Tag Archives: OET reading

ANGINA PECTORIS OET READING

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

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


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



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


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



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


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

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

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

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


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

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

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

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

Text 1: Ebola Virus and Marburg Virus


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

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

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

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

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

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

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

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

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

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

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

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

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

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



Text 1: Questions 7-14


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

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

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

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

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

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

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

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



PART C Text 2: A Chronic Disease – Atopic Dermatitis

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

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

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

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

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

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

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

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

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

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



Text 2: Questions 15 to 22

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

VIEW ANSWER KEYSOET READINGOET SPEAKINGOET ROLE PLAYSOET LETTER WRITINGOET LISTENING

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ANGINA PECTORIS OET READING ANSWERS

1 C
2 A
3 B
4 C
5 D


6 D
7 B
8 CHEST PAIN
9 SEDENTARY LIFESTLYE
10 CARDIOVASCULAR DISEASE


11 THARRUBOLYTIC THERAPY / ANTICOAGULANTS
12 UNNECESSARY TESTS.
13 BEDREST/CHAIR REST
14 EXERCIRE ECG
15 PIC


16 LVSD
17 AFRICAN – AMERICAN
18 INTRAORTIC BALLON PUMP
19 CIGERETTE SMOKING
20 2G



READING SUB – TEST – ANSWER KEY LIVING WILL -2
1. C
2. A
3. A
4. B
5. B
6. B


PART C: QUESTIONS 7-14 Ebola Virus and Marburg Virus
7. C
8. D
9. B
10. D
11. D
12. C
13. A
14. B


PART C: QUESTIONS 15-22. A Chronic Disease – Atopic Dermatitis
15. C
16. D
17. D
18. B
19. A
20. A
21. C
22. C


ANGINA PECTORISOET READINGOET SPEAKINGOET ROLE PLAYSOET LETTER WRITINGOET LISTENING

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ASPIRIN OVERDOSE OET READING

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OET READINGOET SPEAKINGOET LETTER WRITINGOET LISTENING

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APPENDICITIS OET READING TEST

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OET READINGOET SPEAKINGOET LETTER WRITINGOET LISTENING

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TREATMENT OF FRACTURES OET READING ANSWERS

Part A – Answer key 1 – 7 

1: D

2: B

3: D

4: C

5: A

6: A

7: C 

Part A – Answer key 8 – 14

8: Pre-emptive analgesia

9: After healing

10: Pain

11: Sling

12: Internal fixation

13: medications knowledge

14: Closed manipulation 

Part A – Answer key

15 – 20 15: DVT

16: mal-union

17: several injuries

18: useful sensation

19: fat embolism

20: fractured bone 

Reading part B – answer key 

Questions 1-6 

1: Wall sphygmomanometer

2: Indications for using the Powerheart AED G3

3: NAFLD is more prevalent in Middle East.

4: Impact Of Delirium On ICU Patient

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

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

Reading test – part C – answer key 

Text 1 – Answer key 7 – 14 

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

Text 2 – Answer key 15 – 22

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

16: MMR is an example of effective combined vaccine.

17: Immunogenicity of the prepared vaccines.

18: Antigen role

19: Antigen competition

20: Combined vaccines often produce different results.

21 : Various combinations bring in various results.

22: Combined vaccine helps with retaining immunogenicity. 

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TEMPOROMANDIBULAR DIORDER OET READING

TEXT A: The temporomandibular joint (TMJ) is one of the most frequently used joints of the human body. It is used when speaking, chewing, yawning, swallowing and other activities during the day and even in sleep. The frequency of movement is assessed as about 1500-2000 times a day. The term ‘temporomandibular disorder’ (TMD) stands for a number of disorders related to the masticatory muscles or the TMJs and related structures. In the greatest number of cases, the cause of temporomandibular disorder is a disturbance of function in the form of increased muscular tonus and myofascial trigger points. It is essential to start treatment at the stage of mere dysfunction, i.e., at the stage when the changes are still reversible, in order to prevent irreversible structural changes. According to epidemiological statistics, 70% of the randomized population suffers from at least one symptom or sign of TMD, but only one fourth of this number is aware of it and only 5% seeks medical treatment.

TEXT B: Symptoms: Dull aching pain, which varies in strength from mild to severe, is the most common symptom associated with TMJ disorders. The pain is usually felt in the jaw, but can also be felt in the surrounding areas, including the face, ear, and even the teeth. The pain may also radiate to the neck or shoulders, and is usually made worse by chewing and moving your jaw. Other signs and symptoms associated with TMJ disorders include:
• jaw tenderness;
• jaw clicking, or popping, when you open and close your mouth or chew;
• a grating sensation when chewing;
• an uncomfortable or uneven bite; and
• jaw locking (an inability to open or close the mouth completely).
TMJ disorders can be temporary or chronic, but only a small proportion of people develop significant, long-term problems. Women tend to be affected by TMJ disorders more often than men.

TEXTC: Diagnosis and treatment: A dentist can help identify the source of the pain with a thorough exam and appropriate X-rays. However, for some types of pain, the cause is not easily diagnosed. The pain may be related to the facial muscles, the jaw or the TM joint. Some TMJ problems result from arthritis, dislocation or injury. All of these conditions can cause pain and dysfunction. Muscles that move the joints are also subject to injury and disease. Injuries to the jaw, head or neck might cause some TMJ problems. Other factors relating to the way the upper and lower teeth fit together (the bite) may cause some types of TM disorders. Stress and teeth grinding are also considered as possible factors. There are several treatments for TMJ disorders. They may include stress-reducing exercises, wearing a mouth protector to prevent teeth grinding, orthodontic treatment, medication or surgery. Treatment may involve a series of steps beginning with the most conservative options. In many cases, only minor, non-invasive treatment may be needed to help reduce symptoms.

TEXT D: ABSTRACT: Effectiveness of specific physiotherapy in treatment of TMD. The aim of this study was to evaluate the effect of individual specific physiotherapy in the treatment of temporomandibular disorders, its immediate effect and its effect after two months. The research sample was comprised of 23 subjects, 17 women and 6 men, with an average age of 36.5 years. They complained of pain, sound phenomena and restricted mandibular movements. The patients were first examined by a stomatologist who recommended physiotherapy. The effect of treatment was assessed according to the intensity of pain, the occurrence of reflex changes in soft tissues in the region of the masticatory muscles and digastricus muscle, the range of mouth opening and the intensity of sounds produced by mandibular movements. It was found that after treatment pain was significantly reduced (p<0.001) at the temporomandibular joint (from 4.2 points to 0.7 point on the VAS [Visual Analogue Scale]). There were also fewer reflex changes in the muscles and fascias. The range of mouth opening increased significantly (from 37.3 mm to 41.3 mm, p<0.001) and the intensity of sounds was reduced from 100% to 43% (p<0.001). This state was maintained two months later: intensity of pain (p<0.001), mouth opening (p<0.003) and reduction of sound phenomena (p<0.001). Pain was ameliorated, the intensity of sounds reduced, and the range of movement significantly improved after specific physiotherapy.



For each question, 1-7, decide which text (A, B, C or D) the information comes from.
1 frequently found symptom regarding TMJ disorders?
2 improvements noted after treatment?
3 right time to begin the treatment?
4 ratio of patients to the ones who get medical care?
5 gender-wise prevalence of TMJ disorders?
6 how to reduce the symptoms?
7 role of physiotherapy in the treatment?


Questions 8-14. Answer each of the questions, 8-14, with a word or short phrase from one of the texts


8 Which healthcare professional normally does the diagnosis of TMJ disorders?
9 What is the very common symptom exhibited by TMJ disorders?
10 What does ‘VAS’ stand for based on the information given in the texts?
11 What was the average age of the subjects in the research study?
12 What is the term for the inability to open or close the mouth completely?
13 What type of treatment was offered to the subjects in the research study?
14 Where does a patient suffering from TMJ disorders normally sense the pain?


Questions 15-20. Complete each of the sentences, 15-20, with a word or short phrase from one of the texts.
15 TMJ is one among the more regularly used in our body.
16 Apart from the pain and sound phenomena, the subjects also complained about .
17 An oral guard is used to avoid .
18 Small, may be required to reduce symptoms of TMJ in most cases.
19 TMJ disorders can be or non-permanent.
20 The aching caused by TMJ disorders may also emanate to the .



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

1. According to the extract, the nursing facilities require more physicians, who
A. increase the demand of quality long-term care.
B. lead the clinical decision-making for patients after care.
C. can offer care on-site to nursing facility residents.
Nursing Facility Care: Nationwide, nursing facility care is changing to include not only long-term care of frail residents but also complicated and resource-intensive post-hospital care. The population of people receiving care in nursing facilities is more medically complex as patients are discharged ‘sicker and quicker’ from the hospital to skilled nursing facilities and the hospitals focus on decreasing readmission rates. However, the majority of patients are still long term stay patients who themselves have increased in medical complexity and acuity. Both of these imperatives have resulted in an increased need for highly trained and committed health care practitioners willing to provide care on-site to nursing facility residents. Physician involvement in nursing facilities is essential to the delivery of quality long-term care. Attending physicians should lead the clinical decision-making for patients under their care. They can provide a high level of knowledge, skill, and experience needed in caring for a medically complex population in a climate of high public expectations and stringent regulatory requirements

2. Material-mediated pyrogenicity is not assessed using
A. traditional non biocompatibility extraction method.
B. pyrogenicity test equivalent validated method.
C. material-mediated pyrogenicity testing.
Pyrogenicity: Implants as well as sterile devices having direct or indirect contact with the cardiovascular system, the lymphatic system, or cerebrospinal fluid and devices labeled as “non-pyrogenic,” should meet pyrogen limit specifications. Pyrogenicity information is used to help protect patients from the risk of febrile reaction. There are two sources of pyrogens that should be considered when addressing pyrogenicity. The first, material – mediated pyrogens, are chemicals that can leach from a medical device during device use. Pyrogens from bacterial endotoxins can also produce a febrile reaction similar to that mediated by some materials. Material-mediated pyrogenicity testing is not needed if chemical characterization of the device extract and previous information indicate that all patient- contacting components have been adequately assessed for pyrogenicity. Otherwise, we recommend that you assess material-mediated pyrogenicity using traditional biocompatibility extraction methods, using a pyrogenicity test or an equivalent validated method.

