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

Write your answers on the separate Answer Sheet.

____________________________________________________________________________

1. Application of MeTro involves

A. Sutures
B. Electric-magnetic waves
C. Non-degradable enzyme

MeTro

A highly elastic and adhesive surgical glue named MeTro that quickly seals wounds
without the need for common staples or sutures could transform how surgeries are
performed. MeTro’s high elasticity makes it ideal for sealing wounds in body tissues
that continually expand and relax – such as lungs, hearts and arteries – that are
otherwise at risk of re-opening.
It sets in just 60 seconds once treated with UV light, and the technology has a built-
in degrading enzyme which can be modified to determine how long the sealant lasts
– from hours to months, in order to allow adequate time for the wound to heal. It
also seems to remain stable over the period that wounds need to heal in demanding
mechanical conditions and later it degrades without any signs of toxicity.

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 2. The guidelines inform that

A. it must be ensured that a set procedure is not performed for a wrong patient
B. when the patient is a child, staff from an earlier location should be consulted
C. patient should first be given the identification details and asked for confirmation

Guidelines For Staff: Patient identification

The patient’s identity must be confirmed before any procedure commences.

Staff must confirm they have the correct patient by asking the patient, or their
person responsible, to state the patient’s full name and date of birth. Staff must not
state the patient’s name or date of birth and then ask the patient, or their person
responsible, if this information is correct.
The response must be confirmed against the details on the consent form / request
form / referral / treatment plan and patient identification band.
Where patient details are incomplete or there is a discrepancy with the information
received from the patient, or their person responsible, the correct information must
be verified before commencing the procedure and actions taken documented in the
patient’s health care record. If the patient is unable to participate in the patient
identification step, for example due to physical incapacity, language issues, or is a
child, and their person responsible is not present, a member of staff from the
preceding location of the patient (e.g. ward or emergency department) must act as
the patient’s advocate to confirm the patient’s identity

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3. The main purpose of the article is to

A. Raise awareness among health staff about HCAIs

B. Recommend ways to avoid spread of pathogens through a particular routine
C. Describe the right way to wash nurses' uniforms at home

Extract From Hospital Meeting:

With rises in healthcare-acquired infections (HCAIs) and antibiotic resistance,

understanding transmission routes of bacteria is paramount. One possible route is
nurses’ uniforms, which they wash at home.
Increasing staff awareness, improving their education on infection prevention, and
standardising domestic laundering policies at national level would be useful steps
towards ensuring that staff know how to effectively wash their uniforms at home.
Providing suitable changing facilities so staff can easily change in and out of their
uniforms in the workplace would reduce the need for them to wear their uniforms to
and from work. However, the ideal solution would be a change from home
laundering to in-house industrial laundering of uniforms. This would avoid cross-
contamination in the domestic setting altogether and increase the chances of
uniforms being washed according to guidance.

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4. "whistleblower" is entitled to legal protection when

A. the concern raised is in the public interest

B. the employer tries to harm the "whistleblower"
C. the concern raised is in accordance with the set guidelines

What is ‘whistleblowing’?

Whistleblowing is when a worker, including a student nurse or student midwife, raises a

concern about wrongdoing in the public interest. Whistleblowing can take place within
an organisation or, if the worker feels they are unable to do this, to a third person
known as a ‘prescribed person’. The NMC is named as a prescribed person in the law.
There is a difference between raising concerns and whistleblowing. The law sets out
several criteria that must be met for raising concerns to qualify as whistleblowing.
If all of the conditions set out in the law are met, the person who is blowing the whistle
has legal protections to stop them suffering any disadvantage from their employer
because of what they have done.

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5. The key to a continuous supply of oxygen to patient is

A. efficiency of zeolite granules

B. availability of multiple canisters
C. changing pressures in canisters

Manual Extract: Oxygen Concentrator: Mechanism

An oxygen concentrator uses air as a source of oxygen by separating oxygen and

nitrogen. It utilizes the property of zeolite granules to selectively absorb nitrogen
from compressed air.

Atmospheric air is gathered, filtered and raised to a pressure of 20 pounds per

square inch (psi) by a compressor. The compressed air is then introduced into one
of the canisters containing zeolite granules where nitrogen is selectively absorbed
leaving the residual oxygen available for patient use. After about 20 seconds the
supply of compressed air is automatically diverted to the second canister where the
process is repeated enabling the output of oxygen to continue uninterrupted. The
zeolite is then regenerated and ready for the next cycle. By alternating the pressure
between the two canisters, a constant supply of oxygen is produced and the zeolite
is continually being regenerated.

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6. Which of the following require a process before disposal?

