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“EM YOUNG – CIGARRETTE WITH YOUR MORNING BREAST MILK?” OET Reading

January 23, 2024 jomon Leave a comment

TEXT A. US researchers have found altered sleep patterns among breastfeed infants of mothers who smoke. Julie Mannella from the Monell Chemical Senses Centre in Philadelphia recruited 15 breastfeeding mothers who smoked. Sleep and activity patters in their babies, which were aged between two and six months, were monitored on two occasions over a three-hour period after the children were fed. On both occasions they were allowed to smoke just before they fed their babies. The women were also asked to avoid caffeinated drinks during the study.

TEXT B. Tests on the milk from mothers who had recently smoked confirmed that the babies were receiving a significant increase in nicotine dose, and the team found that the amount of sleep taken during the fallowing three hours by these babies fell from an average of 85 minutes to 53 minutes, a drop of almost 40%. This is probably due to the neuro-stimulatory effects of nicotine, which has been shown to inhibit regions of the brain which are concerned with controlling sleep. It may also, suggests Manella, explain why neonatal nicotine exposure has been linked in the past with long-term behavioural and learning deficits, since these could be the consequence of sleep disturbance. In light of these findings, mothers who smoke might want to consider planning their smoking around their breast feeding. Nicotine levels in milk peak 30-60 minutes after smelting, but take three hours to return to baseline, so this might be feasible.

TEXT C. Cigarette smoke. What is in smoke?
Scientific studies show that there can be around 4000 chemicals in cigarette smoke. They can be breathed in by anyone near a smoker. They can also stick to clothes, hair, skin, walls and furniture.
Some of these chemicals are:
• tar – which has many chemicals in it some of which cause cancer
• carbon monoxide – reduces the oxygen in blood – so people can develop heart disease
• poisons – including arsenic, ammonia and cyanide.

TEXT D. Passive smoking and respiratory function in very low birth weight children
Abstract Aim: To determine if an adverse relationship exists between passive smoking and respiratory function in very low birth weight (VLBW) children at 11years of age.
Setting: The Royal Women’s Hospital. Melbourne.
Patients: 154 consecutive surviving children of less than 1501 g birth weight born during the 18 months from 1October 2006.
Methods: Respiratory function of 120 of the 154 children (77.9%) at 11years of age was measured. Exposure to passive smoking was established by history; no children were known to be actively smoking. The relationships between various respiratory function variables and the estimated number of cigarettes smoked by household members per day were analysed by linear regression
Results: Most respiratory function variables reflecting airflow were significantly diminished with increasing exposure to passive smoking. In addition, variables indicative of air-trapping rose significantly with increasing exposure to passive smoking.
Conclusions: Passive smoking is associated with adverse respiratory function in surviving VLBW children at 11years of age. Continued exposure to passive smoking, or active smoking, beyond 11years may lead to further deterioration in respiratory function in these children.

Part A. TIME: 15 minutes. Questions 1-7. Choose A, B, C or D. In which text can you find information about
1. how many chemicals are there in cigarette smoke? _____________
2. which chemical Vs in cigarette smoke cause/s cancer? _____________
3. when does nicotine levels in breast milk reach at peak? _____________
4. How does exposure to passive smoking was established in the study? _____________
5. what happened to respiratory function variables reflecting airflow in the study? _____________
6. what are the side effects of neonatal nicotine exposure? _____________
7. what are the poisons in cigarette smoke? _____________
Questions 8-13. Answer each of the questions, 8-13, with a word or short phrase from one of the texts.
8. How much percentage does the sleep drop in the babies who had significant nicotine dose? ________
9. How much percentage of children at 11years of age was measured for respiratory function? _______
10. What was the maximum birth weight of babies who were considered for the study? _____________
11. Which chemical component in cigarette smoke reduces the oxygen in blood? _____________
12. Who recruited subjects for the study conducted by Monell Chemical Senses Centre? _____________
13. Which chemical component in cigarette smoke is responsible for heart disease? _____________
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. If children are continually exposed to active smoking, it can lead to _________ in respiratory function.
15. Cigarette smoke can be breathed in by anyone near a ___________________
16. During the study some women were asked to avoid ____________________
17. ______________________ can also stick to clothes, hair, skin, walls and furniture.
18. Variables indicative of _____________rose significantly with increasing exposure to passive smoking.
19. _____________ of nicotine can inhibit regions of the brain which control sleep.
20. The relationships between respiratory function variables and number of cigarettes smoked per day were analysed by_____________

PART B. Choose the answer (A, B or C) which you think fits best according to the text.
B.P.sets: Functioning: The cuff on the arm is inflated until blood flow in the artery is blocked. As the cuff pressure is decreased slowly, the sounds of blood flow starting again can be detected. The cuff pressure at this point marks the high (systolic) pressure of the cycle. When flow is unobstructed and returns to normal, the sounds of blood flow disappear. The cuff pressure at this point marks the low (diastolic) pressure.
1. When should one note the diastolic pressure of patient?
A. blood flow is limited to make the sound disappear
B. blood flow is normal and the sound disappear
C. blood flow is obstructed and the sound disappear

Aspirators: Suction is generated by a pump. This is normally an electrically powered motor, but manually powered versions are also often found. The pump generates a suction that draws air from a bottle. The reduced pressure in this bottle then draws the fluid from the patient via a tube. The fluid remains in the bottle until disposal is possible. A valve prevents fluid from passing into the motor itself.
2. The purpose of bottle in aspirator is to
A. deliver suction that draws air
B. draw the fluid from the patient
C. keep pressure stable if valve prevents fluid

Operating Theatre and Delivery Tables: Where the table has movement, this will be enabled by unlocking a catch or brake to allow positioning. Wheels have brakes on the rim or axle of the wheel, while locks for moving sections will normally be levers on the main table frame. Care should be taken that the user knows which lever applies to the movement required, as injury to the patient or user may otherwise result. The table will be set at the correct height for patient transfer from a trolley then adjusted for best access for the procedure.
3. The email is reminding user that the
A. importance of lever for the required movements
B. locks of moving wheels are on main table frame
C. table should be set at correct height of the patient

Methods of reporting hospital infection: A mass outbreak of a hospital infection, which can result in severe injury or death, must be reported without delay, by telephone, fax or e-mail to the local public health protection authority (usually to the regional hygiene departments). The following cases are subject to the reporting of hospital infections:
Severe injury, as a result of hospital infection, A mass outbreak, an infection that led to the death of a patient.
4. The guidelines establish that the healthcare professional should
A. report a mass outbreak of hospital infection immediately
B. report severe injury, as a result of hospital infection with delay
C. report an infection that led to the death of a patient only

Admission and treatment in medical and social care facilities: Hygiene requirements for the admission and treatment of patients at medical inpatient facilities, day care and outpatient care facilities are set out in the operating rules of each healthcare provider, and always take into consideration the nature and scope of activity, and the type of healthcare provided. The receiving healthcare professional at the healthcare facility such as an inpatient facility, day care or social care facility, records anamnesis information that is significant in terms of the potential occurrence of hospital infection, including travel and epidemiological anamnesis, or conducts an examination of the overall health of the individual.
5. This guideline extract says that hygiene requirements are
A. determined by the healthcare professional
B. implemented by the healthcare provider
C. written in the operating rules of the facilities

Treatment of used contagious and surgical linen: The healthcare provider and the laundry contractually agree on a system for classifying and labelling containers according to the content (e.g., in colour or numerical) and the procedure in terms of the quantity, deadlines and handling is documented. Linen is sorted at the place of use but it is not counted. The linen is not to be shaken before placing into the containers in the ward. It is sorted into bags according to the degree of soiling, type of material and colour.
6. The purpose of this email is to
A. report on a rise in used contagious and surgical linen in healthcare facility
B. explain the background to a change healthcare provider and the laundry contract
C. remind staff about procedures for treatment of used contagious and surgical linen
_______________________________________________________________________________
PART C. Choose the answer (A, B, C or D) which you think fits best according to the text.
PANCREATIC ISLET TRANSPLANTATION
Paragraph 1: The pancreas, an organ about the size of a hand, is located behind the lower part of the stomach. It makes insulin and enzymes that help the body digest and use food. Spread all over the pancreas are dusters of cells called the islets of Langerhans. Islets are made up of two types of cells: alpha cells, which make glucagon, a hormone that raises the level of glucose (sugar) in the blood, and beta cells, which make insulin.

Paragraph 2: Islet Functions: Insulin is a hormone that helps the body use glucose energy. If your beta cells do not produce enough insulin, diabetes will develop. In type 1diabetes, the insulin shortage is caused by an autoimmune process in which the body ‘s immune system destroys the beta cells.

Paragraph 3: Islet Transplantation: In an experimental procedure called islet transplantation, islets are taken from a donor pancreas and transferred into another person. Once implanted, the beta cells in these begin to make and release insulin. Researchers hope that; transplantation will help people with type 1 diabetes live without daily injections of insulin.

Paragraph 4. Research Developments: Scientists have made many advances in islet transplantation recent years. Since reporting their findings in the June issue of the New England Journal of Medicine, researchers the University of Alberta in Edmonton, Canada, have continued to use a procedure called the Edmonton protocol to transplant pancreatic islets into people with type 1 diabetes. According to the Immune Tolerance Network (ITN), as of June 2003, about 50 percent of the patients have remained insulin-free up to g 1year after receiving a transplant. Researchers use specialized enzymes to remove islets from the pancreas of a deceased donor. Because the islets are fragile, transplantation occurs soon after they are removed.

Paragraph 5: During the transplant, the surgeon uses ultrasound to guide placement of a small plastic tube (catheter) through the upper abdomen and into the liver. The islets are then injected through the catheter into the liver. The patient will receive a local anesthetic. If a patient cannot tolerate local anesthesia, the surgeon may use general anesthesia and do the transplant through a small incision. Possible risks include bleeding or blood clots. It takes time for the cells to attach to new blood vessels and begin releasing insulin. The doctor will order many tests to check blood glucose levels after the transplant, and insulin may be needed until control is achieved.

Paragraph 6. Transplantation: Benefits, Risks, and Obstacles: The goal of islet transplantation is to infuse enough islets to control the blood glucose level without insulin injections. For an average-size person (70 kg), a typical transplant requires about 1 million islets, extracted from two donor pancreases. Because good control of blood glucose can slow or prevent the progression of complications associated with diabetes, such as nerve or eye damage, a successful transplant may reduce the risk of these complications.
But a transplant recipient will need to take immunosuppressive drugs that stop the immune system from rejecting the transplanted islets.

Paragraph 7. Researchers are trying to find new approaches that will allow successful transplantation without the use of immunosuppressant drugs, thus eliminating the side effects that may accompany their long-term use. Rejection is the biggest problem with any transplant. The immune system is programmed to destroy bacteria, viruses, and tissue it recognizes as “foreign,” including transplanted islets. Immunosuppressive drugs are needed to keep the transplanted islets functioning.

Paragraph 8. Immunosuppressive Drugs: The Edmonton protocol uses a combination of immunosuppressive drugs, also called antirejection drugs, including daclixrm (Zenapax), sirolimus (Rapamune), and tacrolimus (Prograf). Dacliximab is given intravenously right after the transplant and then discontinued. Sirolimus and tacrolimus, the two drugs that keep the immune system from destroying the transplanted islets, must be taken for life.

Paragraph 9. These drugs have significant side effects and their long-term effects are still not known. Immediate side effects of immunosuppressive drugs may include mouth sores and gastrointestinal problems, such as stomach upset or diarrhea. Patients may also have increased blood cholesterol levels, decreased white blood cell counts, decreased kidney function, and increased susceptibility to bacterial and viral infections. Taking immunosuppressive, drugs increase the risk of tumors and cancer as well.

Paragraph 10: Researchers do not fully know what long-term effects this procedure may have. Also, although the early results of the Edmonton protocol are very encouraging, more research is needed to answer questions about how long the islets will survive and how often the transplantation procedure will be successful. Before the introduction of the Edmonton Protocol, few islet cell transplants were successful. The new protocol improved greatly on these outcomes, primarily by increasing the number of transplanted cells and modifying the number and dosages of immunosuppressants. Of the 267 transplants performed worldwide “from 1990 to 1999, only 8 percent of the
people receiving them were free -of insulin treatments one year after the transplant. The CITR’ s second annual report, published in July 2005, presented data on 138 patients. At six months after patients’ final infusions, 67 percent did not need to take insulin treatments. At one year, 58 percent remained insulin independent. The recipients who still needed insulin treatment after one year experienced an average reduction of 69 percent in their daily insulin needs.

Paragraph 11: A major obstacle to widespread use of islet transplantation will be the shortage of islet cells. The supply available from deceased donors will be enough for only a small percentage of those with type 1diabetes. However, researchers are pursuing avenues for alternative sources such as creating islet cells from other types of cells. New technologies could then be m employed to grow islet cells in the laboratory.

QUESTIONS
Q1. The pancreas is
A. in the hand
B. in the stomach
C. above the stomach
D. behind the lower part of the stomach
Q2. What is the main purpose of insulin?
A. Itis a hormone
B. to destroy beta cells
C. to assist in energy production
D. to stimulate the auto immune process
Q3. According the article, is islet transplantation common practice?
A. Yes, it’s frequently used
B. No, it’s still being trialed
C. Not stated in the article
D. Yes, but only in Canada
Q4. What is the Edmonton Protocol?
A. A trade agreement
B. The journal of Alberta University
C. A way to transplant pancreatic islets
D. Not stated in the article
Q5. What’s the source of the pancreatic islets that are in the transplant operation?
A. They are donated by relatives
B. They come from people who have recently died
C. They are grown in a laboratory
D. They come from foetal tissue
Q6. Which one of the sentences below is true?
A. A local anaesthetic is preferred where possible.
B. A general anaesthetic is preferred where possible.
C. A general anaesthetic is too risky due to the possibility of blood clots and bleeding.
D. An anaesthetic is not necessary if ultrasound is used
Q7. How soon after the operation can the patient abandon insulin injections?
A. Immediately
B. After about two weeks
C. When the blood glucose levels are satisfactory
D. After the first year
Q8. How many islets are required per patient?
A. About a million
B. 70 kg
C. Whatever is available is used
D. it depends on the size of the patient

PART C. Choose the answer (A, B, C or D) which you think fits best according to the text.
SEASONAL INFLUENZA VACCINATION AND THE HLNL VIRUS

Paragraph 1: As the novel pandemic influenza A (H1N1) virus spread around the world in late spring 2009 with a well-matched pandemic vaccine not immediately available, the question of partial protection afforded by seasonal influenza vaccine arose. Coverage of the seasonal influenza vaccine had reached 30%- 40% in the general population in 2008-09 in the US and Canada, following recent expansion of vaccine recommendations.

Paragraph 2. Unexpected Findings in a Sentinel Surveillance System: The spring 2009 pandemic wave was the perfect opportunity to address the association between seasonal trivalent inactivated influenza vaccine (TIV) and risk of pandemic illness. In an issue of PLoS Medicine, Danuta Skowronski and colleagues report the unexpected results of a series of Canadian epidemiological studies suggesting a counterproductive effect of the vaccine. The findings are based on Canada’s unique near-real-time sentinel system for monitoring influenza vaccine effectiveness. Patients with influenza-like illness who presented to a network of participating physicians were tested for influenza virus by RT-PCR, and information on demographics, clinical outcomes, and vaccine status was collected.

Paragraph 3. In this sentinel system, vaccine effectiveness may be measured by comparing vaccination status among influenza-positive “case” patients with influenza negative “control” patients. This approach has produced accurate measures of vaccine effectiveness for TIV in the past, with estimates of protection in healthy adults higher when the vaccine is well-matched with circulating influenza strains and lower for mismatched seasons. The sentinel system was expanded to continue during April to July 2009, as the H1N1 virus defied influenza seasonality and rapidly became dominant over seasonal influenza viruses in Canada.

Paragraph 4. Additional Analyses and Proposed Biological Mechanisms: The Canadian sentinel study showed that receipt of TIV in the previous season (autumn 2008) appeared to increase the risk of H1N1 illness by 1.03- to 2.74-fold, even after adjustment for the comorbidities of age and geography. The investigators were prudent and conducted multiple sensitivity analyses to attempt to explain their perplexing findings, importantly, TIV remained protective against seasonal influenza viruses circulating in April through May 2009, with an effectiveness estimated at 56%, suggesting that the system had not suddenly become flawed. TIV appeared as a risk factor in people under 50, but not in seniors-although senior estimates were imprecise due to lower rates of pandemic illness in that age group.
Interestingly, if vaccine were truly a risk factor in younger adults, seniors may have fared better because their immune response to vaccination is less rigorous.

Paragraph 5. Potential Biases and Findings from Other Countries: The Canadian authors provided a full description of their study population and carefully compared vaccine coverage and prevalence of comorbidities in controls with national or province-level age-specific estimates-the best can do short of a randomized study. In parallel, profound bias in observational studies of vaccine effectiveness does exist, as was amply documented in several cohort studies overestimating the mortality benefits of seasonal influenza vaccination in seniors.

Paragraph 6: Given the uncertainty associated with observational studies, we belie would be premature to conclude that TIV increased the risk of 2009 pandemic illness, especially in light of six other contemporaneous observational studies in civilian populations that have produced highly conflicting results. We note the large spread of vaccine effectiveness estimates in those studies; indeed, four of the studies set in the US an Australia did not show any association whereas two Mexican studies suggested a protective effect of 35%-73%.