3. What is the purpose of the Staffing Reallocation Plan?
A. reallocate RNs from home unit to another unit to provide needed patient care.
B. balance patient census and care needs with RN competencies and availability.
C. flex RNs who match patient census with patient care needs according to their specialty.
Staffing Reallocation Plan: The Staffing Reallocation policy was revised to ensure a consistent system-wide approach that correlates patient census and patient care needs with RN competencies and availability. The newly standardized process may include reallocating RNs from their home unit to another like unit to provide needed patient care. The policy was reviewed and vetted by nurses at all levels of the organization. A standard icon was created in scheduling and productivity system to easily identify RNs who sign- up for additional shifts to support patient care needs. This allows the nursing division to utilize the most cost-effective staffing resources at the appropriate time for the specific patients requiring care. The Clinical Administrators work collaboratively with the Staffing Resources Office and nursing leadership to reallocate and/or flex RN staff matching patient census with patient care needs and the specialty RNs needed to provide care.



4. If a patient request for an assisted death, nurses must
A. explore the reasons and understand them to seem helpful
B. ensure every opportunity to relieve suffering is offered
C. talk to their superior and team for a formal request
Assisted Death: Every question from a patient about assisted death signifies that the patient is, or is worried about, suffering and is an opening for a dialogue with that individual. It is important for us, as nurses, to explore the reasons for the request in order to understand what supports might be helpful, and whether the patient has unmet needs.
Whether or not, a nurse is prepared to be involved in any way in assisting someone to die, they remain a part of the team caring for the patient. Nurses should advocate for their patients, including the pursuit of aggressive symptom management strategies, to ensure every opportunity to relieve suffering is offered. Nurses should also understand the process for medical assistance in dying, and their professional role in the process. Any nurse could be asked by a patient or family member about assisted death. For some, it might be an exploration of options, or simple information seeking. For others, their questions may indicate intent to pursue an assisted death. Please talk to your supervisor and team if a patient would like to proceed with a formal request.

5. The policy document tells us that the potential toxicity of a component is evaluated by
A. testing the component exclusively.
B. testing the exposure separately.
C. adequate assessment of the material.
Inclusion of Multiple Components: For devices that include components with different lengths of contact, we recommend that any extract-based biocompatibility testing be conducted separately. If the components are combined into a single test article, this will dilute the amount of component materials being presented to the test system and may not accurately identify potentially toxic agents that would have been found if the components were tested separately. For example, we recommend testing implants separately from delivery systems or other kit components. For devices or device components that contain multiple materials with differing surface areas or differing exposure to the body, if one or more materials is new, it may also be necessary to test the new material components separately as well, to further understand the potential toxicity of this component. For example, for a catheter-based delivery system that contains a new balloon material, tests of the delivery system separate from the balloon may be necessary to ensure adequate assessment of each of the materials.

6. What is being described in this extract?
A. detailed information about medical records.
B. purpose of medical records in patient care.
C. how to avoid errors in medical records
Medical records: Medical records is a broad term, encompassing a range of data and information storage mediums containing patient information. Whether paper based or electronic, the term “medical records” applies to clinical notes, investigations, letters from other doctors and healthcare providers, photographs and video footage. However, information exchanges (such as correspondence, email and file notes of discussions) between a medical practitioner and their medical indemnity insurer or solicitor should not be stored in the medical record. For this reason, it is recommended that you keep a separate medico-legal file in which to store these documents. Medical records are an integral part of good quality patient care. The primary purpose of the medical record is to facilitate patient care and allow you or another practitioner to continue the management of the patient. Clinical observations, decision making and treatment recommendations or plans should be recorded contemporaneously. This reduces the possibility of an error occurring and is an important risk management tool.



PART C. TEXT 1: GOOD LOOKS

Paragraph 1: Attempts to find out what makes a person physically attractive date back at least to the Ancient Greeks. Plato wrote that the ideal face should have a width two-thirds of its length, and that a nose should be no longer than the distance between the eyes. His theory of ‘golden proportions’, while not necessarily accepted by researchers today, nevertheless represented an attempt to define a fundamental preference for symmetry that scientists say is a highly evolved trait seen in both humans and animals. Human babies, for example, spend more time staring at pictures of symmetric faces than they do at photos of asymmetric ones. In the bird kingdom, female swallows prefer males with longer and more symmetric tails, while female zebra finches mate with males with symmetrically colored leg bands.

Paragraph 2: The rationale behind symmetry preference in both humans and animals is that symmetric individuals have a higher mate-value. Scientists also believe that symmetry is equated with a strong immune system. Thus, beauty is indicative of more robust genes, improving the likelihood that an individual’s offspring will survive_ This evolutionary theory is supported by research showing that standards of attractiveness are similar across cultures. John Manning of the University of Liverpool does not agree entirely, however, and cautions against such over- generalization, especially by Western scientists. Darwin thought that there were few universals of physical beauty because there was much variance in appearance and preference across human groups,’ he says.

Paragraph 3: Research overwhelmingly shows that beauty matters. It pervades society, it affects how people choose partners, and it influences how people are seen and how they see others. One of the chief beneficiaries of this focus on physical attractiveness is the cosmetic medicine and cosmetic surgery industry. Once only for the rich and privileged, cosmetic procedures nowadays are mainstream and affordable. For a fraction of the cost and time required even a decade ago, practitioners these days can remove wrinkles and blemishes, straighten teeth and noses, and sculpt bodies into works of art.

Paragraph 4: In most countries, due to the range of procedures available and of practitioners performing them, from plastic surgeons to cosmetic doctors and dermatologists, statistics for cosmetic surgery are either not collected or not reliable. In the United States, however, statistics released by the American Society for Aesthetic Plastic Surgery show that nearly 11.7 million cosmetic surgical and nonsurgical procedures were performed in 2007. The Aesthetic Society, which has been collecting multi-specialty procedural statistics since 1997, says the overall number of cosmetic procedures in the US has increased 457% since the collection of the statistics first began.

Paragraph 5: It is important to bear in mind that there are potential pitfalls, both physical and emotional, associated with this growing cultural phenomenon. While people have the right to maximize their attractiveness, there is the danger that, for some, cosmetic medicine may become an unhealthy obsession or be mistaken as the answer to life’s problems. Studies spanning four decades have reported that most people undergoing cosmetic interventions are satisfied with the result; however, there is a particular subgroup of people who appear to respond poorly to cosmetic procedures. These are people with the psychiatric condition known as ‘body dysmorphic disorder’ (BDD), which is characterized by a preoccupation with an objectively absent or minimal deformity that causes clinically significant distress or impairment in social, occupational, or other areas of functioning.

Paragraph 6: While few methodologically robust studies have been done, some clinicians and researchers have attempted to evaluate whether improvement in psychosocial wellbeing following cosmetic enhancement can be objectively verified at all. Overall, studies suggest that those patients who were pleased with the outcome showed improvements in ‘self worth’, ‘self esteem ‘, ‘distress and shyness’ and ‘quality of life’. What does appear to be an important factor in assessments of satisfaction is the patient’s expectation of the outcome of the procedure. Research suggests that the more extensive ‘type change’ procedures (e.g., rhinoplasty, breast augmentation) appear to require greater psychological adjustment by the patient than ‘restorative ‘ procedures (e.g., facelift, botulinum toxin A injection).

Paragraph 7: Given the range of possible reactions to cosmetic procedures, it is important for the practitioner to evaluate the patient ‘s motivations for surgery before the procedure is undertaken. First, the individual’s attitude towards the cosmetic problem, and the distress and disability associated with it, should be assessed. Patients should be advised of what the cosmetic outcome is likely to be and fully informed of potential side effects and complications. It is also useful to review past cosmetic interventions, including the number of previous procedures and their cosmetic and psychosocial outcome as perceived by the patient as well as family and friends. The cosmetic specialist should probably be most concerned about people who have had numerous procedures performed by many practitioners, and particularly those who report the outcome of such procedures to have been unsatisfactory.

7. In the first paragraph, babies are mentioned because they
A. prefer faces with symmetric features.
B. have highly evolved symmetric traits.
C. react negatively to asymmetric images.
D. display the same preferences as birds.
8. In the second paragraph, the phrase ‘is equated with’ indicates that symmetry and immunity are
A. linked to each other.
B. equal to each other.
C. dependent on each other.
D. opposite to each other.
9. Which one of the following statements according to John Manning’s opinion, is NOT supported by information given in second paragraph?
A. Western scientists take a Darwinist approach to attractiveness.
B. Darwin’s theories go against some current views of attractiveness.
C. Western scientists tend to take a simplistic view of attractiveness.
D. there is no definitive basis for symmetry’s role in attractiveness.
10. Scientists believe that humans and animals are instinctively attracted by symmetry in potential partners
A. because they want a good-looking mate.
B. in the interests of survival of the species.
C. to strengthen their own immune systems.
D. because symmetrical bodies are noticeable.
11. The cosmetic surgery industry is popular because
A. society is preoccupied with beauty.
B. it is considered an art form.
C. so many people feel unattractive.
D. it promotes wealth and glamour.
12. Aside from the United States, country-specific statistics on cosmetic surgery are unreliable because______
A. the United States dominates the market.
B. of the number of different professions involved.
C. there are too many instances to count.
D. of the rapid increase in demand.
13. In the fifth paragraph, the phrase ‘potential pitfalls’ refers to
A. life’s problems. B. maximum attractiveness. C. unhealthy obsessions. D. dangerous outcomes.
14. Based on the seventh paragraph, the doctor should tell patients about
A. the different attitudes of patients to cosmetic surgery.
B. how distress influences the outcome of surgery.
C. what the result might be and what could go wrong.
D. the success rate of his/her previous procedures.


