Reading Test - 4

Practice Test 1
Text A
ALZHEIMER’S DISEASE
When one is affected by disease, neurons in the brain are progressively destroyed
and the transmission of signals across the synapses is disrupted. Over time, nerve
cell death and tissue loss results in dramatic shrinkage of the brain and loss of
brain function, affecting learning and memory, thinking and planning, speech and
communication, and eventually involving virtually all areas of brain function. It is
normal to suffer occasional lapses of memory, especially with advancing age.
However, serious memory loss, confusion and difficulties with thinking that
interfere with daily functioning could indicate some form of dementia.
Alzheimer’s disease accounts for 50 to 70 per cent of dementia.
While it is more common in older people, even people in their 30s and 40s may
have early-stage of Alzheimer’s. While there is no cure, there are treatments that
may help slow or delay progression and assist with symptoms. Symptoms may be
cognitive {affecting memory, language. judgment and planning) or behavioural and
psychiatric {such as emotional distress,
uncontrolled outbursts, yelling and paranoia}. Depending on the nature and
severity of symptoms, a doctor can advise which medicines and supportive
measures may help. Early diagnosis and assessment is vital for future planning as
well as to maximise opportunities to take advantage of available treatments.
Text B
Treatment Options
MEDICATIONS
Cholinesterase Most effective at early stage of disease.
inhibitors
PROCEDURES
Counselling Helps patients cope with trauma and loss.
Physical therapies Improve mobility, speech, daily function.
NATURAL METHODS
Herbs Ginkgo biloba and huperzine A
Vitamins Antioxidants help protect brain coils
Text C
Launch of Australia’s first dementia and exercise study

National Ageing Research Institute [NARI] has started recruiting volunteers for an
Australian-first study to assess whether physical activity can improve the memory,
concentration and well being of people with Alzheimer’s Disease [AD]. The
collaborative study, officially launched at NARI in June, also involves the
Universities of Melbourne, Western Australia and Queensland. Alzheimer’s
Australia is also supporting Fitness at the Ageing Brain Study II [known as FABS
II]. At the launch, Professor Nicola Lautenschlager, who heads the study,
highlighted how her earlier research had shown that regular exercise improved
brain function in older people. The hope is that a physical activity program will
also benefit people with mild to moderate AD.
“Several medications are available to treat AD but this isn’t enough to help
families deal with this complex problem. We are pleased to be looking at a non-
pharmacological option,” says Professor Lautenschlager. The physical activity
program involves a commitment of 150 minutes a week, which is about 20
minutes daily. Walking is the most popular physical activity for older people but
the program will be tailored to each person’s interests.
Before stoning the program, participants will be assessed on aspects like muscle
strength, flexibility, balance and memory function.
Text D
Exercise and Alzheimer’s disease
(University of Washington study published in Annals of Internal
Medicine)
The study followed 1,740 people aged 65 and older over a six-year
period. At the start of the study none showed signs of dementia.
After six years, 158 participants had developed dementia, of which 107 had
been diagnosed with Alzheimer’s disease.
People who exercised three or more times a week had a 30% to 40% lower
risk of developing dementia compared with those who exercised fewer than
three times per week.
Lead researcher Dr. Eric Larson said walking for 15 minutes three times a
week was enough to out the risk.
Part A
QUESTIONS
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. What is the most effective medications at early stage of AD?
2. Where did the study by the University of Washington was published?
3. What are the cognitive symptoms of Alzheimer’s disease?
4. What does ‘NARI’ stands for?
5. Who was the lead researcher in the University of Washington study?
6. Who is supporting FABS II?
7. What are the behavioural and psychiatric symptoms of AD?

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. How many subjects were there in the University of Washington study?
9. What is the most popular physical activity in the physical activity program?
10. Which procedure helps the patients cope with trauma and loss?
11. Who can advise medicines and supportive measures for AD?
12. Which procedures improve the mobility of the patients with AD?
13. What can improve the brain function in older people?

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. According to , walking for 15 minutes three times a week can minimize the
risk of AD.
15. aren’t enough to help families deal with the complex problem of AD.
16. like Ginkgo biloba, are used for the treatment of AD.
17. is hoped to benefit people with mild to moderate AD.
18. contains antioxidants that help to protect the brain coils.
19. At the start of the University of Washington study showed signs of dementia.
20. When one is affected by AD, neurons in the brain are .

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 the
answer (A, B or C) which you think fits best according to the
text.
1. The manual informs us that the Biopotential Amplifiers

A. record potentials, voltages, and electrical field strengths
generated by nerves and muscles
B. amplify biosignals to make them compatible with devices such as
displays or recorders
C. provide amplification selective to superimposed noise and
interference signals
Biopotential Amplifiers
Biosignals are recorded as potentials, voltages, and electrical field
strengths generated by nerves and muscles. The signals need to be
amplified to make them compatible with devices such as displays,
recorders, or A/D converters for computerized equipment.
Amplifiers adequate to measure these signals have to satisfy very
specific requirements. They have to provide amplification selective
to the physiological signal, reject superimposed noise and
interference signals, and guarantee protection from damages
through voltage and current surges for both patient and electronic
equipment.
Amplifiers featuring these specifications are known as biopotential
amplifiers.
2. What does this manual tell us about the programmer ?
A. used to provide communications between generator and lead
B. can alter the therapy delivered by the pacemaker
C. retract essential diagnostic data for optimally titrating the therapy
Implantable Cardiac Pacemakers
The modern pacing system is comprised of three distinct components: pulse

generator, lead, and programmer. The pulse generator houses the battery and
the circuitry which generates the stimulus and senses electrical activity. The
lead is an insulated wire that carries the stimulus from the generator to the
heart and relays intrinsic cardiac signals back to the generator. The
programmer is a telemetry device used to provide two-way communications
between the generator and the clinician. It can alter the therapy delivered by
the pacemaker and retrieve diagnostic data that are essential for optimally
titrating that therapy.
3. What does this extract from a handbook tell us about external
defibrillators?
A. used only in the treatment of life-threatening cardiac rhythms
B. used mostly for elective treatment of less threatening rapid rhythms
C. convert excessively fast and ineffective heart rhythms to slower rhythms
External Defibrillators
Defibrillators are devices used to supply a strong electric shock to a patient in

an effort to convert excessively fast and ineffective heart rhythm disorders to
slower rhythms that allow the heart to pump more blood. External
defibrillators have been in common use for many decades for emergency
treatment of life-threatening cardiac rhythms as well as for elective treatment
of less threatening rapid rhythms. The most serious arrhythmia treated by a
defibrillator is ventricular fibrillation. Without rapid treatment using a
defibrillator, ventricular fibrillation causes complete loss of cardiac function
and death within minutes.
4. The notice is giving information about
A. therapeutic uses of showers and baths
B. importance of essential oils in bath therapy
C. when and where the warm wet treatment is used
Thermopositive (warm) wet treatment

The warm wet treatment includes showers and baths, i.e. used therapeutically
in addition to washing. They have an overall effect. They are used in the
treatment of scars, burns, when preheating the body before exercise, when
replacing bandages after surgery, etc. Baths are used on part of or all of the
body. Essential oils can be also used in bath therapy. Warm wet therapy is
widely used in balneology.
5. The guidelines establish that the healthcare professional should
A. administer oral hygiene several times per day
B. aware of accumulation of mucus in certain patients
C. provide oral care several times per day, if needed
Special oral care

Patients with febrile illnesses, after a stroke, with paralysis of the facial
nerve, after surgery, after injury, or unconscious and dying patients suffer
from an accumulation of mucus in their mouth and coated mucous
membrane. A patient can breathe in the accumulated mucus and the mucous
membrane coatings cause bad breath. Defects on the tongue make sucking
and chewing difficult. Oral hygiene must be administered as required, several
times per day.
6. The guidelines require those undertaking the preparation of plaster
bandages to
A. do attaching quickly, only if you are experienced
B. avoid spilling the plaster during the process
C. soak plaster and the bandage in a 40 °C hot water
Plaster bandages
Plaster bandages are impregnated with plaster. They provide reliable fixation
of the broken bone. It is a hydrofile bandage which is impregnated with fine
plaster. The bandages are wrapped in moisture-proof packaging; moisture
would harden the plaster and the bandage would be spoiled. Before use, the
bandage is soaked in a 40 °C hot water; the bandage is not moved at this
point so as not to spill the plaster. Then it is removed and gently wrung and
then immediately attached. Attaching requires experience as it must be done
quickly – the time for moulding the bandage is short (2 - 3 minutes).
Part C
In this part of the test, there are two texts about different aspects of
healthcare. Choose the answer (A, B, C or D) which you think fits best
according to the text.
Text 1 : Does Tamiflu really work?
The British Medical Journal (BMJ) was dominated in 2009 by a cluster of
articles on oseltamivir (Tamiflu). Between them the articles conclude that the
evidence that oseltamivir reduces complications in otherwise healthy people
with pandemic influenza is now uncertain and that we need a radical change
in the rules on access to trial data.
The use of meta-analysis is governed by the Cochrane review protocol.
Cochrane Reviews investigate the effects of interventions for prevention,
treatment and rehabilitation in a healthcare setting. They are designed to
facilitate the choices that doctors, patients, policy makers and others face in
health care. Most Cochrane Reviews are based on randomized controlled
trials, but other types of evidence may also be taken into account, if
appropriate.
If the data collected in a review are of sufficient quality and similar enough,
they are summarised statistically in a meta-analysis, which generally provides
a better overall estimate of a clinical effect than the results from individual
studies. Reviews aim to be relatively easy to understand for non-experts
(although a certain amount of technical detail is always necessary). To
achieve this, Cochrane Review Groups like to work with “consumers”, for
example patients, who also contribute by pointing out issues that are
important for people receiving certain interventions. Additionally, the
Cochrane Library contains glossaries to explain technical terms.
Briefly, in updating their Cochrane review, published in late 2009. Tom

Jefferson and colleagues failed to verify claims, based on an analysis of 10
drug company trials, that oseltamivir reduced the risk of complications in
healthy adults with influenza. These claims have formed a key part of
decisions to stockpile the drug and make it widely available.
Only after questions were put by the BMJ and Channel 4 News has the
manufacturer Roche committed to making “full study reports” available on a
password protected site. Some questions remain about who did what in the
Roche trials, how patients were recruited, and why some neuropsychiatric
adverse events were not reported. A response from Roche was published in
the BMJ letters pages and their full point by point response is published
online.
Should the BMJ be publishing the Cochrane review given that a more
complete analysis of the evidence may be possible in the next few months?
Yes, because Cochrane reviews are by their nature interim rather than
definitive. They exist in the present tense, always to be superseded by the
next update. They are based on the best information available to the
reviewers at the time they complete their review. The Cochrane reviewers
have told the BMJ that they will update their review to incorporate eight
unpublished Roche trials when they are provided with individual patient data.
Where does this leave oseltamivir, on which governments around the world
have spent billions of pounds? The papers in last years journal relate only to
its use in healthy adults with influenza. But they say nothing about its use in
patients judged to be at high risk of complications- pregnant women, children
under 5, and those with underlying medical conditions; and uncertainty over
its role in reducing complications in healthy adults still leaves it as a useful
drug for reducing the duration of symptoms. However, as Peter Doshi points
out on this outcome it has yet to be compared in head to head trials with non-
steroidal inflammatory drugs or paracetamol. And given the drug’s known
side effects, the risk-benefit profile shifts considerably if we are talking only
in terms of symptom relief.
We don’t know yet whether this episode will turn out to be a decisive battle
or merely a skirmish in the fight for greater transparency in drug evaluation.
But it is a legitimate scientific concern that data used to support important
health policy strategies are held only by a commercial organisation and have
not been subject to full external scrutiny and review. It can’t be right that the
public should have to rely on detective work by academics and journalists to
patch together the evidence for such a widely prescribed drug. Individual
patient data from all trials of drugs should be readily available for scientific
scrutiny.
Text : QUESTIONS 7-14
7. A cluster of articles on oseltamivir in the British Medical Journal
conclude
a. complication are reduced in healthy people by oseltamivir
b. the efficacy of Tamiflu in now in doubt
c. complications from pandemic influenza are currently uncertain
d. a series of articles supporting Tamiflu
8. Cochrane Reviews are designed to
a. set randomized controlled trials to specific values
b. compile literature meta-analysis
c. peer review articles
d. influence doctors choice of prescription
9. According to the article, which one of the following statements about