Paragraph 7. Policy Implications and a Way Forward: The alleged association between seasonal vaccination and 2009 H1N1 remains an open question, given the conflicting evidence from available research. Canadian health authorities debated whether to postpone seasonal vaccination in the autumn of 2009 until after a second pandemic wave had occurred, but decided to follow normal vaccine recommendations instead because of concern about a resurgence of seasonal influenza viruses during the 2009-10 season.

Paragraph 8: This illustrates the difficulty of making policy decisions in the midst of a public health crisis, when officials must rely on limited and possibly biased evidence from observational data, even in the best possible scenario of a well-established sentinel monitoring system already in place. What happens next? Given the timeliness of the Canadian sentinel system, data on the association between seasonal TIV and risk of H1N1 illness during the autumn 2009 pandemic wave will become available very soon, and will be crucial in confirming or refuting the earlier Canadian results.

Paragraph 9: In addition, evidence may be gained from disease patterns during the autumn 2009 pandemic wave in other countries and from immunological studies characterizing the baseline immunological status of vaccinated and unvaccinated populations. Overall, this perplexing experience in Canada teaches us how to best react to disparate and conflicting studies and can aid in preparing for the next public health crisis.
QUESTIONS
Q1. The question of partial protection against H1N1 arose _
A. before spring 2009
B. 2. during Spring 2009
C. 3. after spring 2009
D. 4. during 2008-09
Q2. According to Danuta Skowronski—-
A. the inactivated influenza vaccine may not be having the desired effects.
B. Canada’s near-real-time sentinel system is unique.
C. the epidemiological studies were counterproductive
D. the inactivated influenza vaccine has proven to be ineffective.
Q3. The vaccine achieved higher rates of protection in healthy adults when
A. it was supported by physicians.
B. the sentinel system was expanded.
C. used in the right season.
D. it was matched with other current influenza strains.
Q4. Which one of the following is closest in meaning to the word prudent?
A. Anxious
B. 2. cautious
C. 3. busy
D. 4. confused
Q5. The Canadian sentinel study demonstrated that _
A. age and geography had no effect on the vaccine ‘s effectiveness.
B. vaccinations on senior citizens is less effective than on younger people
C. the vaccination was no longer effective.
D. the risk of H1N1 seemed to be higher among people who received the TIV vaccination.
Q6. Which of the following sentences best summarises the writers’ opinion regarding the uncertainty associated with observational studies?
A. More studies are needed to determine whether TIV increased the risk of the 2009 pandemic illness.
B. It is too early to tell whether the risk of catching the 2009 pandemic illness increased due to TIV.
C. The Australian and Mexican studies prove that there is no association between TIV and increased risk of catching the 2009 pandemic illness.
D. Civilian populations are less at risk of catching the 2009 pandemic illness.
Q7. Which one of the following is closest in meaning to the word alleged?
A. Reported
B. 2. likely
C. 3. suspected
D. 4. possible
Q8. Canadian health authorities did not postpone the Autumn 2009 seasonal vaccination because —–
A. of a fear seasonal influenza viruses would reappear in the 2009-10 season.
B. there was too much conflicting evidence regarding the effectiveness of the vaccine.
C. the sentinel monitoring system was well established.
D. observational data may have been biased.

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Show answers
EM YOUNG – CIGARRETTE

Part A: Cigarette with your morning

1. C

2. C

3. B

4. D

5. D

6. B

7. C

8. Almost 40%

9. 77.9%

10. 1500g

11. Carbon monoxide

12. Julie Mannella

13. Carbon monoxide

14. Deterioration

15. Smoker

16. Caffeinated drinks

17. Cigarette smoke

18. Air-trapping

19. Neuro-regulatory effect

20. Linear regression

Part B: Cigarette with your morning

1. B

2. B

3. A

4. A

5. C

6. C

Part C (Text 01: Cigarette with your morning)

1. D

2. C

3. B

4. C

5. C

6. A

7. C

8. D

Part C (Text 02: Cigarette with your morning)

1. B

2. A

3. D

4. B

5. D

6. B

7. C

8. A

ECONOMY CLASS SYNDROME: OET Reading

January 23, 2024 jomon Leave a comment

TEXT A.
International flights are suspected of contributing to the formation of DVT in susceptible people, although the research evidence is currently divided. Some airlines prefer to err on the side of caution and offer suggestions to passengers on how to reduce the risk of DVT. Suggestions include:
• Wear loose clothes
• Avoid cigarettes and alcohol
• Move about the cabin whenever possible
• Don’t sit with your legs crossed
• Perform leg and foot stretches and exercises while seated
• Consult with your doctor before travelling

TEXT B. Previous research: Venous thrombosis was first linked to air travel in 1954, and as air travel has become more and more common, many case reports and case series have been published since. Several clinical studies have shown an association between air travel and the risk of venous thrombosis. English researchers proposed, in a paper published in the Lancet, that flying directly increases a person’s risk. The report found that in a series of individuals who died suddenly at Heathrow Airport, death occurred far more often in the arrival than in the departure area.
Two similar studies reported that the risk of pulmonary embolism in air travellers increased with the distance travelled. In terms of absolute risk, two studies found similar results: one performed in New Zealand found a frequency of 1% of venous thrombosis in 878 individuals who had travelled by air for at least 10 hours. The other was a German study which found venous thrombotic events in 2.8% of 964 individuals who had travelled for more than 8 hours in an airplane. In contrast, a Dutch study found no link between DVT and long-distance travel of any kind.

TEXT C. Symptoms

• Pain and tenderness in the leg
• Pain on extending the foot
• Tenderness in calf (the most important sign)
• Swelling of the lower leg, ankle and foot
• Redness in the leg
• Bluish skin discoloration
• Increased warmth in the leg

TEXT D. Travel-Related Venous Thrombosis: Results from a Large Population¬ Based Case Control

Study Background: Recent studies have indicated an increased risk of venous thrombosis after air travel. Nevertheless, questions on the magnitude of risk, the underlying mechanism, and modifying factors remain unanswered.
Methods: We studied the effect of various modes of transport and duration of travel on the risk of venous thrombosis in a large ongoing case-control study on risk factors for venous thrombosis in an unselected population. We also assessed the combined effect of travel in relation to body mass index, height, and oral contraceptive use. Since March 2015, consecutive patients younger than 70 years of age with a first venous thrombosis have been invited to participate in the study, with their partners serving as matched control individuals. Information has been collected on acquired and genetic risk factors for venous thrombosis. –
Results: Of 1,906 patients, 233 had travelled for more than 4 hours in the 8 weeks preceding the event. Travelling in general was found to increase the risk of venous thrombosis. The risk of flying was similar to the risks of traveling by bus or train. The risk was highest in the first week after traveling. Travel by bus, or train led to a high relative risk of thrombosis in individuals with factor V Leiden, in those who had a body mass index of more than 30, those who were more than 190 cm tall, and in those who used oral contraceptives. For air travel these people shorter than 160 cm had an increased risk of thrombosis after air travel as well.
Conclusions: The risk of venous thrombosis after travel is moderately increased for all modes of travel. Subgroups exist in which the risk is highly increased.

QUESTIONS 1-7. Choose A, B, C or D. In which text can you find -information about
1. what are the symptoms of DVT?
2. how much risk of DVT is there in the first week after traveling?
3. what is the most important sign of DVT?
4. when did DVT was first linked to air travel? —
5. what are the safe practices to reduce the risk of DYT?
6. which exercises reduce the risk of DVT? —
7. what were the conclusions of the Dutch study on DVT? __

QUESTIONS 8-13. Answer each of the questions, 8-13,”with a word or short phrase from one of the texts.
8. What is the type of skin discolouration seen in DVT patients?
9. What type of clothes reduce the risks of DVT?
10. Which type of flights are more suspected of contributing to the formation of DVT?
11. Name the physical activity which was found to increase the risk of DVT in general?
12. Which type of population was the subject for travel related DVT study?
13. Name the body part/s where tenderness was observed as a symptom of DVT?

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. The risk of flying was similar to the risks of traveling by___________
15. Recent studies have indicated an increased risk of venous thrombosis after ___________
16. ___________ of the lower leg, ankle and foot is a symptom of DVT.
17. Several ___________ have shown an association between air travel and the risk of venous thrombosis.
18. ___________in general, was found to increase the risk of venous thrombosis.
19. Venous thrombosis was first linked to air travel in ___________
20. Some airlines offer ___________ to passengers on how to reduce the risk of DVT.

PART B. Choose the answer (A, B or C)
Flowmeter: A flowmeter is an instrument used to measure the flow rate of a liquid or a gas. In healthcare facilities, gas flowmeters are used to deliver oxygen at a controlled rate either directly to patients or through medical devices. Oxygen flowmeters are used on oxygen tanks and oxygen concentrators to measure the amount of oxygen reaching the patient or user. Sometimes bottles are fitted to humidify the oxygen by bubbling it through water.
1. The purpose of bottles that are fitted with flowmeter is to
A. humidify the oxygen tanks by bubbling it through water
B. humidify the oxygen reaching the patient or user
C. dehumidify the gas in the flowmeter

Pulse Oximeters: Non-invasive monitors: The coloured substance in blood, haemoglobin, is carrier of oxygen and the absorption of light by haemoglobin varies with the amount of oxygenation. Two different kinds of light (one visible, one invisible) are directed through the skin from one side of a probe, and the amount transmitted is measured on the other side. The machine converts the ratio of transmission of the two kinds of light into a % oxygenation. Pulse oximeter probes can be mounted on the finger or ear lobe.
2. What does these notes tell us about pulse oximeters?
A. levels vary with amount of oxygenation
B. converts percent of light into a % oxygenation
C. probes can be mounted either on finger or earlobe

Measuring Patient Weight: Measuring patient weight is an important part of monitoring health as well as calculating drug and radiation doses. It is therefore vital that scales continue to operate accurately. They can be used for all ages of patient and therefore vary in the range of weights that are measured. They can be arranged for patients to stand on, or can be set up for weighing wheelchair bound patients. For infants, the patient can be suspended in a sling below the scale or placed in a weighing cot on top of the scale.
3. These notes are reminding staff that the
A. importance of precise reading of scales to monitor health of patient
B. infants should stand in a weighing cot on top of the scale
C. wheelchair bound patients should be suspended in a set up

Breast Examination: Detection of changes in the breast depends on routine medical check-ups, especially by an oncologist, regular breast scanning and mammography, and women’s self-examination. If early detected, a tumor is usually small, and the smaller it is, the less probability of metastases. Early detection considerably improves prognosis in women with breast cancer: Mammography enables detection of breast cancer at least one year ahead of its manifestations. The smallest clinically palpable tumor is about 1cm in size.
4. The purpose of these notes about mammography is to
A. help maximise awareness about its efficiency
B. give guidance on early detection and prognosis
C. decrease probability of metastases

Catheterisation: Regardless of the instrumental examination carried out in the urinary tract, it is obligatory to maintain perfectly sterile conditions, to apply analgesic and sedative drugs in order to alleviate patient’s suffering, and to use gel substances that facilitate the introduction of the instrument into the urinary tract. While introducing instruments into the bladder, it is necessary to remember about overcoming the resistance of the urethral sphincter gently.
5. What must all staff involved in the catheterization process do?
A. maintain perfect aseptic conditions
B. use non lubricant substances
C. inhibit analgesic and sedative drugs

Ophthalmoscopy: Direct ophthalmoscopy is the most common method of examining the eye fundus. It provides a 15x magnified upright image of the retina. Ophthalmoscopy is much easier through a dilated pupil. Tropicamide 1% drops (0.5% for children) are recommended. The pupil mydriasis starts 10 to 20 minutes after installation and lasts for 6-8 hours. There is a small risk of angle closure glaucoma caused by mydriasis in eyes with shallow anterior chambers, particularly in elderly patients.
6. The guidelines establish that the healthcare professional should
A. recommend 1% drops of Tropicamide for elderly patients
B. recommend 5% drops of Tropicamide for children
C. recommend 10% drops of Tropicamide for elderly patients

PART C. TEXT 1. Choose the answer (A, B, C or D) Is ADHD a valid diagnosis in adults?

Paragraph 1: Attention deficit hyperactivity disorder (ADHD) is well established in childhood, with 3.6% of children in the United Kingdom being affected. Most regions have child and adolescent mental health or paediatric services for ADHD. Follow-up studies of children with ADHD find that 15% still have the full diagnosis at 25 years, and a further 50% are in partial remission, with some symptoms associated with clinical and psychosocial impairments persisting.

Paragraph 2: ADHD is a clinical syndrome defined in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, by high levels of hyperactive, impulsive, and inattentive behaviours in early childhood that persist over time, pervade across situations, and lead to notable impairments. ADHD is thought to result from complex interactions between genetic and environmental factors.

Paragraph 3: Proof of validity. Using the Washington University diagnostic criteria, the National Institute for Health and Clinical Excellence (NICE) reviewed the validity of the system used to diagnose ADHD in children and adults.

Paragraph 4: Symptoms of ADHD are reliably identifiable. The symptoms used to define ADHD are found to cluster together in both clinical and population samples. Studies in such samples also separate ADHD symptoms from conduct problems and neuro developmental traits. Twin studies show a distinct pattern of genetic and environmental influences on ADHD compared with conduct problems, and overlapping genetic influences between ADHD and neuro developmental disorders such as autism and specific reading difficulties. Disorders that commonly, but not invariably, occur in adults with ADHD include antisocial personality, substance misuse, and depression.

Paragraph 5: Symptoms of ADHD are continuously distributed throughout the population. As with anxiety and depression, most people have symptoms of ADHD at some time. The disorder is diagnosed by the severity and persistence of symptoms, which are associated with high levels of impairment and risk for developing co-occurring disorders. ADHD should not be diagnosed to justify the use of stimulant drugs to enhance performance in the absence of a wider range of impairments- indicating a mental health disorder.

Paragraph 6: ADHD symptoms have been tracked from childhood through adolescence into adult life. They are relatively stable over time with a variable outcome in which around two thirds show persistence of symptoms associated with impairments. Current evidence defines the syndrome as being associated with academic difficulties, impaired family relationships, social difficulties, and conduct problems. Cross sectional and longitudinal follow-up studies of adults with ADHD have reported increased rates of antisocial behaviour, drug misuse, mood and anxiety disorders, unemployment, poor work performance, lower educational performance, traffic violations, crashes, and criminal convictions.

Paragraph 7: Several genetic, environmental, and neurobiological variables distinguish ADHD from non-ADHD cases at group level, but are not sufficiently sensitive or specific to diagnose the syndrome. A family history of ADHD is the strongest predictor-. parents of children with ADHD and off spring of adults with ADHD are at higher risk for the disorder. Heritability is around 76%, and genetic associations, have been identified. Consistently reported associations include structural and functional brain changes, and environmental factors (such as maternal stress during pregnancy and severe early deprivation).

Paragraph 8: The effects of stimulants and atomoxetine on ADHD symptoms in adults are similar to those seen in children. Improvements in ADHD symptoms and measures of global function are greater in most studies than are reported in drug trials of depression. The longest controlled trial of stimulants in adults showed improvements in these response measures over six months. Stimulants may enhance cognitive ability in some people who do not have ADHD, although we are not aware of any placebo-controlled trials of the effects of stimulants on work or study related performance in healthy populations. This should not, however, detract from their specific use to reduce symptoms and associated impairments in adults with ADHD.

Paragraph 9: Psychological treatments in the form of psychoeducation, cognitive behavioural therapy, supportive coaching, or help with organising daily activities are thought to be effective. Further research is needed because the evidence base is not strong enough to recommend the routine use of these treatments in clinical practice.
Paragraph 10: Conclusions. ADHD is an established childhood syndrome that often (in around 65% of cases) persists into adult life. NICE guidelines are a milestone in the development of effective clinical services for adults with ADHD. Recognition of ADHD in primary care and referral to secondary or tertiary care specialists will reduce the psychiatric and psychosocial morbidity associated with ADHD in adults.

QUESTIONS
Q1. The article reports what proportion of diagnosed children present with ADHD in adulthood?
a. Half
b. 3.6%
c. A quarter
d. 15%

Q2. According to the article _ _
a. ADHD is triggered by genetic factors
b. ADHD is the result of environmental factors
c. both A and B.
d. neither A nor B.

Q3. According to the article symptoms _
a. vary across clinical and population samples.
b. varies across situational factors.
c. need to pervade across time and situations for a diagnosis to be made.
d. are not reliably identifiable.

Q4. Which co-occurring disorders does ADHD frequently present with?
a. Antisocial personality disorder.
b. Substance misuse.
c. Depression.
d. All of the above.

Q5. According to the article, which one of the following statements about ADHD is FALSE?
a. The use of stimulants is justified in the absence of a wider range of impairments.
b. Symptoms of ADHD are evenly prevalent throughout the population.
c. The criteria for diagnosis measure the severity and persistence of symptoms.
d. High levels of impairment and risk for developing co-occurring disorders are related with ADHD.

Q6. Which heading would best describe paragraph 6?
a. Symptoms associated with impairments.
b. ADHD and outcomes in adulthood.
c. Further definition of the syndrome.
d. none of the above

Q7. The strongest predictor of ADHD is _
a. Diagnostic and Statistical Manual of Mental Disorders, fourth edition.
b. Social and academic impairment.
c. Heritability.
d. Family environment.

Q8. The effectiveness of atomoxetine on ADHD symptoms is _
a. less than described in drug trials of depression.
b. greater when measured over six months.
c. reduced in adults with ADHD.
d. known to improve measures of global functioning.

PART C. TEXT 2. Choose the answer (A, B, C or D)
Risks and Benefits of Hormone Replacement Therapy

Paragraph 1: Several recent large studies have provoked concern amongst both health professionals and the general public regarding the safety of hormone replacement therapy (HRT). This article provides a review of the current literature surrounding the risks and benefits of HRT in postmenopausal women, and how the data can be applied safely in everyday clinical practice.