PART C. TEXT 2: RABBIT CALICIVIRUS DISEASE
David Lord’s family arrived in western New South Wales in 1870. The first rabbit plague came 10 years later. In the 1940s rabbits would flock in thousands to waterholes, kicking up storms of dust. In the 1950s they disappeared, and were thought to be gone. But they came back. Last year Mr. Lord’s property, 40 kilometers west of Broken Hill, had 25,000 warrens and about a million rabbits. Then in early November he found a dead one near his home, and felt pretty sure his problem was solved. Within a week, 600,000 more were dead. Few carcasses were seen above ground but the stench was overpowering as the rabbits just crawled into their burrows and died. The killer is rabbit calicivirus disease (RCD. Transmitted primarily by rabbits themselves, the naturally occurring virus scythes through populations of the European rabbit yet is not known to infect any other species. Proponents of the virus as a biological control say it could save up to $1 billion a year in lost primary production and degraded land, as well as priceless native flora and fauna.

Mr. Lord born in the 1950s, when another imported disease, myxomatosis, killed 99 per cent of the country’s rabbits-calls it “the best thing to happen to inland Australia in 40 years.” But it wasn’t meant to happen now. The virus was not due for release for another two years. Its escape from a South Australian testing station in October severely embarrassed the government and the CSIRO and threatened a nine-year program of testing and hearings to win public support. As the virus is now out, scientists and farmers want to ensure its effectiveness with a controlled release in the next two months. Autumn is believed to be the best time for release as young rabbits, whose underdeveloped immune system makes them less susceptible to the disease, are less common. Yet while the Minister for Primary Industry, John Anderson, said this week that he favored early release, he doubted bureaucratic and legislative approvals could be granted in time. In Western Australia a defense coalition against RCD, including animal rights groups and the fledgling rabbit farming industry, is demanding a public inquiry into the disease. Any virus is hard to sell.

“We recognized years ago that virus-dread, as we call it, would need to be managed,” says Nicholas Newland, the coordinator of the RCD program. Although the CSIRO never guaranteed it could contain the virus on Wardang Island, it had taken great precautions to ensure an escape never happened. The calicivirus – so called because under a microscope its surface resembles a set of inverted chalices –was found in China in 1984. It reached Europe two years later, killing about 64 million farmed rabbits in two months in Italy alone. Scientists here watched with interest. Rabbits had developed some immunity to myxomatosis, and no other control had been as successful. The rabbit count was steadily increasing, to about one-fifth of pre-myxomatosis numbers. In 1991 quarantine authorities allowed the CSIRO to import the virus. At the Animal Health Laboratory in Geelong. scientists injected 28 species with a virus dose 1000 times greater than one lethal to a rabbit. None of these species which included dogs, cats, native mammals and birds, were infected.

Testing moved to Wardang Island in 1994. A direct flight transported the virus, packed into containers so secure that a plane crash would not destroy them. In a scene from science fiction, the quarantine station had an electric fence, double fenced pens and high security shacks that required researchers to change cloths three times before leaving. Rabbits wore radio collar so scientists would know instantly if one had died. Yet the virus escaped-from the shacks to rabbits elsewhere on the island, then across a four-kilometer strait. Researchers blame an insect, perhaps a fly. Once on the mainland, the virus jumped 380 kilometers almost overnight, probably through insects floating on air currents. By Christmas it covered one-third of South Australia. In the Flinders Ranges, where 95 per cent of rabbits are thought to have died, flora such as the bullock bush and mulga tree showed new shoots for the first time in decades, says Ron Sinclair of the Animal and Plant Control Commission. Since Christmas, perhaps because of a hot summer and poor conditions for insects, the spread has slowed.

The first sign of the virus in Victoria appeared only recently with dead rabbits near Castlemaine, Maryborough and Marong. Again, insects on air currents may be responsible. The untimely escape has forced authorities to concertina an approval process of years into months. In December, two American scientists wrote to Australia’s Biological Control Authority and he then Prime Minister, warning that the calicivirus could jump species barriers. Dr. Alvin Smith, professor of veterinary medicine at Oregon State University, wrote that if the virus mutated-and it was far too early to be sure that it wouldn’t or it could endanger livestock and even humans. Australian scientists say there is no evidence the rabbit calicivirus can jump species. Only one virus-feline panleukopaenia, or cat flu-has been documented to have increased its host range (to dogs), says Tony Robinson, a senior CSIRO virologist. He says that after 10 years of contact with diseased rabbits in Europe, no human has been infected.

Nevertheless, the debate has bothered Hugh Wirth. “Two lots of scientists are arguing, so the jury is still out,” says the head of the RSPCA. Yet conservation groups such as the Wildlife Preservation Society favor release. “Calicivirus is a blessing. to all who care for Australia’s plants and animals,” society president Vincent Serventy has written. One thing is sure: the virus will not eradicate all rabbits. “We made that mistake with myxomatosis – apathy crept in,” says lan Lobban, spokesman on rabbit control for the Victorian Farmers’ Federation. In Canberra, CSIRO scientists have already begun to try to engineer a new strain of myxomatosis that causes rabbit sterility. In Europe the rabbit poses a different problem. Worried about the animal’s decline because of calicivirus, Spain is stocking a national park with inoculated rabbits to ensure prey for species such as the lynx and imperial eagle. In its birthplace, the rabbit is struggling. Here it is not wanted, and has thrived. The effects of the Australian and Spanish programs are opposite but the intent is the same: to help to balance an unbalanced world.

15. Australian farmers like David Lord consider the release of the virus to be
A. a dangerous mistake.
B. an embarrassing incident.
C. a fortunate accident.
D. a bureaucratic error.
16. Scientists prefer to release the virus in autumn because
A. there are fewer young rabbits in autumn.
B. rabbits have weaker immune systems in autumn.
C. young rabbits catch the disease more easily in autumn.
D. rabbits are more plentiful in autumn.
17. Official early release of the virus is unlikely because
A. the Minster for Primary Industry supports it.
B. rabbit farmers disagree with animal rights groups.
C. the general public refuses to pay for the program.
D. groups opposing RCD are demanding an inquiry.
18. The number of rabbits in Australia prior to the release of RCD was
A. 20% more than in the period before myxomatosis.
B. 20% less than in the period before myxomatosis.
C. remaining stable.
D. seems to be rising.
19. How did the virus enter Australia?
A. carried by insects.
B. brought by dogs and cats.
C. imported by scientists.
D. found in European rabbits.
20. From the article, we can infer that the virus was being tested on Wardang Island for what reason?
A. to prevent its uncontrolled spread.
B. to eliminate rabbits from the island.
C. to protect the researcher.
D. to keep the tests a secret.
21. Because of the escape of the virus, authorities are trying to:
A. delay the approval process for several months.
B. modify the approval process.
C. speed up the approval process.
D. extend the approval process.
22. Which of the following was not a concern of the American scientists who contacted the Biological Control Authority?
A. that humans could catch the disease.
B. that sheep and cattle could die.
C. that insufficient research had been done before the release.
D. that the virus had already mutated.


VIEW ANSWER KEYSOET READINGOET SPEAKINGOET ROLE PLAYSOET LETTER WRITINGOET LISTENING

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SURVEY ON SKIN LIGHTENING CREAMS OET READING

TEXT A: A British Skin Foundation survey found that fifteen per cent of dermatologists believe lightening creams are ‘completely unsafe’ and four in five feel they are only safe when prescribed by a dermatologist. “Many skin- lightening creams contain illegal compounds that can damage your health,” says Indy Rihal of the British Skin Foundation. “The most common compounds are high-dose steroids.” Although steroids can be useful in treating some skin diseases, such as psoriasis and eczema, this must take place under the supervision of a skin specialist. “Unmonitored use of high-dose steroids can lead to many problems,” says RihaI. If you’ve used a skin-lightening cream and are worried about the effect it has had, see a G P. “Medically approved preparations prescribed by a GP or a dermatologist are not dangerous, within reason,” says Rihal. A cream that you buy over the counter is not necessarily medically approved and could permanently damage your skin.

TEXT B: The cosmetic use of skin-lightening products during pregnancy in Dakar, Senegal. Many women of childbearing age from sub-Saharan Africa use topical skin lighteners, some of which present a risk of toxic systemic effects. The goals of this study were to evaluate, in this environment, the frequency of this practice during pregnancy, as well as eventual consequences on pregnancy. Ninety nine women from 6 to 9 months pregnant were randomly selected among those attending a standard maternal centre in Dakar for a prenatal visit. Investigations consisted of questions about the use of skin lighteners, a standard clinical examination, follow-up until delivery and a morning blood sample for plasma cortisol levels. Sixty-eight of the 99 selected women used skin lighteners during their current pregnancy, the main active ingredients being hydroquinone and highly potent steroids (used by 44 and 24 women, respectively). No difference in the main outcomes of pregnancy were found between skin lightener users and the others; however, women using highly potent steroids, when compared with those who did not, had a statistically significant lower plasma cortisol level and a smaller placenta, and presented a higher rate of low-birth-weight infants. Skin lightening is a common practice during pregnancy in Dakar, and the use of steroids may result in consequences in the mother and her child.

TEXT C: Tanning: Biological and Health Effects. Tanning is the skin’s response to ultraviolet (UV) radiation, a type of light exposure. As skin cells are exposed to UV radiation, they produce a brown pigment (melanin) to protect themselves from further UV exposure. This results in a darkening of the skin (tanning), which is the body’s natural defense mechanism and attempt to prevent further damage from UV radiation. Sunlight and artificial tanning methods, such as tanning booths or salons, are sources of UV exposure. Sufficient amounts of UV exposure are known to cause adverse health effects in humans and are a public health concern. Tanning and burning play a role in health effects, including skin cancer. UV radiation damage to DNA in skin cells can result in mutations that promote or cause cancer, and recurring UV exposures may result in aging (wrinkles, loss of elasticity, and sun spots). Other short-term effects on skin are sunburns, fragility, and scarring. Cataracts are a known health effect from UV radiation exposure and eye protection is essential when tanning.

