
C. The global gynecology devices market size.
The market size was valued at USD 10,984.1 million in 2014. Introduction of minimally invasive procedures such as laparoscopy and high-definition imaging devices such as 3D endoscope is primarily boosting market growth. In addition, rising prevalence of diseases, such as uterine fibrosis and sexually transmitted diseases (STDs), associated with female reproductive organs are anticipated to support market growth during the forecast period.
According to the United Nations, the global female population accounted for more than 3.64 billion in 2015. Every woman visits a gynecologist at least once in her lifetime either for pregnancy or other complications related to menstrual cycle. The growing number of patients is likely to drive market growth during the forecast period.
Moreover, healthcare agencies are now promoting routine-check-ups for early cancer detection and other gynecological conditions. For example, The American Cancer Society recommends annual breast cancer screening with mammography for women aged between 40 to 44 years. Increase in routine check-ups has helped these devices gain usage rates.

PART C. TEXT 1. For questions 7-22, choose the answer (A, B, C or D).
ALL ABOUT FETAL ALCOHOL SPECTRUM DISORDERS:

Fetal Alcohol Spectrum Disorders (FASDs) are an assortment of different conditions that can occur in a person whose mother drank alcohol during pregnancy. These effects can include physical problems and problems with behavior and learning. Often, a person with an FASD has a mix of these problems. FASDs are caused by a woman drinking alcohol during pregnancy when alcohol in the mother’s blood passes to the baby through the umbilical cord. When a woman drinks alcohol, so does her baby. There is no known safe amount of alcohol during pregnancy or when trying to get pregnant.

To curtail down the risks of FASDs, a woman should not drink alcohol while she is pregnant, or when she might get pregnant. This is because a woman could get pregnant and be asymptomatic for up to 4 to 6 weeks. In the United States, nearly half of pregnancies are unplanned. If a woman is drinking alcohol during pregnancy, it is never too late to stop drinking. Because brain growth takes place throughout the pregnancy, the sooner a woman stops drinking, the safer it will be for her and her baby.

FASDs can affect every person in different ways, and can range from mild to severe. It may not be difficult to assess why certain problems occur, however, still they have their own appearance time and pattern. A person with an FASD might have: abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum); small head size; shorter-than-average height; low body weight; poor coordination etc.

Different terms are used to describe FASDs, depending on the type of symptoms.
(i) Fetal Alcohol Syndrome (FAS): FAS represents the most involved end of the FASD spectrum. Fetal death is the most extreme outcome from drinking alcohol during pregnancy. People with FAS might have abnormal facial features, growth problems, and central nervous system (CNS) problems. People with FAS can have problems with learning, memory, attention span, communication, vision, or hearing. They might have a mix of these problems. People with FAS often have a hard time in school and trouble getting along with others. (ii) Alcohol-Related Neurodevelopmental Disorder (ARND): People with ARND might have intellectual disabilities and problems with behavior and learning. They might do poorly in school and have difficulties with math, memory, attention, judgment, and slow, lethargic behaviour.
(iii) Alcohol-Related Birth Defects (ARBD): People with ARBD might have problems with the heart, kidneys, or bones, or with hearing; they might have a combination of these.

Diagnosing FAS can be hard because there is no medical test, like a blood test, for it. And other disorders, such as ADHD (attention-deficit/hyperactivity disorder) and Williams syndrome, have some symptoms like FAS. To diagnose FAS, doctors look for: heteroclite facial features (e.g., smooth ridge between nose and upper lip); lower-than-average height, weight, or both; central nervous system problems (e.g., small head size, problems with attention and hyperactivity, poor coordination); prenatal alcohol exposure; although confirmation is not required to make a diagnosis etc.

FASDs last a lifetime. There is no cure for FASDs, but research shows that early intervention treatment services can improve a child’s development. There are many types of treatment options, including medication to help with some symptoms, behavior and education therapy, parent training, and other alternative approaches. No single treatment is effective for every child. Good treatment plans will include close monitoring, follow-ups, and changes as needed along the way.

7. As per the information given in paragraph 1, FASDs;
A. Occur due to alcohol consumption.
B. Aren’t known to cause behavioral and learning disabilities.
C. Are a collection of diseases, which occur only in women.
D. Are a collection of complex, proof-less medical conditions.
8. Paragraph 2 talks more about;
A. How to prevent FASDs
B. Why FSADs women should not get pregnant?
C. What FSADs women should do when pregnant?
D. How to protect the baby from FASDs during pregnancy?
9. The most appropriate heading for paragraph 3 is.
A. Signs and symptoms
B. How FASDs affect babies
C. Common features of FASDs
D. None of the above
10. According to paragraph 4, what is not true about FAS?
A. People affected with the FAS show uneven growth.
B. FAS can lead to development of extra facial features.
C. People with FAS show poor memory.
D. FAS children can have health problems but they may mix well with other children.
11. According to paragraph 4, people with ___________ show low agility levels.
A. ARND
B. FAS
C. ARBD
D. ARND and FAS
12. According to paragraph 5, at the time of diagnosis, most doctors look for;
A. Effects on facial features
B. Height and body weight problems
C. Problems with brain functioning
D. All of the above
13. According to paragraph 5, when is a diagnosis not required?
A. When it is known that the patient’s mother is an alcoholic.
B. When the features such as abnormal facial features, low body weight and lower height become obvious.
C. When the patient shows all abnormal signs and symptoms of the FAS
D. a and c
14. According to paragraph 6, treatment for FASDs is;
A. Specific
B. Common for all conditions
C. Dependent on types of conditions
D. Depends on age

PART C. TEXT 2. VALLEY FEVER

Valley fever, also called coccidioidomycosis, is an infection caused by the fungus, Coccidioides. The fungus is known to live in the soil in the south-western United States and parts of Mexico and Central and South America. The fungus was also recently found in south-central Washington. People can get Valley fever by breathing in the microscopic fungal spores from the air, although most people who breathe in the spores don’t get sick. Usually, people who get sick with Valley fever may get better on their own within weeks to months, but some people need antifungal medication. Certain groups of people are at a higher risk of becoming severely ill. It’s difficult to prevent exposure to Coccidioides in areas where it’s common in the environment, but people who are at a higher risk of severe Valley fever should try to avoid breathing in large amounts of dust if they’re in such localities.