Tamiflu is FALSE?
a. The use of randomized controls is suspect
b. The efficacy of Tamiflu is certain
c. Oseltamivir induces complications in healthy people
d. Cochrane reviews are useful when examining the efficacy of Tamiflu
10. According to the article, Cochrane Review Groups

a. like to work for “consumers”.
b. are being overhauled.
c. use language suitable for expert to expert communication.
d. evaluate a clinical effect better than individual studies.
11. Which would make the best heading for paragraph 4?

a. Analysis of 10 drug company trials
b. The stockpiling of Oseltamivir
c. Risk of complications in healthy adults
d. Tamiflu claims fail verification
12. According to the article, which one of the following statements about
Roche is TRUE?
a. Full study reports were made freely available on the internet
b. Patients were recruited through a double blind trial
c. The identities and roles of researcher in the Roche trials are not fully
accounted for
d. Not all neuropsychiatric adverse events were reported
13. Cochrane reviews should

a. use a more complete analysis
b. not be published until final data is available
c. be considered interim rather than definitive advice
d. be superseded by a more reliable method of reporting results
14. Which would make the best heading for paragraph 7?

a. Risk-benefit profile of Tamiflu
b. Studies limited to healthy adults
c. High risk of complications
d. Oseltamivir only for high risk patients
.
Part C
Text : 2 Miracle Jab Makes Fat Mice Thin
After a four-week course of treatment with a protein called ob, the fat simply
falls off, leaving vastly overweight mice slim, active and sensible eaters. If
the protein has the same effect on people, it could be the miracle cure
millions have been waiting for that at least, is the theory. But skeptics warn
that too little is known about the way the human version of the ob protein
works to be sure that extra doses would help people lose weight.
But when the results of the tests were leaked last week, Amgen, the
Californian biotechnology company which owns exclusive rights to develop
products based on the protein, saw an overnight jump in its share price.
Last December, a team led by Jeffrey Friedman and his colleagues at the
Howard Hughes Medical Institute at the Rockefeller University, New York,
discovered a gene, which they called ob. In mice, a defect in this gene makes
them grow hugely obese. Humans have an almost identical gene, suggesting
that the product of the gene - the ob protein - plays a part in appetite control,
The ob protein is a hormone, which Friedman has dubbed leptin.
In April, Amgen, which is based in Thousand Oaks, California, paid the

institute $20 million for exclusive rights to develop products based on the
discovery. Amgen will carry out safety tests on the protein in animals next
year, and hopes to begin clinical trials on people within a year.
The excitement began last week when the journal Science published the
findings of three groups which have been working on the protein. The results
in obese mice with a defective gene that prevents them making the protein
were dramatic. Mary Ann Pelleymounter and her colleagues at Amgen gave
obese mice shots of the protein every day for a month. Those on the highest
dose lost an average of 22 percent of their weight.
“Before treatment, these mice overate, had lower metabolic rates than
normal, lower temperatures, and raised E levels of insulin and glucose in
their blood.” says Pelleymounter. “The protein brought all of these back to
normal levels,” she says.
More significantly, in terms of the potential for a human slimming drug, the
treatment also worked on normal mice, which lost what little spare fat they
had. They lost between 3 and 5 percent of their body weight, almost all of it
in the form of fat, according to Pelleymounter. This is important because no
one has identified a mutation in the human ob gene that might lead to
obesity, suggesting that whatever the cause for obesity, the ob protein might
still help people lose weight.
Friedman and his team carried out similar experiments. In just one month,
their obese mice shed around half their body fat. In the average obese mouse,
fat makes up about 60 percent as much as untreated animals. Their fat is
practically melted away, falling to 28 per cent of their body weight after a
month. In normal mice, treatment reduced the amount of fat from an average
of 12.22 percent of body weight to a spare 0.67 percent.
Friedman and Pelleymounter believe that the protein, which is produced by

fat cells, regulates appetite. “We think it’s something like a circulating
hormone to tell the brain there are normal amounts of fat, or too much, in
which case the brain turns down your appetite,” says Pelleymounter.
The experiments also show that treated mice have an increased metabolic
rate, suggesting that they burn fat more efficiently. Their appetites decrease
— and they are less sluggish, becoming as active as normal mice.
The third group of researchers from the Swiss Pharmaceuticals company

Hoffman-La Roche, are more skeptical about how significant the ob protein
might be in treating obesity. From their studies, they conclude that the protein
is just one of many factors that control appetite and weight. “This is a very
important signal, but it’s one of several.” says Arthur Campfield, who led the
team.
Campfield doubts whether the ob protein alone will have much effect in
overweight humans. His team hopes to unravel the whole signaling system
that regulates weight, and is particularly keen to find the receptor in the brain
that responds to the ob hormone. Hoffman-La Roche, excluded by the Amgen
license to deal from developing products based on the ob protein itself, hopes
to develop pills that interfere with message pathways in appetite control.
Stephen Bloom, professor of endocrinology at London s Hammersmith

Hospital, agrees, “l think the work with ob is a major advance, but we’ve not
got the tablet yet. That will come when people have made a pill that
stimulates the ob receptor in the brain so it switches off appetite.”
Even Pelleymounter at Amgen cautions against over optimism at this stage.

“We don’t know whether it would be true that people would lose weight, but
you can predict from mice that it would have some positive effect,” she says.
“However, I don’t think obese people should hold out for this. They should
carry on with their exercises and dieting.
Text 2 : QUESTIONS 15-22
15. The first paragraph informs the reader that.
a) A protein treatment has caused mice to lose weight dramatically.
b) A protein treatment for mice cannot be adapted for use in humans.
c) Scientists agree that a new protein treatment will make people lose weight.
d) A scientific method of making obese people slim has been developed.
16. The reader can infer from the second paragraph that
a) The public is skeptical about the possibility of developing a scientific
slimming method.
b) The Californian company, Amgen, is eager to share its new-found
technical knowledge.
c) Several companies will be able to develop products based on the results of
the research.
d) Many people are confident that a product which guarantees weight loss
will sell very well.
17 . Friedman and his colleagues found that a genetic defect in the gene
called ob
a) Causes obesity in mice.
b) Causes obesity in humans and mice.
c) Has the same structure in mice and humans.
d) Produces a protein called leptin.
18. According to Friedman and his colleagues, the ob protein

a) May be transferred from mice to humans.
b) May be a factor in appetite control.
c) Is produced by the ob hormone.
d) Is mainly found in obese mice.
19. According to the article, the Californian company called Amgen

a) Was paid $20 million by the Howard Hughes Institute.
b) Intends to use humans to test new products based on the ob protein.
c) Has begun to trial new products based on the ob protein.
d) Is one of several companies trialling products based on the ob protein.
20. A study by Mary Ann Pelleymounter and her colleagues found that
a) The ob protein caused subjects in the study to decrease their metabolic
rate.
b) The ob protein caused people to lose about twenty percent of their weight.
c) A deficiency in the ob protein had caused obesity in the subjects.
d) A defective ob gene resulted in the production of the ob protein.
21. According to the Friedman and Pelleymounter studies, treatment with ob

protein
a) May be useful only for people with a defective ob gene.
b) May be useful for anyone who wants to lose Weight.
c) Is effective only on mice with a defective ob gene.
d) Will not be effective on people who want to lose weight.
22. The evidence gathered in Friedman’s and Pelleymounter’s studies

a) Demonstrates conclusively that the ob protein controls appetite.
b) Proves that the ob protein causes animals to lose 40 percent of their
Weight.
c) Suggests that the ob protein is a factor in determining appetite.
d) Suggests that the normal amount of fat is 0.67 percent of bodyweight.
Practice Test - 2
Glaucoma
Text A
Glaucoma
Description
Glaucoma is the name given to a group of eye diseases 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 aqueous, or its drainage. In other patients the damage may be
caused by poor blood supply to the vital optic nerve fibers, a weakness in the
structure of the nerve, and/or a problem in the health of the nerve fibres
themselves. Over 146,000 Australians have been diagnosed with glaucoma.
While it is more common as people age, it can occur at any age. Glaucoma is
also far less common in the indigenous population.
Symptoms
Chronic (primary open-angle) glaucoma is the commonest 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 fibres have been damaged, 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.
Intraocular pressure (IOP) Central corneal thickness (CCT) and
Glaucoma correlations.
Central
corneal Intraocular Intraocular pressure + Predictor of
thickness pressure Central corneal development of
thickness of thickness glaucoma (r²)
555 microns or .36*
less
thickness of
more -.13*
than 588
microns pressure of .38*
less than 21
mmHg
pressure of .07*
more than 22
mmHg
Thickness less than 555 -.49*

and pressure less than
21 mmHg
*power >.05
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 suffer 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 and 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 cost- effectiveness
comparison of various interventions to inform policy development.
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.
Your answers should be correctly spelt.
QUESTIONS
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.
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
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.
Q
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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 the answer (A, B or C)
which you think fits best according to the text.
1. What does this extract tell us about parenteral infusion devices?

A. used to provide flow through an intravenous catheter
B. 80% of hospitalized patients receive parenteral infusion devices
C. provide an effective pathway for the delivery of fluid, blood
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.
2. The purpose of these notes about Biomedical Lasers is to
A. state the factors that led to the expanding biomedical use of laser
technology
B. give valid reasons for the increase in the biomedical use of lasers in
surgery
C. recommend an alternate for ultraviolet- infrared (UV-IR) radiation in
biomedical use
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.
A. the circumstances for prescribing the infant monitor by the doctor
B. why infants shouldn’t be discharged from the hospital with infant monitor
C. why infants unidentified with breathing problems need infant monitor
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.
4. What does this extract tell us about post traumatic stress disorder?
A. It is a physiological reaction of the patient to stress.
B. It is only a local response of the patient to stress.
C. It can definitely turn into a post-operative complication.
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.
5. The email is reminding staff that the
A. benefits of rinses to patients using suitable solutions.
B. solutions less suitable should not be applied to wounds.
C. epithelizing wounds should be rinsed with antiseptic solution.
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 clean the wound of
early leaching residues, coatings, necrotic tissue, pus, blood clots, 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.
6. The purpose of these notes about drains and drainage systems is to
A. help maximize efficiency of healing process.
B. give guidance on certain medical procedures.
C. avoid accumulation of fluid in body cavities.
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 tissue 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).
Part C
Text 1 : 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 André Boué,
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 role 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.
7. “Which of the following is FALSE?
a) Zagury’s experiments have been controversial before.
b) An inquiry found obvious irregularities in Zagury’s work.
c) ANRS is to re-evaluate Zagury’s tests.
d) Zagury’s intention had been to increase patients’ immune systems with
proteins.
8. The preparation which the patients received

a) had been accidentally infected with a form of the vaccinia virus.
b) was made from white blood cells which had been manufactured in the
laboratory.
c) had been stored in formaldehyde. ,
d) contained laboratory-treated white blood cells which had been taken from
them.
9. According to the article, vaccinia

a) is potentially lethal for all humans.
b) has been used to fight both cowpox and smallpox all around the world.
c) can be dangerous in people who have abnormal immune systems.
d) in none of the above.
10. Jean-Claude Guillaume

a) was also a member of Zagury’s team.
b) examined one of the patients who had been referred to him by Zagury’s
team.
c) informed the Chicago Tribune about the results of the tests on the tissue
samples.
d) was/did none of the above.
11. Which of the following people does NOT work with Zagury?
a) Odile Picard.
b) Luc Montalgnier.
c) Robert Gallo.
d) None of the above works with Zagury.
12. It is FALSE that findings at the Pasteur institute
a) were ignored by Zagury’s team.
b) did not lead to intervention by the National institutes of Health.
c) showed that intravenous injections were not good for patients with weaker
immune systems.
d) led to Zagury’s team keeping quiet about the patients who had died.
13. How many people were injected with the preparation in the trial?
a) Fourteen
b) Nineteen
c) Twenty eight
d) Thirty three ’
14. Which of the following statements best describes the initial condition of
the people who took part in the trial?
a) Fewer than half of them had AIDS
b) Half of them had AIDS
c) Most of them had AIDS
d) 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 limited. 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,
refer 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.
15. In paragraph 1, the author suggests that
A. many people have poor eyesight at retirement age.
B. sight problems of the aged are often treatable.
C. cataract and glaucoma are the inevitable results of growing older.
D. few sight problems of the elderly are potentially damaging.
16. According to paragraph 2, cataracts

A. may affect about half the population of Australians aged over 64.
B. may occur in about 4—5% of Australians aged over 64.
C. are directly related to smoking and alcohol consumption in old age.
D. are the cause of more than 50% of visual impairments.
17. According to paragraph 3, age-related macular degeneration (AMD)
A. responds well to early treatment.