TEXT D: Banned Sunbeds. Unsupervised sunbeds have “no redeeming features”, says Wales’ chief medical officer. Dr Tony Jewell spoke as the facilities are being banned in Wales: laws to clamp down on sunbed use are extended. From Monday, businesses with unstaffed coin-operated sunbeds could be fined £5,000. Welsh cancer charity Tenovus said the ban was important as skin cancer is the most common cancer in 15 to 24-year-olds in the UK, and south Wales has one of the highest incidences in the country. “Skin cancer incidence is very strongly linked to over-exposure to ultra-violet radiation through sunbeds, levels of which can be six times stronger than the Australian midday sun,” said Tenovus head of research Dr Ian Lewis. “Wales alone has 500 cases of malignant melanoma a year, the most dangerous and potentially fatal form of skin cancer, resulting in nearly 100 deaths annually. “The rise in incidence of this type of skin cancer is truly alarming; between 2006 and 2016, Wales saw the rate of malignant melanoma in men and women double.”
In which text can you find information about


1. the contents of skin lightening creams?
2 the risks of over-exposure to UV radiation?
3 the sources of ultra-violet exposure?
4 who use topical skin lighteners?
5 reason for increase in rate of malignant melanoma?
6 the risks of repeated UV exposures?
7 the usual practice during pregnancy?


Questions 8-15. Answer each of the questions, 8-15, with a word or short phrase from one of the texts.
8 Which kind of skin lighteners are used by women in sub-Saharan Africa?
9 What type of sunbeds are subjected to penalties in Wales?
10 How many death cases of malignant melanoma were reported annually in Wales?
11 Which is the common eye disease related to damage from UV radiation exposure?
12 What was the main active ingredient in the skin lighteners used by majority of women in Dakar?
13 What are the most common sources of UV exposure other than sunlight?
14 Which skin cell pigment offers guard against UV exposure?
15 Which type of UV exposures could accelerate the aging processes?
Questions 16-20. Complete each of the sentences, 16-20, with a word or short phrase from one of the texts.
16 are proven to be effective in the treatment of some dermal conditions.
17 The soaring prevalence of is genuinely appalling.
18. Darkening of the skin plays a role in , including skin cancer.
19. Women who used had comparatively small placenta.
20. is vital when the skin is darkened.


PART B. For questions 1-6, choose (A, B or C) which you think fits best according to the text.
1. As explained in the extract, material standards are
A. absolutely helpful to inform a risk assessment.
B. insufficient to find biocompatibility risks.
C. used to find the biocompatibility evaluation.
Medical device standards: Standards specific to a particular device type or material may be helpful to inform a risk assessment; however, the extent to which the standard could be utilized may be dependent on the specificity of the standard and/or the specific material. Ideally, a standard would have sufficient specificity to provide useful information regarding material risks. For example, standards that outline both mechanical and chemical properties of a device type with pass/fail criteria may be particularly informative because of the specificity of such a standard. Standards that address bulk material composition can also be informative as a starting point for incorporating material characterization into a risk assessment. For example, it may be appropriate to use material standards to support the biocompatibility evaluation of stainless steel surgical vascular clamps, as long as any risks associated with manufacturing are appropriately considered and mitigated. Given the effects that manufacturing and processing may have on a polymer as incorporated into the final finished medical device, use of material standards may not be sufficient to identify biocompatibility risks for devices made from polymers.

2. The results of the studies described in the memo may explain why the relationship between
A. enough RN staffing and lower hospital related morbidity.
B. nurse patient ratios interpret gastrointestinal bleeding.
C. RN staffing for post- surgical patients and pulmonary compromise.
Failure To Rescue: The number of patients a Registered Nurse (RN) cares for can directly and indirectly impact patient safety during their hospitalization. “Safety” in this case refers to infection rates, patient falls, hospital-acquired pressure ulcers, and even death. Multiple studies using different methodology and from a variety of disciplines consistently show associations between adequate RN staffing and lower hospital related morbidity, mortality and adverse patient events. RN staffing levels for post- surgical patients have been shown to have an inverse relationship with urinary tract infections, pneumonia, thrombosis and pulmonary compromise; in medical patients, higher nurse patient ratios translated into a reduction in gastrointestinal bleeding, shortened length of stay, and lower rates of ‘failure to rescue’. Failure to rescue is the term used when early warning signs of upper gastrointestinal bleeding, sepsis, deep venous thrombosis, shock or cardiac arrest are not detected and acted upon.

3. What is the most recommended implantation testing?
A. clinically relevant implantation study.
B. in vivo animal study.
C. toxicology implantation study
Implantation: For implantation testing, if there are characteristics of the device geometry that may confound interpretation of this test, it may be acceptable to use device sub-components or coupons instead of the device in its final finished form, with appropriate justification. For example, it may be acceptable to use a coupon instead of a stent, if information is provided to demonstrate that the manufacturing and resulting surface properties are comparable. Instead of a traditional toxicology implantation study in subcutaneous, muscle, or bone tissues, a clinically relevant implantation assessment may be more appropriate for certain implant devices with relatively high safety risks. Clinically relevant implantation studies are critical to determine the systemic and local tissue responses to the implant in a relevant anatomical environment under simulated clinical conditions. In some cases, the toxicity outcomes that would be obtained from a clinically relevant implantation study can be assessed as part of in vivo animal studies that are performed to assess overall device safety.


4. The term ‘mass immunizer’ refers to a
A. Medicare-enrolled provider offering either influenza vaccinations or pneumococcal vaccinations
B. traditional Medicare provider offering neither influenza vaccinations nor pneumococcal vaccinations
C. non-traditional provider offering influenza vaccinations, pneumococcal vaccinations, or both
Mass Immunization Providers: To increase vaccination availability to Medicare beneficiaries, the Centers for Medicare & Medicaid Services (CMS) created the mass immunizer program and simplified the influenza and pneumococcal vaccination claims process by creating roster billing for mass immunizers. CMS defines a ‘mass immunizer’ as a Medicare-enrolled provider offering influenza vaccinations, pneumococcal vaccinations, or both to a group of individuals (e.g., the public, senior center participants, retirement community or retirement housing residents).
A mass immunizer can be either:
• A traditional Medicare provider or supplier, such as a hospital outpatient department; or
• A non-traditional provider that is usually ineligible to enroll in the Medicare Program, such as a supermarket, senior citizen home, public health clinic or an individual practitioner.

5. The guidelines inform us that device materials should not
A. cause any exposure to the body.
B. have benefits that outweigh any potential risks.
C. have any potential risks that outweigh benefits
Evaluation of Local and Systemic Risks: Biological evaluation of medical devices is performed to determine the acceptability of any potential adverse biological response resulting from contact of the component materials of the device with the body. The device materials should not, either directly or through the release of their material constituents: (i) produce adverse local or systemic effects; (ii) be carcinogenic; or (iii) produce adverse reproductive and/or developmental effects, unless it can be determined that the benefits of the use of that material outweigh the risks associated with an adverse biological response. Therefore, evaluation of any new device intended for human use requires information from a systematic analysis to ensure that the benefits provided by the device in its final finished form will outweigh any potential risks produced by device materials over the intended duration and use of the device in or on the exposed tissues. When selecting the appropriate endpoints for biological evaluation of a medical device, one should consider the chemical characteristics of the device materials and the nature, degree, frequency, and duration of exposure to the body.

6. What point does the extract make about designated nursing units?
A. have a team of nurses, mental health technician and behavioral counselor.
B. have specially trained nurses for work exclusively using different strategies.
C. a place where medically stabilized behavioral health patients seeking care are placed.
Behavioral Health Response Plan: A robust Behavioral Health Response Plan has been established to support staff and patients for the growing number of behavioral health patients seeking care. When patients are medically stabilized, up to 11 patients may be cohorted in a specially designed unit to promote patient and staff safety while patients await placement at behavioral health specialized facilities. For patients who require medical treatment, whenever possible they are placed on designated nursing units. Nurses working on these units have received special training and are adept at various communication techniques and strategies. This specialized unit team also consists of a mental health technician and a behavioral counselor.


PART C. TEXT 1: BIRTH CONTROL PILL AND SEXUAL PROBLEMS
In the January issue of The Journal of Sexual Medicine, researchers have published a new investigation measuring sex hormone binding globulin (SHBG) before and after discontinuation of the oral contraceptive pill. The research concluded that women who used the oral contraceptive pill may be exposed to long-term problems from low values of “unbound” testosterone potentially leading to continuing sexual, metabolic, and mental health consequences. Sex hormone binding globulin (SHBG) is the protein that binds testosterone, rendering it unavailable for a woman’s physiologic needs. The study showed that in women with sexual dysfunction, elevated SHBG in “Oral Contraceptive Discontinued-Users” did not decrease to values consistent with those of “Never-Users of Oral Contraceptive”. Thus, as a consequence of the chronic elevation in sex hormone binding globulin levels, pill users may be at risk for long-standing health problems, including sexual dysfunction.


Oral contraceptives have been the preferred method of birth control because of their ease of use and high rate of effectiveness. However, in some women oral contraceptives have ironically been associated with women’s sexual health problems and testosterone hormonal problems. Now there are data that oral contraceptive pills may have lasting adverse effects on the hormone testosterone. The research, in an article entitled: “Impact of Oral Contraceptives on Sex Hormone Binding Globulin and Androgen Levels: A Retrospective Study in Women with Sexual Dysfunction” published in The Journal of Sexual Medicine, involved 124 premenopausal women with sexual health complaints for more than 6 months. Three groups of women were defined: i) 62 “Oral Contraceptive Continued-Users” had been on oral contraceptives for more than 6 months and continued taking them, ii) 39 “Oral Contraceptive Discontinued-Users” had been on oral contraceptives for more than 6 months and discontinued them, and iii) 23 “Never-Users of Oral Contraceptives” had never taken oral contraceptives. SHBG values were compared at baseline (groups i, ii and iii), while on the oral contraceptive (groups i and ii), and well beyond the 7 day half-life of sex hormone binding globulin at 49-120 (mean 80) days and more than 120 (mean 196) days after discontinuation of oral contraceptives (group ii).