Paragraph 2: Worldwide, approximately 47 million women will undergo the menopause every year for the next 20 years. The lack of circulating oestrogens which occurs during the transition to menopause presents a variety of symptoms including hot flushes, night sweats, mood disturbance and vaginal atrophy, and these can be distressing in almost 50% of women.

Paragraph 3: For many years, oestrogen alone or in combination with progestogens, otherwise known as hormone replacement therapy (HRT), has been the treatment of choice for control of problematic menopausal symptoms and for the prevention of osteoporosis. However, the use of HRT declined worldwide following the publication of the first data from the Women’s Health Initiative (WHI) trial in 2002.

Paragraph 4: The results led to a surge in media interest surrounding HRT usage, with the revelation that there was an increased risk of breast cancer and, contrary to expectation, coronary heart disease (CHD) in those postmenopausal women taking oestrogen plus progestogen HRT. Following this, both the Heart and Estrogen/Progestin Replacement Study Follow-up (HERS II) and the Million Women Study published results which further reduced enthusiasm for HRT use, showing increased risks of breast cancers and venous thromboembolism (VTE), and the absence of previously suggested cardioprotective effects in HRT users. The resulting fear of CHD and breast cancer in HRT users left many women with menopausal symptoms and few effective treatment options.

Paragraph 5: Continued analysis of data relating to these studies has been aimed at understanding whether or not the risks associated with HRT are, in fact, limited to a subset of women. A recent publication from the International Menopause Society has stated that HRT remains the first-line and most effective treatment for menopausal symptoms. In this article we examine the evidence that has contributed to common perceptions amongst health
professionals and women alike, and clarify the balance of risk and benefit to be considered by women using HRT.

Paragraph 6: One of the key messages from the WHI in 2002 was that HRT should not be prescribed to prevent age-related chronic disease, in particular CHD. This was contradictory to previous advice based on observational studies.
However, recent subgroup analysis has shown that in healthy individuals using HRT in the early postmenopausal years (age 50-59 years), there was no increased CHD risk and HRT may potentially have a cardioprotective effect.

Paragraph 7: Recent WHI data has suggested that oestrogen-alone HRT in compliant women under 60 years of age delays the progression of atheromatous disease (as assessed by coronary arterial calcification). The Nurses’ Health Study, a large observational study within the USA, demonstrated that the increase in stroke risk appeared to be modest in younger women, with no significant increase if used for less than five years.

Paragraph 8: Hormone replacement therapy is associated with beneficial effects on bone mineral density, prevention of osteoporosis and improvement in osteoarthritic symptoms. The WHI clearly demonstrated that HRT was effective in the prevention of all fractures secondary to osteoporosis. The downturn in HRT prescribing related to the concern regarding vascular and breast cancer risks is expected to cause an increase in fracture risk, and it is predicted that in the USA there will be a possible excess of 243,000 fractures per year in the near future.

Paragraph 9: The WHI results published in 2002 led to a significant decline in patient and clinician confidence in the use of HRT. Further analysis of the data has prompted a re-evaluation of this initial reaction, and recognition that many women may have been ‘denied’ treatment. Now is the time to responsibly restore confidence regarding the benefit of HRT in the treatment of menopausal symptoms when used judiciously. Hormone replacement therapy is undoubtedly effective in the treatment of vasomotor symptoms, and confers protection against osteoporotic fractures.

Paragraph 10: The oncologic risks are relatively well characterised and p9-tients considering HRT should be made aware of these. The cardiovascular risk of HRT in younger women without overt vascular disease is less well defined and further work is required to address this important question. In the interim, decisions regarding HRT use should be made on a case-by-case basis following informed discussion of the balance of risk and benefit. The lowest dose of hormone necessary to alleviate menopausal symptoms should be used, and the prescription reviewed on a regular basis.

QUESTIONS
Q1. Which statement is the closest match to the description of the recent studies in Paragraph?
a. They demand a prompt review of current HRT practices.
b. They have shown that HRT can be used safely in clinical practice.
c. They have decreased the confidence of doctors and the public in HRT.
d. They have given menopausal women a new confidence to undergo HRT.

Q2. Which statement is the closest match to the description of projected menopause figures in Paragraph 2?
a. 47 international women will enter menopause annually for the next 20 years.
b. All women are likely to go through menopause if they live long enough.
c. 47 million women globally will enter menopause each year for the next 20 years.
d. Most women will succumb to menopause if they do not undertake HRT.

Q3. What cause does the article cite for the symptoms of menopause?
a. Lack of circulation
b. Age
c. Low progesterone levels
d. Low circulating estrogen levels
Q4. What has been the effect of the 2002 WHI study?
a. HRT has become less popular.
b. HRT has increased in popularity as the treatment of choice for problematic menopause symptoms.
c. There has been an increase in combined estrogen and progesterone therapy.
d. The women ‘s health initiative has since been established to investigate HRT.

Q5. Why were many women left with menopausal symptoms and no effective treatment?
a. They were unable to afford HRT treatments.
b. They were concerned about coronary heart disease and breast cancer.
c. They were concerned about breast cancer and venous thromboembolism.
d. They were concerned about breast cancer and the cardioprotective effects.

Q6. Which of these statements is a TRUE summary of Paragraph S?
a. Surveys since WHI have attempted to find out if the WHI results are representative
b. Results of past surveys are only valid for a subset of women, whether or not the public is aware of this.
c. The present study aims to show that HRT is safer than previously believed.
d. Women should ask their doctors to clarify the balance of risks and benefits of HRT

Q7. Which study showed an increased risk of VTE?
a. The Nurses’ Health Study
b. The Million Women Study
c. The Women’s Health Initiative Study
d. The WISDOM Study

Q8. Which of the following does the article recommend HRT should NOT be used to treat’?
a. Vasomotor symptoms
b. Atheromatous disease
c. Age-related chronic disease
d. Osteoarthritic symptoms

How did it go? Please share your feedback in the comment section below:
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Show answers
ECONOMY CLASS SYNDROME:

Part A: Economy class syndrome

1. C

2. D

3. C

4. B

5. A

6. A

7. B

8. Bluish

9. Loose

10. International flights

11. Traveling

12. Large

13. Calf and leg

14. Bus and train

15. Air travel

16. Swelling

17. Clinical studies

18. Traveling

19. 1954

20. Suggestions

Part B: Economy class syndrome

1. B

2. B

3. A

4. A

5. A

6. A

Part C (Text 01: Economy class syndrome)

1. D

2. C

3. C

4. D

5. A

6. B

7. C

8. D

Part C (Text 02: Economy class syndrome)

1. C

2. C

3. D

4. B

5. B

6. A

7. B

8. C

Diseases of Affluence – OET reading

January 5, 2024 jomon Leave a comment

TEXT A Tobacco: Tobacco smoking is also an important risk factor for cardiovascular diseases. Currently, an estimated 967 million of the world’s 7.6 billion smokers liv in the developing world. Tobacco smoking increased among men, followed by women, in industrialized nations in the last century, and has subsequently declined in some nations such as Canada, the United States, and the United Kingdom. Descriptive models based on historical patterns in the industrialized world predict a reduction in the number of male smokers and an increase in the number of female smokers in the developing world over the coming decades. However, there have been major recent transformations in global tobacco trade, marketing, and regulatory control. As a result, tobacco consumption among men and women in most nations is primarily determined by opposing industry efforts and tobacco control measures, and by the socio¬ cultural context, rather than national income.

TEXT B. BMI: The observed rapid BMI increase with national income indicates that preventing obesity, which may be more effective than reacting after it has occurred, should be a priority during economic growth and urbanization of a nation. Overweight and obesity are also important because they cause a number of non- cardiovascular outcomes including cancers, diabetes, and osteoarthritis which cannot be addressed by reducing risk factors such as blood pressure and cholesterol. Current _intervention options for obesity in principle include those that reduce calorie intake and increasing energy expenditure of a population through urban design which incorporates space for outdoor activities.

TEXT C. Current Research (WHO, 2018)
Background: Cardiovascular diseases and their nutritional risk factors-including overweight and obesity, elevated blood pressure, and cholesterol-are among the leading causes of global mortality” and morbidity, and have been predicted to rise with economic development in countries and societies throughout the world.
Methods and Findings: We examined age-standardized mean population levels of body mass index (BMI), systolic blood pressure, and total cholesterol in relation to national income, food share of household expenditure, and urbanization in a cross-country analysis. Data were from a total of over 100 countries and were obtained from systematic reviews of published literature, and from national and international health agencies. BMI and cholesterol increased rapidly in relation to national income, then flattened, and eventually declined. BMI increased most rapidly until an income of about 1$ 5,000 (international dollars) and peaked at about 1$ 12,500 for females and I$ 17,000 for males. Cholesterol’s point of inflection and peak were at higher income levels than those of BMI (about 1$ 8,000 and 1$ 18,000, respectively). There was an inverse relationship between BMI/cholesterol and the food share of household expenditure, and a positive relationship with proportion of population in urban areas. Mean population blood pressure was not significantly affected by the economic factors considered.
Conclusions: When considered together with evidence on shifts in income–risk relationships within developed countries, the results indicate that cardiovascular disease risks are expected to systematically shift to low- and middle-income countries and, together with the persistent burden of infectious diseases, further increase global health inequalities. Preventing obesity should be a priority from early stages of economic development, accompanied by measures to promote awareness of the causes of high blood pressure and cholesterol.

TEXT D. Health Repercussions of Western Lifestyle
Factors associated with the increase of these illnesses appear to be, paradoxically, things which many people would regard as lifestyle improvements. They include:
• Less strenuous physical exercise, often through increased use of a car
• Easy accessibility in society to large amounts of low-cost food
• More food generally, with much less physical exertion expended to obtain a moderate amount of food
• More high fat and high sugar foods in the diet are common in the affluent developed economies
• Higher consumption of meat and dairy products -Higher consumption of grains and white bread
• More foods which are processed, cooked, and commercially provided (rather than seasonal, fresh foods prepared locally at time of eating)

QUESTIONS 1-7. For 1-7, decide which text (A, B, C or D): in which text can you find information about
1. from where did the data for the research were collected?
2. name one important risk factor for cardiovascular diseases?
3. what does the observed rapid BMI increase with national income indicate?
4. which types of foods are common in the affluent developed economies?
5. what can cause a number of non- cardiovascular outcomes? —
6. what was the influence of economic factors on the mean population blood pressure? _
7. how many smokers are there in the developing world?

QUESTIONS 8-13. Answer each of the questions, 8-13, with a word or short phrase from one of the texts.
8. Who conducted the current research on diseases of affluence?
9. How many countries contributed the data for the research?
10. What is the efficient way to minimize diseases of affluence?
11. What is the basis of description models that predicts number of smokers?
12. What is the estimated population of the world?
13. Where did tobacco smokers increase in the last century?

QUESTIONS 14-20. Complete each of the sentences, 14-20, with a word or short phrase.
14. Cholesterol is one among the leading causes of _____________________ and morbidity.
15. Current intervention option for ____________________ in principle include reducing calorie intake.
16. Overweight and obesity can cause _____________________ outcomes including cancers, diabetes, and osteoarthritis.
17. Preventing obesity should be apriority during economic growth and __________________ of a nation.
18. There have been major recent transformations in global ________________________ marketing, and regulatory control.
19. There was an inverse relationship between BMl/cholesterol and the food share of __________________
20. Factors of these illnesses -are things which many people would regard as ______________________

PART B. Choose the answer (A, B or C).

Ultrasound Machines: Diagnostic ultrasound machines are used to give images of structures within the body. The diagnostic machine probes, which produce the ultrasound, come in a variety of sizes and styles, each type being produced for a particular special use. Some require a large trolley for all the parts of the unit, while the smallest come in a small box with only an audio loudspeaker as output. They may be found in cardiology, maternity, outpatients and radiology departments and will often have a printer attached for recording images. Unlike X-rays, ultrasound poses no danger to the human body.

1. The manual informs us that the ultrasound machines
A. are used to give images of structures with the body.
B. have a printer attached for recording images.
C. poses negligible danger to the human body.

X-Ray Machines: X-rays are high energy electromagnetic waves. The transformer produces a high voltage that directs electrons onto a target in the machine head. X-rays are produced by the target and are directed into beams by a collimator towards the human body. Soft body tissue absorbs less X-rays, i.e., passes more of the radiation, whereas bone and other solids prevent most of the X-rays from going through. Users must ensure proper radiation safety protocols and supervision are in place.

2. The guidelines establish that the healthcare professional should
A. must ensure proper safety protocols.
B. evaluate the radiation absorbed by bones and tissues.
C. respect the wishes of the patient above all else.
Biomedical waste: Biomedical waste is all waste tissue and body fluids, including clinical items contaminated with these. It is covered under the rules framed by the Central Pollution Control Board. Hospital management must take steps to segregate, manage and safely dispose of this waste. Equipment users must be aware of the systems that exist for this and follow local procedures. Most importantly, users must keep biomedical waste separate from other waste.

3. The purpose of this email is to
A. inform biomedical waste rules are framed by the Central Pollution Control Board.
B. inform users must beware of the systems that exist and follow local procedures.
C. inform users must keep biomedical waste separate from other waste.

Hygienic requirements for cleaning: All healthcare and social care facilities are wet cleaned daily and even more frequently if necessary. According to the nature of the operation, the floor must be suitable for this method of cleaning. In operating theatres using invasive procedures, cleaning is carried out both pre- and post-surgery for each patient. Intensive care units and the rooms for collecting biological material are cleaned three times a day. The frequency of cleaning in other workplaces corresponds to the nature of the operation. In the event of cleaning by a subject other than the healthcare or social care facility provider, the designated worker must proceed according to the contract and the disinfecting or cleaning rules.

4. The manual informs us that the intensive care units
A. are cleaned thrice a day
B. are wet cleaned more frequently
C. frequency of cleaning corresponds to nature of operation

Decontamination: Decontamination procedures include mechanical cleaning, which removes impurities and reduces the presence of microorganisms. In the event of contamination by biological material, it is necessary to include mechanical cleaning before the disinfection process. Detergents with a disinfectant effect are applied manually or by washing and cleaning machines, pressure guns, ultrasonic devices, etc. All tools and equipment must be kept clean. Cleaning machines and other equipment are used in accordance with the manufacturer’s instructions, including checks of the cleaning process.

5. The notice is giving information about
A. cleaning process before disinfection process
B. cleaning process before decontamination process
C. cleaning process after disinfection process

Physical disinfection
• Boiling under atmospheric pressure for at least 30 minutes.
• Boiling in pressurized containers for at least 20 minutes.
• Disinfection in equipment at a temperature determined by parameter A. The equipment must guarantee to reduce living microorganisms on the disinfected object at a given temperature to a predetermined level suitable for further use.

6. What must all staff involved in the physical disinfection process do?
A. Boil under atmospheric pressure for at least 20 minutes
B. Boil under atmospheric pressure for at least 30 minutes
C. Boil in pressurized containers for at least 30 minutes

PART C. TEXT 1. Choose the answer (A, B, C or D) BREAST CANCER AND THE ELDERLY

Paragraph 1: Breast cancer is one of the highest-profile diseases in women in developed countries. Although the risk for women younger than 30 years is minimal, this risk increases with age. One-third of all breast cancer patients in Sweden, for example, are 70 years or older at diagnosis. Despite these statistics, few breast cancer trials take these older women into account. Considering that · nowadays a 70-year-old woman can expect to live for at least another 12-16 years, this is a serious gap in clinical knowledge, not least because in older women breast cancer is more likely to be present with other diseases, and doctors need to know whether cancer treatment will affect or increase the risk for these diseases.

Paragraph 2: In 1992, guidelines were issued to the Uppsala/Orebro region in Sweden (with a population of 1.9 million) that all women with breast cancer should be able to receive equal treatment. At the same time, a breast cancer register was set up to record details about patients in the region, to ensure that the guidelines were being followed. Sonja Eaker and colleagues set out to assess data from the register to see whether women of all ages were receiving equal cancer treatment.

Paragraph 3: They compared the 5-year relative survival for 9,059 women with breast cancer aged 50-84 years. They divided them into two age groups: 50-69 years, and 70-84 years. They also categorized the women according to the stage of breast cancer. They looked at differences between the proliferative ability of breast cancer cells, estrogen receptor status, the number of lymph nodes examined, and lymph node involvement. The researchers also compared types of treatment-Le., surgical, oncological (radiotherapy, chemotherapy, or hormonal)-and the type of clinic the patients were treated 1n.

Paragraph 4: They found that women aged ·70-84 years had up to a 13% lower chance of surviving breast cancer than those aged 50-69 years. Records for older women tended to have less information on their disease, and these women were more likely to have unknown proliferation and estrogen receptor status. Older women were less likely to have their cancer detected by mammography screening and to have the stage of disease identified, and they had larger tumours. They also had fewer lymph nodes examined, and had radiotherapy and chemotherapy less often than younger patients.

Paragraph 5: Current guidelines are vague about the use of chemotherapy in older women, since studies have included only a few older women so far, but this did not explain why these women received radiotherapy less often. Older women were also less likely to be offered breast-conserving surgery, but they were more likely to be given hormone treatment such as tamoxifen even if the tumours did not show signs of hormone sensitivity. The researchers suggest that this could be because since chemotherapy tends to be not recommended for older women, perhaps clinicians believed that tamoxifen could be an alternative.