B. affects 1 in 5 of people aged 65—74.
C. is a new disease which originated in the USA.
D. causes a significant amount of sight loss in the elderly.
18. According to paragraph 3, the detection of glaucoma

A. generally occurs too late for treatment to be effective.
B. is strongly associated with ethnic and genetic factors.
C. must occur early to enable effective treatment.
D. generally occurs before optic nerve damage is very advanced.
19. Statistics in paragraph 4 indicate that

A. existing eye care services are not fully utilised by the elderly.
B. GPs are generally aware of their patients’ sight difficulties.
C. most of the elderly in the USA receive adequate eye treatment.
D. only 40% of the visually impaired visit an opthalmologist.
20. According to paragraph 4, which one of the following statements is Q

true?
A. Many elderly people believe that eyesight problems cannot be treated
effectively.
B. Elderly people with chronic diseases are more likely to have poor
eyesight.
C. The facilities for eye treatments are not always readily available.
D. Many elderly people think that deterioration of eyesight is a product of
ageing.
21. In discussing social factors affecting the use of health services in

paragraph 5, the author points out that
A. wealthier people use health services more often than poorer people.
B. poorer people use health services more regularly than wealthier people.
C. poorer people deliberately avoid having their eye sight examined.
D. poorer people have less access to the range of available eye care services.
22. According to paragraph 6, in Australia in the year 2031

A. about one tenth of the country’s population will be elderly.
B. about one third of the country’s population will be elderly.
C. the proportion of people over 65 will be twice the present proportion.
D. the number of visually impaired will be twice the present number.
Practice Test 3
Text A
Illness floors Robb
A depressive illness is forcing senior Coalition frontbencher Andrew Robb to
take three months’ leave from his shadow cabinet duties. Columnist Laurie
Oakes reveals in today’s Herald Sun that Mr. Robb has been diagnosed with
a biochemical disorder known as diurnal variation. Mr. Robb, 58, is going
public with his battle lest there be any misunderstanding why he is
temporarily vacating Malcolm Turnbull‘s front bench. In an interview with
Oakes, Mr. Robb explains he has suffered for as long as he can remember —
without actually knowing his condition had a name. “I thought it was just that
I wasn’t good in the mornings,” Mr. Robb says.
“It’s like a little black dog has been visiting me every morning for most of
my life.” Mr. Robb tells how he wakes up feeling flat and negative but
eventually settles into the positive and confident mindset needed to tackle
politics on the front line. As a youngster, he recalls suffering but telling
nobody. “I can remember as a 12-year old, walking to the station on the way
to school at 7.15 in the morning. I’d see old fellows who had retired and I’d
wish I was one of them.” A telephone call to Beyond Blue chairman Jeff
Kennett six weeks ago led to Mr. Robb visiting a psychiatrist who diagnosed
the condition. Treatment, however, has proved more gruelling than Mr. Robb
expected. Drugs are sending him into deeper depression before any benefits
emerge, prompting his decision to temporarily move to the back bench.
Text B
Diagnosis of depression
If you are clinically depressed you would have at least two of the following
symptoms for at least 2 weeks.
An unusually sad mood that does not go away

Loss of enjoyment and interest in activities that used to be enjoyable
Tiredness and lack of energy
As well, people who are depressed often have other symptoms such as:
Loss of confidence in themselves or poor self-esteem

Feeling guilty when they are not at fault
Wishing they were dead
Difficulty concentrating or making decisions
Moving more slowly or, sometimes becoming agitated and unable to
settle
Having sleeping difficulties or, sometimes, sleeping too much
Loss of interest in food or, sometimes eating too much. Changes in
eating habits may lead to either loss of weight or putting on weight.
Text C
Not every person who is depressed has all these symptoms. People who are
more severely depressed will have more symptoms than those who are mildly
depressed. Here is a guide to severity of depression:
Mild depression - 4 of the 10 symptoms listed above over the past 2 weeks.
Moderate depression - 6 of the 10 symptoms of the past 2 weeks.
Severe depression - 8 of the 10 symptoms over the past 2 weeks.
Occasionally, depression is a sign of another illness or is caused by the side
effects of medications. Your doctor will want to check out whether there are
any other medical problems or pills that could be causing your depression.
(WHO, The ICD-10 Classification of Mental and Behavioural Disorders,
Geneva.)
Text D
Antidepressant drugs
Occasional sadness or loss of heart are normal, and they usuallypass quickly.
However, more severe deprtession that is accompanied by feelings of despair,
lethargy, loss of sex drive, and often poor appetite may call for medical attention.
Such depression can arise from ilfe stresses such as the death of someone close,
an illness, or sometimes from no apparent cause. Three main types of antidepressant
are used to treat depression: tricyclic antidepressants (TCAs), selective serotonin
re-uptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs). These
groups of drugs are equally effective. Treatment usually begins with an SSRI.
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.
• Your answers should be correctly spelt.
QUESTIONS
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.
1. How the severity of depression is assessed?
2. What are the symptoms of depression?
3. Who is Mr. Andrew Robb?
4. What does ‘TCA’ stands for?
5. How can you check whether you’re clinically depressed?
6. What are the symptoms of severe depression?
7. What does ‘MAOI’ stands for?

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 antidepressant is given first in the treatment of depression?
9. Who classified depression on the basis of severity?
10. Who diagnosed the condition of Mr. Robb?

11. Which type of depression can arise from stress caused by death of
someone close?
12. How many symptoms are minimum required for a moderate depression?
13. Who reported the condition of Mr. Robb?
Questions 14-20
14. or loss of heart are normal and pass quickly.
15. Occasionally, depression is a sign of or is caused by the side
effects of medications.
16. Changes in may lead to either loss of weight or putting on weight.
17. If you are clinically depressed you would have the symptoms for at least
18. The chairman of Jeff Kennett led Mr. Robb to visit a psychiatrist.
19. Three main types of used to treat depression are equally effective.
20. shows four of the ten symptoms over the past two weeks.
Part B
1. The manual informs us that the tonometer
A. is activated by pulling a button by the patient or the staff
B. display mostly the blood pressure systolic and diastolic values
C. display only the pulse value of the patient immediately
Method of BP measurement using a digital tonometer
The procedure involves the correct positioning of the cuff on the appropriate
place after previously positioning the disposable circular PVC cuff. This
protection cuff helps to prevent the transmission of infection between patients
in the healthcare facility. After positioning the cuff, the tonometer is activated
by pressing a button and the cuff is automatically inflated. After a while, the
display will show the blood pressure systolic and diastolic values and some
types of tonometers also display the pulse value.
2.What must all staff involved in the reprocessing process do?
A. certify their facilities and procedures by a regulatory authority or an
accredited quality system auditor
B. ensure the cleanliness, sterility, safety and functionality of the reprocessed
equipments
C. All of the above.
Single-Use Medical Equipments
Critical and semi-critical medical equipments labeled as single-use must not
be reprocessed and reused unless the reprocessing is done by a licensed
reprocessor. Health care settings that wish to have their single-use medical
equipments reprocessed by a licensed reprocessor should ensure that the
reprocessor’s facilities and procedures have been certified by a regulatory
authority or an accredited quality system auditor to ensure the cleanliness,
sterility, safety and functionality of the reprocessed equipments.
3. The purpose of this email is to
A. report on a rise in special cases such as local environmental conditions
B. explain the background to conduct preventive maintenance
C. remind staff about procedures and intervals for preventive maintenance
Preventive maintenance (PM)
PM involves maintenance performed to extend the life of the device and
prevent failure. PM is usually scheduled at specific intervals and includes
specific maintenance activities such as lubrication, cleaning or replacing parts
that are expected to wear or which have a finite life. The procedures and
intervals are usually established by the manufacturer. In special cases the user
may change the frequency to accommodate local environmental conditions.
Preventive maintenance is sometimes referred to as ‘planned maintenance’ or
‘scheduled maintenance’.
4. The guidelines require those undertaking micro-enema to
A. administer the solution with a Janet rectal syringe
B.administer the other solution with a rectal tube
C.thoroughly shake the contents of the Yal bottle
Micro-enema
This is a form of enema administration, i.e. small liquid volumes (in adults 60
- 180 ml). An example of a micro-enema solution used for cleansing the
rectum is Yal, which is already prepared by the manufacturer in a transparent
bottle with an attached applicator. The contents of the bottle must be
thoroughly shaken before use and the sealed end of the applicator cut off. If
administering a micro-enema with another solution, not originally prepared
by the manufacturer, rinsing is done with a Janet rectal syringe and an
appropriate sized rectal tube. Other aids are the same as for other types of
enema.
A. should monitor the overall behaviour of the patient.
B. evaluate the strength of the impulse in a particular patient.
C. note internal and external factors influencing the pain.
Intensity of pain
The intensity of pain is expressed by the question “How much does it hurt?”
It is not easy to assess pain as it is a subjective symptom. We cannot objectify
the intensity of pain or measure the strength of the impulse in a particular
patient. Experiencing pain is influenced by many internal and external
factors. The nursing staff should monitor the overall behaviour of the patient,
especially the quality of sleep, appetite, communication with other patients,
family members, staff etc.
6. The purpose of this email is to
A. report on a rise in patient malnutrition complications.
B. explain the background that cause patient malnutrition.
C. remind staff to identify patient malnutrition early.
Patient malnutrition
Poor nutrition brings a number of negative aspects for both treatment and
further patient prognosis. It is reported that the frequency of complications of
the disease in these patients is 27 % higher; the mortality of these patients is
12.4 % higher, hospitalization time is 7 – 13 days longer and the cost of
treatment is 210% higher. According to international studies, 40% of
hospitalized patients and 40-80 % of institutionally treated elderly patients
are at risk of malnutrition. Patients with malnutrition should be identified
early and provided with a sufficiently nutritional diet.
Part C
Text 1 : Pandemic Flu The Bird Flu

Paragraph 1
What everyone should know about the avian influenza?
A growing number of avian influenza (bird flu) cases are turning up among
bird populations around the world. While the flu has yet to have a large-scale
influence on human lives, the World Health Organization (WHO) and the
United States Center for Disease Control (CDC) warns that it is not a matter
of if we will be affected, but when. The first step you can take is to educate
yourself and stay informed. What follows are questions and answers that will
help you to take this first step.
What is the bird flu (avian influenza)?
The bird flu is an infection caused by avian (bird) influenza (flu) virus. These
flu viruses occur naturally among birds. Wild birds worldwide carry the virus
in their intestines, but usually do not get sick from it. However, avian
influenza is very contagious among birds and can make some domesticated
birds, including chickens, ducks, and turkeys, very sick and kill them.
Paragraph 2
How does the bird flu virus differ from seasonal flu viruses that infect
humans?
Of the few bird flu viruses that have crossed the species barrier to infect
humans, the most recent virus that you are hearing about in the news has
caused the largest number of reported cases of severe disease and death in
humans. In Asia, more than half of the people infected with the virus have
died. Most cases have occurred in previously healthy children and young
adults. However, it is possible that the only cases currently being reported are
those in the most severely ill people and that the full range of illness caused
by the current bird flu virus has not yet been defined. Unlike seasonal
influenza, in which infection usually causes only mild respiratory symptoms
in most people, bird flu infection may follow an unusually aggressive clinical
course, with rapid deterioration and high fatality.
Paragraph 3
How does the bird flu spread among birds?
Infected birds shed influenza virus in their saliva, nasal secretions, and feces.
Susceptible birds become infected when they have contact with contaminated
excretions or with surfaces that are contaminated with excretions or
secretions. Domesticated birds may become infected with avian influenza
virus through direct contact with infected waterfowl or other infected poultry
or through contact with surfaces (such as dirt or cages) or materials (such as
water or feed) that have been contaminated with the virus.
Do bird flu viruses infect humans?
Bird flu viruses do not usually infect humans, but more than 100 confirmed
cases of human infection with bird flu viruses have occurred since 1997.
Paragraph 4
What would make the bird flu a ‘pandemic flu’?
A ‘pandemic flu’ is defined as a global outbreak of disease that occurs when
a new virus appears in the human population and then spreads easily from
person to person. Three conditions must be met for a pandemic to start: 1) a
new virus subtype must emerge; 2) it must infect humans and cause serious
illness; and 3) it must spread easily and continue without interruption among
humans. The current bird flu in Asia and Europe meets the first two
conditions: it is a new virus for humans and it has infected more than 100
humans.
Paragraph 5
How do people become infected with bird flu viruses?
Most cases of the bird flu infection in humans have resulted from direct or
close contact with infected poultry (e.g., domesticated chicken, ducks, and
turkeys) or surfaces contaminated with secretions and excretions from
infected birds. The spread of bird flu viruses from an ill person to another
person has been reported very rarely, and transmission has not been observed
to continue beyond one person. During an outbreak of bird flu among
poultry, there is a possible risk to people who have direct or close contact
with infected birds or with surfaces that have been contaminated with
secretions and excretions from infected birds.
Paragraph 6
What are the symptoms of avian influenza in humans?