A. Liquid drugs
B. Contents of part used ampoules
C. Used syringes

Management of Controlled Drugs in wards and departments:

Destruction and disposal

Unused doses, part doses or partly used prepared doses of CDs must be destroyed
promptly and witnessed by a Registered Nurse. The CD to be discarded must be
rendered irretrievable by emptying the contents of ampoule/vial, syringe or infusion
bag into a pharmaceutical waste bin (generally blue lidded). Liquids should be
rendered secure by use of a self-setting compound (such as Pre-Gel or equivalent).
Tablets should be crushed, where possible and capsules should be opened prior to
disposal. Full details of the destruction must be recorded in the CD register (for part
ampoules or other unused doses) or on the patient's prescribing/recording chart (for
partly used prepared doses) including the names and signatures of those involved.

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 Part C
In this part of the test, there are two texts about different aspects of health care. For questions 1
to 8, choose the answer ( A , B , C or D ) which you think fits best according to the text.

Write your answers on the separate Answer Sheet.

Text 1:

THE doctors were stumped. After months of cancer treatment at the University of Tokyo
Hospital, the patient – a woman in her 60s – was not getting much better. So the medical team
plugged the woman’s symptoms into IBM’s Watson, the supercomputer that once famously
trounced human champs in the TV quiz show Jeopardy! Watson rifled through its storehouse of
oncology data and announced that she had a rare form of secondary leukemia. The team
changed the treatment, and she was soon out of hospital. Watson spotted in minutes what could
otherwise have taken weeks to diagnose, one doctor told The Japan Times. “It might be an
exaggeration to say AI saved her life, but it surely gave us the data we needed in an extremely
speedy fashion.”

Is this the future of medicine? Artificial intelligence researchers have long dreamed of creating
machines that can diagnose health conditions, suggest treatment plans to doctors, and even
predict how a patient’s health will change. The main advantage of such an AI wouldn’t be
speed, but precision. A study published earlier this year found that medical error is the third
leading cause of death in the US, and a significant chunk of that is incorrect diagnoses.

There are just too many health conditions and the literature is changing too rapidly for a primary
care physician to retain it all, says Herbert Chase, who works on biomedical informatics at
Columbia University in New York City. “We’ve exceeded where it’s humanly possible for doctors
to know what they need to know,” he says. “There are dozens of conditions that are being
missed that could easily be diagnosed by a machine.” Chase once advised the IBM Watson
team. These days, he is working on an algorithm that scours doctors’ notes for subtle clues that
patients may be developing multiple sclerosis. He imagines a future in which software will
automatically analyse electronic health records and spit out warnings or recommendations. “It’s
a partnership. The machine makes a recommendation, then the human gets involved,” says
Chase. But the spectrum of human illness is complex, so “algorithms will have to be built brick
by brick”, with the focus on one medical question at a time.
These building blocks often rely on machine learning, a branch of artificial intelligence that
seeks patterns in mounds of statistics.

For example, a team at Stanford University in California recently unveiled a machine-learning

algorithm trained to scrutinise slides of cancerous lung tissue. The computer learned to pick out
specific features about each slide, like the cells’ size, shape and texture. It could also distinguish
between samples from people who had only lived for a short time after diagnosis – say, a few
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months – and ones from those who survived much longer. The study verified the algorithm’s
results by testing it on historical data, so now the AI could in principle be used with patients.

Stanford’s slide-reader is just one in a long string of AIs that are learning to perform medical
tasks. At a conference on machine learning and healthcare in Los Angeles, researchers
presented new algorithms to detect seizures, predict the progression of kidney or heart disease,
and pick out anomalies in pregnant women or newborn babies. Participants in one programming
challenge are getting AIs to listen to recordings of heartbeats, sorting the normal rhythms from
the abnormal.
Yet other projects are trying to make medical judgments using more obscure or indirect sources.
A Microsoft algorithm, published in June, makes guesses about who has pancreatic cancer
based on their web searches. Google Deep Mind, based in London, is using masses of
anonymised data from the UK’s National Health Service to train an AI that will help
ophthalmologists. The aim here is to spot looming eye disease earlier than a human can,
although the project does raise questions about whether commercial firms are gaining access to
health data too cheaply.

Some fear that AI diagnosis may backfire, encouraging doctors to overdiagnose and overtest
patients. Even if the algorithms work well, there’s the question of how to integrate them
seamlessly into clinical practice. Doctors, notoriously overworked, aren’t likely to want to add yet
more items to their checklist. Chase thinks that artificially intelligent diagnostics will end up
being integrated right into databases of electronic health records, so that seeking machine
insights becomes as routine as getting hold of a patient’s data.