Paragraph 6: The researchers admit that one drawback of their study is that there was little information on the other diseases that older women had, which might explain why they were offered treatment less often than younger patients. However, the fact remains that in Sweden, women older than 70 years are offered mammography screening much less often than younger women- despite accounting for one-third of all breast cancer cases in the country- and those older than 74 years are not screened at all. Eaker and co-workers’ findings indicate that older women are urgently in need of better treatment for breast cancer and guidelines that are more appropriate to their age group. Developed countries, faced with an increasingly aging population, cannot afford to neglect the elderly.

Q1. The main idea presented in paragraph one is that. …..
a. only older women need to be concerned about breast cancer.
b. breast cancer trials seldom consider older women.
c. breast cancer is more common than other diseases in older woman.
d. older women do not take part in breast cancer trials.
Q2. Regarding cancer treatment, it can be concluded that. …
a. doctors know cancer treatment will increase the risk of disease in elderly patients.
b. cancer treatments may be a risk for all elderly people
c. it is unknown whether or not cancer treatments will affect the treatment of other diseases in elderly people.
d. older women are less likely to have other diseases
Q3. 1992 Guidelines issued to the Uppsala/Orebro region in Sweden stated that.
a. Sweden has a population of 1.9 million.
b. women with breast cancer need to register their condition to ensure they receive equal treatment.
c. identical breast cancer treatment should be available to women of all ages.
d. all women with breast cancer should have access to equivalent breast cancer treatment.
Q4. Which of the following was not part of Sonja Eaker and her colleagues research?
a. Comparing ability of breast cancer cells to increase in number.
b. Grouping woman according to their survival rate.
c. Identifying differences in treatment methods.
d. Splitting the groups based on age.
QS. Findings by the researchers indicate that …….
a. older women are less likely to have chemotherapy recommended.
b. older women prefer hormone treatment to breast-conversing surgery.
c. older women have fewer lymph nodes.
d. older women respond better to chemotherapy than to hormone treatment.
Q6. The word vague is paragraph 5 means ……
a. uncertain
b. unclear
c. unknown
d. doubtful
Q7. One limitation of the study is that …..
a. older women are treated less often than younger women.
b. older women have a lower incidence of breast cancer.
c. younger women are treated more often than older women.
d. there is a lack of information on other diseases which older women have.
Q8. Which of the following statements best represents the view expressed by the writer at the end of the article?
a. Due to ageing population in developed countries, the needs of the elderly must not be ignored.
b. Older women need more appropriate treatment to suit their age.
c. Developed countries have neglected the elderly for too long.
d. It is too expensive treat the elderly.

PART C. TEXT 2. Choose the answer (A, B, C or D) PARENTS, KIDS & VEGIES

Paragraph 1: Most parents have waged epic battles with their kids over eating vegies. But if they don’t clean their plate of the last brussels sprout, does it really matter? Vegetables are behind some of the greatest battles between parents and children. Most parents have dinnertime horror stories involving small bits of vegetable and lots of screaming, and while these stories can be entertaining, the research showing how few vegies our kids are eating is not.

Paragraph 2: The 2009 Australian Institute of Health and Welfare national report card found that a whopping 78 per cent of 4–8-year-olds, 86 per cent of 9-13 year¬ olds and 95 per cent of 14–16-year-olds are not eating the recommended daily servings of vegetables. Take out potatoes, which most kids eat as chips, and the percentage of kids not getting the nutrition they need jumps to 97, 98 and 100 per cent respectively. Other research has made similar findings.

Paragraph 3: But Australian children are hardly going to starve if they don’t eat vegetables and it’s not easy for parents to keep cooking meals that are left on the plate or worse, tipped on the floor. Does it really matter if our kids don’t eat their greens? Professor Louise Baur, paediatrician and director of weight management services at The Children’s Hospital at Westmead, says we all need to eat a wide variety of foods – including vegetables – and children are no different. Research shows vegetable consumption can help prevent chronic diseases such as heart disease, type 2 diabetes and a range of cancers.

Paragraph 4: According to Australia’s dietary guidelines, children aged between four and seven should be eating two to four serves of vegetables daily. Eight- to 11-year-olds should be eating an extra serve; teenagers should have between four to six serves every day. One serve of vegetables is one cup of raw salad vegetables, one medium potato or half a cup of cooked vegetables or legumes.

Paragraph 5: In the short-term, children who don’t eat vegetables can end up with dental issues, constipation (especially if they skip on fruit as well) and on rare. occasions nutritional deficiencies, Baur says. But perhaps more importantly, we tend to develop our eating habits in childhood, so if you’re not eating vegetables and other healthy foods as a child then you are less likely to do so as an adult.

Paragraph 6: Excess weight is also a problem; between 6-8 per cent of school age children in Australia are obese and at least another 17 per cent are overweight. You won’t automatically put on weight if you don’t eat vegetables, Baur says, but children who don’t eat vegetables are often eating foods that are high in saturated f ats, sugar and salt. Children who are overweight are more likely to become overweight or obese adults, who are then at greater risk of chronic diseases.

Paragraph 7: And while the most hardened young vegie hater might enjoy an apple, banana or piece of watermelon, Baur says fruit doesn’t contain the iron and other minerals found in vegetables, and it also contains more sugars. While fruit is an important part of a healthy diet, the dietary guidelines suggest kids under 12 only need one to two serves a day. So, we know that kids need their vegies, but getting them to eat a mouthful, let alone several cups can be a challenge.

Paragraph 8: Nutritionist Dr Rosemary Stanton suggests nutrition should be a whole family affair; you can boost your child’s vegetable intake by eating your evening meal together at the dinner table, preferably with the television off. “Vegetables have traditionally been eaten mainly at dinner and with many families no longer having a family meal, many kids get themselves something to eat – often instant noodles, pizza or some kind of pasta dish (rarely with vegies),” Stanton says.

Paragraph 9: Children are also more likely to eat and enjoy vegetables, and other healthy foods, if they find them interesting, says Stanton. “Several studies show that when kids grow vegies or attend a school with a kitchen garden, they tend to eat more vegies … For those in flats, there are community gardens in some areas, or if they have a balcony lettuce, herbs, cherry tomatoes etc …can all be grown in pots.” ·

Paragraph 10: You can also pique your child’s interest in vegetables by including them in a range of tasks, such as grocery shopping, going to markets or by getting them to help prepare meals. Small children can toss a salad (you can rewash any salad leaves that end up on the floor), and older children can take on more difficult tasks, for example peeling and cutting vegetables. But perhaps the most important thing parents can do is model healthy eating. Research has shown children’s eating patterns are affected by the family’s eating behaviour. Lisa Renn, spokesperson for the Dietitians Association Australia, encourages parents to be persistent.

Paragraph 11: She says there are many easy and crafty ways to get vegies off your children’s plates and into their mouths:
• grate extra vegetables and add them to a favourite pasta sauce
• make green mash, add spinach or rocket when mashing potato
• serve vegie sticks with dips (think avocado, pumpkin or sweet potato) and other snacks
• add extra vegetables or legumes to your next soup or stew
• make muffins using vegetables – com, pumpkin and sweet potato all work well.

Paragraph 12: She also suggests the scattergun approach: offering a wide variety of vegetables (the more different colours the better) in small amounts throughout the day, not just at dinner time. There’s no denying these suggestions require time, effort and creative ‘marketing’. Ultimately, says Renn, “you do what you can do, get them in where you can, be as inventive as possible and be persistent”.

QUESTIONS
Q1. According to the passage what is the reason behind the battle between parents & children?
a. over eating of vegies
b. not cleaning
c. vegetables
d. not eating vegies
Q2. Who stand first is avoiding vegies from daily servings?
a. 4-8 years
b. Teen years
c. 14-16 years
d. Kids
Q3. Why do parents feel discomfort in cooking vegetables?
a. Children won’t eat them
b. Vegetables will be in plates/ floors
c. Children will starve
d. b and c.
Q4. Who cannot be eliminated according to Prof. Louise?
a. diabetic patients
b. children
c. children prone to cancer
d. a and c
QS. Along with a potato how munch vegetables should be taken in a day?
a. a cup
b. a cup of cooked veggies
c. none of the above
d. a and b
Q6. Which has the less possibility to occur with eating les veggies?
a. Dental issues
b. Constipation
c. Deficiency
d. None
Q7. What will automatically happen when you are not eating vegetables?
a. put on weight
b. reduce in weight
c. occurrence of obese
d. nothing will happen
Q8. Who needs 2 serves of vegetables a day according to the passage?
a. 4-7 years
b. b. 8-11years
c. c. Below 12 years
d. d. A and c

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DISEASE OF AFFLUENCE(TOBACCO)

Practice Test 1

I. C

1. A

2. B

3. D

4. B

5. C

6. A

7. WHO

8. 100

9. Preventing obesity

10. Historical patterns

11. 7.6 billion

12. Industrialized nations

13. Global mortality

14. Obesity

15. Non-cardiovascular

16. Urbanization

17. Tobacco trade

18. Household expenditure

19. Lifestyle improvements

Practice Test 2

1. B

2. A

3. C

4. A

5. A

6. B

Practice Test 3

1. B

2. C

3. D

4. B

5. A

6. B

7. D

8. A

Practice Test 4

1. D

2. B

3. B

4. B

5. C

6. C

7. D

8. D

BED BUGS – OET reading

January 4, 2024 jomon Leave a comment

Text A: Bed bugs have feasted on sleeping humans for thousands of years. After World War II, they were eradicated from most developed nations with the use of DDT. This pesticide has since been banned because it’s so toxic to the environment. Spurred perhaps by increases in international travel, bed bugs are becoming a problem once again. The risk of encountering bed bugs increases if you spend time in places with high turnovers of night-time guests – such as hotels, hospitals or homeless shelters. Bed bugs are reddish brown, oval and flat, about the size of an apple seed. During the day, they hide in the cracks and crevices of beds, box springs, headboards and bed frames. It’s a daunting task to eliminate bed bugs from your home. Professional help is recommended.
Symptoms: It can be difficult to distinguish bed bug bites from other insect bites. In general, the sites of bed bug bites usually are:
• red, often with a darker red spot in the middle
• itchy
• arranged in a rough line or in a cluster
• located on the face, neck and arms

Text B Reactions to bed bug bites in humans
Skin reactions are commonly associated with bed bugs, which result from the saliva injected during feeding. Some individuals, however, do not react to their bite, whereas others note a great deal of discomfort often with loss of sleep from the persistent biting. Reactions to the bites may be delayed, up to 9 days before lesions appear.
Common allergic reactions include the development of large wheals, often >1-2 cm, which are accompanied by itching and inflammation. The wheals usually subside to red spots but can last for several days. Bullous eruptions have been reported in association with multiple bed bug bites and anaphylaxis may occur in patients with severe allergies. In India, iron deficiency in infants has been associated with severe infestations. It has been suggested that allergens from bed bugs may be associated with asthmatic reactions.

Text C Bed bug-detecting canines
The bed bug, Cimex lectularius L., like other bed bug species, is difficult to visually locate because it is cryptic. Detector dogs are useful for locating bed bugs because they use olfaction (smell) rather than vision. Dogs were trained to detect the bed bug (as few as one adult male or female bug) and viable bed bug eggs (as few as five, collected 5-6 days after feeding) by using a modified food and verbal reward system. Their efficacy was tested with adult bed bugs and viable bed bug eggs placed in vented polyvinyl chloride containers. Dogs were able to discriminate bed bugs from the insects Camponotus floridanus (Buckley), Blattella germanica L., and Reticulitermes flavipes (Kollar), with a 97.5% positive indication rate (correct indication of bed bugs when present) and 0% false positives (incorrect indication of bed bugs when not present). Dogs also were able to discriminate live bed bugs and viable bed bug eggs from dead bed bugs, cast skins, and feces, with a 95% positive indication rate and a 3% false positive rate on bed bug feces. In a controlled experiment in hotel rooms, dogs were 98% accurate in locating live bed bugs. A pseudoscent prepared from pentane extraction of bed bugs was recognized by trained dogs as bed bug scent (100% indication). The pseudoscent could be used to facilitate detector dog training and quality assurance programs. If trained properly, dogs can be used effectively to locate live bed bugs and viable bed bug eggs.

Text D. Bed bugs as vectors of human disease
Transmission of more than 40 human diseases has been attributed to bed bugs, but there is little evidence that such transmission has ever occurred. Older scientific literature postulated that bed bugs may be vectors of plague, yellow fever, tuberculosis, relapsing fever, leprosy, filariasis, kala azar (leishmaniasis), cancer, smallpox, and Chagas disease (Trypanosoma cruzi). Recently, the possibility of human immunodeficiency virus and hepatitis B virus transmission by bed bugs has been investigated. Human immunodeficiency virus can be detected in bed bugs up to 8 days after ingestion of highly concentrated virus in experimental blood meals. However, no viral replication has been observed within the insects and no virus has been detected in bed bug feces. Mechanical transmission of human immunodeficiency virus has not been demonstrated using an artificial system of feeding bed bugs through membranes.

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. normal allergic reactions to bed bugs?
2. signs that bed bugs may spread diseases?
3. dogs can be trained to detect bed bug eggs?
4. bed bugs showed no viral replication?
5. bed bug bites may be seen in a cluster?
6. places where bed bugs are found?
7. what is used to facilitate quality assurance programs?

Questions 8-15. Answer each of the questions, 8-15, with a word or short phrase from one of the texts.

8. How much was the false positive indication rate of bed bugs by detector dogs?
9. What was used to eliminate bed bugs from developed countries?
10. What is the usual symptom exhibited by bed bug infestation?
11. What was detector dogs’ positive indication rate for distinguishing live and dead bed bugs?_______
12. What caused serious infestations of bed bugs in newborns?
13. What is the reason for reappearance of bed bugs in developed countries?
14. How many diseases are said to be spread by bed bug being vectors?
15. What are responsible for asthma symptoms caused by bed bugs?
Questions 16-20. Complete each of the sentences, 16-20, with a word or short phrase from one of the texts.
16. The usage of is prohibited as it is proven to be very harmful to our surroundings.
17. The presence of is not detected in ordure of the bed bugs.
18. To locate bed bugs, detector dogs use olfactory senses despite their.
19. Numerous bed bug bites are found to produce.
20. is made from the pentane extraction of bed bugs. END OF PART A

PART B Choose the answer (A, B or C)

1. According to the extract, every physicians must
A. declare modifications regarding requirement of seasonal influenza immunization.
B. provide help to get proper immunization against the seasonal influenza virus.
C. get a flu vaccination from an appropriate place that offer a valid substantiation.
The seasonal influenza immunization: In an effort to protect our patients, visitors, and colleagues, we are announcing an important change regarding the requirement of seasonal influenza immunizations for all employees, physicians, active volunteers, vendors, contracted staff, and students. As health care providers, it is our responsibility and obligation to protect our patients, visitors, and colleagues—as well as ourselves and our family members—by being immunized against the seasonal influenza virus. As we have done in the past, seasonal influenza immunizations will be provided free of charge to all employees, physicians, contracted staff and active volunteers. Participation in this year’s seasonal influenza immunization program is required. All employees, physicians, contracted staff, active volunteers and students will be required to do one of the following:
• Receive a flu vaccination through RH Occupational Health Office.
• Provide proof of immunization if you received a vaccination outside of RH’s planned immunization program— from another health care provider or local pharmacy, for example.

2. The policy document tells us that tolerance for risk is greater for permanently implanted medical devices
A. in pediatric patients with a limited life expectancy.
B. such as pacemaker pulse generators.
C. in a healthy pediatric population.
Risk Assessment of Medical Devices: The risk assessment should consider the proposed clinical use of the device, including the anatomical location, duration of exposure, and intended use population. For example, for pediatric patients with a limited life expectancy, the tolerance for risk associated with a permanently implanted medical device may be higher than the tolerance for risk from the same device in an otherwise healthy pediatric population. The potential exposure duration should also consider which material components of the device have direct or indirect contact with tissue, and whether exposure would be a one-time exposure, a constant exposure over time, or an intermittent exposure over time that could have a cumulative effect. For example, pacemaker pulse generators commonly contain internal electronic components made from chemicals that could be toxic to the body, but appropriate bench testing can demonstrate that the pulse generator is hermetically sealed and will limit exposure of those chemicals to the surrounding tissues.

3. What is being described in this section of the guidelines?
A. changes in procedures.
B. best practice procedures.
C. exceptions to the procedures.
Patient Admission: If the patient medically requires hospital inpatient services and the physician believes that the patient will need to stay in the hospital at least 2 midnights, the physician should order inpatient admission. If the patient does not medically require inpatient hospital services or the physician does not expect the patient to stay past 2 midnights, the physician should order observation or outpatient services. The certification must be signed and documented in the medical record prior to patient discharge. Hospitals may choose to have physicians record these elements of the certification either on a specific form or throughout the medical record such as in the orders, history and physical, or physician progress notes.
Guidelines:
• Excellent patient care should continue to be the top priority.
• Document the diagnosis, medical rationale, plan of care and anticipated discharge.
• Sign the admission order and certification (if appropriate) prior to discharge.

4. The purpose of these instructions is to explain
A. how to wear respirators effectively
B. how to use respirators appropriately
C. necessity of wearing proper respirators
Respirators: Respirators are an effective method of protection against designated hazards when properly selected and worn. Respirator use is encouraged, even when exposures are below the exposure limit, to provide an additional level of comfort and protection for workers. However, if a respirator is used improperly or not kept clean, the respirator itself can become a hazard to the worker. Workers who occasionally wear filtering face-piece respirators on a voluntarily basis must be aware of the following information. This information is intended for employees who are not required to wear respirators for protection from recognized airborne hazards. Employees who perceive exposures to any airborne contaminants, particularly outside of a chemical fume hood, should request an exposure evaluation before selecting a respirator.