The researchers concluded that SHBG values in the “Oral Contraceptive Continued-Users” were 4 times higher than those in the “Never-Users of Oral Contraceptives”. Despite a decrease in SHBG values after discontinuation of oral contraceptive pill use, SHBG levels in “Oral Contraceptive Discontinued-Users” remained elevated when compared to “Never-Users of Oral Contraceptives”. This led to the question of whether prolonged exposure to the synthetic estrogens of oral contraceptives induces gene imprinting and increased gene expression of SHBG in the liver in some women who have used the oral contraceptives. Dr. Claudia Panzer, an endocrinologist in Denver, CO and lead author of the study, noted that “it is important for physicians prescribing oral contraceptives to point out to their patients potential sexual side effects, such as decreased desire, arousal, decreased lubrication and increased sexual pain. Also if women present with these complaints, it is crucial to recognize the link between sexual dysfunction and the oral contraceptive and not to attribute these complaints solely to psychological causes.”


“An interesting observation was that the use of oral contraceptives led to changes in the synthesis of SHBG which were not completely reversible in our time frame of observation. This can lead to lower levels of ‘unbound’ testosterone, which is thought to play a major role in female sexual health. It would be important to conduct long- term studies to see if these increased SHBG changes are permanent,” added Dr. Panzer. Dr. Andre Guay, study co- author and Director of the Center for Sexual Function/Endocrinology in Peabody, MA affirmed that this study is a revelation and that the results have been remarkable. “For years we have known that a subset of women using oral contraceptive agents suffer from decreased sex drive,” states Dr. Guay. “We know that the birth control pill suppresses both ovulation and also the male hormones that the ovaries make in larger amounts during the middle third of the menstrual cycle. SHBG binds the testosterone, therefore, these pills decrease a woman’s male hormone availability by two separate mechanisms. No wonder so many women have had symptoms.”

“This work is the culmination of 7 years of observational research in which we noted in our practice many women with sexual dysfunction who had used the oral contraceptive but whose sexual and hormonal problems persisted despite stopping the birth control pill,” said Dr. Irwin Goldstein, a urologist and senior author of the research. “There are approximately 100 million women worldwide who currently use oral contraceptives, so it is obvious that more extensive research investigations are needed. The oral contraceptive has been around for over 40 years, but no one had previously looked at the long-term effects of SHBG in these women. The larger problem is that there have been limited research efforts in women’s sexual health problems in contrast to investigatory efforts in other areas of women’s health or even in male sexual dysfunction.” To better appreciate the scope of the problem, oral contraceptives were introduced in the USA in 1960 and are currently used for reversible pharmacologic birth control by over 10 million women in the US, including 80% of all American women born since 1945 and, more specifically, 27% of women ages 15-44 and 53% of women age 20-24 years. By providing a potent synthetic estrogen (ethinyl estradiol) and a potent synthetic progesterone (for example, norethindrone), highly effective contraception is achieved by diminishing the levels of FSH and LH, thereby reducing metabolic activity of the ovary including the suppression of ovulation.

Several studies over the last 30 years reported negative effects of oral contraceptives on sexual function, including diminished sexual interest and arousal, suppression of female initiated sexual activity, decreased frequency of sexual intercourse and sexual enjoyment. Androgens such as testosterone are important modulators of sexual function. Oral contraceptives decrease circulating levels of androgens by direct inhibition of androgen production in the ovaries and by a marked increase in the hepatic synthesis of sex hormone binding globulin, the major binding protein for gonadal steroids in the circulation. The combination of these two mechanisms leads to low circulating levels of “unbound” or “free” testosterone.


7. Which statement is the most accurate summary of the method of the study?
A. Levels of SHBG were monitored over a period of time in women who were using the pill.
B. Levels of SHBG were measured in women using pill and women who had stopped using pill, and these were compared to women who had never used pill.
C. Levels of SHBG were compared in women who were using the pill, women who had stopped using the pill, and women who had never used the pill.
D. Medical complications were compared between women using the pill and those who had stopped using the pill.
8. What is the role of SHBG?
A. To prevent sexual dysfunction in human females.
B. To prevent testosterone from being used in the female body.
C. To prevent women from needing to take traditional contraceptive pills.
D. To prevent oncological complications.
9. Which group had the highest level of unbound testosterone?
A. Women with a genetic predisposition for higher testosterone levels.
B. Women who had never taken the pill.
C. Women who had previously taken the pill but since stopped.
D. Women who were taking the pill during the study.
10. Which of the following reasons is given in the study for popularity of oral contraceptive pill?
A. Less interference with sexual routine than other contraceptives.
B. High percentage of contraceptive success.
C. Favorable aesthetic effects on women’s physiques due to reduced testosterone.
D. Low cost.
11. Which is the most accurate description of the study discussed in the article?
A. It involved one hundred and twenty four pre-pubescent girls.
B. It involved 124 premenstrual women who had sexual health issues for 6 months or more.
C. SHBG levels were monitored at different times in three groups of adult women with various status regarding contraceptive pill usage.
D. SHBG levels were compared at regular intervals in each of three groups of women who had different status regarding contraceptive pill usage.
12. Levels of SHBG decreased in women who had stopped using the contraceptive pill
A. due to increased gene expression of SHBG in the livers of these women.
B. in spite of lengthened exposure to artificial estrogen found in pills.
C. because of psychological factors associated with taking the pill.
D. but their levels remained elevated compared to women who had never used pill.
13. Which of the following is an opinion of Dr. Panzer?
A. SHBG levels remained higher in women who discontinued pill use for the duration of the study.
B. The use of oral contraceptives led to changes in SHBG levels which were not reversible within the timeframe of the study.
C. Physicians usually mention the sexual side effects of the pill to their patients.
D. Further studies should determine whether SHBG levels ultimately return to normal over longer periods.
14. Which of the following statements has the same meaning as a statement in the text?
A. The contraceptive pill was invented in the USA in 1960.
B. The pill has been used by over 100 million women globally.
C. Dr. Goldstein monitored women with a history of pill use and sexual dysfunction in his clinic for seven years.
D. Lower levels of unbound testosterone is a result of both higher SHBG and accelerated metabolism in the ovaries.


PART C. TEXT 2: BOVINE SPONGIFORM ENCEPHALOPATHY


Vets at the Ministry of Agriculture have identified a new disease in cows that is causing dairy farmers some consternation. The fatal disease, which they have called bovine spongiform encephalopathy, causes degeneration of the brain. Afflicted cows eventually become uncoordinated and difficult to handle. The first case was reported in 1985. Now there are 92 suspected cases in 53 herds, mostly in the south of England. So far 21 cases in 18 herds have been confirmed. All are Friesian/Holstein dairy animals. Gerald Wells and his colleagues at the Central Veterinary Laboratory in Weybridge, Surrey, describe the symptoms and pathology in the current issue of The Veterinary Record. No one yet knows the cause of the disease but there are some similarities with a group of neurological diseases caused by the so called “unconventional slow viruses”.

This group of progressive diseases includes scrapie in sheep and goats, chronic wasting disease in mule deer and transmissible mink encephalopathy. In humans Kuru and Creutzfeldt-Jakob disease, both fatal neurological diseases, come into the same category. The precise nature of the agents causing this group of diseases is a matter of intense debate but all are infectious. Like scrapie and the other diseases, bovine spongiform encephalopathy is insidious and progressive. A farmer is unlikely to suspect that a cow has the disease until it has almost run its course. Previously healthy animals become highly sensitive to normal stimuli, they grow apprehensive and their movements uncoordinated. In the final stages the cows may be frenzied and unpredictable and have to be slaughtered. At autopsy, Wells and his colleagues found that some areas of the brain were full of holes, giving it a spongy appearance. The pattern of holes shows some similarity with that in the other unconventional encephalopathies.

In all these diseases an important diagnostic feature is the presence of proteinaceous fibrils seen in brain extracts in the electron microscope. No one knows for certain what the fibrils are – whether they are the agents of the disease, a type of subviral particle, as some researchers suggest, or are a product of the disease. The veterinary researchers analyzed the brain tissue from cows that died from the disease and found similar fibrils. Brain tissue from healthy cows did not contain fibrils. At the moment researchers at the Central Veterinary Laboratory are keeping an open mind on the cause of the disease. If it is not a scrapie-like agent it might be something to do with the genetics of Friesian cows. Another suggestion is that contaminated food might be to blame. “It is too early to come to conclusions,” said a spokesman at the Ministry of Agriculture. “It might be caused by toxic products, or food, or it might be genetic.”

According to Richard Kimberlin, of the AFRC/MRC Neuropathogenesis Unit in Edinburgh: “The similarities are enough to make us think that it’s in the scrapie family, but without evidence of transmission it’s impossible to say anything more certain”. Scientists at the Neuropathogenesis Unit will look for evidence of transmission in experiments on mice, while Wells and his colleagues try to transmit the disease in cows. It will take at least two years of experiments before transmission can be proved. What is certain is that the number of reported cases is increasing rapidly. Not all reports will turn out to be bovine spongiform encephalopathy. Farmers and vets might just be getting better at recognizing symptoms. In the past farmers probably got rid of nutty middle-aged cows without thinking too much about it. If the disease turns out to be transmissible then it might spread to other breeds of cows. Many countries ban the import of sheep from areas where scrapie occurs.

In the US, consumer rights groups won a ban on the purchase of meat from scrapie flocks because no one could rule out absolutely the possibility of transmission to humans. If bovine spongiform encephalopathy turns out to be infectious, it could cause problems out of proportion to the number of cases. Vacuoles in the brain prevent the passage of nerve impulses (left). Fibrils in brain tissue resemble those that are diagnostic of scrapie.