Symptoms of the bird flu in humans have ranged from typical human flu-like
symptoms (fever, cough, sore throat, and muscle aches) to eye infections,
pneumonia, severe respiratory diseases (such as acute respiratory distress
syndrome), and other severe and life-threatening complications. The
symptoms of the bird flu may depend on type of virus causing the infection.
How is avian influenza detected in humans and treated?
A laboratory test is needed to confirm bird flu in humans. Studies done in
laboratories suggest that the prescription medicines approved for human flu
viruses should work in treating bird infection in humans. However, flu
viruses can become resistant to these drugs, so these medications may not
always work. Additional studies are needed to determine the effectiveness of
these medicines.
Paragraph 7
Does a seasonal flu vaccine protect me from avian influenza?
No. Seasonal flu vaccines do not provide protection against the bird flu.
However, it is always a good idea to obtain a vaccine for your well-being.
Should I Wear a surgical mask to prevent exposure to the bird flu?
Currently, wearing a mask is not recommended for routine use (e.g., in
public) for preventing flu virus exposure.
Is there a risk for becoming infected with avian influenza by eating
chicken, turkey, or duck?
There is no evidence that properly cooked poultry or eggs can be a source of
infection for bird flu viruses. The U.S. government carefully controls
domestic and imported food products, and in 2004 issued a ban on
importation of poultry from countries affected by bird flu viruses.
Paragraph 8
What can I do to help reduce the risk for infection from wild birds in the
United States?
As a general rule, the public should observe wildlife, including wild birds,
from a distance. This protects you from possible exposure to pathogens and
minimizes disturbance to the animal. Avoid touching wildlife. If there is
contact with wildlife do not rub eyes, eat, drink, or smoke before washing
hands with soap and water. Do not pick up diseased or dead wildlife.
Consumer Services for issues related to poultry flocks or the Fish and
Wildlife Conservation Commission for issues relating to wild birds.
Paragraph 9
Is there a vaccine to protect humans from the bird flu virus?
There currently is no commercially available vaccine to protect humans
against the bird flu virus that is currently being detected in Asia and Europe.
However, vaccine development efforts are taking place. Research studies to
test a vaccine that will protect humans against the current bird flu virus began
in April 2005, and a series of clinical trials is under way.
Does CDC recommend travel restrictions to areas with known bird flu
outbreaks?
CDC does not recommend any travel restrictions to affected countries at this time.
However, CDC currently advises that travelers to countries with known outbreaks of
avian influenza avoid poultry farms, contact with animals in live food markets, and any
surfaces that appear to be contaminated with feces from poultry or other animals.
Paragraph 10
Is there a risk to importing pet birds that come from countries
experiencing outbreaks of the bird flu ?
The U.S. government has determined that there is a risk to importing pet
birds from countries experiencing outbreaks of the avian influenza. CDC and
the U.S. Department of Agriculture (USDA) have both taken action to ban
the importation of birds from areas where avian influenza has been
documented.
Can a person become infected with the bird flu virus by cleaning a bird
feeder?
There is no evidence of the avian influenza having caused disease in birds or
people in the United States. At the present time, the risk of becoming infected
with the virus from bird feeders is low. Generally, perching birds are the type
of birds commonly at feeders. While there are documented cases of avian
influenza causing death in such birds (e.g., house sparrow, Eurasian tree-
sparrow, house finch), most of the wild birds that are traditionally associated
with bird flu viruses are waterfowl and shore birds.
7. Which of the following statements is NOT true?
a) Wild birds carry the virus in their intestines.
b) Avian influenza is very contagious among birds.
c) Avian flu can make domestic birds very ill and may be fatal.
d) Wild birds often die from Avian flu.

a) 50% of the people in Asia infected with bird flu have died.
b) Healthy people have been infected.
c) Bird flu causes mild respiratory symptoms in most people.
d) It’s likely that we don’t yet know the full range of illnesses caused by the
bird flu virus.
9. How does a bird become infected?

a) Contact with the saliva, nasal secretions or faeces of an infected bird.
b) Contact with surfaces that have been contaminated by excretions or
secretions from infected birds.
c) Direct contact with an infected bird.
d) Any of the above.
10. How many confirmed cases of human infection with bird flu viruses have
occurred since 1997?
a) 100+
b) 50
c) Over a thousand.
d) 25
11. Is the current outbreak a ‘pandemic?’

a) Yes
b) No
c) The information is not given in the text.
d) Not sure.
a) Bird flu can be transmitted from bird to bird
b) Bird flu can be transmitted from bird to human.
c) Bird flu can be transmitted from one person to another person.
d) Bird flu can be transmitted from one person to another person and beyond.
13.Which of these are typical symptoms of bird flu in humans?

a) fever, cough, sore throat and muscle aches.
b) vomiting and diarrhoea.
c) insomnia
d) swollen limbs and earache.
14. If you have had a seasonal flu vaccine this year, are you also protected
against bird flu?
a) Yes
b) No
c) Yes, if the virus doesn’t mutate.
d) The information is not given in the text.
Part C
Text 2 : The Mental Health Risks of Adolescent Cannabis Use
Paragraph 1
Since the early 1970s, when cannabis first began to be widely used, the
proportion of young people who have used cannabis has steeply increased
and the age of first use has declined. Most cannabis users now start in the
mid-to-late teens, an important period of psychosocial transition when
misadventures can have large adverse effects on a young person’s life
chances. Dependence is an underappreciated risk of cannabis use. There has
been an increase in the numbers of adults requesting help to stop using
cannabis in many developed countries, including Australia and the
Netherlands. Regular cannabis users develop tolerance to many of the effects
of delta-9- tetrahydrocannabinol, and those seeking help to stop often report
withdrawal symptoms. Withdrawal symptoms have been reported by 80% of
male and 60% of female adolescents seeking treatment for cannabis
dependence.
Paragraph 2
In epidemiological studies in the early 1980s and 1990s, it was found that 4%
of the United States population had met diagnostic criteria for cannabis abuse
or dependence at some time in their lives and this risk is much higher for
daily users and persons who start using at an early age. Only a minority of
cannabis-dependent people in surveys report seeking treatment, but among
those who do, fewer than half succeed in remaining abstinent for as long as a
year. Those who use cannabis more often than weekly in adolescence are
more likely to develop dependence, use other illicit drugs, and develop
psychotic symptoms and psychosis.
Paragraph 3
Surveys of adolescents in the United States over the past 30 years have
consistently shown that almost all adolescents who had tried cocaine and
heroin had first used alcohol, tobacco, and cannabis, in that order; that regular
cannabis users are the most likely to use heroin and cocaine; and that the
earlier the age of first cannabis use, the more likely a young person is to use
other illicit drugs. One explanation for this pattern is that cannabis users
obtain the drug from the same black market as other illicit drugs, thereby
providing more opportunities to use these drugs.
Paragraph 4
In most developed countries, the debate about cannabis policy is often
simplified to a choice between two options: to legalize cannabis because its
use is harmless, or to continue to prohibit its use because it is harmful. As a
consequence, evidence that cannabis use causes harm to adolescents is
embraced by supporters of cannabis prohibition and is dismissed as “flawed”
by proponents of cannabis legalisation.
Paragraph 5
A major challenge in providing credible health education to young people
about the risks of cannabis use is in presenting the information in a
persuasive way that accurately reflects the remaining uncertainties about
these risks. The question of how best to provide this information to young
people requires research on their views about these issues and the type of
information they find most persuasive. It is clear from US experience that it is
worth trying to change adolescent views about the health risks of cannabis; a
sustained decline in cannabis use during the 1980s was preceded by increases
in the perceived risks of cannabis use among young people.
Paragraph 6
Cannabis users can become dependent on cannabis. The risk (around 10%) is
lower than that for alcohol, nicotine, and opiates, but the earlier the age a
young person begins to use cannabis, the higher the risk. Regular users of
cannabis are more likely to use heroin, cocaine, or other drugs, but the
reasons for this remain unclear. Some of the relationship is attributable to the
fact that young people who become regular cannabis users are more likely to
use other illicit drugs for other reasons, and that they are in social
environments that provide more opportunities to use these drugs.
Paragraph 7
It is also possible that regular cannabis use produces changes in brain
function that make the use of other drugs more attractive. The most likely
explanation of the association between cannabis and the use of other illicit
drugs probably involves a combination of these factors. As a rule of thumb,
adolescents who use cannabis more than weekly probably increase their risk
of experiencing psychotic symptoms and developing psychosis if they are
vulnerable—if they have a family member with a psychosis or other mental
disorder, or have already had unusual psychological experiences after using
cannabis. This vulnerability may prove to be genetically mediated.
TEXT 2 QUESTIONS 15 - 22
15. In paragraph 1, which of the following statements does not match the
information on cannabis use?
a. The use of cannabis by teenagers has been increasing over the past 40
years.
b. Cannabis use has adverse effects on young people.
c. Withdrawal symptoms are more common in males.
d. People try cannabis for the first time at a younger age than previously.
16. Epidemiological studies in the 1980s & 1990s have found that
a. 4% of the US population currently suffer from cannabis abuse or
dependence.
b. starting cannabis use at a young age increases the risk of dependence or
abuse.
c. only a minority of surveys researched treatment options for cannabis
dependent people.
d. people who start cannabis use at a young age have high risk of becoming
daily users.
17. The main point of paragraph 3 is that

a. alcohol, tobacco and cannabis can lead to the use of heroin and cocaine.
b. most adolescents who have used cocaine or heroin first try alcohol,
followed by tobacco and then cannabis.
c. there is a clear link between habitual cannabis use and the use of heroin
and cannabis.
d. the black market is the main source of illicit drugs.
18. Which of the following would be the most appropriate heading for
paragraph 4?
a. Opinion on an effective cannabis policy is divided.
b. Cannabis use is harmful to adolescents and should be prohibited.
c. Cannabis use is a serious problem in a majority of developed countries.
d. Cannabis use should be legalised.
19. The word closest in meaning credible in paragraph 5 is

a. believable
b. possible
c. high quality
d. inexpensive
20. Cannabis use in the US declined during the 1980s because

a. parents were able to explain the health risks of cannabis use.
b. there was good health education regarding the health risks associated with
cannabis use available at that time.
c. cannabis had increased in price
d. young people had became more worried about its effect on their health
21. The word relationship in paragraph 6 refers to the connection between
a. legal drugs such as alcohol and nicotine and illegal drugs such as cannabis,
cocaine and heroin.
b. cannabis use and dependency.
c. the use of hard drugs such as heroin and cocaine and cannabis use.
d. regular users and their partners.
22. Which of the following statements best matches the information in the
last paragraph?
a. Regular cannabis use produces changes in brain function.
b. Regular adolescent cannabis users with a genetic predisposition to mental
disorders have an increased risk of encountering psychosis.
c. Regular adolescent users of cannabis are vulnerable to psychosis.
d. Occasional use of cannabis can make other drugs more appealing.
Practice Test 4
PART – A
• Exposure to lead in Australia has dropped significantly over recent decades