Apps that offer diagnostic help already exist, like Isabel, which doctors can run on Google Glass
in order to keep their hands free. But Chase says this approach is unpopular, as doctors must
spend time inputting patient data to use them. AI diagnostics will only take off when it imposes
no additional time pressure. There are social roadblocks, too, says Leo Anthony Celi, a doctor
at the intensive care unit of the Beth-Israel Deaconess Medical Center in Boston. Down the line,
Celi thinks, doctors will function more “like the captain of a ship”, delegating most daily tasks
either to machines or to highly trained nurses, medical techs and physician’s assistants. For that
system to succeed, doctors must first cede some control, admitting that the machine can
perform better than them in some domains. That’s a tough ask in a career in which everyone
from medical school professors to patients expects that doctors will always have the right
answers.

Ultimately, there needs to be a cultural shift toward respect for big data and AI’s potential in
medicine, argues Celi. Only then can we let machines and humans do what each does best.
“No one can really replace doctors’ ability to talk to patients,” he says. “Doctors should focus on
what they do better, which is talking to patients and eliciting their values and their advance
directives, and leave it up to the machine to make the complex decisions. We’re not really good
at it.”

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Questions: 7 to 14

7. By quoting a doctor the author infers that

A) Without Watson, the patient would have died

B) technology can help save human life
C) the role of AI in medicine is often exaggerated
D) The Japan Times published an article on IBM Watson.

8. What point is made about incorrect diagnoses in the second para?

A) They often lead to fatalities in the U S

B) They mostly result from medical errors
C) They are the third leading cause of deaths in the United States
D) They are the reason for one in every three deaths in the U S

9. Why does Herbert Chase say that algorithms should be built brick by brick?

A) It is ideal to focus on one medical question at a time

B) Human involvement would be useful only after the machine makes
recommendation
C) Literature on human conditions is changing very quickly
D) An ailment involves a wide range of factors

10. The phrase "in principle" in the fourth paragraph could best be replaced by

A) finally
B) mainly
C) practically
D) theoretically

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11. Which title best synopsises the fifth paragraph?

A) Who is planning what

B) What happened where
C) How to do what
D) What to do why

12. What point is made about algorithms in the sixth paragraph?

A) Their success may not ensure the success of AI diagnosis

B) They might add burden to doctors
C) They cannot be integrated into clinical practice
D) They could prompt doctors to overdiagnose and overtest patients

13. Leo Anthony Celi mentions which of the following as one of the social roadblocks
for doctors to function like “captain of the ship"

A) additional time to be spent by doctors

B) doctors delegating duties to other staff and machines
C) the expectations that patients have on doctors
D) machines performing as well as doctors in some domains

14. What is meant by "it" in the last para?

A)making advance directives

B) speaking to patients
C) making difficult choices
D) the machine

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Text 2:
Cannabis
Cannabis is in the headlines for its potential medical benefits after the recent confiscation of
cannabis oil medication from the mother of a 12-year-old British boy with severe epilepsy. The
furore that ensued is shining a light on campaigns for cannabis oils to be made legal for medical
reasons, and the UK government has now announced a review into the use of medicinal
cannabis. Cannabis oil is extracted from the cannabis plant Cannabis sativa. The plants
medicinal properties have been touted for more than 3,000 years. It was described in the
ancient Eygyptian Ebers papyrus around 1550BC, and it had likely been used as a medicine in
China before that. Some varieties of the plant contain high levels of the psychoactive substance
tetrahydrocannabinol (THC), which is responsible for the “high” that comes from smoking or
eating cannabis leaves or resin. The plant’s other major chemical component is cannabidiol,
which has no psychoactive effect. Both act on the body’s natural cannabinoid receptors which
are involved in many processes such as memory, pain and appetite. The cannabis plant also
contains more than 100 other different cannabinoid compounds at lower concentrations.

Whether it can make you high depends on the THC content. Some types of Cannabis sativa
plant, known as hemp, contain very little THC. The extracts from these plants contain mainly
cannabidiol, so will not get anyone stoned. In the UK cannabidiol is legal. Cannabis plant
extracts (known as hemp or CBD oils) are available in high-street stores but the THC content
must be below 0.2 per cent. “THC is not psychoactive at this level,” says David Nutt, a
neuropsychopharmacologist at Imperial College London. But cannabidiol is illegal in many other
countries.
In the USA for example, cannabidiol is classed as a schedule 1 controlled substance, and can
only be sold in states where cannabis use is legal.