15. Bovine spongiform encephalopathy is a disease which is currently found in
A. all dairy cows.
B. some beef cows.
C. beef and dairy cows.
D. Freisian/Holstein dairy cows.
16. When bovine spongiform encephalopathy is confirmed in cows, which of the following symptoms do they not exhibit?
A. chronic wasting.
B. ungainly action.
C. frantic and agitated behavior.
D. sensitivity to usual stimuli.
17. Bovine spongiform encephalopathy is similar to other neurological diseases caused by ‘unconventional slow viruses’, which
A. is transmitted rapidly.
B. develops inconspicuously.
C. is caused by the same agents.
D. can be treated when detected early.
18. Pathology tests conducted on brains of cows which died of bovine spongiform encephalopathy show the presence of
A. fibrils which cause the disease.
B. fibrils which are caused by the disease.
C. fibrils which are also found in other animals infected with unconventional encephalopathies.
D. fibrils similar to those found in healthy cows.
19. Which of the following is not being considered as a cause of bovine spongiform encephalopathy?
A. the intake of contaminated food.
B. a genetic deficiency peculiar to Freisian cows.
C. parasite-produced vacuoles in the brain.
D. exposure to toxic products.
20. Bovine spongiform encephalopathy in cows appears similar to scrapie in sheep because
A. it is transmitted in a similar way.
B. the fibrils in diseased brains are similar.
C. it occurs in animals of a similar age.
D. of the rate at which the disease is transmitted.
21. Vets in Surrey are conducting experiments which will attempt to
A. infect healthy mice with bovine spongiform encephalopathy.
B. infect healthy sheep with bovine spongiform encephalopathy.
C. infect healthy humans through milk from bovine spongiform encephalopathy infected cows.
D. infect healthy cows with bovine spongiform encephalopathy.
22. The purchase of meat from scrapie infected flocks is banned in some countries because
A. the disease may then be transmitted to humans.
B. the disease will then be transmitted to humans.
C. it may lead to the spread of scrapie to other sheep.
D. it will lead to the spread of scrapie to other sheep.


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RHEUMATIC HEART DISEASE OET READING

TEXT A:
• People with a history of acute rheumatic fever (ARF) and a diagnosis of rheumatic heart disease (RHD)
• Aboriginal and Torres Strait Islander people (children aged between 5 and 14 are most at risk) and immigrants from developing countries
• Increased cardiac load during pregnancy will exacerbate pre-existing rheumatic valvular heart disease
• Importance of early diagnosis and regular secondary prophylaxis will help prevent deterioration of disease to a point where pregnancy is a risk
• Secondary prophylaxis is safe and should be continued during pregnancy
• Antibiotic prophylaxis to prevent endocarditis if prolonged labour and/or ruptured embranes
• Pre-conception counselling and assessment for all women with known rheumatic valvular disease
What is rheumatic heart disease (RHD)?
• When a person becomes infected by Group A Streptococcus bacterium (GAS), the immune response can cause acute generalised inflammation that affects the heart, joints, brain and skin. This is called acute rheumatic fever (ARF)
• Recurrent ARF can cause permanent damage to the heart valves – most commonly the mitral and aortic valves
• This damage is known as rheumatic heart disease (RHD)
• RHD can be classified as mild, moderate or severe
• In a mild case there will be no clinical evidence of heart failure
• In severe cases there are signs of valvular disease, oedema, angina and syncope

TEXT-B. Table 1. Classification of rheumatic heart disease
ClassDefinition of category
HX ARE or no RHD. Priority 4.• No pathological mitral or aortic regurgitation, but may have minor morphological changes to mitral or aortic valves on echocardiography
Mild RHD. Priority 3.• Mild mitral or aortic regurgitation clinically and on echocardiography, with no clinical evidence of heart failure, and no evidence of cardiac chamber enlargement on echocardiography
Moderate RHD. Priority 2.• Any valve lesion of moderate severity clinically (e.g., mild moderate cardiomegaly and/or mild – moderate heart failure) or on echocardiography • Mild mitral regurgitation together with mild aortic regurgitation clinically or on echocardiography • Mild or moderate mitral or aortic stenosis • Any pulmonary or tricuspid valve lesion co-existing with a left-sided valve lesion
severe RHD. Priority 1.• Any clinically severe valve lesion (e.g., moderate to severe cardiomegaly Or heart failure) on echocardiography • Any impending or previous cardiac valve surgery

TEXT C: Management
• The fundamental long term goal to manage RHD is to prevent ARF recurrences and therefore prevent the progression of valve disease
• This is achieved by regular delivery of secondary prophylaxis with intramuscular LA Bicillin
• Where adherence to secondary prevention is poor there is greater need for surgical intervention and long term surgical outcomes are poor
Client education and health promotion
• Discuss what RHD is, how it progresses and its association with throat and skin infections
• Recognizing the signs and symptoms of recurrent ARF and of RHD
• The need for timely access to health services and follow up
• Encourage the client to identify barriers to adequate lifestyle modification and medical adherence and to set goals to overcome those barriers based on their capacity and
understanding
• Provide relevant service and educational resources
Social emotional support
• A self- or clinician-rated mood scale can be used to assess for altered moo. Rating scales should be supplemented by a clinical assessment by suitably qualified mental health clinician to make a diagnosis
• Acknowledge any client concerns and reassure them that good adherence to appropriate treatment can improve the symptoms of their condition
Secondary prophylaxis (antibiotics)
• All clients with evidence of RHD and a history of ARF should have secondary antibiotic prophylaxis to control streptococcal infections
• Discuss the effectiveness of Bicillin regimes to prevent recurrence of ARF and minimize RHD
• Consider adverse reactions to medications
Regular physical health and specialist review
• Follow the care plan for RHD, Access to timely specialist physician, paediatric and/or cardiologist services for examination of heart and lungs
• Echocardiography
• Examination of throat, teeth and skin every presentation
• Assessment for shortness of breath, ankle swelling, palpitations or dizziness and chest pain
Dental care
• The risk of infective endocarditis and further heart valve damage increases with poor dental hygiene and oral infections
• 6 – 12 monthly dental care (depending on classification level) is essential for clients with a history of ARF and RHD
• Discuss dental hygiene and oral health at each visit
• Where appropriate, antibiotic prophylaxis are given prior to dental procedures
• A dental assessment and any treatment is required prior to valvular surgery
Recall and review
• Place client on a facility ARF/RHD recall system
• Provide client with the date of the next scheduled Bicillin injection
• Recall client from 21 days after the last injection to ensure that injections are given no more than 28 days apart
• Provide the client and other health services with Bicillin prophylaxis details when client is travelling to different communities
Surgery
• Surgery is determined by the severity of damage to the heart valves (severe RHD)
• Early referral to a cardiologist is required to identify heart failure and consideration for valve repair
• Repair or replacement of damaged heart valves prevents left ventricular dysfunction and severe pulmonary hypertension
• Heart valve replacement risks include stroke and infective endocarditis

TEXT-D: Medications
• Primary prophylaxis involves prompt treatment with antibiotics for treatment of streptococcal infection
• Secondary prophylaxis involves regular administration of Bicillin to prevent recurrent ARF
Secondary prophylaxis
• Decisions to cease secondary prophylaxis should be based on clinical and echocardiographic assessment by a specialist ARF/RHD physician
• All persons with
––ARF or RHD should have prophylaxis for a minimum of 10 years after most recent episode of ARF or until age 21 years (whichever is longer). Clients > 25 years of age who are diagnosed with RHD, without any documented history of prior ARF, should receive prophylaxis until the age of 35 years and then
––no RHD or mild RHD, if clinically assessed by echocardiography can discontinue prophylaxis at this time
––moderate RHD continue prophylaxis until 35 years of age
––severe RHD continue prophylaxis until 40 years of age. Although the risk of recurrence is extremely low in people aged > 40 years, in some cases prophylaxis may be continued beyond the age of 40 years, or even for life e.g. when a client decides they want to reduce even a minimal risk of recurrence

Table 2. Antibiotic regimens for secondary prevention
AntibioticDoseRouteFrequency
First line
Benzathine penicillin C (Bicillin)≥20 kg 900 mg (1,200,000 U) <20 kg 450 mg (600,000 U)Deep 1M injection28 days
Second line
If 1M route is nol possible or refused • Adhprpncp shoul d bp carefully monitored • Oral secondary prophylaxis is nowhere near as effective as Bicillin
Phenoxymethylpenicillin (Penicillin V)250 mgOralTwice daily
Following documented penicillin allergy
Erythromycin250 mgOralTwice daily


For 1-7, decide which text (A, B, C or D) the information comes from.
1. Classification of RHD
2. Steps to be taken when assessing a patient
3. Providing proper medicines
4. How to determine a patient with RHD
5. High risk groups
6. Giving support to patients
7. Counseling and assessment for women


Questions 8-13. Complete each of the sentences, 8-14, with a word or short phrase from one of the texts.
8. Heart valve substitution dangers include _______________ and infective endocarditic.
9. _______________ to continue, when a client decides they want to reduce even a minimal risk of recurrence over 40 years of age.
10. The prevention of recurring Acute Rheumatic Fever is achieved by regular delivery of secondary prophylaxis with _______________
11. _______________ months of dental care is essential for a patient with history of ARF/ RHD
12. Moderate RHD has been given the _______________ priority
13. No evidence of _______________ can be identified in person identified with mild RHD


Questions 14-20. Answer each of the following questions, 15-20, with a word or short phrase.
14. If IM route is not possible or refused to take medicines, what antibiotic is used to treat?
15. The ultimate aim of RHD is to prevent?
16. If a patient identified with mild rheumatic heart disease while review, what to discontinue
17. Which heart valves will damage, if RHD is attacking again and again?
18. When does a doctor can assess and give the patient Priority 1 of RHD?
19. What should have done prior to Valvular surgery?
20. What involves in Secondary prophylaxis to prevent recurring Acute Rheumatic Fever

PART B. Choose the answer (A, B or C) which you think fits best according to the text.
1. What does this manual extract tell us about?
A. To project I-dopa is not an ideal drug for long term treatment.
B. Treatment is not always ideal for Premature Parkinson’s disease
C. To project that the I-dopa is very effective in removing brain cells
Treatment: Treatment isn’t always needed in the early stages of Parkinson’s disease – mild tremor, for instance, may be inconvenient and cause social embarrassment but otherwise life can go on pretty much as normal. As the disease progresses, it will usually be treated with drugs. Several different drugs are available. These drugs act to increase signally within the dopamin pathways in the basal ganglia.
The best known of these is levodopa, also called l-dopa. When this drug was introduced in the 1960s it was a revolution in the treatment of Parkinson’s disease. It crosses easily from the bloodstream into the brain tissue, where it is converted by surviving brain cells to become dopamine. The symptoms of tremor and rigidity are often dramatically improved. The effect of the drug is not as potent in patients after several years of treatment as fewer remaining brain cells are able to convert the l-dopa to dopamine.