as a result of measures restricting the use of lead in paint, petrol and
consumer goods. As a result, the average blood lead level in Australia is
estimated to be less than 5 micrograms per decilitre.
• NHMRC recommends that if a person has a blood lead level greater than 5
micrograms per decilitre, the source of exposure should be investigated and
reduced, particularly if the person is a child or pregnant woman.
• Investigating the source of exposure where blood lead levels are greater
than 5 micrograms per decilitre will reduce the risk of harm not only to the
individual, but others in the community, including those who may be more
vulnerable to the effects of lead (such as children).
Text B
Health effects of lead
• The health effects due to exposure to lead vary greatly between individuals
and depend on a variety of factors such as a person’s age, the amount of lead
a person is exposed to and for how long, and if they have other health
conditions.
• The possibility of health effects from lead in the body is higher for children
and babies (including unborn babies) than for adults, because their bodies are
smaller and their brains are developing rapidly. Lead toxicity affects a range
of molecular processes, in part due to its ability to inhibit and mimic the
actions of calcium. This impacts on many organs and systems within the
body.
• There is an association between blood lead levels of 5 to 10 micrograms per
decilitre and adverse cognitive effects (reduced Intelligence Quotient (IQ)
and academic achievement) and behavioural problems (effects on attention,
impulsivity and hyperactivity) in children. However, it is unclear whether this
association is causal.
• For blood lead levels greater than 10 micrograms per decilitre there are well
established adverse effects on the body’s digestive, cardiovascular, renal,
reproductive and neurological functions.
Text C
Testing blood lead levels
• Measurement of blood lead should be considered when symptoms or health
effects associated with lead are present and/or a source of lead exposure is
suspected.
• Testing of asymptomatic children should be conducted based on the
individual’s risk profile (eg. life stage, exposure of other household members,
local environment and current health status).
• A blood lead test is considered the most reliable biomarker for general
clinical use. Results tend to reflect more recent exposure but do not
necessarily provide information about stored lead in the body.
• Other types of blood tests (e.g. plasma lead test or erythrocyte
protoporphyrin test) and tests of bone, teeth, sweat, nails or hair are not
recommended for clinical use.
Management of individuals
• Health practitioners should be aware of the requirements in their state or
territory for notification of blood lead levels to public health authorities.
• Collaboration between primary health practitioners and state and territory
environmental health agencies is recommended to identify and manage
exposure.
• Management approaches are based on individual blood levels and the
person’s overall health and social environment.
• Testing family members, and others suspected of being exposed to the lead
source should be considered as part of the management plan.
Text D
Investigating the source of exposure
• The first step to reducing elevated blood lead levels in individuals is to
identify the source/s of exposure. A planned, logical process should be
followed to identify lead hazards, and the presence of multiple lead sources
should not be ruled out or overlooked.
• Once the source has been identified, an exposure assessment should be
undertaken to identify the extent and pathways of exposure.
Interventions for reducing elevated blood lead levels
• Management strategies should focus on breaking the exposure pathway.
Addressing or removing the source of lead is the most effective intervention,
provided it can be successfully applied. This should take place before
attempts are made to change behaviour (e.g. through access restriction and
education).
• Substituting lead-containing products with lead-free products will have an
immediate beneficial effect. Remediation of widespread diffuse sources of
lead will require consultation with the local, state or territory health and
environmental protection authorities.
Part A
TIME: 15 minutes
information.
QUESTIONS
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.
1. What are the benefits of investigating the source of lead exposure?
2. What is the first step to reduce the elevated blood lead levels in individuals?
3. What is the most effective intervention for reducing the elevated blood
lead levels?
4. What are the factors that determine health effects due to exposure to lead?
5. Which blood tests are not recommended for clinical use?
6. What is the basis for testing blood lead levels of asymptomatic children?
7. Which body functions are adversely affected by blood lead levels

greater than 10 micrograms per decilitre?
Q
u
e
s
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. Who should notify public health authorities about blood lead levels?
9. What is the most reliable biomarker to find lead exposure for general
clinical use?
10. Who are more adversely affected from lead in the body?
11. Which metal is inhibited and mimicked by lead in the body?
12. what does the blood lead test result reflects?
13. What does ‘IQ’ stands or?
Questions 14-20
14. The average blood lead level in is estimated to be less than 5

micrograms per decilitre.
15. affects a range of molecular processes.
16. Blood lead levels of 5 to 10 micrograms per decilitre can have adverse
effects and behavioural problems.
17. Tests of bone, teeth, sweat, nails or hair are not recommended for .
18. Management approaches are based on and the person’s overall

health and social environment.
19. Testing people who are suspected of being exposed to the lead source
should be considered as part of the .
20. A planned, logical process should be followed to identify .

Part B
1. This guideline extract says that when investigating an unexplained failure
the technical personnel
A. should cooperate with electrical power system managing staff in the
health-care organization
B. should collaborate with staff who manages the electrical equipment in the
health-care organization
Factors affecting equipment failures

When investigating an unexplained failure, environmental factors should be
taken into due consideration. For example, medical devices that require
electrical power may be adversely affected by power issues. Ideally, electrical
power should have a steady voltage (of the appropriate value); be free of
transient distortions, such as voltage spikes, surges or dropouts; and be
reliable, with only rare loss of power. Technical personnel should collaborate
with those responsible for the electrical power system in the health-care
organization to help make the system function as effectively as possible.
2. What does this extract tell us about calibration?
A. medical equipment with therapeutic energy output needs to be calibrated
periodically
B. medical equipment that take measurements needs to be calibrated
periodically
Calibration
Some medical equipment, particularly those with therapeutic energy output
(e.g. defibrillators, electrosurgical units, physical therapy stimulators, etc.),
needs to be calibrated periodically. This means that energy levels are to be
measured and if there is a discrepancy from the indicated levels, adjustments
must be made until the device functions within specifications. Devices that
take measurements (e.g. electrocardiographs, laboratory equipment, patient
scales, pulmonary function analysers, etc.) also require periodic calibration to
ensure accuracy compared to known standards.
3. The guidelines establish that the healthcare professional should use
A. common universal descriptive names for devices from a internationally
accepted source
B. specific names for devices from the user manual given by the
manufacturer
C. common descriptive nomenclature from the directory of healthcare facility
Common descriptive nomenclature

Using common universal descriptive names from a single internationally
accepted source is key to comparing inspection procedures, inspection times,
failure rates, service costs and other important maintenance management
information from facility to facility. Although manufacturers have specific
names for devices, it is important to store the common name of the device as
listed in the nomenclature system.
A. maximize efficient use of patient-care unit resources
B. attend preadmission planning meetings
C. discuss the necessary of bed utilization
Preadmission Preparation
The clinical staff will conduct preadmission planning for each scheduledadmission of
patients. These discussions should address patient schedules and special needs.
Physicians, dentists, and other licensed independent practitioners, nursing staff, research
nurses, and protocol coordinators may participate in these meetings, which also may
involve social workers, nutritionists, pharmacists, and other members of the
multidisciplinary care team. To maximize efficient use of patient-care unit resources and
anticipate the possible need to “board” patients on other units, meeting participants may
discuss bed utilization.
A. staff who should conduct multidisciplinary clinical rounds at least weekly.
B. importance of multidisciplinary clinical rounds in patient management.
C. staff who should use information from multidisciplinary clinical rounds.
Multidisciplinary Patient Care Rounds
All the relevant staff constituting a multidisciplinary team should hold and
document clinical rounds at least weekly during patients’ hospitalizations and
prior to discharge. The purpose of these multidisciplinary clinical rounds is to
discuss patient data, progress in the protocol, problems relating to the
patient’s care, evaluations by specialists, and recommendations for
management. The primary care team can then use this information to devise
treatment plans, prepare patient education, and formulate recommendations
for referring physicians.
6. This guideline extract says that the medical staff
A. will have access to treatment guidelines endorsed by national
organizations
B. to practice guidelines in developing recommendations for patient
management
C. to develop patient management and treatment guidelines for supportive
care of patients
Patient Management And Treatment Guidelines
Even when the primary treatment is determined by a clinical research
protocol, supportive care for seriously ill patients may benefit from
guidelines developed by institute and center specialists. The medical staff
will have access to treatment guidelines endorsed by national organizations.
We encourage investigators and consultants, when appropriate, to consider
practice guidelines in developing their recommendations for patient
management. In addition, we encourage multi-specialty teams to develop
patient management and treatment guidelines for supportive care of patients
in clinical research protocols that are based on clinical trial data and expert
opinions.
Part C
Text 1 : The senses of the newborn

Paragraph 1
Tests for hearing and vision have improved
Shakespeare’s description of the infant, “Mewling and puking in the nurse’s
arms,” was echoed in the attitudes of doctors earlier this century. The
newborn baby was thought to be either drowsy, asleep, or crying, and to
experience the world as a “great, blooming, buzzing confusion.” But, we
have learnt over the past 30 years that the healthy newborn baby can
discriminate between different sensations from the environment and respond
selectively. ‘Within hours of birth the baby will look at the mother‘s face, and
given the choice newborn babies prefer to look at a card showing the features
of another human being rather than the same features jumbled up or the
features condensed into a large black patch.’
Paragraph 2
The newborn baby spends only 11% of the time awake and alert in the first
week of life, a proportion that rises to 21% in the fourth week. This small
traction of wakefulness hindered the early development of methods of testing
senses. When eliciting responses it is important to record the baby’s state of
arousal - between deep sleep at one extreme and crying at the other - and
Prechtl’s group first described five possible behavioural states. Brazelton
extended this work to include items of higher neurological function,
including visual and auditory responses to a bail and rattle, and his neonatal
behavioural assessment scale is a means of scoring interactive behaviour.’
Paragraph 3
Why do we need to test the senses of the newborn? We want to ensure that
the baby is able to interact with the parents and with the environment and that
there is no impairment to social, emotional, cognitive, and linguistic
development. It is often difficult to prove that early intervention is effective
in minimising handicap, but there is evidence - for instance, that deaf children
fined with hearing aids in the first six months of life have better speech than
those fitted later. And all parents and most therapists agree that they would
like to know of any handicap as early as possible.
Paragraph 4
Finding reliable and methods of testing hearing and vision in newborn babies
has proved difficult. They show behavioural responses to sound, blinking and
startling to a sudden clap and “stilling” to interesting noise, with alteration in
their breathing pattern. Every mother recognises these responses, but they
cannot be used to detect deaf babies reliably because of the spontaneous
random movements that babies make and possible bias on the part of the
observers. The use of a simple rattle to produce head and eye turning has
been described, but the method has not found widespread acceptance.
Behavioural responses may be recorded by devices incorporating
microprocessors such as the auditory response cradle (which should eliminate
observer bias). The sensitivity and specificity of this cradle have varied
among trials, and the sound stimulus has to be very loud (80-85 dB) to result
in a behavioural response by the baby, so that moderate hearing losses are
missed.
Paragraph 5
The electrophysiological response to sound may be detected by audiometry