5. The extract informs us that your
A. input will help evaluate the current HOCC program and its future program review.
B. participation ensure that patients’ needs are met exclusively by physicians.
C. support and elaborate retrospect will help in fulfilling targets of

HOCC program review.
Hospital On-Call Coverage Program Review: We are requesting your assistance with the detailed review of the Hospital On-Call Coverage (HOCC) Program; your input will help evaluate the current HOCC program and assist to identify future directions. With your participation, we can ensure that the HOCC program meets the needs of patients, participating physicians and other health care stakeholders. The HOCC Program review has three primary objectives:
 To identify and examine the effectiveness of key elements of the program already in place at hospitals. These elements include eligibility criteria, compensation structures, process metrics, resource requirements, and others.
 To develop recommendations for improving the organization and delivery of on-call services based on evidence and best practices identified through the data and information collection processes.
 To explore specific issues: Participation of doctors, use of regional call networks, and coverage for long-term care, sexual assault centres, chronic care facilities and palliative care programs.

6. What point does the extract make about processing of medical devices?
A. could significantly affect the biocompatibility of the medical devices.
B. includes passivating surface of medical devices by acid bath or other method.
C. uses resin supplier to remove all processing solvents from medical devices.
Identification of Potential Risks: An assessment of potential biocompatibility risk should include not only chemical toxicity, but also physical characteristics that might contribute to an unwanted tissue response. These characteristics can include surface properties, forces on surrounding tissue, geometry, and presence of particulates, among others. In addition, changes in manufacturing and processing parameters can also have an impact on biocompatibility. For example, the original processing for an implanted device might include placing the device in an acid bath to facilitate passivation of the implant surface. If this passivation process is changed to eliminate the acid bath in favor of a different method of passivating the surface, removal of the acid bath might unintentionally lead to a smaller reduction in pyrogenic material, which could result in pyrogenic reactions (fever) following implantation of the device. Another common change that might impact biocompatibility is a change in resin supplier. For example, if the new resin supplier does not remove all processing solvents (some of which may be known toxic compounds, such as formaldehyde), the final manufactured device could cause unexpected toxicities that were not seen with devices manufactured from the original resin.

PART C. TEXT 1. MEASURING LIFE. Choose the answer (A, B, C or D).

Somewhere out in the future there’s a final moment with our name on it: life’s only certainty is death. It’s coming, and the only mystery about mortality’s last call is: when? But if your doctor could tell you, would you want to hear how long you are likely to live? American researchers now believe that they are able to determine a person’s “natural” life span from a simple blood test. They have identified the ability of a common gene to influence the ageing process, and the form it takes in any given individual can they say, indicate medical vulnerability and predict when the person may die. The news has created much excitement but it also has raised concerns about the ethical dilemmas involved if science is able to read our lifelines and forecast our susceptibility to deadly diseases. It’s a development that revives the eternal question: should a doctor tell?

Apo E, as it’s known, is not a new discovery but, hitherto, scientists believed that its only function was to remove cholesterol from the bloodstream. Only lately as they have been able to study the ever increasing numbers of elderly, has the gene’s relationship with longevity become apparent. It apparently operates as a kind of caretaker gene, maintaining the system’s cells and keeping them running smoothly, and its efficiency can determine the rate at which the body holds up or wears out. “Apo E is one of those genes that we suspect controls life span because it affects people’s susceptibility to diseases of ageing”, says Dr Jan Vigh; a molecular geneticist at Beth Israel Hospital, in Boston. The gene has three variants, known as E2, E3, E4, and we all inherit one of them from each of our parents. More than half of us are born with two E3s, but it is the distribution of the other two forms that has proved so compelling to scientists that they have been analyzing data on the elderly.

People with one or – more rarely – two E2s tend to survive the longest, while those with E4s die considerably earlier than the rest. Studies in Canada, France, Sweden and Finland found that E2 carriers were about four times more likely to reach their 100th birthday than those born with an E4. The E2 is, it seems, an excellent caretaker. By comparison, E4 does sloppy work and its inadequacies at cell upkeep make those who have it vulnerable to illness and early death. Doctors now accept that the presence of the Apo E4 gene signals a risk of heart disease and Alzheimer’s. American studies show that middle aged women with an E4 are twice as likely to develop coronary heart disease as those who don’t, while E4 men have a 50 per cent higher risk than other men. Among men under 40 who require surgery for clogged heart arteries, the incidence of two E4s is 16 times higher than among others in their age group And Dr Alan Roses, the Duke University neurologist who first made the link between Apo E and Alzheimer’s, says those with two E4s have about six times the normal risk of developing the disease, while people born with two E2s may be protected from it.

More than 4 million Americans are afflicted by this devastating brain disorder and nearly two-thirds of them have at least one Apo E4 gene, compared with only 15 percent in the general population. So, Apo E may be a critical marker for life span and vulnerability to grave diseases, and evidence of its presence is in the records of millions of blood tests conducted for other reasons. But is it ethical or wise for doctors to use that information to tell people something they may not want to know and which, in any case, alerts them to threats that may be unavoidable? “We consulted bioethicists and got a variety of opinions,” says Dr Norman Relkin, the New York neurologist who gathered other concerned doctors to discuss the issue at a conference in Chicago. After two days, they called for more research to establish the nature and the risks of the Apo E family but many researchers seem opposed to confronting people with alarming news about conditions that cannot be fought, based on blood samples given for other purposes.

“Have you done them a service?” asks Dr Lindsay Farrer, an Alzheimer ‘s researcher at Boston University Medical Centre. “What good does it do to tell someone about being at risk from a dreaded disease that can neither be prevented nor effectively treated?” Dr Rudolph Tanzi, an Alzheimer’s specialist at Massachusetts General Hospital, agrees but, because his own family has a history of early heart problems, he was unable to resist having his own Apo E analyzed. He is an E3, in the same wide, neutral middle ground as most of humanity. The problems raised by Apo E are varied and complex. Some doctors worry about possible discrimination from employers and insurance companies if people are routinely told they may have a predisposition to serious illness and premature death.
Because blows to the head seem to increase the risk of getting Alzheimer’s among people with the E4 gene, should boxers and other athletes, and children wanting to play contact sports, be tested for their Apo classification? “Already!”, says Dr Relkin, pregnant women are asking for their fetuses to be screened so they can consider abortion if their babies show two E4s.

Duke University’s Dr Roes is working with a major drug company to try to define what gives Apo E2 its ability to improve the body’s defenses, so that its protection can be duplicated in the laboratory. “The hope is that we shall be able to make a drug that does what Apo E2 does,” he says. Meanwhile, for millions of people around the world, their destiny -how they will live, when they will die is perhaps already foretold in a dusty medical file.

Text 1: Questions 7-14

7. Researchers have identified
A. a way to monitor a person’s life span from a blood test.
B. a gene which could affect the process of ageing in humans.
C. the mystery about mortality’s last call.
D. a way to predict the vulnerability of an individual.
8. The discovery of being able to estimate the life span of a person
A. has generated apprehension about people’s predisposition to deadly diseases.
B. has initiated an ethical puzzle involved in being able to predict disease.
C. has rekindled debate about a perpetual dilemma for doctors.
D. has been instrumental in forecasting deadly diseases.
9. Apo E functions within a person’s system as
A. a cholesterol gene controller.
B. a maintainer of the gene’s relationship with longevity.
C. a gene which monitors and determines the ageing process.
D. the gene which inhibits the rate at which the body degenerates.
10. Scientists have been in a position to study the Apo E phenomenon because
A. of the steadily ageing population in North America.
B. Apo E has been known about for many years.
C. diseases which affect the elderly have increased.
D. they knew that its only function is to remove the cholesterol from the blood.
11. A molecular geneticist in Boston has found that
A. we all inherit Apo E2, E3 or E4 from either parent.
B. the greater number of us inherit three variants of Apo E from both parents.
C. the majority of us will inherit two Apo E3s from both parents.
D. more than half of us inherit either two Apo E2s or two Apo E4s from both parents.
12. Middle aged women with an Apo E4 gene
A. are at greater risk of being vulnerable to illnesses.
B. have a 50% higher risk factor than men.
C. experience a higher incidence of Alzheimer’s disease.
D. are more likely to develop heart disease.
13. Which statement is not true? The neurologist who made initial connection with Apo E and Alzheimer’ s believes people with
A. 2 E4s are more likely to develop the disease.
B. 2 E4s are more likely to be protected by it.
C. 2 E4s are six times more at risk of vulnerability to Alzheimer’s than others.
D. 2 E2s are less in 15% of general population who have the disease.
14. Neurologists and bioethicists who met at a conference in Chicago
A. were mildly in favor of telling people alarming news about their condition.
B. agreed that there was sufficient information to establish risks of Apo E gene.
C. agreed that it was insufficient to determine extent of risks using Apo E information.
D. were not in favor of giving bad news based on blood samples only.

PART C. TEXT 2. E.Coli Outbreak. Choose the answer (A, B, C or D).

An outbreak of E. coli in Germany that has killed at least 16 people and left hundreds battling infection across Europe raises questions about what risks the infection continues to pose and what fallout it will cause. The source of the E. coli outbreak is still unknown but has been traced to cucumbers imported to Germany from Spain. It is not clear whether the vegetables were infected at source or in transit. The European Center for Disease Prevention and Control (ECDPC) says transmission of the strain of bacterium, commonly found in cattle, usually occurs through contaminated food or water and contact with animals. Infections have so far only been linked to Spanish cucumbers originating from the cities of Almeria and Malaga, but there are fears other raw vegetables such as lettuce and tomatoes could be affected. The European Union says a suspect batch of cucumbers imported from either Denmark or the Netherlands and sold in Germany is under investigation.

The ECDCP says the bacteria’s impact on individuals can be affected by their age with children under five usually at higher risk of developing disease and dying from infection. However, statistics published on May 27 showed that of 276 cases, 87% were adults and 68% were women. One hospital in Hamburg said it had up to 700 infected patients. Of 85 people at risk of renal failure, 20 were children and 65 were adults. Sweden, which appears to have the biggest cluster of cases outside of Germany, has reported several dozen people hospitalized. Escherichia coli (E. coli) is a bacteria found living in the intestines of people and animals. It can be transmitted through contaminated water or food — especially raw vegetables and undercooked meat. It is usually harmless, but can cause brief bouts of diarrhea. Some nastier strains can cause severe diarrhea and followed by serious organ system damage such as kidney failure. Healthy adults usually recover within a week, but young children and older adults can develop a life- threatening kidney failure.

The European Food Safety Alert Network identifies the bacteria linked to the contaminated cucumbers as EHEC, or enterohemorrhagic Escherichia coli, a strain which is particularly virulent and resistant to antibiotics. In Hamburg, up to 30% of people admitted to hospital with the infection were said to have developed haemolytic-uremic syndrome, a life-threatening form of kidney failure. The ECDPC says the outbreak is the largest in the world of its kind. So far there have been more than a dozen E. coli-linked deaths in Germany and hundreds of infections, but more are expected. Infections have also been reported across Western Europe but so far, the cases in Austria, Britain, Denmark, France Netherlands, Sweden and Switzerland have all involved people returning from travel to Germany. The European Food Safety Alert Network said E. coli had been found in cucumbers from Spain, packaged in Germany, and distributed to countries including Austria, the Czech Republic, Denmark, Germany, Hungary and Luxembourg.
Germany is advising people to avoid all raw vegetables, particularly cucumber, lettuce and tomatoes. The ECDPC says there is a risk of person-to-person transmission from people carrying the infection. “Personal hygiene messages are important,” it says. With exports of Spanish vegetables “paralyzed” according to officials, weekly losses of about €200 million ($288 million) are predicted. There are also concerns about the long-term impact this will have on Spain’s fruit and vegetable market, last year worth €8.6 billion. Producers have already reported that seeded fruit exports are being affected, despite being unrelated to the scare. In addition to Germany, a number of European countries including Russia and Belgium have banned vegetable imports from Spain. Germany has reportedly also drastically reduced imports from the Netherlands. The cucumber alert could also have diplomatic fallout, with producers urging Spain’s prime minister to step in, complaining German authorities have condemned Spanish produce without proof.

Leire Pajin, the Spanish Health Minister, has discussed the outbreak on Twitter, saying: “In the absence of proof, we’re not ruling out using all necessary measures to make sure there’s compensation for the (economic) damage,” she wrote. “From the first day, the government launched a diplomatic offensive to prevent the linking of this health crisis with our products.” While Germany accounts for much of Spain’s vegetable export market, the country does export further afield to countries including Russia and the United States. There is also the risk of so- called “secondary clusters” of infection caused by person-to-person transmission by anyone who had become contaminated during a visit to Germany.

Text 2: Questions 15-22

15. hat is the meaning of the word ‘fallout’ in the first paragraph?
A. What effects the infection will have on the infected people.
B. What the causes of the infection are.
C. What effects the breakout will have.
D. What the causes of eating too many cucumbers are.
16. The source of the E. Coli outbreak is thought to be caused by
A. cucumbers exported from Germany.
B. infected cattle.
C. contaminated food or water and contact with animals.
D. cucumbers exported from Spain to Germany.
17. Which one of the following statements is not true?
A. Cucumbers from Almeria and Malaga are thought to be infected.
B. Tomatoes and lettuce from Spain may be affected.
C. A suspect batch of cucumbers sold in Denmark or the Netherlands is under investigation.
D. A suspect batch of cucumbers imported to Germany is under investigation.
18. What do the statistics published on May 27 show?
A. That women are less likely to be infected.
B. That children are more likely to be infected.
C. That adults are more likely to be infected.
D. That men are more likely to be infected.
19. Which of the following statements is correct?
A. A Hospital in Hamburg reported 276 cases of E.coli.
B. 700 cases have been reported worldwide.
C. Sweden has reported the most cases of E. coli.
D. 85 people are at risk of renal failure in a hospital in Hamburg.
20. How is E. coli transmitted?
A. From person to person.
B. Through contaminated water or food.
C. Through eating the kidney’s of animal products.
D. From young children to older adults.
21. Why is this strain of E.Coli so deadly?
A. It is particularly virulent and resistant to antibiotics.
B. It leads to haemolytic-uremic syndrome.
C. It is a bacteria linked to contaminated cucumbers.
D. Because 30% of people with E.Coli have died.
22. Which of the following is not true? Infections have been reported in people who
A. live in Australia and Spain.
B. have returned from traveling in Germany.
C. live in Austria, Britain, Denmark, France, Netherlands, Sweden and Switzerland.
D. have eaten cucumbers which were from Spain and packaged in Germany.

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Bed bugs

PART A: QUESTIONS 1-20

1. B

2. D

3. C

4. D

5. A

6. A

7. C

8. 0%

9. DDT

10. skin reactions

11. 95%

12. iron deficiency

13. international travel

14. 40

15. allergens

16. DDT

17. human immunodeficiency virus

18. vision

19. bullous eruptions

20. pseudoscent

PART B: QUESTIONS 1-6

1. C get a flu vaccination from an appropriate place that offer a valid substantiation.

2. A in pediatric patients with a limited life expectancy.

3. B best practice procedures.

4. C necessity of wearing proper respirators

5. C support and elaborate retrospect will help in fulfilling targets of HOCC program review.

6. A could significantly affect the biocompatibility of the medical devices.

PART C: QUESTIONS 7-14

7. B a gene which could affect the process of ageing in humans.

8. C has rekindled debate about a perpetual dilemma for doctors.

9. C a gene which monitors and determines the ageing process.

10. A of the steadily ageing population in North America.

11. C the majority of us will inherit two Apo E3s from both parents.

12. D are more likely to develop heart disease.

13. B 2 E4s are more likely to be protected by it.

14. C agreed that it was insufficient to determine extent of risks using Apo E information.

PART C: QUESTIONS 15-22

15. C What effects the breakout will have.

16. D cucumbers exported from Spain to Germany.

17. C A suspect batch of cucumbers sold in Denmark or the Netherlands is under investigation.

18. C That adults are more likely to be infected.

19. D 85 people are at risk of renal failure in a hospital in Hamburg.

20. B Through contaminated water or food.

21. A It is particularly virulent and resistant to antibiotics.

22. A live in Australia and Spain.

Aspirin Resistance – OET reading

January 4, 2024 jomon Leave a comment

TEXT A.
In the last few years, the concept of aspirin resistance has been largely emphasised in the medical literature, although its definition, mechanism, and specific guidelines for its management remain unclear. Aspirin displays good antithrombotic activity. Various laboratory parameters assessing the efficacy of aspirin like bleeding time, platelet reactivity, thromboxane-A2 (TX-A2) production, and measurement of platelet aggregation, have confirmed the lack of its uniform effect on the platelets. Few studies have reported aspirin resistance to the tune of 5 – 45%. Various extrinsic and intrinsic factors influence the resistance. Numerous studies reveal that aspirin resistance can be overcome by combining it with another antithrombotic agent, i.e., clopidogrel. Further, clopidogrel resistance has also been reported. So, much is expected in the field of diagnostic tests in order to know the true picture of aspirin resistance.

TEXT B Mechanisms of aspirin resistance
The exact mechanisms are not clear: True aspirin resistance:
The proposed factors for this type of resistance include:
a. Decreased bioavailability of aspirin.
b. Accelerated platelet turnover introducing newly f armed, non-aspirinated platelets into the blood stream.
c. Competition of aspirin with other NSAIDs(like ibuprofen)preventing aspirin access at Serine 530 of Cox-I.
d. Transcellular formation of TxA2 by aspirinated platelets from PGH2 released by other blood cells or vascular cells.
e. TxA2 production by aspirin insensitive Cox-2 in newly formed platelets or other cells.
f. (Theoretical) presence of variant Cox-I which is less sensitive to aspirin inhibition.
g. Poor compliance by the patient.