2. Where to use panic door exit devices:
A. Public buildings, visitor rooms
B. Smoke control rooms, schools.
C. Community centers, schools, and hospitals.
EMERGENCY EXIT DOOR PANIC DOORS: In panic situations the safety and rescue possibilities for people in the building are the main concern. In Europe uniform standards for emergency exit door fittings are in application.
Within the meaning of these standards, emergency exit door systems are subdivided in emergency exit devices according to EN 179, and panic door Exit devices according to EN 1125. Emergency exits acc. to EN 179 are designated to buildings to which the general public does not have access and whose visitors understand the function of the emergency doors.
Panic door exit devices acc. to EN 1125 are used in public buildings where the visitors are not familiar with the function of emergency doors, like schools, hospitals, shopping malls. The WICSTYLE door systems offer a comprehensive range of applications, which can also be combined with other functions and design options.
TECHNICAL PERFORMANCE. Profile technology:
• Doors in accordance with EN 179 (emergency Exit devices) or with EN 1125 (panic exit devices)
• Many system options for the emergency application, allowing for a unified door design within the building, irrespective of additional functions
• Single or double leaf possible
• Combination with burglar resistance in classes RC1 and RC2 possible
• Execution in combination with fi re protection in classes T30 and T60 and in combination with smoke control possible (national regulations must be respected)


3. What led for confrontation in resolving patient’s grievances or complaints by many organizations?
A. Lack of uniform rules across the country in dealing with complaints
B. No clear guidelines for channeling patients’ grievances to appropriate
C. Overriding the guidelines lay down by CMHCs.
Responding to complaints and grievances: Requirements for certain providers: Certain entities participating in Medicare and Medicaid are required to have specific grievance policies and procedures.
For example, under the Centers for Medicare and Medicaid Services’ (CMS) Conditions of Participation for Community Mental Health Centers (CMHCs) , CMHCs must inform clients that they have the right to voice grievances. CMHCs must also distribute written information to clients on filing a grievance during the patient’s initial evaluation. Although the Conditions of Participation for CMHCs only apply to a narrow subset of community behavioral health organizations, the standards are similar to expectations related to client rights in many states.
For hospitals, CMS’ Conditions of Participation require more in terms of a specific patient grievance process, including suggested time frames to investigate, resolve and follow-up on grievances. CMS also differentiates between a “complaint” and a “grievance.” While many organizations use these terms interchangeably, the definitions/distinctions laid out by CMS can help to determine the appropriate response when a patient makes a complaint or grievance.

4. The purpose of these notes about a counseling agent is
A. To aid and advice patient’s caretakers at home
B. To consider various aspects while treating a patient
C. Modify himself as patient’s caretaker.
Counseling: a Service to Society: Counselors advise and assist individuals, families, groups and organizations. The American Counseling Association describes counseling as a collaborative effort between counselors and their clients. To be an effective counselor, a trained professional needs to be able to work on numerous levels. For example, counselors help people of all ages identify problems, strengths and goals; work through issues; improve interpersonal and coping skills; address mental health concerns; change behavior and focus on personal growth.
Often, when one person is seeing a counselor, the effect goes beyond what the individual gains. Families and family dynamics are affected when someone who has been grappling with difficult problems begins working with a trained counselor. As the individual client learns what is causing her distress and how to manage it, family members open to evolving may benefit from knowledge, understanding and improvements acquired through counseling sessions. Other beneficiaries include extended family, employers, colleagues and friends, community groups and society.

5. What we understood form the manual extract is
A. Technological progress made product delivery easy to the required.
B. Digital copies made user friendly for the Nurses despite costly
C. Criticism in Manuals will not be the sole criteria in evaluating writer’s works.
Medical device user manuals: Shifting Towards Computerization: Consider the challenges facing technical communicators (i.e., technical writers) who design and produce medical device user manuals: First, their work must address the needs of an especially diverse audience, starting with caregivers and extending to trainers, biomedical engineers, sales personnel, government regulators, and many others. Because of its broad potential audience, the typical medical device user manual must be several documents in one. Second, technical communicators often have only limited resources and time to produce high-quality manuals as their companies speed products to market. Third, a user manual’s primary audience—arguably the nurses, physicians, and technicians who deliver direct care to patients—tend to prefer engaging in hands-on training over reading user manuals. The popularity of the hands-on approach creates a perception of user manuals as perfunctory—a perception that could take the wind out of any technical writer’s sails.
As computer technology grows ever more ubiquitous, a popular trend toward computerizing learning tools is cause for new excitement among technical communicators and allied professionals alike. As more caregivers gain computer access, the practicality of their viewing instructions on a medical device’s computer display, on the Web, or on an interactive CD-ROM, for example, will increase. Such technological progress will enable content developers to think beyond the printed page and embrace alternative delivery mechanisms that may be more compatible with a particular user’s learning style. In addition to the benefits it might afford users, computerization will assist manufacturers in updating content as readily as they install new versions of software into devices. As a result of this emerging multimedia approach, the hard-copy medical device user manual is swiftly evolving toward a system of both print and electronic components.

6. Nursing registration guidelines states that
A. A nurse has to complete her full education in vocational schools
B. To proclaim as a registered Nurse, she has to complete preregistration program study.
C. 5 years full term course completion is the only the criteria for registering as a Nurse.
Registered nurses and registered midwives: If you are applying for registration as a registered nurse and/or a registered midwife, you must provide evidence of the completion of five (5) years*(full-time equivalent) of education taught and assessed in English, in any of the recognised countries.
NOTE: a) The Board will only accept the completion of five (5) years* (full-time equivalent) of:
i) tertiary and secondary education taught and assessed in English; or
ii) tertiary and vocational education taught and assessed in English; or
iii) combined tertiary, secondary and vocational education taught and assessed in English; or
iv) tertiary education taught and assessed in English from one or more of the recognised countries listed in this registration standard.
b) The five (5) years referred to in paragraph a above must include evidence of a minimum of two (2) years full-time equivalent pre-registration program of study approved by the recognised nursing and/or midwifery regulatory body in any of the recognised countries listed in this registration standard.

PART C. TEXT 1. Choose the answer (A, B, C or D)
When health anxiety set my mind (and heart) racing. ” You’re too young to be here.”
I couldn’t agree more. I look around the cardiologist’s waiting room, guessing that I’m the youngest person by at least 20 years. Everyone else is slightly crumpled; soft, wrinkled and grey. But, despite my youthful vigour – well, maybe slightly worn around the edges after 39 years – I did need to be there. You see a month or so prior to my walking into the waiting room, my heart had started doing something weird. Every now and then – roughly every 10 or 20 minutes – it would do an extra big beat, or an odd beat, or something like that. I discovered that it’s hard to listen to your own heart. It’s a bit like a quantum physics problem: the act of observing it changes its behaviour. For a few weeks, I ignored it, thinking it was probably related to the horrible cold I was experiencing.

But it continued. And continued. So I did what all internet-equipped hypochondriacs do, I consulted Dr Google. Being a health journalist whose search history tends to demand the good stuff, I like to think that I found some slightly more authoritative and less hysterical sources than your average search would hand up; but it was still enough to make me decide a trip to the doctor was in order. My GP couldn’t find anything. My blood tests were normal, my ECG healthy, so he sent me to a cardiologist. It wasn’t an urgent referral, so I was faintly reassured that the GP wasn’t worried that I was going to do the clutch-heart-and-drop Hollywood thing just yet. Then I had to wait. It was two weeks between seeing the GP and my cardiology appointment, and for the first time in my life, I experienced something that I have read and written about so often: the anxiety of the so-called ‘worried well’.

This is one of the reasons why, even though we have so many tests for so many diseases, we don’t use them on everyone. Because while a test might pick up one person in a hundred with a medical problem (which may not even have been life-threatening), for the other 99 people in that population, the time between having the test and getting the all-clear is for many a time of great anxiety and stress. For many, that stress will be in the background. We might not even be aware of it, but no matter how bullet-proof we try to convince ourselves that we are, ultimately, we’re all waiting for the bomb with our name on it. It will, on some level, eat away at our psyche.

While there’s no blood test or sliding scale to really quantify that stress, it is real, and it is a cost. During this time I had lunch with a dear friend, who was off to get a lump in her breast checked. Our faces mirrored each other’s unspoken anxiety over our obscenely large midday breakfasts. We talked about the fact that ultimately, everyone has to die of something. I said, “Somehow, I don’t think my ticker and your bosom are it for us,” probably sounding a lot more confident than I felt. Lying in bed at night, I would listen intently for my heart’s occasional mega-thump, trying to glean just a little bit more information from the errant beats that might reassure me this wasn’t atrial fibrillation or a dangerous arrhythmia. Instead, my heartbeat began to sound faster and louder than I had ever noticed before. Even when I tried to ignore it and go to sleep, it pounded in my chest like the war drum of Impending Doom.

Finally, the day comes for my trip to the cardiologist. The night before, I’m plagued with intensely stressful dreams, including one in which I’m due to perform on stage right after Tim Minchin. If that isn’t a hard act to follow, I don’t know what is. I wake up with my guts tight, possessed with a slightly hysterical mania that sees me charging around the house, washing, cleaning, tidying. I get the kids out the door for school earlier than usual, much to their and my confusion at the lack of the usual screaming “HURRY UP!” routine. The cardiologist is running late, so I have nearly an hour in the waiting room watching other patients shuffle in and out of the rooms. My heart flip-flops regularly, reassuring me that I’m not going to be wasting his time.

The nurse beckons me in for my stress test. My chest is decorated with sticky dots, like I’m waiting to be digitally rendered as a female Gollum, and I’m connected to a tangle of electrical leads. Then up onto the treadmill, and my test begins. Oh, the irony. My heart problem has stage fright. The nurse cranks up the treadmill until I’m puffing and sweating under the heavy ECG belt, yet my recalcitrant heart steadfastly refuses to give even a single performance of its aberration. Instead, it defiantly beats strong, solid, and regularly, as if trying to prove that it’s all simply a product of my paranoid imagination.