based on evoked responses in the brain stun, and this is considerably more
sensitive. Simpler and more portable brain stem screeners have now been
developed. Most recently newborn babies hearing has been tested by using
otoacoustic emissions, a phenomenon first reported by Kemp in 1978.” A
click stimulus delivered to normal ear results in an “echo” sound generated
by the cochlea, which can be detected by a miniature microphone. The
method is quicker and less invasive than brain stem audiometry and can
detect even mild hearing losses. Stevens and his colleagues tested 346 infants
at risk and showed that 20 of the 21 surviving infants who gave negative
results to brain stem audiometry also failed on the otoacoustic test.
Paragraph 6
This work also highlighted a major problem - that of validating methods of
testing senses in the newborn baby. This has to be by follow up, checking the
outcome with the testing methods that become possible in the older infant.
Steven’s group found a poor correlation between distraction testing of the
babies’ hearing at 8 months of age and brain stem audiometry in the
newborn, a discrepancy confirmed by others. “We must now be more
cautious in interpreting the results of electrophysiological rests in the
newborn. Babies who give negative results will need retesting several times
during the first year. Though the early fitting of hearing aids is desirable, the
degree of hearing impairment needs to be clearly established, particularly as
maturation of the auditory pathways may be taking place, although delayed.
Paragraph 7
Similar problems and challenges occur in testing vision in newborn babies.
Behavioural responses are familiar to the mother, with the baby blinking to
bring light. Babes turn their heads to a diffuse light but (like turning to sound)
this test may not be reliable, especially in preterm infants. All these responses
give a qualitative indication of vision. Optokinetic nystagmus can be shown
when a striped tape or drum is moved in a temporal to nasal direction across
the newborn baby’s field of vision and gives a valuable but crude indication
that vision is present. Electrophysiological recording of the visual evoked
potential to a flash gives limited useful information because of great
individual variations and because it relates as much to general cerebral
function as to visual outcome.
Paragraph 8
Visual evoked potentials to patterns may give a measure of visual function
but only after the age of 2 months. The best method of measuring visual
acuity is to use the preferential looking technique. This is based on the
observation of Fantz 30 years ago that patterned objects are visually
interesting to infants. The latest version, called the acuity card procedure,
uses patterned and plain stimuli mounted in pairs on cards, and these can be
used successfully even in the neonatal intensive care unit. Much fascinating
and enjoyable research is being done into the ability of babies to discriminate
and respond to smell, taste, and touch. We should also be glad that at long
last there is widespread acceptance of fact that newborn babies do experience
real pain and need postoperative analgesia like the rest of us.
7. Doctors now know
a) that it is natural for a newborn baby to experience the world as a great
blooming buzzing confusion.
b) that babies are much more responsive to visual and auditory cues in their
surroundings than was previously thought.
c) the newborn babies are slow to develop a response to visual and auditory
stimulus, since they are awake only 11% of tile time.
d)that babies are less able to discriminate between different features of the
environment than was believed in the first half of this century.
8 According to research referred to in the article, a baby given a choice about what to
look at is more likely to choose
a) a card showing human facial features. ‘
b) a card showing jumbled human features.
c) a card showing a large black patch.
d) a black and white photograph of the mother.
9. The senses of the 4-week-old baby can only be tested

a) 11% of the time.
b) when it is crying.
c) 21% of the time.
d) none of the above.
10 . Which of the following statements is true?

a) There is some evidence that early intervention can prevent handicaps.
b) There is much evidence that early intervention can minimize handicaps.
c) There is some evidence that early intervention can minimize handicaps.
d) There is no evidence that early intervention can minimize handicaps.
11. Testing hearing in newborn babies is difficult for all of the following
reasons, except
a) Newborn babies show behavioural responses to sound such as blinking and
startling.
b) Deaf babies sometimes make movements by chance when interesting
noises are made.
c) Observers may be biased in their interpretation of babies’ responses.
d) The auditory response cradle does not measure moderate hearing losses.
12. Otoacoustic emissions are

a) sounds delivered to the cochlea.
b) ‘echo‘ sounds caused by click stimuli.
c) click stimuli delivered to a normal ear.
d) sounds generated by a miniature microphone.
13. Compared with the use of otoacoustic emissions, brain stem audiometry
a) is quicker.
b) can detect even mild hearing loss.
c) is more invasive.
d) is more sensitive.
14. Of the hearing testing methods described in the text

a) brain stem audiometry correlated well with otoacoustic tests.
b) brain stem audiometry correlated well with distraction testing.
c) otoacoustic tests correlated poorly with brain stem audiometry.
d) otoacoustic tests correlated well with distraction testing.
Part C
Insulin is still a hard act to swallow

Paragraph 1
Research groups around the world are optimistic that they are making
progress towards developing the drug insulin in a form that can be taken by
mouth. Many diabetics must inject themselves every day with insulin to help
control the level of sugar in their blood. For decades, scientists have been
looking for an effective way to give people insulin by mouth instead. Insulin
is an essential hormone for getting glucose from the bloodstream into body
cells, and most people produce it naturally in the pancreas. People with
diabetes mellitus produce either not enough insulin or none at all. The
hormone cannot normally be taken by mouth because insulin molecules are
destroyed by digestive enzymes in the gut. Thus, many diabetics must inject
them-selves with insulin daily.
Paragraph 2
Researchers have therefore been aiming to package the hormone in some way
so that it can survive intact in the gut and cross the gut wall into the
bloodstream. The current experiments are all at an early stage. Even if they
do lead to an effective treatment, it may not be suitable for every diabetic.
Those most likely to benefit are people who find injections difficult, such as
blind people and younger children. This month a team in Ohio is applying for
permission to test its oral insulin on people. The tablet is a gelatin capsule
which contains insulin and a drug similar to aspirin and sodium bicarbonate.
The gelatin has a costing of waterproof plastic that becomes permeable in the
gut.
Paragraph 3
Murray Saffran, who is leading the research at the Medical College of Ohio
in Toledo, says the plastic based on a polymer whose structure contains
certain nitrogen- nitrogen bonds known as azo bonds. In the gut, bacteria
break down the azo bonds, and the plastic becomes permeable to water.
Water enters the capsule and causes a reaction between the aspirin-like drug
and the sodium bicarbonate, giving off carbon dioxide and rupturing the
capsule. The researchers believe the aspirin-like drug may also help the
insulin to be absorbed. The insulin is absorbed directly from the gut into the
vein carrying blood to the liver.
Paragraph 4
Saffran and his colleagues have so far carried out trials of the capsule in rats
and - most recently - diabetic dogs. The researchers found that the level of
glucose in the animals’ blood fell, on average, from more than 400 to 120
milligrams per decilitre after receiving the capsule. At the same time, the
insulin levels in their blood rose, showing they had absorbed the hormone.
Reading Test - Version 2 Another group has already staned testing a
different insulin capsule in humans, having first performed animal trials.
Hanoch Bar- On and his colleagues at the Hadassah Hospital in Jerusalem
have patented their capsule, which is coated so that it is not destroyed by the
stomach acid. Bar-On says the capsule contains insulin and “other
ingredients” which help to enhance the hormone’s absorption in the gut and
to inhibit the enzymes that destroy it.
Paragraph 5
So far, the trial in Jerusalem has been small, involving only eight health
volunteers. In future, Bar-on wants to extend the trials to diabetics, but he
stresses the need for more research before he can do so. The success of the
tests so far has been limited, but encouraging, says Bar-On: in three of the
eight, the level of sugar in their blood fell after they took the capsule from
100 milligrams per decilitre to between 80 and 85. At the same time, the
insulin level in their blood was seen to rise to a peak then tail off. For the
remaining five people, there was no significant effect from the capsule.
Paragraph 6
A third project is led by Yough Cho at Murdoch University in Perth,
Australia, together with Cortecs, a company in Isle Worth near London. Cho
has devised a combination of insulin and fatty molecules, encapsulated in
gelatin. The fatty molecules, which occur naturally in the gut as a product of
the digestion of fat, are easily absorbed from the gut and carried to the liver.
Insulin attached to these molecules can enter the bloodstream.
Cho gave three diabetic men this preparation, in liquid form. In each of the
men there was a “substantial reduction” in the level of blood sugar. Their
insulin levels were also seen to peak and tail off. The team has published this
work in The Lancet, and clinical trials of the capsule are due to start soon at
Guy’s Hospital, in London.
Paragraph 7
There are, however, several problems with oral insulin. First, it is relatively
inefficient: several times as much insulin is needed to achieve the same drop
in blood sugar that a specific amount could achieve if injected. This suggests
that a significant amount of insulin is still being destroyed in the gut. Also,
the amount of insulin that will be absorbed is unpredictable and can be
disrupted, for example, by illness.
Text 2 QUESTIONS 15-22
15. According to the article,
a) it is no longer desirable that diabetics should inject themselves with insulin
b) a large number of diabetics no longer want to inject themselves with
insulin
c) a viable oral form of insulin has been developed
d) a viable oral form of insulin may soon be developed
16. The major problem with an oral form of insulin has been
a) producing it in sufficient quantities outside the pancreas
b) delivering it undamaged into the bloodstream ‘
c) preventing it from attacking digestive enzymes in the gut
d) its previous inability to cross the gut wall into the bloodstream
17. The capsule which is to be tested in Ohio

a) will also be tested on blind people and younger children
b) contains a combination of insulin, aspirin and sodium bicarbonate
c) has protection which enables it to overcome the previous problems
d) none of the above
18. The reaction between the capsule and water in the gut
a) is likely to destroy the insulin
b) causes the insulin and the aspirin-like drug to “be taken into the
bloodstream
c) produces carbon dioxide as a by-product
d) allows the insulin and the sodium bicarbonate to pass into the bloodstream
19. Research at the Medical College of Ohio in Toledo

a) has shown signs of being successful has been carried out on diabetic rats and dogs
b) has shown an increase in blood level in the animals tested
c) all of the above
20. In tests carried out at the Hadassah Hospital in Jerusalem

a) Saffran’s capsule has had similar results with humans
b) Saffran’s capsule has not had similar results with humans
c) the researchers have used a capsule which is almost identical to Saffran‘s
d) the capsule being used contains substances to protect the insulin from
attacking in the stomach
21. Which of the following statements is TRUE?

a) Bar-On has used healthy diabetic volunteers exclusively in his trials
b) Bar-On is ready to extend his trials
c) Bar-On has not been discouraged by results to date
d) Less than 50% of Bar-On‘s subjects experienced minimal change of
insulin level in the blood
22. In the Australian project,

a) fatty molecules, similar to those found naturally-occurring in the body are
used to cost the insulin-gelatin combination
b) the artificially-introduced fatty molecules solidify in the gut
c) fatty molecules carry the insulin
d) the gelatin enters the bloodstream with the insulin
Practice Test 5
Text A
Patchy and scratchy
European scientists say they can explain why nicotine patches designed to
help smokers kick their habit can cause skin irritation. Nicotine activates a
so-called ion channel in skin cells that unleashes an inflammatory response
by the immune system, leading to itching, they reported in the journal Nature
Neuroscience on Sunday. Previously, the irritation had been blamed on
stimulation of special nicotine receptors on nerve cells, causing pain signals
to be sent to the brain. The investigation, carried out on mice, could pave the
way to smoking therapies with fewer side effects, the authors say.
Text B
Pay poorer smokers to quit, heart lobby urges
Australians should be paid to quit smoking to help reduce the burden of heart
disease in poorer outer suburban and regional areas, the head of the Heart
Foundation of Victoria, Kathy Bell, says. The call came as a new survey of
about 20,000 people found the municipality of Dandenong in Melbourne’s
outer south-east had the highest rate of heart disease in Victoria, with nearly
32 per cent of the population affected by it. Regional areas of Victoria,
including East Girppsland and the Ovens-Murray strict, showed similarly bad
results, whereas Ms Bell said only about 14 per cent of people in high-
income areas, close to the city, had experienced heart disease.
“These regions are some of the lowest-income areas in Victoria, with a high
proportion of households earning income of less than $350 per week,” she
said. Ms Bell said research showed disadvantaged areas had high rates of
smoking which needed to he addressed. She said financial incentives should
be considered alongside higher taxes on cigarettes — both recommendations
of a resort recently released by the Federal Government’s preventive health
taskforce. A study of more than 800 General Electric employees in the US
found those who were offered rolling payments of up to $750 a year to quit
smoking and remain abstinent were about three times more likely to rant
long-term, compared with use who were not given money.
Text C
Cyber aid to quitting smoking
Battling one’s cigarette demons in a virtual world may prove to be an
effective way to help people quit smoking, a research team has found in a
preliminary study. Scientists from Canada’s GRAP Occupational Psychology
Clinic and the University of Quebec modified a three-dimensional video
game to create a computer-generated virtual reality environment as part of an
anti-smoking program. Of 91 regular smokers enlisted in the 12-week
program, 46 of them crushed computer-simulated cigarettes as part of
psychosocial treatment, while the other 45 grasped a computer-simulated
ball. The group who crushed cigarettes had a “statistically significant
reduction in nicotine addiction” compared with the ball graspers, according to
the study in the journal Cyber-Psychology and Behaviour.
Text D
By the 12th week, abstinence among the cigarette-crushers was 15 per cent,
compared with 2 per cent for the other group. The crushers also stayed in the
program longer and, at a six- month follow-up, 39 per cent of them reported
not smoking during the previous week, compared with 20 per cent of the ball-
graspers. “It is important to note that this study increased treatment
retention,” said Brenda Wiederhold, the journal’s (Cyber-Psychology and
Behaviour) editor-in-chief, adding that such treatment should now be
compared to other popular treatments such as the nicotine patch. The study
said about 45 per cent of smokers in the US attempt to quit each year, with
limited success.
Part A
TIME: 15 minutes
information.
QUESTIONS
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.
1. Which are the lowest-income areas in Victoria?
2. Who created the video game to as part of an anti-smoking program?
3. Who are the cigarette-crushers?