Anyone who lives in or travels to the south-western United States (Arizona, California, Nevada, New Mexico, Texas, or Utah), or parts of Mexico or Central or South America can get Valley fever. Valley fever can affect people of any age, but it’s most common in adults aged 60 years and over. Certain groups of people may be at a higher risk of developing the severe forms of Valley fever, such as: people with weakened immune systems, for example, people with HIV/AIDS; people who have had an organ transplant; people who are taking medications such as corticosteroids or TNF-inhibitors; pregnant women; and people who have diabetes.

The fungus that causes Valley fever, Coccidioides, doesn’t have that potential to cross barriers; the transmission is often formidable, a mighty task that could lead to stark failure. However, in extremely rare instances, a wound infection with Coccidioides can spread Valley fever to someone else or the infection can be spread through an organ transplant with an infected organ.

The most common way for someone to get Valley fever is by inhaling Coccidioides spores that are in the air. In extremely rare cases, people can get infected from an organ transplant if the organ donor had Valley fever, inhaling spores from a wound infected with Coccidioides, contact with objects (such as rocks or shoes) that have been contaminated with Coccidioides etc.

Scientists continue to study how weather and climate patterns efficaciously affect the habitat of the fungus that causes Valley fever. Coccidioides is thought to grow expeditiously in soil after heavy rainfall and then disperse into the air most vigorously during hot, dry conditions. For example, hot and dry weather conditions have been shown to parlously correlate with an increase in the number of Valley fever cases in Arizona and in California (but to a lesser extent). The ways in which climate change may be affecting the number of Valley fever infections, as well as the geographic range of Coccidioides, isn’t known yet, but is a subject for further research.

Healthcare providers rely on your medical and travel history, symptoms, physical examinations, and laboratory tests to diagnose Valley fever. The most common way that healthcare providers test for Valley fever is by taking a blood sample and sending it to a laboratory to look for Coccidioides antibodies or antigens. Healthcare providers may do imaging tests such as chest x-rays or CT scans of your lungs to look for Valley fever pneumonia. They may also perform a tissue biopsy, in which a small sample of tissue is taken from the body and examined under a microscope.

Text 2: Questions 15-22

15. According to paragraph 1, the fungus mentioned is a native of.
A. US
B. Washington
C. Mexico
D. A and C
16. According to paragraph 1, treatment for valley fever is;
A. Required
B. Not required
C. Required in some specific cases
D. Not given
17. The most appropriate heading for paragraph 2 is;
A. When Valley fever may affect someone?
B. Who gets Valley fever?
C. Who can show symptoms of Valley fever?
D. Conditions that are common with Valley fever.
18. The most suitable heading for paragraph 3 is;
A. Is it contagious?
B. How can Valley fever transfer?
C. Valley fever is half contagious
D. None of the above
19. The most suitable heading for paragraph 4 is;
A. Uncommon sources of Valley fever
B. Common sources of Valley fever
C. How people may get affected with Valley fever
D. A and C
20. The most appropriate heading for paragraph 5 is;
A. Valley fever agent and its habitat.
B. Valley fever and weather.
C. How temperature affects Valley fever patients?
D. Climate and Valley fever.
21. Which word in paragraph 5 may mean quickly?
A. Efficaciously
B. Vigorously
C. Expeditiously
D. B and C
22. The most suitable heading for paragraph 6 is;
A. How valley fever is identified?
B. Common ways of identifying Valley fever.
C. Ways of identifying and treating Valley fever.
D. Three common tests for Valley fever.

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Show answer
GERIATRIC PHARMACOLOGY

Part A – Answer Key 1 – 7:

1. A

2. C

3. D

4. D

5. A

6. B

7. B

Part A – Answer Key 8 – 14:

8. Process of Aging

9. Cholestyramine

10. Aging

11. Decreases, increases

12. Benzodiazepines

13. Concurrent drug administration

14. Drug with toxicity

Part A – Answer Key 15 – 20:

15.  peripheral vascular resistance 

16. Cockroft-Gault formula

17. Body fat

18. Non-microsomal enzyme

19. drug effects.

20. Antacid

PART B:

1. When baby gets a primary infection through the mother.

2. Zika

3. Digital blood pressure monitoring device.

4. A and B

5. Poppy

6. The global gynecology devices market size.

PART C – Text 1: Questions 7-14:

7. Occur due to alcohol consumption.

8. How to prevent FASDs 

9. Common Features of FASDs

10. FAS children can have health problems but they may mix well with other children.

11. ARND

12. All of the above

13. When it is known that the patient’s mother is an alcoholic.

14. Specific

Text 2: Questions 15-22:

15. A and C

16. Required in some specific cases

17. Who gets Valley fever?

18. Is it contagious?

19. Uncommon sources of Valley fever

20. Valley fever and weather.

21. Expeditiously

22. How valley fever is identified?