TEXT C ·Aspirin dosage
According to the Antithrombotic Trialists’ Collaboration, daily doses of aspirin (75 – 150 mg) are as effective as higher doses for prevention of thrombotic events and are associated with low risk of bleeding. Bornstein et al in their study have shown that even 100 mg of aspirin completely inhibits Cox-1 enzyme, thus further substantiating the f act that patients with resistance established during low dose aspirin therapy may respond to higher doses. The results of this study showed that aspirin in doses of 500 mg/day- significantly prolonged the time between first and second stroke (p= 0.002) compared with lower doses. Helgasonetal revealed that an increase in the dose of aspirin to 625 that suboptimal reduction of urinary 11-dehydro TxB2 level during aspirin treatment is associated with increased risk for future MI and cardiovascular death, thereby suggesting that “true aspirin resistance” may be a clinically relevant phenomenon. Inadequate inhibition of TxA2 biosynthesis by aspirin can be seen in patients on ibuprofen therapy, because of competition of these 14 mg/day in five patients who were aspirin resistant with 325 mg/day showed aspirin sensitivity. Another study has revealed that these patients remained resistant with aspirin 1,300 mg. This shows that inadequate dose cannot explain aspirin resistance in all subjects.

TEXT D Management of aspirin resistance
Currently there are no specific guidelines for the management of aspirin resistance. The first step is to enquire about the patient’s compliance. Regarding optimal aspirin dosing, it is controversial. No convincing data are available showing that the antithrombotic effect of aspirin is dose related. The meta-analysis by Anti-Thrombotic Trialist’ s Collaboration refuted the claim that high doses of aspirin (500 – 1,500 mg/day) were effective than low doses (75 – 150 mg/day). Other method to manage aspirin resistance is by addition of another antiplatelet agent – clopidogrel, because CAPRI£ trial has shown greater benefit of combination of- aspirin and clopidogrel compared with aspirin alone. The combination of aspirin with clopidogrel is an ideal one since clopidogrel inhibits another pathway of platelet activation. However, till date, it is not clear whether the superiority of a combination of clopidogrel and aspirin over aspirin is due to clopidogrel compensation for aspirin non-responders. Resistance to even clopidogrel has been reported, which is associated with an increased risk of recurrent thrombotic events in patients with acute MI.

Part A. TIME: 15 minutes. Questions 1-7. For 1-7, choose(A, B, C or D) In which text can you find information

1. what are the factors of true aspirin resistance?
2. how much of aspirin completely inhibits Cox-1 enzyme?
3. what will happen if aspirin compete with other NSAIDs?
4. how the true picture of aspirin resistance is revealed?
5. what are the parameters for assessing the efficacy of aspirin?
6. list the methods to manage aspirin resistance?
7. whether true aspirin resistance is a clinically relevant phenomenon?

Questions 8-13. Answer each of the questions, 8-13, with a word or short phrase from one of the texts.

8. How much mg of aspirin is minimum required to completely inhibit Cox-1 enzyme?
9. Which patients show inadequate inhibition of TxA2 biosynthesis by aspirin?
10. Name the antiplatelet agent used to manage aspirin resistance?
11. What are responsible for transcellular formation of TxA2?
12. What is the daily doses range of aspirin according to the Antithrombotic Trialists’ Collaboration?
13. Which trial has shown greater benefit of combination of aspirin and clopidogrel?

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

14. Aspirin displays good___________ activity.
15. Few studies have reported aspirin resistance to the tune of ___________
16. TxA2 may be produced by aspirin insensitive _________in newly formed platelets or other cells.
17. Increase in the dose of aspirin to 625 is associated with increased risk for future MI and_____________
18. Inadequate inhibition of TxA2 __________ by aspirin can be seen in patients on ibuprofen therapy.
19. The first step in management of aspirin resistance is to enquire about the patient’s _________________
20. The combination of ______________ with clopidogrel is an ideal one.

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

Anaesthetic Machines: The anaesthetic machine (or anaesthesia machine in America) is used by anaesthesiologists and nurse anaesthetists to support the administration of anaesthesia. The most common type of anaesthetic machine is the continuous-flow anaesthetic machine, which is designed to provide an accurate and continuous supply of medical gases (such as oxygen and nitrous oxide), mixed with an accurate concentration of anaesthetic vapour (such as halothane or isoflurane), and deliver this to the patient at a safe pressure and flow. Modern machines incorporate a ventilator, suction unit, and patient monitoring devices.
1. The manual is giving information about
A. how to use anaesthetic machines
B. types of anaesthetic machines
C. an overview of anaesthetic machines

Autoclaves and Sterilizers: Sterilization is the killing of microorganisms that could harm patients. It can be done by heat (steam, air, flame or boiling) or by chemical means. Autoclaves use high pressure steam and sterilizers use boiling water mixed with chemicals to achieve this. Materials are placed inside the unit for a carefully specified length of time. Autoclaves achieve better sterilization than boiling water sterilizers. Heat is delivered to water either by electricity or
flame. This generates high temperature within the chamber. The autoclave also contains high pressure when in use, hence the need for pressure control valves and safety valves. Users must be careful to check how long items need to be kept at the temperature reached.

2. Why autoclaves are better than boiling water sterilizers?
A. Heat is transferred to water by electricity or flame
B. Autoclaves use high pressure steam
C. Autoclaves generates high temperature within the chamber

ECG: How it works: The electrical activity is picked up by means of electrodes placed on the skin. The signal is amplified, processed if necessary and then ECG tracings displayed and printed. Some ECG machines also provide preliminary interpretation of ECG recordings. There are 12 different types of recording displayed depending upon the points from where the recordings are taken. Care must be taken to make the electrode sites clean of dirt before applying electrode jelly. Most problems occur with the patient cables or electrodes.

3. The guidelines establish that the healthcare professional should
A. aim to make patients fully aware of how ECG works.
B. carefully clean the electrode sites.
C. respect the wishes of the patient above all else.

Benefits of electronic health records: EHR systems are complex applications which have demonstrated benefits. Their complexity makes it imperative to have good application design, training, and implementation. Studies have evaluated EHR systems and reported on various benefits and limitations of these systems. Benefits included increase in immunization rates, improved data collection, increased staff productivity, increased visitor satisfaction with services, improved communication, quality of care, access to data, reduced medical errors, and more efficient use of staff time. Some of the disadvantages noted were: time- consuming data entry, slow access of data and decreased quality of patient- doctor interaction.

4. The notice is giving information about
A. pros and cons of electronic health records
B. necessity of electronic health records
C. demonstrated benefits of electronic health records

mHealth: The use of mobile technologies for data collection about individuals and interactive information services are a part of a growing area of eHealth called mHealth. The GOe published a volume on this subject in 2011which documents the uptake of mHealth worldwide by types of initiatives and main barriers to scale. Mobile technologies are emerging as a powerful tool for health information transfer including making patient information portable. Such technologies can be more fully utilized through electronic patient information such as EMRs and EHRs. Electronic records will work best, however, if there are standards in place for their use and interoperability.

5. The note tells us that the mHealth
A. is a published volume on the GOe
B. is a powerful tool for information transfer
C. makes patient information portable

Systematized Nomenclature of Medicine (SNOMED): SNOMED was designed to provide a comprehensive nomenclature of clinical medicine for the purpose of describing records of clinical care in human medicine. It is a multi-axial and hierarchical classification system. It is multi¬ axial in that any given clinical condition can be described through multiple axes such as topography (anatomy), morphology, organisms such as bacteria and viruses, chemicals such as drugs, function (signs and symptoms), occupation, diagnosis, procedure, physical agents or activities, social context, and syntactic linkages and qualifiers. SNOMED is hierarchical in that each of the axes has a hierarchical tree that proceeds from general terms to more specific ones. For example, topography (anatomic) terms are first divided into major organs such as lung, heart, and then into the smaller components of each.

6. What does this extract from a handbook tell us about Systematized Nomenclature of Medicine?
A. is a multi-axial and hierarchical classification system
B. is a comprehensive nomenclature of trial medicines
C. is used to described any clinical condition through axis

PART C. TEXT 1. Choose the answer (A, B, C or D) which you think fits best according to the text.

Paragraph 1: All life is connected Cancer in Humans and Wildlife. WILDLIFE-HUMAN LINKS
It may be that biologists, rather than physicians, will be the major contributors to the health of our wildlife caused by the combined action of pesticides planet and its people. It was Rachel Carson, a biologist, who researched and wrote of the harm to wildlife caused by the combined action of pesticides and radiation. In the tradition of the observant biologist is Theo Colborn, who, with her colleagues, provided a significant breakthrough in understanding the hormonal effects of environmental contaminants. In July 1991, a gathering of some of the world’s most astute, – scientists were held at the Wingspread Conference Center in Wisconsin, where they defined the pattern of diverse endocrine malfunction seen throughout the animal · kingdom. They revealed a gm”: picture of the Brave New World we should m rigorously seek net to leave as a legacy to our children.

Paragraph 2: The conferees, studying wildlife over the globe, described ominous findings of disease are linked to environmental pollution. Exposure to toxic chemicals that possess unintended h actions has resulted in anatomic, physiologic, reproductive, carcinogenic, and behavioural abnormalities across all forms of animal life: in mollusks, fish, birds, seals, and rodents. These creatures are to we humans as canaries were to the miners. We must understand that the destruction of eons of evolutionary function and development in wildlife ‘ foreshadows destruction of the entire biosphere, humans included.

Paragraph 3: These widespread adverse effects were attributed to xenoestrogens. Xeno – comes from a Greek origin, meaning “foreign.” Foreign itself is not bad: how else do we share and spread culture and ideas? But xenoestrogens are less foreigners than invaders, gaining entrance by the Trojan horse of seemingly harmless routes: milk, meat; cheese, fish, the products we use to nourish ourselves and families. Like the invaders of Troy, after the xenoestrogens gain entrance to the bodies of animals and humans alike, they weaken defences and wreak their harm of cancer, hormonal disruption, immunological abnormalities, and birth defects.

Paragraph 4: Xenoestrogens are an insidious enemy, but they have had help from powerful allies: the purveyors of products and chemicals, and legislators, regulators, and scientists reluctant to bite the money- laden hands that feed them.
Wingspread researchers found that birds exposed to xenoestrogens show reproductive failure, growth retardation, life-threatening deformities, and alterations in their brains and liver functions.” There is direct experimental evidence for permanent [organizational] effects of gonadal steroids on the brain as well as reproductive organs throughout life. This means that offspring whose brains have been altered are unable to function as had their parents. They become different in ability or function.

Paragraph 5: This means that the sea of hormonally active chemicals in which the fetus develops may change forever the health and function of the adult, and in some cases, may alter the course of an entire species. Worldwide there are reports of declining sperm counts and reduced ratio in births of male babies. Without the capacity to reproduce, a species ceases to exist. Extinction is forever; a species loss has never been reversed.

Paragraph 6: The data derived from animal observations are unequivocal: breast and genital cancers, _ital abnormalities, interference with sexual development, and changes in reproductive behaviour all expressions of a root cause. A possible connection between women with breast cancer and those having children with reversed sexual orientation is a question that bears study. This is n n. from science fiction, considering what we have learned from observing wildlife and the effects inappropriate hormonal influence upon the breast, brain, and reproductive organs. If an unequivocal answer were to emerge from human observation, it could have a significant impact upon the prevailing political and economic landscape, and may finally settle the nature or nu issue of sexual orientation.

Paragraph 7, SILENT SPRING-SILENT WOMEN. Considering the accumulated knowledge linking chemical and radioactive contamination environment with increasing breast cancer rates means we must focus our energies and prevention. Early were the eloquent words and pleas for prevention from Rachel Carson. Her book, Silent Spring, originally published in 1962, while she herself was suffering from breast cancer, is still a best seller. Ms. Carson documented wholesale killing of species; animals, birds, fish, insects; the destruction of food and shelter for wild creatures; failure of reproduction; damage to the nervous system; tumors in wild animals; increasing rates of leukemia in children; and chronicled the pesticides and chemicals known at that time to cause cancer. This was over 30 years ago!

Paragraph 8: Carson’s is a book for every citizen, for without understanding of our collective actions and permissions, we cannot govern democratically. In Australia, a citizen is required to vote. In the United States, proclaimed by some politicians as the “greatest democracy on earth,” often fewer than 50% bother to vote in a major election. Of those who do take the time to register and vote, few are sufficiently alert and/or educated to vote with intelligence, thought, and compassion. Requiring participation in the governance of one’s own country is not a bad idea. Requiring thoughtful voting may be more difficult, especially when it comes to such issues as cancer, pesticide use, consumer products, nuclear radiation, toxic chemicals, and environmental destruction. Taking this thought one step further; this democracy could do far worse than to require reading of Silent Spring as a requirement to vote! Radical? Perhaps. But is the ongoing cancer epidemic any less radical?

Paragraph 9: One successor to Ms. Carson has emerged in the person of Sandra Steingraber, an ecologist, poet, and scientist. In her book, Living Downstream, she writes eloquently of the connections between environmental contamination and cancer. Dr. Steingraber was diagnosed with bladder cancer at age 20, a highly unusual diagnosis in a woman, a young woman, a non-smoker and non-drinker. She pursued the question, why? She realized a connection with our wild relations and she asks: Tell me, does the St. Lawrence beluga drink too much alcohol and does the St. Lawrence beluga smoke too much and does the St. Lawrence beluga have a bad diet. . . is that why the beluga whales are ill? …Do you think you are somehow immune and that it is only the beluga whale that is being affected?

Paragraph 10: The portion of Dr. Steingraber’s book that struck me most personally was when she says: First, even if cancer never comes back, one’s life is utterly changed. Second, in all the years I have been under medical scrutiny, no one has ever asked me about the environmental conditions where I grew up, even though bladder cancer in young women is highly unusual. I was once asked if I had ever worked with dyes or had been employed in the rubber industry. (No and no.) Other than these questions, no doctor, nurse, or technician has ever shown interest in probing the possible causes of my disease-even when I have introduced the topic. From my conversations with other cancers, patients, I gather that such lack of curiosity in the medical community is usual.

Paragraph 11: I take her words as an indictment of the medical and scientific establishment, whose point of view must be changed. Certainly, the lack of curiosity among physicians, scientists, policymakers and politicians has contributed to the epidemic of illness among humans and wildlife alike. An equally talented woman is Terry Tempest Williams, an ecologist and wildlife researcher whose book, Refuge: An Unnatural History of Family and Place, tells the story of her Utah family, whom she “labels “a clan of one-breasted women.” Ms. Williams contrasts the life-affirming awareness Great Salt Lake wildlife refuge against the erosion-of-being, as cancer takes away the women in her family: her mother, her grandmothers, and six aunts. She writes: “I cannot prove that my mother Diane Dixon Tempest, or my grandmothers, Lettie Romney Dixon and Kathryn Blackett Tempest along with my aunts, developed cancer from nuclear fallout in Utah. But I can’t prove that didn’t.”

Paragraph 12: Times are changing. It is becoming impossible to ignore the carnage of endocrine-disruption chemicals, nuclear radiation, and chemical carcinogens, alone and in combination, invading nearly every family with cancer. Facing this reality may be too much for some people, afraid to look, or afraid of being the next victim. The story of cancer is not an easy one, and neither is cancer. But if we do not exert our efforts to prevent this disease, we doom our children and grandchildren to repeat our collective errors. What does it take to change from environmental destruction and random killing to affirmation of life? Can the protection of life for ourselves and our environment be accomplished by women with breast cancer; the women at risk for breast cancer; the families of breast cancer victims? Who should lead? If we citizens can’t and don’t try, what are our alternatives?

QUESTIONS

Q1. The author’s main contention is that
A. wildlife all around the world is being linked to environmental pollution
B. fish, birds, seals and canaries are being exposed to toxic chemicals
C. humans need to understand the link between destroying the planet’s wildlife, through exposure to toxic chemicals, and the destruction of the entire biosphere -which includes human life itself.
D. humans need to understand the link between destroying the planet’s wildlife, through exposure to toxic chemicals, and behavioural abnormalities across all forms of life. ”

Q2. The author states that in an environment of “hormonally active chemicals”
A. males with higher sperm counts may result ‘
B. more male babies are born
C. lower sperm count in males may result in a particular species being wiped out ‘
D. males with more sperm count may result

Q3. Dr Sandra Steingraber, ecologist, poet and scientist:
A. realised that contracting bladder cancer was not due to her alcohol drinking
B. realised her bladder cancer was not due to her smoking
C. believed her bladder cancer was due to environmental contamination
D. doctors, nurses and technicians were very interested in her unusual cancer

Q4. The wildlife researcher, Terry Tempest Williams, sees the dichotomy which exists in the Salt Lake wildlife refuge area:
A. many women in her family have died from breast cancer after a nuclear fallout in Utah
B. many men in her family have died from breast cancer
C. her family have many one-breasted women -unusual for Utah
D. such wide-spread cancer is probably due to environmental, not genetic causes

Q5. Animal observations show:
A. changes in sexual maturity are not only due to a root cause
B. genital abnormalities may be due to a root cause
C. inappropriate hormones adversely affect the development of breast, brain and reproductive organs
D. humans are not similarly affected.

Q6. The author puts forward several ideas about governance except for one of the following:
A. People who participate in elections are not alert and educated enough
B. Unless the wants and needs of the population are known, it is difficult for politicians to govern democratically
C. People being required to vote, to participate in the decision-making process, is a good idea
D. Reading Carson’s book, Silent Spring, should be made compulsory for all voters.