However, the tide may turn in favour of cannabidiol after a recent World Health Organisation
review. This concluded that cannabidiol “exhibits no effects indicative of any abuse or
dependence potential” but “has been demonstrated as an effective treatment of epilepsy … and
may be a useful treatment for a number of other medical conditions.” Although there is some
scientific evidence that THC has potential to control convulsions, its mind-altering effects mean
that much of the focus has turned to cannabidiol – particularly for childhood epilepsies that
conventional drugs fail to control. Two recent high quality randomised and placebo controlled
trials showed that cannabidiol is an effective treatment for Lennox-Gastaut syndrome and
Dravet syndrome, severe forms of epilepsy. The mechanism of action is unknown, but it may be
due to a combination of effects, such as inhibiting the activity of neurons and dampening
inflammation in the brain. The situation is less clear when it comes to the use of commercial
cannabis oils to control seizures, where the evidence is mainly anecdotal, and the oils can
contain differing concentrations of cannabidiol and THC.

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There are few cannabis-based epilepsy drugs on the market yet. The UK government
announced that it would review the use of medical cannabis. The first part of the review will look
at the evidence for the therapeutic value of cannabis-based products. It can recommend any
promising ones for the second part of the review. This will be carried out by the government’s
Advisory Council for the Misuse of Drugs, which can recommend a change to the legal medical
status of cannabis and cannabinoids. This will hopefully lead to a relaxation of the rules
surrounding research into cannabis-based medicines says Tom Freeman, a clinical
psychopharmacologist at King’s College London. The US Food and Drug Administration
recommended the approval of a drug called Epidiolex for Lennox-Gastaut syndrome and Dravet
syndrome. Its active ingredient is cannabidiol, and final approval is due soon.

However, it is possible the drug is not as effective as cannabis oil containing THC, says Nutt.
For example, the cannabis oil used to treat Billy Caldwell, the boy at the centre of the recent
cannabis oil confiscation furore, contained cannabidiol and a low dose of THC, because
cannabidiol alone did not stop all his seizures. This is one of the big unknowns. It is important to
remember that there is currently very little scientific evidence to support cannabis oil containing
both THC and cannabidiol as a treatment for epilepsy. Interestingly, a synthetic version of THC
called Nabilone has been used since the 1980s to treat nausea after chemotherapy and to help
people put on weight. A drug called Sativex is also approved for the treatment of pain and
spasms associated with multiple sclerosis. It contains an equal mix of THC and cannabidiol, but
would not be suitable for the treatment of children with epilepsy such as Billy.

.
In the UK cannabis currently has Schedule 1 status, the most restrictive category, which is for
drugs which are not used medicinally such as LSD. “This creates a Catch 22 situation,” says
Freeman. “You can’t show that cannabis and cannabis-based products have medicinal value
because of restrictions on medical research.” If cannabis is moved to the Schedule 2 category,
it will join substances such as morphine and diamorphine (heroin) which can be prescribed by
doctors if there is a clinical need.

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Questions: 15-22

15. What do we learn about cannabis in the first paragraph?

A) It has been in use for over three millennia

B) Use of cannabis oil for medical purposes is legal in China
C) It has been in use in Egypt only for the past 1550 years
D) Cannabis is highly addictive

16. In the second paragraph the writer does Not confirm that

A) Cannibdiol is is prohibited in parts of America

B) Cannabidiol is relatively harmless
C) 0.2 per cent of THC content is safe
D) Cannabis plant extracts are available for sale in the UK

17. According to the third paragraph, Cannabidiol is preferred to THC because

A) THC is ineffective in treating epilepsy

B) Cannabidiol does not have the side-effects that THC has
C) Conventional drugs cannot control childhood epilepsy
D) WHO review declared cannabidiol safe

18. What does the word "anecdotal" refer to in the third paragraph?

A) Factual
B) Empirical
C) Unscientific
D) Unreliable

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 19. What point can be made about medicinal cannabis in the fourth paragraph?

A) Cannbis-based epilepsy drugs are not available in the market now

B) The rules governing research into cannabis-based medicines will soon be
relaxed.
C) Some cannabis-based drugs for epilepsy are available in the market now
D) Epidolex is currently being used to treat Lnnox-Gestaut syndrome in the US.

20. In the fifth paragraph, the author cites Billy Caldwell's case in order to

A) reccommend using cannabis oil to control paediatric convulsions

B) support that cannabidiol cannot control seizures
C) highlight the importance of THC in treating epilepsy
D) question the potential of Epidiolex

21. The author expresses surprise because

A) The existing THC based drugs have not proven useful for paediatric epileptics
B) Nibalone, a synthetic form of THC has been in use for decades
C) Sativex is used to provide relief for multiple sclerosis patients
D) Use of THC is illegal in many countries

22. What does "this" refer to in the final paragraph?

A) LSD not being used for medicinal purposes

B) the status given to cannabis
C) medical research into cannabis
D) prescription of heroin

END OF READING TEST

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