4. Who is Brenda Wiederhold?
5. Why the nicotine patches are causing skin irritation?
6. Who proposed the idea to pay Australians to quit smoking?
7. How much smokers in the US attempt to quit each year?
Questions 8-13
Answer each of the questions, 8-13, with a word or short phrase from one
8. Who is the editor-in-chief journal Cyber-Psychology and Behaviour?
9. How many regular smokers enlisted in the Canadian Cyber-aid program?
10. Where did the European scientists’ published their findings?
11. How many General Electric employees were offered payments to quit
smoking?
12. What was the trial subject for the study conducted by European
scientists?
13. How many crushed computer-simulated cigarettes?
Questions 14-20
14. Nicotine activates an ion channel in skin cells that unleashes by the
immune system.
15. In Australia, 14 per cent of people in high-income areas had experienced

.
16. By the 12th week, abstinence among the ball-graspers was .
17. In the US, 45 per cent of smokers attempt to quit each year with .
18. Previously, nicotine patch irritation was blamed on stimulation of

on nerve cells.
19. stayed in the Cyber aid program longer than the other group.
20. Ms Bell’s research showed had high rates of smoking.

Part B
health professionals. For questions 1-6, choose the answer (A, B or C) which
you think fits best according to the text.
1. This guideline extract says that the safety inspections should not
A. be performed to ensure the device is electrically and mechanically safe
B. include checks for radiation safety or dangerous gas or chemical pollutants
C. be the same than planned maintenance and performance inspections
Safety inspections of medical equipments

These are performed to ensure the device is electrically and mechanically
safe. These inspections may also include checks for radiation safety or
dangerous gas or chemical pollutants. When these inspections are done, the
results are compared to country or regional standards as well as to
manufacturer’s specifications. The frequency of safety inspections may be
different than planned maintenance and performance inspections, and are
usually based on regulatory requirements.
2. The purpose of this email is to take steps that allow
A. both equipment users and equipment technicians access to operation
manuals
B. only the equipment technicians access to operation manuals
C. only the equipment users access to operation manuals
Operation and service manuals
Ideally, the maintenance programme will have an operation (user) manual
and a service manual for each model of medical equipment. The operation
manual is valuable not only for equipment users but also for equipment
technicians who need to understand in detail how the equipment is used in
clinical practice. The service manual is essential for inspection, preventive
maintenance, repair, and calibration. Unfortunately, operation manuals and
service manuals are not always available, or may be in a language not spoken
by equipment technicians. Therefore, it is important to take steps that allow
them access to such manuals.
A. use technician efficiently to reduce down-time of equipment and expenses
B. only plan inspection for immobile equipment in a given clinical
department
C. schedule inspection of equipment of different types simultaneously
Scheduling maintenance
Efficient use of technician time will reduce down-time of equipment and
minimize overall expenses. The most appropriate method for scheduling
maintenance in a particular health-care facility should be chosen. For
inspections, one approach is to plan for the equipment in a given clinical
department to be inspected at the same time. This works very well for
equipment that does not move from the department. Another approach would
be to schedule inspection of equipment of a given type (e.g. defibrillators)
simultaneously.
4. When referring a patient to physician, it is necessary to
A. provide a concise summary of evaluation, treatment, and management
recommendations of the patient
B. provide a form containing discharge instructions, patient’s medication list
and contact phone number
C. explain patient’s evaluation, treatment, and management recommendations
as well as the follow-ups
Patient Discharge And Referring Physician Interface
Care teams that may include the attending physician or dentist, fellows, other
licensed independent health-care practitioners, research nurses, and patient-
care unit nursing staff will meet with patients at the time of their discharge to
explain their evaluation, treatment, and management recommendations as
well as the follow-up that may be required at the clinical center. The care
teams will provide patients with a form containing discharge instructions,
their medication list, and a contact phone number at the clinical center.
Referring physicians will receive a concise summary of evaluation, treatment,
and management recommendations from the responsible attending physician
or other designated licensed independent practitioner within a week of
discharge, or earlier if necessary for appropriate continuity of care.
5. The purpose of these notes about Quality Assurance is to
A. provide an appropriate opportunity to discuss outcomes of protocol
participation
B. review the occurrences and complications of procedures that caused
patient harm
C. ensure attendance of patient-care staff and appropriate key staff
Quality Assurance
To review the occurrences and complications of procedures that caused—or
had the potential to cause—patient harm, the institutes and centers should
conduct Quality Assurance Rounds on a regular basis. These rounds also
provide an appropriate opportunity to discuss especially serious outcomes of
protocol participation—even when unassociated with an occurrence or
procedural complication. These conferences, which should be attended by all
levels of patient-care staff, will regularly include the unit nurse manager and
other representatives from the nursing staff. When appropriate, other key staff
(e.g., from the Pharmacy or Social Work Department) may be included.
A. monitor compliance with standardized forms, tools, and methods for
transitions of care
B. use surveys and data collection to find root causes of effective transitions
C. identify patient and caregiver dissatisfaction with ineffective transitions
Evaluation Of Transitions Of Care Measures
Monitor compliance with standardized forms, tools, and methods for
transitions of care. Use surveys and data collection to find root causes of
ineffective transitions and to identify patient and caregiver satisfaction with
transitions and their understanding of the care plan. For example, this three-
item survey queries patients about key aspects of a care transition:
• The hospital staff took my preferences and those of my family or caregiver
into account in deciding what my health care needs would be when I left the
hospital.
• When I left the hospital, I had a good understanding of the things I was
responsible for in managing my health.
• When I left the hospital, I clearly understood the purpose for taking each of
my medications.
Part C
Text 1 Exercise, fitness and health
Paragraph 1
Physical inactivity is a substantial risk factor for cardiovascular disease. Exercise
probably works by increasing physical fitness and by modifying other risk factors.
Among other benefits, it lessens the risk of stroke and osteoporosis and is associated with
a lower all-cause mortality. Moreover, it has psychological effects that are surely
underexploited. A pervasive benefit is the gain in everyday reserve capacity - that is, the
ability to do more without fatigue. Nevertheless, there is much debate about how intense
the exercise should be. Some studies show a dose-response relation between activity and
reduction of risk, with a threshold of effect; some suggest that vigorous aerobic activity is
needed and others that frequent moderate exercise is adequate - and indeed safer if
ischaemic heart disease might be present. A few surveys have found a slightly increased
risk of heart attack with extreme activity, though further analysis in one study suggested
this applied only to men with hypertension.
Paragraph 2
A commonly recommended minimum regimen for cardiovascular benefit is
thrice weekly exercise for 20 minutes, brisk enough to produce sweating or
hard breathing (or a heart rate 60-80% of maximum). Indeed, this is what the
Allied Dunbar national survey of fitness among adults in the UK
recommends. It conveys a simple popular message of broad minimum targets
for different age groups expressed in terms of activities of different intensity.
The aim is to produce a training effect through exercise beyond what is
customary for an individual.
Paragraph 3
The main reason why people fail to take exercise is lack of time. Thus an
important message is that exercise can be part of the daily routine - walking
or cycling to work or the shops, for instance. Relatively few people in the
national fitness survey had walked continuously for even 1-25 km in the
previous month (11-30% depending on age and sex), and other surveys have
also found little walking. Cycling is also beneficial, however many are put
off cycling to work by the danger. Certainly more cycle routes are needed,
but even now life years lost through accidents are outweighed by the
estimated life years gained through better health. Employers could encourage
people to make exercise part of the working day by providing showers and
changing rooms, flexible working hours, individual counselling by
occupational health or personnel staff, and sometimes exercise facilities - or
at least encouragement for exercise groups.
Paragraph 4
In the promotion of exercise children, women, middle aged men, and older
people need special thought. Lifelong exercise is most likely to be started in
childhood, but children may have little vigorous exercise. Women tend to be
much less active than men and are less fit at all ages. The proportion judged
on a treadmill test to be unable to keep walking at 5 km/h up a slight slope
rose with age from 34% to 92% - and over half of those aged over 54 would
not be able to do so even on the level. Women have particular constraints:
young children may prevent even brisk walking. Thus they need sensitive
help from health professionals and women’s and children’s groups as well as
the media.
Paragraph 5
A high proportion of men aged 45-54, who have a high risk of coronary heart
disease, were not considered active enough for their health. Promotion of
exercise and individual counselling at work could help. Forty per cent of 65-
74 year olds had done no “moderate” activity for even 20 minutes in a month.
Yet older people especially need exercise to help them make the most of their
reduced physical capacity and counteract the natural deterioration of age.
They respond to endurance training much the same as do younger people.
Doctors particularly should take this challenge more seriously.
Paragraph 6
People need to be better informed, and much can be done through the media.
For instance, many in the survey were mistaken in thinking that they were
active and fit. Moreover, many gave “not enough energy” and “too old” as
reasons for not exercising. Precautions also need publicity - for example,
warming up and cooling down gradually, avoiding vigorous exercise during
infections, and (for older people) having a medical check before starting
vigorous activity. Doctors are in a key position. Some general practitioners
have diplomas in sports medicine, and a few are setting up exercise
programmes. As the Royal College of Physicians says, however, all doctors
should ask about exercise when they see patients, especially during routine
health checks, and advise on suitable exercise and local facilities. Their
frequent contact with women and children provides a valuable opportunity.
Excluding ischaemic heart disease and also checking blood pressure before
vigorous activity is started are important precautions. But above all doctors
could help to create a cultural change whereby the habit of exercise becomes
integral to daily life.
Text 1
Question 7-14
7. All of the following are mentioned in paragraph 1 as benefits of exercise
EXCEPT
A. increase in the capacity to withstand strenuous activity.
B. significant decrease in the risk of osteoporosis.
C. reduction of the risk of heart disease.
D. weight control and decrease in levels of body fat.
8. According to paragraph 2, the recommendations of the report on the

national fitness survey included
A. long, vigorous aerobic sessions for all men, women and children.
B. no more than three, 20 minute exercise sessions per week.
C. avoiding any exercise that brought on hard breathing.
D. different levels of exercise intensity for different age groups.
9. According to paragraph 3, one reason many people do not exercise

is
A. they are unaware of its importance.
B. difficulty in fitting it into their daily routine.
C. they are unaware of its long-term health benefits.
D. they live too far from work to walk or cycle.
10. Which one of the following is mentioned in paragraph 3 as a way in

which employers can help improve the physical fitness and health of their
staff?
A. Making it mandatory for employees to exercise during lunch breaks. Providing
encouragement and advice from staff within the organisation.
B. Hiring trained sports educators to counsel members of staff about exercise.
C. Setting an example, as individuals, by regularly exercising themselves.
11. According to paragraphs 4 and 5, older men and women need to remain
physically active and fit because
A. they need to counteract the risk of coronary disease.
B. fitness levels decrease rapidly over the age of 54.
C. they need to guard against poor health and inactivity.
D. exercise works against the physical effects of ageing.
12. Which one of the following is NOT mentioned in paragraph 6 as a

precaution to be taken when considering exercise?
A. The need to balance aerobic activity with stretching.
B. The need to warm up before and cool down after exercise.
C. The need to eliminate the risk of ischaemic heart disease before starting. ,
D. The need to exclude strenuous exercise from the routine during infection.
13. Which one of the following needs in relation to the improvement of

national fitness are NOT mentioned in the article?
A. The need for people to make exercise a regular daily habit.
B. The need to provide information on health and fitness to the community.
C. The need for doctors themselves to improve their own fitness levels.
D. The reed to consult a doctor before starting an exercise program.
14. According to the article, which one of the following is FALSE?