Q7. Rachel Carson’s book Silent Spring, written in 1962, revealed:
A. more had to be done to prevent chemical contamination of the environment
B. there was a link between pesticides, chemicals and cancer
C. chemicals were leading to an inability to reproduce leading to the eradication of entire species of insects, birds, fish and animals
D. all of the above

Q8. Research about xenoestrogens reveals
A. they are everywhere
B. they are harmless
C. they are in our everyday foods
D. they are in our everyday foods and disrupt hormonal function

PART C. TEXT 2

Paragraph 1: A compilation of articles within the British Medical Journal meticulously scrutinises the effectiveness of oseltamivir, more commonly referred to as Tamiflu. This assemblage of scholarly works collectively arrives at a nuanced and significant conclusion — casting an intricate shadow of doubt over the previously asserted efficacy of Tamiflu. The skepticism arises from a meticulous analysis encompassing ten pivotal drug company trials. Specifically, these trials were intended to substantiate the claims that oseltamivir diminishes the risk of complications in otherwise healthy adults grappling with influenza. The intricacies unearthed in this comprehensive examination intricately challenge the hitherto uncontested efficacy of Tamiflu, injecting a layer of uncertainty into its purported ability to stave off complications, particularly in individuals without pre-existing health conditions.

Paragraph 2: The use of meta-analysis is governed by the Cochrane review protocol. Cochrane Reviews investigate the effects of interventions for prevention, treatment and rehabilitation in a healthcare setting. They are designed to facilitate the choices that doctors, patients, policy makers and others face in health care. Most Cochrane Reviews are based on randomized controlled trials, but other types of evidence may also be taken into account, if appropriate.

Paragraph 3: If the data collected in a review are of sufficient quality and similar enough, they are summarised statistically in a meta-analysis, which generally provides a better overall estimate of a clinical effect than the results from individual studies. Reviews aim to be relatively easy to understand for non-experts (although a certain amount of technical detail is always necessary). To achieve this, Cochrane Review Groups like to work with “consumers”, for example patients, who also contribute by pointing out issues that are important for people receiving certain interventions. Additionally, the Cochrane Library contains glossaries to explain technical terins.

Paragraph 4: Briefly, in updating their Cochrane review, published in late 2009. Tom Jefferson and colleagues failed to verify claims, based on an analysis of 10 drug company trials, that oseltamivir reduced the risk of complications in healthy adults with influenza. These claims have farmed a key part of decisions to stockpile the drug and make it widely available.

Paragraph 5: Only after questions were put by the BMJ and Channel 4 News has the manufacturer Roche committed to making “full study reports” available on a password protected site. Some questions remain about who did what in the Roche trials, how patients were recruited, and why some neuropsychiatric adverse events were not reported. A response from Roche was published in the BMJ letters pages and their full point by point response is published online.

Paragraph 6: Should the BMJ be publishing the Cochrane review given that a more complete analysis of the evidence may be possible in the next few months? Yes, because Cochrane reviews are by their nature interim rather than definitive. They exist in the present tense, always to be superseded by the next update. They are based on the best information available to the reviewers at the time they complete their review. The Cochrane reviewers have told the BMJ that they will update their review to incorporate eight unpublished Roche trials when they are provided with individual patient data.

Paragraph 7: Where does this leave oseltamivir, on which governments around the world have spent billions of pounds? The papers in last year’s journal relate only to its use in healthy adults with influenza. But they say nothing about its use in patients judged to be at high risk of complications- pregnant women, children under 5, and those with underlying medical conditions; and uncertainty over its role in reducing complications in healthy adults still leaves it as a useful drug for reducing the duration of symptoms. However, as Peter Doshi points out on this outcome it has yet to be compared in head-to-head trials with non-steroidal inflammatory drugs or paracetamol. And given the drug’s known side effects, the risk-benefit profile shifts considerably if we are talking only in terms of symptom relief.

Paragraph 8: We don’t know yet whether this episode will turn out to be a decisive battle or merely a skirmish in the fight for greater transparency in drug evaluation. But it is a legitimate scientific concern that data used to support important health policy strategies are held only by a commercial organisation and have not been subject to full external scrutiny and review. It can’t be right that the public should have to rely on detective work by academics and journalists to patch together the evidence for such a widely prescribed drug. Individual patient data from all trials of drugs should be readily available for scientific scrutiny.

QUESTIONS

Q1. A cluster of articles on oseltamivir in the British Medical Journal conclude—–
a. complications are reduced in healthy people by oseltamivir
b. the efficacy of Tamiflu in now in doubt
c. complications from pandemic influenza are currently uncertain
d. a series of articles supporting Tamiflu

Q2. Cochrane Reviews are designed to _
a. set randomized controlled trials to specific values
b. compile literature meta-analysis
c. peer review articles
d. influence doctors’ choice of prescription

Q3. According to the article, which one of the following statements about Tamiflu is FALSE?
a. The use of randomized controls is suspect
b. The efficacy of Tamiflu is certain
c. Oseltamivir induces complications in healthy people
d. Cochrane reviews are useful when examining the efficacy of Tamiflu

Q4. According to the article, Cochrane Review Groups _
a. like to work for “consumers”.
b. are being overhauled.
c. use language suitable for expert to expert communication.
d. evaluate a clinical effect better than individual studies.

Q5. Which would make the best heading for paragraph 4?
a. Analysis of 10 drug company trials
b. The stockpiling of Oseltamivir
c. Risk of complications in healthy adults
d. Tamiflu claims fail verification

Q6. According to the article, which one of the following statements about Roche is TRUE?
a. Full study reports were made freely available on the internet
b. Patients were recruited through a double-blind trial
c. The identities and roles of researcher in the Roche trials are not fully accounted for
d. Not all neuropsychiatric adverse events were reported

Q7. Cochrane reviews should _
a. use a more complete analysis
b. not be published until final data is available
c. be considered interim rather than definitive advice
d. be superseded by a more reliable method of reporting results

Q8. Which would make the best heading for paragraph 7
a. Risk-benefit profile of Tamiflu
b. Studies limited to healthy adults
c. High risk of complications –
d. Oseltamivir only for high-risk patients

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Show answers
Aspirin Resistance

Part A

01. B

02. C

03. B

04. A

05. A

06. D

07. C

08.100MG

09. lbuprofen therapy patients

10. Clopidroel

11. Aspirinated platelets

12. 75 – 150mg

13. CAPRIE

14. Antithrombotic

15.5-45%

16. Cox-2

17. Cardiovascular death

18. Biosynthesis

19. Compliance

20. Aspirin

Part B

01. C

02. B

03. B

04. A

05. C

06. A

PART C (TEXT 1}

1. C

2. C

3. C

4. D

5. C

6. A

7. D

8. D

PART C (TEXT 2}

01. B

02. B

03. B

04. D

05. D

06. A

07. C

08. A

Aspirin overdose OET Reading

January 4, 2024 jomon Leave a comment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

PART C. TEXT: 2 ADHD

It’s one of the most common disorders of childhood, affecting an estimated 3 to 5 per cent of Australian schoolchildren, but few topics in children’s health arouse more controversy than Attention Deficit/Hyperactivity Disorder – or ADHD. Formerly known as Attention Deficit Disorder or ADD, ADHD is characterised by difficulties staying focused and paying attention, ‘problem’ behaviour and hyperactivity. ADHD is three times more common in boys than in girls, and symptoms usually emerge before the child starts school.

Skeptics may dismiss the condition as being nothing more than childhood exuberance and energy, but child behaviour experts have longed acknowledged that ADHD represents behaviour well outside the youthful norm. There is on-going debate about the best diagnostic criteria for ADHD, especially now that it is recognised that in a significant number of people, childhood ADHD can persist into adulthood. The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) has been revised to include diagnostic criteria not only for children, but also for adolescents and adults.

Another aspect of the controversy is that ADHD is usually treated with a class of drugs – psychostimulants – that are considered addictive and dangerous in adults (although it is also argued that this is high dose related, and less likely to occur with oral medications, because of slow absorption). However, those who have lived their lives with ADHD, or with an affected child, say that accurate diagnosis and treatment of the disorder has transformed their lives, enabling them to function normally. It’s one of the most common disorders of childhood, affecting an estimated 3 to 5 per cent of Australian schoolchildren, but few topics in children’s health arouse more controversy than Attention Deficit/Hyperactivity Disorder – or ADHD.

A diagnosis of ADHD is usually made by a paediatrician or child psychiatrist, who will take a detailed developmental history from the parents. The specialist will also talk to the child, and assess their functioning in a range of environments, such as home and school. Sometimes the child’s teacher will also be asked to fill in a questionnaire.

It is important that the specialist is able to rule out other factors or undiagnosed conditions that might be responsible for the symptoms, for example, middle-ear infections causing hearing problems, or significant life events, such as a divorce, that might be affecting the child. Doctors should take a careful history of the child’s family and social background to see whether things like upbringing and parental factors are the cause of the symptoms before a diagnosis of ADHD is made. It shouldn’t be made after a single session with the child.

For a positive diagnosis the symptoms need to have lasted for at least six months, started before the child was seven, and be causing problems at home and school. Children must present with at least six symptoms from either (or both) the inattention group of criteria and the hyperactivity and impulsivity criteria, while older adolescents and adults (over age 17 years) must present with five for a diagnosis of ADHD to be made.

Because all two- to three-year-olds (and many four- and five-year-olds) are impulsive and inattentive, the symptoms must be shown to slow the child’s ability to learn, socialise or function before an ADHD diagnosis is given. Deciding whether a child has the characteristics of ADHD can be very subjective. There’s no sign of physical abnormality in these children, and there is no test to prove that a child has the condition.

However, in 2013, US regulators approved the first brain wave test for attention deficit hyperactivity disorder for children age six to 17 years. The new test, known as the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, measures electrical impulses given off by neurons in the brain. It can help confirm an ADHD diagnosis or help decide if further treatment should focus on other medical or behavioural conditions that produce symptoms similar to ADHD. ADHD may also overlap with other conditions, such as oppositional behaviour and with a learning disability. The latter may need an educational assessment and remediation.

Pediatricians may differ in how often they will diagnose ADHD, and sometimes it will come down to which pediatrician or child psychiatrist the child sees as to whether the diagnosis of ADHD is made. It can help parents to do some research on the condition, through reading books and evidence-based articles online, talking to experts or attending workshops, before accepting the diagnosis.

Questions 15-22
15. What is the author’s view on ADHD from the first paragraph?
A. ADHD is not a severe disorder to be afraid
B. It is the most common disorder in teens
C. It is identified with learning difficulties in children
D. It is less frequent in boys
16. Why does the need for the best diagnostic criteria for ADHD aroused?
A. Because of criticism by skeptics
B. The nature of ADHD
C. Prevalence of ADHD in large number of children
D. Based on samples collected from research
17. What do you understand from the third paragraph?
A. ADHD is less likely to impact children’s mental status
B. ADHD is not been treated as a dangerous disorder
C. The impact of other child disorders will undermine ADHD
D. No appropriate diagnosis and treatment for ADHD is available
18. Who will do the primary diagnosis of ADHD in children?
A. Paediatrician
B. child’s teacher
C. specialist
D. parents
19. Why doctors shouldn’t make determination of ADHD after a single session with the child?
A. It cannot be determined with some symptoms
B. ADHD determination requires through study over child’s behaviour and other social aspects
C. May be area of other symptoms unidentified with ADHD
D. Unable to determine the impacts of early determination of ADHD
20. What do you understand from the last sentence in the 7th paragraph?
A. It doesn’t include many other aspects of determining ADHD
B. It focuses mainly on analysing the impact of ADHD
C. No appropriate test for diagnosis of ADHD
D. Abnormal behaviour of children is essential in determining ADHD
21. What does the word “it” in the 8th paragraph refers to?
A. NEBA system
B. Electric impulses
C. Hyperactivity
D. Neurons
22. Who does the word “they” refers to?
A. Teachers
B. Children
C. Paediatricians
D. Child Specialists

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

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Appendicitis OET reading test

December 16, 2023 jomon Leave a comment

PART A.

TEXT A: Appendicitis is acute inflammation of the appendix, the thin pouch attached to the large intestine on the right side of the abdomen. It is usually about the size of a finger. The exact cause of appendicitis is not known. Some people think the appendix becomes obstructed during a bout of appendicitis. Others believe it is an obstruction that causes appendicitis. Regardless, the result is an obstruction of the appendiceal lumen, possibly by faeces, foreign body, or even worms. There are no medically proven ways to prevent appendicitis and there is no known diet to prevent appendicitis. Many people treated for acute appendicitis may have had previous episodes of appendicitis that they did not seek treatment for. Appendicitis can occur at any age, but is most common in children and young adults. In 2013, Australia’s rate of appendicectomy was among the highest in the Organisation for Economic Co-operation and Development (OECD). Rates per 100,000 population were 194 in South Korea, 177 in Australia, 168 in Germany, 139 in New Zealand, 105 in Canada and 94 in the United Kingdom. Appendicectomy was the most common emergency surgery performed in public hospitals in 2014–15. In 2014– 15, approximately 30,000 appendicectomies were performed in public or private hospitals as a result of an emergency admission.

TEXT B. Symptoms and diagnosis of appendicitis: Appendicitis typically starts with a pain in the middle of the abdomen that may come and go. Within hours, the pain travels to the lower right-hand side, where the appendix is usually located, and becomes constant and severe. Some people’s appendix may be located in a slightly different part of their body, such as: the pelvis; behind the large intestine or around the small bowel. The pain may be worsened by pressing around the area, coughing, or walking. Other symptoms include: nausea and/or vomiting; anorexia; diarrhoea; pyrexia or a flushed face. Diagnosing appendicitis can be tricky because the typical symptoms are only present in about half of all cases. Some people develop pain similar to appendicitis, but it’s caused by something else, such as: •Gastroenteritis;•Severe irritable bowel syndrome; •Constipation,•Ectopic pregnancy, •A urine infection History taking and abdominal examination to see if the pain gets worse when pressure is applied to the appendix area are usually sufficient to diagnose appendicitis. Further tests may involve: a blood test to look for signs of infection; a pregnancy test for women; a urine test to rule out other conditions, such as a bladder infection; an ultrasound scan to see if the appendix is swollen or a computerised tomography (CT) scan.

TEXT C. Managing appendicitis: Medical advice should be sought for ongoing abdominal pain, and if the pain suddenly gets worse, emergency transfer to hospital is required. If appendicitis is strongly suspected, the appendix is surgically removed as an emergency, without full investigation rather than run the risk of it bursting. This means some people will have their appendix removed even though it’s eventually found to be normal. This is called a negative appendicectomy. Surgery may be laparoscopic or open.
An alternative to immediate surgery is the use of antibiotics to treat appendicitis. However, studies have looked into whether antibiotics could be an alternative to surgery. As yet there isn’t enough clear evidence to suggest this is the case.
In some cases where a diagnosis is not certain and symptoms are not too severe, a doctor may recommend waiting up to 24 hours to see if symptoms improve, stay the same, or get worse. Sometimes appendicitis can lead to the development of a lump on the appendix called an appendix mass. This lump, consisting of appendix and fatty tissue, is an attempt by the body to deal with the problem and heal itself. If an appendix mass is found during an examination, your doctors may decide it’s not necessary to operate immediately. Instead, a course of antibiotics is given and an appendicectomy is performed a few weeks later, when the mass has settled. Without surgery or antibiotics, the mortality rate for appendicitis is 50%. With early surgery, the mortality rate is < 1%, and convalescence is normally rapid and complete. With complications such as rupture and development of an abscess or peritonitis and/or advanced age, the prognosis is worse: Repeat operations and a long convalescence may follow.

TEXT D. Potential complications from appendicitis: The obstruction of the appendix can lead to distention, bacterial overgrowth, ischemia, and inflammation. If untreated, necrosis, gangrene, and perforation occur. If the appendix perforates or bursts, it releases bacteria into other parts of the body. This can cause peritonitis if the infection spreads to the peritoneum, the thin layer of tissue that lines the inside of the abdomen. If peritonitis isn’t treated immediately, it can cause long-term problems and may even be fatal. Sometimes an abscess forms around a burst appendix. This is a painful collection of pus that occurs as a result of the body’s attempt to fight the infection. It can also occur as a complication of surgery to remove the appendix in about 1 in 500 cases. Abscesses can sometimes be treated using antibiotics, but in the vast majority of cases the pus needs to be drained from the abscess. Wound infection can occur after surgery. The risk of this is less for people who have a laparoscopic appendicectomy.

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. Where the appendix is usually found?
2. The adverse situations a person may experience if they have appendicitis?
3. Appendicitis can be avoided?
4. An unnecessary appendicectomy?
5. The surgical approach the keeps infection risk low?
6. The way a person’s body can try and manage appendicitis itself?
7. The prevalence of appendix removals in Australia?

Questions 8-14. Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.
8. The number of people who would die from appendicitis without modern treatments?
9. How big is a healthy appendix in most people?
10. Where does pain usually start if a person has appendicitis?
11. If an appendix ruptures, what condition could develop in the membrane of the tummy?
12. What drugs can be used instead of surgery if a person has appendicitis?
13. If an inflamed appendix is left alone, it might burst and what other conditions might develop?
14. What is the appendix usually attached to?

Questions 15-20. Complete each of the sentences, 15-20, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.
15. After a few hours of appendicitis developing, the _______________ to the lower right-hand side of the abdomen.
16. An _______________ can envelop a burst appendix
17. Some believe an appendix _______________ in an episode of appendicitis.
18. A doctor examines a patient’s tummy to find out if the _______________ when they press around the appendix
19. An accumulation of ___________ can develop as the body tries to get rid of any infection.
20. It is not always easy to confirm a person has appendicitis because the ______________only show up about 50% of the time.