Even after the test is finished, and I’m cooling off in the waiting room while the doctor reviews the results, my heart beats as reliably as an atomic clock. Despite the absence of anything on the ECG, he diagnoses me as having ventricular ectopic beats. These are occasional misfiring, like an extra heartbeat that happens in the lower chamber of the heart (the ventricle). In otherwise healthy individuals, they are no cause for alarm. In fact, they reassure me that my heart is healthy enough that I could apply for a job with police rescue.

He schedules an echocardiogram to check there’s not some other valve weirdness going on, but by that stage I’m skipping out the door, feeling like a possible death sentence has been lifted and instead I’m contemplating doing a half-marathon for the first time in my life.


7. Why does she heard the words “you’re too young to be here”
A. Because she is not having any problem
B. She is healthy, so, not to come there
C. They think her age is not ideal to have problems
D. It is an restricted area for minors
8. Why the author does compare her increased heartbeat with quantum physics?
A. Probably it was her perception that she had high heartbeat
B. She overwhelmingly responded to the difficult problem in physics
C. Used in the context of her ideas to actions conflicting in her mind.
D. Unable to define a proper form, instead she used.
9. Why she delayed to consult Cardiologist?
A. She thinks it’s unnecessary
B. She was willing consult another GP, instead cardiologist
C. Because it was not an urgent referral
D. Undermined the importance of referral
10. Why she used the words “worried well” in the second paragraph?
A. She is afraid of what going to face, when she meet cardiologist.
B. She is anxious to meet cardiologist
C. It is hard to digest, until she gets positive report
D. Worried to get appointment after two weeks
11. What do you understand from the last sentence in the third paragraph?
A. Stress cannot be in varied from person to person
B. It projects surprisingly at sometimes
C. Stress cannot be hidden at all times
D. Nothing
12. Why does she talk about some quoted words in the fifth paragraph?
A. To regain their confidence
B. To refrain from stress
C. To mobilize themselves to meet doctor regularly
D. To verify that theirs GP have referred correctly
13. The word “Beacons” means
A. Searches B. Signs C. Signals D. Warns
14. Who does the word “they” refers to?
A. Doctors B. Cardiologists C. Nurses D. Patients


PART C. TEXT: 2
News reports about a study from Germany may provide the ultimate excuse for men to dress more casually for work, finding neckties reduce blood supply to the brain.

The study showed that wearing a tie that causes slight discomfort can reduce blood flow to the brain by 7.5 per cent, but the reduction is unlikely to cause any physical symptoms, which generally begin at a reduction of 10 per cent. Past research shows that compression of the jugular vein in the neck reduces blood flow to the brain. In this new study, published recently in the journal Neuroradiology, the researchers tested whether the pressure of a necktie could induce these changes.

They recruited 30 young men aged 21 to 28 years and split them into two groups: those wearing neckties and those without. Using magnetic resonance imaging (MRI), the researchers tested the cerebral blood flow (total blood flow to the brain) using a technique that showed changes to the flow via a colour change. They also tested the blood flow from their jugular vein.

The first MRI took a “baseline” scan, while the participants in both groups had an open collar (and those in the tie-wearing group had a loosened tie). For the second scan, the men’s collars were closed and participants in the tie group tightened their Windsor knot until they felt slight discomfort. A third scan followed, in the same conditions as the baseline scan. All scans lasted 15 minutes.

The authors found that wearing a necktie with a Windsor knot tightened to level of slight discomfort for 15 minutes led to a 7.5 per cent drop in cerebral blood flow, and a 5.7 per cent drop in the 15 minutes after the tie was loosened. The men’s blood flow in the control group — those who weren’t wearing a tie — didn’t change. No change was found in jugular venous flow between the two groups.

The study didn’t go into any detail about the effects, so let’s consider what they might be. The researchers found a reduction in blood flow to the brain of 7.5 per cent, which is unlikely to cause problems for most men. Healthy people are likely to begin experiencing symptoms when blood flow to the brain reduces by about 10 per cent — so, a larger reduction than the study found. Along with an increase in blood pressure at the site, a 10 per cent reduction in blood flow can cause dizziness, light-headedness, headaches and nausea. But even with a 7.5 per cent drop in blood loss to the brain, a person could still experience some temporary dizziness, headaches or nausea.

Compounded with other factors, such as smoking or advanced age, a 7.5 per cent decrease could bring some people over this 10 per cent threshold of blood flow loss, placing extra stress on their already strained bodies and increasing their risk of losing consciousness or developing high-blood pressure. It’s unclear why there was no change to the jugular, but this may be due to the circular nature of the restriction: the pressure is equally distributed across the neck, rather than just the jugular.

Further research is needed to assess the impact of wearing a tie for longer periods and wearing different knots. Any pressure on the neck is slightly discomforting, and men’s style guides advise tightening a necktie to be “tight but not too tight”. Whether this tightness aligns with the participants’ classification of “slight discomfort” is unclear. This study had a sample size of 30 participants, which is relatively small. Most human studies investigating blood pressure and cerebral blood flow have at least 40 to 60 participants.

Another limitation is that the study did not include a discussion about the potential impact of the blood restriction, or the finding that jugular blood flows didn’t change. But overall, the study is simple and well-designed. It adds to a small but growing body of research about the problems with neckties: they can lead to higher rates of infection, as they’re infrequently washed; and they may increase intraocular pressure (blood pressure in the eyes) to the point of increasing the risk of glaucoma.

Perhaps it’s time to get rid of this unwelcome guest from our wardrobe, or restrict it to special occasions.

15. As per the new study report on using neckties by professionals will result in
A. Causing pain to Brian
B. Causes physical changes
C. Will not have major impact on blood supply to brain
D. No relation in causing physical symptoms.
16. How the researchers identified the blood flow change to brain
A. By using a specially designed meter
B. Based on colour
C. With the help of nerves blood flow density
D. Based on samples collected from research
17. The word ‘Baseline’ defines that
A. The first scan was taken as referral mark
B. They considered it as the minimum level to conduct the research
C. It was considered as the highest level to check
D. It was the first stage in process
18. What was the researcher’s conclusion at the end?
A. There was the change of color in blood flow to brain
B. Identified no relation to jugular venous flow
C. Had developed a new technique to check this instead
D. It was a disappointing result for them
19. What will cause, if an aged patient using his necktie continuous for 2-3 hours?
A. May develop additional symptoms to the existing
B. Will develop resistance to blood flow to brain
C. Nothing will happen in prolonged exposure
D. Unable to determine the impacts
20. What was the major limitation in study report?
A. It doesn’t include many other aspects of the study
B. It focuses mainly on analyzing the impact of jugular venous flow.
C. It includes only a small group of people
D. Lack of technical support.
21. What does the word “it” refers to?
A. The study
B. The jugular venous flow
C. Blood flow
D. Infection
22. What does the word “this” refers to?
A. Necktie B. Infection C. Blood pressure D. Research


How did it go? Please share your feedback in the comment section below:

VIEW ANSWER KEYSOET READINGOET SPEAKINGOET ROLE PLAYSOET LETTER WRITINGOET LISTENING

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GLAUCOMA OET READING TEST

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

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

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

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

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

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

Text C. Other forms of Glaucoma.        •

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

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

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

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

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

1. which is the rare form of glaucoma?  

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

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

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

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

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

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

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

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

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

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

11. How many Australians have been diagnosed with glaucoma?

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

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

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

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

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

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

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

18. Glaucoma is far less common in the_______

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

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

Part B.

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

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

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

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

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

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

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

3. The notice is giving information about

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

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

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

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

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

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

Less suitable solutions: Betadin,  Braunol,  saline,  Permanganate

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

5. The email is reminding  staff that  the

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

                           

Q1. “Which of the following is FALSE?

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

Q2. The preparation which the patients received

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

Q3. According to the article, vaccinia   _

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

Q4. Jean-Claude Guillaume         _

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

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

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

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

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

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

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

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

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

Part C. TEXT 2.

Going blind in Australia

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

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

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

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

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

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

Q1. In paragraph 1, the author suggests that         _

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

Q2. According to paragraph 2, cataracts       _

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

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

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

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

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

QS. Statistics in paragraph 4 indicate that    _

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

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

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

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

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

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

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

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GERIATRIC PHARMACOLOGY – OET Reading


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

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

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

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



PART A – QUESTIONS AND ANSWER SHEET. Questions 1-7. For each question, 1-7, decide which text (A, B, C or D) the information comes from. In which text can you find information about;
1. Substance which is known to decrease absorption. Answer
2. Various factors are known to create an effect on how drug distribution is weakened. Answer _
3. Belongs to the class of medicines called digitalis glycosides Answer
4. With increase in age, various other health problems increase. Answer
5. Bioavailability and absorption. Answer
6. Drug distribution. Answer
7. Heart will pump less amount of blood through the circulatory system. Answer

QUESTIONS 8-14: Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may include words, numbers or both. Your answers should be correctly spelt.
8. What causes delay in gastric emptying? ______________
9. What can reduce effectiveness of blood thinners? ______________
10. One of the factors that lead to decrease in body fat is? ______________
11. How age can have its effect on cardiac output and peripheral vascular resistance? ______________
12. What is often stamp out by Hepatic metabolism? ______________
13. What can have major impact on hepatic drug metabolism? ______________
14. What cimetidine is known to be? ______________
Questions 15-20. Complete each of the sentences, 15-20, with a word or short phrase from one of the texts. Each answer may include words, numbers or both. Your answers should be correctly spelt.
15. In most of the patients, __________will often get transformed.
16. In most of the adults, the __________ will help signal the pathway for creatinine.
17. With steady increase in __________, there can be increase in volume of distribution of fat- soluble drugs.
18. __________ pathways may not show any kind of change though age increases.
19. Many of these substances, when they are not altered as needed, are recorded to be effective and known to enhance__________
20. __________is known to be very effective in curtailing down the absorption of drug.



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

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

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

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

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


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

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



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


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

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

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

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

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

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


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



PART C. TEXT 2. VALLEY FEVER

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

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

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

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

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

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



Text 2: Questions 15-22

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


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