A. It is unsafe for people with high blood pressure to do regular moderate
exercise.
B. Experts agree on the importance of both type and intensity of exercise.
C. Men are generally fitter and more active than women.
D. Cycling, though unsafe, is a beneficial form of exercise.
Part C
Text- 2 Employment records reveal the detail of asbestos danger
Paragraph 1
About a quarter of the people who worked in an asbestos mine in Western
Australia between 1963 and the closure of the pit in 1986 are already
suffering from diseases related to their exposure to the mineral, or do in the
future. This is the estimate of researchers who say that the mine’s
employment records have enabled them to carry out one of the most thorough
studies ever of the long-term health effects of exposure to asbestos fibre. The
team, based at the University of Western Australia and the Sir Charles
Gairdner Hospital in Perth, says that it is the only study in which a well-
defined group of people has been exposed to a single form of asbestos over a
specified period.
Paragraph 2
Of the 6502 men and 410 women who worked at the mine, almost 2000 have
developed or will develop cancer and other diseases related to asbestos. The
Asbestos Diseases Society of Australia, a group formed to help people
exposed” to asbestos, claims that 300 former workers have already died of
diseases that are asbestos-related. The people, mostly migrant labourers from
Europe, worked in an asbestos mine and mill in Wittenoom, a town in the
Hamersley Range, about 1600 kilometres north of Perth. Wittenoom, once
the home for 4000 people, is now virtually deserted. The state government
cut essential services to the town last year. Blue asbestos, or crocidolite, was
mined there.
Paragraph 3
The researchers were able to determine how much asbestos the workers were
exposed to by making calculations based on readings of dust that were taken
at various times during the mine’s operation. The most extensive exposure to
asbestos occurred in the mill where ore was ground down and the fibre
extracted. The Australian study was published last month in the Medical
Journal of Australia. Other records of exposure to blue asbestos - such as
those from South Africa - have not been as useful to researchers as the data
from Wittenoom, says William Musk, from the University of Western
Australia.
Paragraph 4
Blue asbestos fibres are very thin, straight and small - about 0.1 micrometres
in diameter. As a result, they are more likely to enter the lungs than other
types of asbestos fibres. They are also the least likely to adhere to and be
intercepted by the protective mucus in the airways. Scientists have associated
the fibres mined at Wittenoom with three types of disease: malignant
mesothelioma, lung cancer and asbestosis, a scarring of the lung. Most of the
workers were at the mine for only short periods - months, rather” than years.
The diseases may take up to 40 years to develop.
Paragraph 5
The records until 2006 show 94 cases of mesothelioma, 141 lung cancers and
356 cases of asbestosis among the Wittenoom workers. In the general
population, mesothelioma, a cancer of the outer covering of the lung, is rare,
occurring at the rate of less than one per million people each year. The
scientists say that exposure to asbestos can account for about 40 per cent of
the cases of lung cancer at Wittenoom; the remainder were caused by the
effects of smoking. Over the next 30 years, there will be a sevenfold increase
in the number of cases of mesothelioma, according to the researchers‘
estimates. There will be as many as 25 cases of the disease a year by the year
2030.
Paragraph 6
The team predicts that between 1997 and 2040, a total of 692 new cases of
mesothelioma will occur. Most will be in the lung (pleural mesothelioma),
but some will be in the abdomen (peritoneal mesothelioma). Cases of lung
cancer and asbestos among the workers will reach a peak by about 2020, with
a total of 183 and 482 respectively by the year 2040. The Asbestos Diseases
Society claims that the problem will not be confined to former workers.
About 6000 of the 14 000 wives and children of workers at Wittenoom will
also suffer from asbestos-related disease, according to the society. “Forty-one
people in their late 30s or 40s who were children at Wittenoom have died of
mesothelioma.” according to Robert Vojakovic, the President of the society.
He obtained the statistics from death certificates. The university study only
examined the records of workers.
Paragraph 7
Last year, after a legal battle lasting 13 years, CSR, the mining company
whose subsidiary, Australian Blue Asbestos, operated the plant, agreed in an
out-of-court settlement to pay compensation to former miners and residents
of Wittenoom. By 5 December, 350 people and their families had received
compensation totalling $42 million. The State Government Insurance
Commission will share the costs of compensation based on exposure to
asbestos at Wittenoom after 1979. The payments, part of the largest industrial
settlement in Australian history, will range in size between A$30,000 and
A$600,000.
Paragraph 8
However, Western Australia has another problem. The red gorges within the
Hamersley Range, including the Wittenoom Gorge, have become a tourist
attraction. The millions of asbestos tailings that still litter the area are
regarded as a health hazard, especially to children who might be tempted to
play on the piles. Camping is forbidden in the Wittenoom Gorge. The state
government is considering burying the tailings or putting them under the
water. Both solutions will be expensive. The asbestos society is trying to
obtain funds from Lang Hancock, the mining magnate who opened the mine
in the late 1950s, and CSR, to help restore Wittenoom Gorge, which it says
could be made into a major tourist attraction. It also wants the town to be
relocated within the gorge.
Text 2 Question 15-22
15. Of all workers in the Western Australian mine, 25%
a) have died since 1986 of mine-related diseases.
b) have already got symptoms of mine-related diseases.
c) may suffer from mine-related diseases in the future.
d) have developed mine-related diseases or may do so.
16.Which of the following is not unique to the West Australian study?

a) The mine kept records of all workers.
b) The effects of only one form of asbestos were studied.
c) Data were collected during a clear period of time.
d) The group studied was well defined. ’
17.The population of Wittenoom is now

a) around 4000 people.
b) extremely small.
c) around 1600 people.
d) non-existent.
18. Which of the following is not typical of blue asbestos fibres?

a) The fibres are so small that they enter the lungs easily.
b) The fibres easily adhere to protective mucus in the airways.
c) The fibres are usually not intercepted by mucus in the airways.
d) The fibres are less than a micrometre in diameter.
19. Of the three types of diseases associated with asbestos fibres at the
Wittenoom mines.
a) mesothelioma is the most frequently occurring type.
b) asbestosis is the most frequently occurring type.
c) asbestosis is the least frequently occurring type.
d) lung cancer is the least frequently occurring type.
20. The research team predicts that by the year 2040 there will be a total of
183 cases of
a) asbestosis.
b) pleural mesothelioma.
c) lung cancer.
d) peritoneal mesothelioma.
21. Statistics quoted in the article are based on

a) death certificates.
b) mine employment records.
c) research conducted at a university.
d) all of the above.
22. A 13-year legal battle for compensation of disease victims resulted in

a) an out-of-court settlement involving payment by two parties.
b) compensation payments to former Wittenoom miners.
c) compensation payments to 350 Wittenoom residents.
d) an out-of-court settlement involving payment only by CSR.
Answer Key
Practice Test 1
1. B
2. D
3. A
4. C
5. D
6. C
7. A
8. 1,740
9. walking
10. counselling
11. doctor
12. physical therapies
13. regular exercise
14. Dr. Eric Larson
15. Medications
16. Herbs
17. physical activity program
18. vitamins
19. none
20. progressively destroyed
Part B
1. B
2. B
3. C
4. C
5. C
6. B
Part C
7. b
8. d
9. b
10. d
11. d
12. a
13. c
14. a
15. a
16. d
17. a
18. b
19. b
20. c
21. b
22. c
Practice Test 2
Part - A
1. C
2. D
3. B
4. A
5. B
6. D
7. A
8. Secondary glaucoma
9. $4.3 billion
10. 0.7
11. Over 146,000
12. $342 million
13. 50%
14. optic nerve
15. an 8-fold
16. Acute glaucoma
17. cortisone
18. indigenous population
19. Chronic glaucoma
20. eye drops
Part - B
1. A
2. A
3. A
4. A
5. A
6. C
Part C
7. b
8. d
9. c
10. d
11. b
12. a
13. b
14. d
15.b
16. b
17. d
18. c
19. a
20. b
21. d
22. c
Practice Test 3
Part A
1. C
2. B
3. A
4. D
5. B
6. D
7. D
8. SSRI
9. WHO
10. psychiatrist
11. severe depression
12. 6
13. Laurie Oakes
14. Occasional sadness
15. another illness
16. eating habits
17. 2 weeks
18. Beyond Blue
19. antidepressant
20. Mild depression
Part - B
1. B
2. C
3. B
4. C
5. A
6. C
Part - C
7. d
8. c
9. d
10. a
11. b
12. d
13. a
14. b
15. b
16. b
17. c
18. a
19. a
20. d
21. c
22. b
Practice Test 4
Part – A
1. A
2. D
3. D
4. B
5. C
6. C
7. B
8. Health practitioners
9. blood lead test
10. children and babies
11. calcium
12. more recent exposure
13. Intelligence Quotient
14. Australia
15. Lead toxicity
16. cognitive
17. clinical use
18. individual blood levels
19. management plan
20. lead hazards
Part B
1. A
2. C
3. A
4. A
5. B
6. A
Part – C
7. b
8. a
9. c
10. c
11. a
12. b
13. c
14. a
15. d
16. b
17. c
18. c
19. a
20. d
21. c
22. c
Practice Test 5
Part- A
1. B
2. C
3. C
4. D
5. A
6. B
7. D
8. Brenda Wiederhold
9. 91
10. Nature Neuroscience
11. 800
12. mice
13. 46
14. an inflammatory response
15. heart disease
16. 2 per cent
17. limited success
18. special nicotine receptors
19. cigarette-crushers
20. disadvantaged areas
Part – B
1. C
2. A
3. A
4. A
5. B
6. A
Part – C
7. d
8. d
9. b
10. b
11. d
12. a
13. c
14. b
15. d
16. a
17. b
18. b
19. b
20. c
21. d
22. a

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Practice Test 1

Launch of Australia’s first dementia and exercise study

2. Where did the study by the University of Washington was published?

3. What are the cognitive symptoms of Alzheimer’s disease?

4. What does ‘NARI’ stands for?

5. Who was the lead researcher in the University of Washington study?

6. Who is supporting FABS II?

7. What are the behavioural and psychiatric symptoms of AD?

13. What can improve the brain function in older people?

17. is hoped to benefit people with mild to moderate AD.

18. contains antioxidants that help to protect the brain coils.

20. When one is affected by AD, neurons in the brain are .

1. The manual informs us that the Biopotential Amplifiers

Implantable Cardiac Pacemakers

The modern pacing system is comprised of three distinct components: pulse

Defibrillators are devices used to supply a strong electric shock to a patient in

Thermopositive (warm) wet treatment

Special oral care

Briefly, in updating their Cochrane review, published in late 2009. Tom

9. According to the article, which one of the following statements about

10. According to the article, Cochrane Review Groups

11. Which would make the best heading for paragraph 4?

13. Cochrane reviews should

14. Which would make the best heading for paragraph 7?

In April, Amgen, which is based in Thousand Oaks, California, paid the

Friedman and Pelleymounter believe that the protein, which is produced by

The third group of researchers from the Swiss Pharmaceuticals company

Stephen Bloom, professor of endocrinology at London s Hammersmith

Even Pelleymounter at Amgen cautions against over optimism at this stage.

18. According to Friedman and his colleagues, the ob protein

19. According to the article, the Californian company called Amgen

21. According to the Friedman and Pelleymounter studies, treatment with ob

22. The evidence gathered in Friedman’s and Pelleymounter’s studies

Table 1: Study of eye pressure and corneal thickness as predictors of

Thickness less than 555 -.49*

Other forms of Glaucoma.

Overview of Glaucoma Facts

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

4. Which is the most common form of glaucoma??

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

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

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

10. What is the predictor of development of glaucoma for intraocular

11. How many Australians have been diagnosed with glaucoma?

13. What is the current percentage of undiagnosed glaucoma

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

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

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

Parenteral Infusion Devices

Intravenous (IV) and intraarterial access routes provide an effective pathway

Drains and drainage systems

Text 1 : AIDS deaths blamed on immune therapy

8. The preparation which the patients received

9. According to the article, vaccinia

10. Jean-Claude Guillaume

16. According to paragraph 2, cataracts

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

A. responds well to early treatment.

18. According to paragraph 3, the detection of glaucoma