PART B
TEXT 1. Loneliness Is Harmful to Our Nation’s Health: It has long been recognized that social support—through the availability of nutritious food, safe housing and job opportunities—positively influences mental and physical health. Studies have repeatedly shown that those with fewer social connections have the highest mortality rates, highlighting that social isolation can threaten health through lack of access to clinical care, social services or needed support. However, how the subjective sense of loneliness (experienced by many even while surrounded by others) is a threat to health, may be less intuitive. It is important to recognize that feelings of social cohesion, mutual trust and respect, within one’s community and among different sections of society, are all crucial to well-being. Perhaps this is especially so at a time of great social polarization exacerbated by contentious politics and vitriolic TV news.

1) What does the reader learn about loneliness in the following article?
a) a person’s sentiments may be more important than objective factors
b) feelings of solitude are increasing in modern society
c) the government should provide more services in order to reduce social isolation

TEXT 2. Introduction to Recurrent Abdominal Pain: Recurrent abdominal pain (RAP) in children describes recurring abdominal pain without organic cause. It presents commonly in general practice and it causes a great deal of school absence and considerable anxiety. Most cases can be managed in primary care. Medication is not normally needed. The initial approach adopted by primary care doctors is crucial to successful management. It involves thorough history and examination skills, understanding and awareness of red flags which suggest organic pathology, and the knowledge and consulting style that offer a clear and empowering approach to patients, whilst avoiding unnecessary investigation. RAP is believed to be a functional gut-brain interaction disorder caused by altered feedback mechanisms between the gut and central pain pathways.

2) The writer uses the words ‘red flags’ to indicate
a) an example of colour codes used in pathology diagnosis
b) a patient has a mental illness (an informal term used by healthcare workers)
c) symptoms which may point to a more serious medical condition

TEXT 3. Emotional Intelligence and Nursing: The concept of emotional intelligence (EI or EQ) emerged over 20 years ago and still applies today. Emotional intelligence is described as the ability to monitor or handle one’s own emotions as well as the emotions of others. Emotional intelligence involves recognizing feelings, self- monitoring or awareness, how emotions impact relationships and how they can be managed. Studies have shown that there is a correlation between emotional intelligence and positive patient outcomes. This includes clinical outcomes, patient satisfaction and the ability to develop therapeutic relationships. Team performance and morale have also been found to be related to emotional intelligence, including positive conflict resolution rather than hostile environments or horizontal violence. Nursing retention, job satisfaction, and engagement have also been associated with emotional intelligence.

3) Which of the following statements is not true?
a) there is a link between emotional intelligence and lower rates of recruitment
b) although beneficial for nursing staff, emotional intelligence has little effect on patients
c) emotional intelligence is a relatively new idea

TEXT 4. Arsenic Trioxide Recommendations: Arsenic trioxide is recommended, within its marketing authorisation, as an option for inducing remission and consolidation in acute promyelocytic leukaemia in adults with untreated, low-to-intermediate risk disease and for patients with relapsed or refractory disease, after a retinoid and chemotherapy. People with untreated, low- to-intermediate risk acute promyelocytic leukaemia are given ATRA plus chemotherapy. Clinical trial evidence shows that arsenic trioxide plus ATRA is effective for untreated disease. Some assumptions in the model, such as the long- term effect of treatment, lead to the cost- effectiveness analyses being uncertain. Arsenic trioxide is already used to treat relapsed or refractory acute promyelocytic leukaemia. The clinical- and cost-effectiveness evidence for arsenic trioxide in relapsed or refractory disease is uncertain, because the clinical trial was small and did not compare arsenic trioxide with other treatments.

4) What is inconclusive about the use of arsenic trioxide?
a) if it represents good value for money
b) if it can be used effectively with intermediate-risk leukaemia patients
c) if arsenic trioxide can be used with treatments other than ATRA therapy

TEXT 5. Who Should Not Be Immunised? Immunisations are generally very safe and effective. The main reasons for a person not to have a vaccine is if they have had a severe allergic reaction to a previous dose of that vaccine or to an ingredient in the vaccine that was also present in a different vaccine. People who have had very severe allergic reactions to egg should not have the yellow fever or flu vaccines other than under specialist care as there may be small amounts of egg protein in these vaccines. Certain vaccines are not usually given to women who are pregnant. They may not be suitable for people who are immunosuppressed. If you are unwell with a high temperature (fever), vaccination is usually put off until you are well again. Question

5) Which of the following statements is not mentioned?
a) some vaccine components can cause an allergic reaction
b) expectant mothers may need to postpone a vaccination
c) some vaccines are developed from the yellow part of eggs

TEXT 6. New Drug Class Available for Eczema: The new drug, Eucrisa, is a topical ointment that contains a phosphodiesterase 4 enzyme inhibitor that helps reduce symptoms of itchiness and inflammation caused by atopic dermatitis. Atopic dermatitis (AD), also known as eczema, is a skin condition experienced in 10-12% of children and 0.9% of adults in the United States. Diagnosis almost always occurs in infancy and childhood. Pruritus is considered the hallmark symptom of AD, as there is no objective test or biomarker that is used for diagnosis. Other symptoms include dry skin and erythema. The most common spots for lesions to occur are inside the elbows and knees, and on the hands and feet. It also can present on the skin around the eyes, eyelids, eyebrows and lashes.

6) What do we learn about pruritus from the following article?
a) pruritus is experienced by 0.9% of adults in the United States
b) pruritus has been superseded by the new treatment, Eucrisa
c) pruritus is the defining characteristic of atopic dermatitis

PART C. TEXT 1

When it comes to summer skincare, most of us feel pretty clued-up. But according to Cancer Research UK, rates of skin cancer are on the rise. Yet, 9 out of 10 cases could be prevented by staying safe in the sun. We look at sun protection mistakes you might be making.

With a variety of products available all promising to keep us safer in the sunshine, it’s no surprise that many of us believe sunscreen offers the best protection during the hot weather. However, we need to combine the use of this product with other forms of sun protection. “One of the biggest mistakes people make is to rely on sunscreen alone as their sole protection,” says Emma Shields, senior health information officer at Cancer Research UK. “However, it’s best to use sunscreen in combination with time in the shade when the sun is strong, wearing a hat, covering up and wearing sunglasses.”

Many of us associate a golden glow with good health, but when it comes to sun- tanning, appearances can be deceptive. “There’s no such thing as a safe tan. In fact, any change in skin colour is a sign of damage.” Shields claims. Consultant dermatologist Dr Daniel Glass of The Dermatology Clinic in London adds “Often, people associate sun-kissed skin with good health, but in fact, UV exposure will account for over 75% of skin ageing. In addition, the extra sun exposure may increase the risk of skin cancer later in life.”

So, we get a little burnt, but if we slap on some after-sun lotion, that will repair the skin, right? Well, no. According to Shields, whilst after-sun lotion products “might help to soothe the skin, they don’t undo the damage.” However, Shields is quick to reassure that skin damage caused by mild sunburn can usually be dealt with by the body’s own healing processes. “Your body does have its own repair mechanisms that can fix sun damage,” she explains.

When we expose vulnerable areas such as the tops of our ears or our nose, it may be tempting to opt for a total block product. However, whilst such a product may look highly protective and usually offers an impressive level of protection, the name is a little misleading. “There is no such thing as a total block, as no cream can prevent all UV rays,” explains Dr Stephanie Munn, dermatology clinical lead at Bupa UK. However, sunblock does provide a good level of protection, when used effectively. “Sunblock is a physical sunscreen such as titanium oxide or zinc oxide which blocks out the UVB rays by acting as a physical barrier, as opposed to sunscreen which absorbs UVA. Sunblocks are less cosmetically acceptable as they create a chalky layer on the skin but are better tolerated on sensitive skin so are preferable to children,” adds Munn.

With the price of sunscreen often on the high side, it can be tempting to dig out last year’s bottle and use it up before restocking. But using an out-of-date or badly stored product could mean that your skin isn’t fully protected. “You should discard any sunscreen after it has been open for a year,” agrees Munn. “Some sunscreens include an expiration date too – so make sure you discard any that go past this.” In addition, that bottle of sunscreen you’ve left in the garden, might not offer the protection it once did. “Leaving your sunscreen in the heat can cause it to break down faster, making it less reliable,” explains Munn. “You’re putting your skin at risk, as you won’t know what the SPF is. Once it’s overheated, you won’t be as protected so it’s important to keep your sunscreen in the shade.”

It can be tempting to think that darker skin, or skin that is already tanned, doesn’t need protection. However, this is not the case. “Anyone can get sunburn, including dark-skinned people,” explains Shields. “Although generally the fairer your skin is, the more you are at risk. The same sun prevention risk applies to everyone, but some people need to be more careful.”

It’s lovely to feel the sun’s rays on your skin, so it’s good to know that a little sun exposure can be beneficial to health. Exposure to sunlight can help our bodies to produce vitamin D and avoid deficiency. “We all need the same amount of vitamin D on a daily basis to maintain healthy bones, but the rate our bodies produce the vitamin differs for everyone,” explains Munn. “If you’ve got paler skin, you should aim for a short period in the sun every day for about 10-15 minutes. Those with darker skin will need a little longer. You will still absorb the necessary rays while wearing sunscreen, but you’ll need to stay out for longer.”

Questions 7-14
7) In the introduction, what does the writer infer about summer skincare?
a) Only 10% of people need to use more skincare
b) Some people need clues to know how much protection to use
c) People in general don’t know enough about it
d) 9 out of 10 people should use more sun cream
8) What advice does Emma Shields offer?
a) effective protection involves using the right products and adopting the right behaviour
b) it is important to choose the right kind of sunglasses
c) sunscreen is more effective in hot rather than cold weather
d) you shouldn’t forget about protecting the soles of your feet
9) What do we learn in the third paragraph about sun tans?
a) some kinds of sun tan are perfectly safe
b) in 75% of cases, sun tans are safe
c) sun tanning is a safe activity except for a small risk of skin cancer later in life
d) acquiring a sun tan is a risky activity
10) What does Emma Shields claim regarding after-sun lotion?
a) it cannot provide any remedial remedies
b) the body doesn’t tolerate after-sun lotion as well as it does sun cream
c) after-sun lotion can help the body’s own mechanisms to heal faster
d) it can fix some minor damage to the skin
11) What do we learn about sun block in the fifth paragraph?
a) oxides of titanium or zinc can reflect the sun’s rays
b) it blocks a higher percentage of UV light on young skin
c) sun block that contains chalky substances can be used on children
d) it isn’t as effective as most people assume.
12) What advice does Dr Munn give in the sixth paragraph?
a) low factor sunscreen can be stored for longer periods than high factor sunscreen
b) each summer, it is worth buying new sunscreen
c) sunscreen should be stored in a refrigerator or similar low-temperature environment
d) restocking sunscreen should take into account expiration dates
13) What danger does the last paragraph highlight?
a) although they feel nice, the sun’s rays always present a risk to health
b) people with pale skin often do not produce enough vitamin D
c) exposure to the sun in winter is just as dangerous as during the summer
d) sunscreen can interfere with normal vitamin D production
14) What would be a suitable title for this article?
a) The New Dermatological Crisis
b) Sunscreen, Sun Cream and Sun Block – A User’s Guide
c) How to Use Sun Cream and Sunbathe Safely
d) Sun Tanning – Changes in Recent Medical Opinion

PART C. TEXT 2

With the decreasing global boundaries and increasing activities, travel medicine has become a rapidly evolving field of medicine. Classically, travel medicine focused on individuals traveling to developing countries with prevention and treatment of malaria, traveller’s diarrhoea, and general vaccinations as its primary goal. Travel medicine has subsequently become a dynamic multidisciplinary specialty that encompasses aspects of infectious disease, public health, tropical medicine, wilderness medicine, and appropriate immunization. Although these aspects are broad in reach, they are tightly integrated within the realm of travel medicine and require appropriate understanding prior to venturing out. Therefore, whether you are a humanitarian aid worker in Tanzania, a volunteer working in the Ebola-stricken areas of West Africa, a tourist, or a businessperson for a multinational corporation, understanding the dynamics of travel and the interplay of healthcare will minimize the adverse effect of travel-related illnesses and concerns while maximizing enjoyment and success for the trip.

The specialty of travel medicine is dynamic and vast in its medical knowledge requirements, as it focuses on the prevention and management of health issues related to global travel. Areas of expertise include vaccinations, epidemiology, region-specific travel medicine, pre-travel management and travel-related illnesses. This increasing globalization of travel facilitates increased health exposures in different environments and the potential spread of disease.

Collaborative sentinel surveillance networks specifically to monitor disease trends among travellers offer new supplemental options for evaluating travel health issues. These networks can inform pre-travel and post-travel patient management by providing complementary surveillance information, facilitating communication and collaboration between participating network sites, and enabling new analytical options for travel-related research. TropNetEurop and GeoSentinel represent two major networks currently available. Data obtained from studying health problems among travellers may provide significant benefits for local populations in resource- limited countries. However, given their limitations, they should be considered as complementary tools and not relied on as an exclusive basis for evaluating health risks among travellers.

With a heightened interest in adventure travel, international destinations, and ecotourism, more patients return from vacations with presentations of possible exotic disease that are beyond the scope of a primary care or emergency physician’s daily practice. However, many of the illnesses encountered could be eliminated with adequate pre-travel education and preparation. In the circumstance when prophylactic treatment and lifestyle modification fail, physicians need to know what to look for and where to find information on exotic diseases beyond the scope of daily practice. Further information can be quickly and easily accessed through the CDC Yellow Book, an online resource providing country-specific information related to endemic diseases.

Whether the participant is on an excursion to Nepal, is serving at a medical mission in Belize, or is the adventure-seeking traveller, preparation is paramount to a successful venture. All people planning travel should become informed about the potential hazards of the countries they are traveling to and learn how to minimize any risk to their health. Forward planning, appropriate preventive measures, and careful precautions can substantially reduce the risks of adverse health consequences. Although the medical profession and the travel industry can provide a great deal of help and advice, the traveller is responsible to ask for information, to understand the risks involved, and to take the necessary precautions for the journey.

Travellers should ascertain the associated travel health information for their specific itinerary several months in advance of departure. This should include general health information such as vaccine requirements, prophylactic medications, disease outbreaks, political environment, and medical resources. As can be seen, this includes but is not limited to a pre-travel medical consultation and evaluation.

Improvisation (i.e., creative use of unusual supplies for diagnosing, treating, splinting, transporting) is an invaluable skill taught in Wilderness Medical Society (WMS) and other similar courses. Efficient selection and knowledge of medications lightens the medical kit. For example, rather than carrying multiple antibiotics of choice for several possible infections, consider carrying a medication, such as ciprofloxacin, which despite some growing resistancy issues, treats travellers’ diarrhoea (TD) as well as respiratory, wound, bladder, and other infections. Another example is diphenhydramine, which is excellent as an injectable local anaesthetic as well as treatment for nausea, allergic reactions, and insomnia.

In anticipation of upcoming travel, it is essential that one is well educated regarding the regions that will be visited and how one’s current level of health may be impacted. Vaccinations are a vital part of any preparatory process. Once the regions of anticipated travel are identified, scheduling a visit to one’s doctor or a travel medicine provider is essential—ideally 4-6 weeks before the trip because most vaccinations require a period of days or weeks to become effective. Reviewing current recommendations for the region of travel is recommended prior to the scheduled medical appointment. In addition, if uncertain regarding previous immunizations, variable tests are available to identify appropriate titer levels and whether updated boosters are indicated.

Questions 15-22

15) In the first paragraph, the example of Ebola is given to show
a) an example of a disease that falls under the category of wilderness medicine
b) not all diseases have a vaccine
c) an example of a disease that may occur in an area where a travel medicine beneficiary could be present
d) travel medicine can prepare you for any and all eventualities
16) What is one effect of the globalization of travel?
a) it has increased the possibilities for health problems
b) the field of epidemiology has had to develop quickly
c) it has resulted in better healthcare facilities
d) it has exposed existing diseases to new environments
17) Increased disease monitoring has led to
a) specific surveillance of certain disease groups
b) advantages to both travellers and individual countries
c) better quality analytical tools for healthcare workers
d) a vast increase in exploitable medical knowledge
18) When do doctors need to find information on exotic diseases?
a) when preventative measures are unsuccessful
b) when travellers remain uneducated
c) when they have limited access to the CDC Yellow Book
d) when they are vacation in exotic destinations
19) What does the fifth paragraph inform the reader concerning responsibility?
a) the medical profession has the responsibility to give specific advice
b) the onus is on the traveller to investigate possible dangers
c) excursion organisers are normally responsible for medical hazard analysis
d) individual countries are responsible to publicize specific health-related hazards
20) Which of the following statements is not mentioned in the sixth paragraph?
a) it is important to prepare well in advance
b) before starting their journey, travellers should see a medical professional
c) travellers should obtain items to ensure safe sexual contact (such as condoms)
d) travellers should be well-informed about conditions in their destination countries or regions
21) What advice is given about medical kits?
a) it may be necessary to carry unusual supplies
b) ciprofloxacin is preferable to diphenhydramine despite resistancy issues
c) it is a good idea to pack injectable local anaesthetic
d) preference should be given to versatile medicines
22) What does the eighth paragraph inform the reader about preparations?
a) trips longer than 4-6 weeks need vaccination boosters
b) preventative actions need to be taken one to two months before travel
c) effective vaccines should be used rather than those that require boosters

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