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INSTRUCTIONS
Type all your *s in the * box provided.
One mark will be granted for each correct *.
* ALL questions. Marks are NOT deducted for incorrect *s.
Part A
TIME: 15 minutes
 Look at the four texts, A-D, in the separate Reading

Part A: Text Booklet.
 For each question, 1-20, look through the texts A-D,
to find the relevant information.
 Type your *s in the * box provided.
 * all the questions within the 15-minute time limit.
 Your *s should be spelled correctly.
Information text
For each of the questions, 1 – 7, decide which text (A, B, C or D) the
information comes from. You may use any letter more than once.
*
1-In which text can you find information regarding necessary
considerations when assessing a child’s pain level?
*:
*
2-In which text can you find information about the methods used to
measure pain?
*:
3-In which text can you find information about specific factors to note
when assessing a child’s pain?
*:
4-In which text can you find information about a tool that uses
behavioural responses to assess pain level.
*:
5-In which text can you find information about the rating scale to use for
self report when assessing pain?
*:
6-In which text can you find information about how to assess a patient’s
pain level via their facial expression?
*:
*
7-In which text can you find information about signs of pain to be aware
of in a patient who is under sedation?
*:
* each of the questions, 8-14, with a word or short phrase from one of
the texts. Each * may include words, numbers or both.
Rules of Use:
 Spell all words correctly.

 Use correct spacing between words.
 Use correct punctuation.
Note: This is an automated system with a range of predetermined *s.
As a result, sometimes a correct * choice may be marked incorrect.
Therefore, please refer to the * key to determine if your * is correct.
*
8-Which pain assessment tools should be used in children who are
developmentally disabled or too young to speak?
*:
9-What is the maximum age for behavioural assessment of pain in an
intellectually disabled patient?
*:
*
10-What risk should you be aware of when assessing pain in children
with disabilities?
*:
11-Who can help provide better assessment of pain in disabled children?
*:
12-Where should pain values be documented?
*:
13-How often should all children have their pain scores recorded?
*:
Questions 14 - 20
Complete the sentences, in questions 15-20, with a word or short phrase
from one of the texts. Each * may include words, numbers or both. Your
*s should be spelled correctly.
Self reporting is considered to be 14* when measure pain in
children.
*
You should avoid using 15* observations on their own as a
way of measuring pain.
You should ensure the patient understands they need to choose the 16*
that most accurately represents their mood when self reporting.
Don’t have patients self report if they lack the required 17*
ability
Make sure to allocate a score of between 18* for each sub-group
when evaluating the behavioural responses of a child.
*
The maximum possible pain score should be given to a patient if you
notice it is hard to 19* them.
Pain should be assessed and recorded 20* analgesia.
Assessing Pain: Texts
Text A
Text B
Pain Assessment Tools

Tools used for pain assessment have been selected on their validity, reliability and usability and are
recognised by pain specialists to be clinically effective in assessing acute pain. All values are documented on
the clinical observation chart as the 5th vital sign.
Three ways of measuring pain:
• Self report – what the child says (the gold standard)

• Behavioural – how the child behaves
• Physiological – clinical observations
Physiological indicators
Physiological indicators in isolation cannot be used as a measurement for pain. A tool that incorporates
physical, behavioural and self report is preferred when possible. However, in certain circumstance (for
example, the ventilated and sedated child) physiological indicators of pain can be helpful to determine a
patient’s experience of pain.
These include:
• heart rate may increase
• respiratory rate and pattern may shift from normal ie: increase, decrease or change pattern
• blood pressure may increase
• oxygen saturation may decrease
Text C
Wong-Baker faces pain scale
The Wong-Baker faces pain scale uses self report of pain to assess a patient’s experience of pain. It can be used
in children aged between 3 and 18 years of age, depending upon their cognitive ability.
Explain to the patient that each face helps us understand how much pain they have, and how this makes
them feel. Face 0 is very happy because he doesn't hurt at all (i.e has no pain). Face 2 hurts just a little bit.
Face 4 hurts a little more. Face 6 hurts even more. Face 8 hurts a whole lot. Face 10 hurts as much as you can
imagine, although you don't have to be crying to feel this bad. Ask the person to choose the face that best
describes how he is feeling.
Text D
FLACC: Face, Legs, Activity, Cry and Consolability
The FLACC is a pain assessment tool that uses that patient’s behaviour to
assess their pain experience. It can be used for children aged between
2 months and 18 years of age, and up to 18 years of age in children with
cognitive impairment and/or developmental disability.
Each category (Face, Legs etc) is scored on a 0-2 scale, which results in
a total pain score between 0 and 10. The person assessing the child should
observe them briefly and then score each category according to the
description supplied.
END OF PART A
Part B
TIME: 45 minutes (Parts B & C)
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.
1-The special access scheme should be used when

Select one:
A. the patient requires specialised treatment.

B. all other possibilities have been exhausted.
C. the standard of the product has been verified.
2-What needs to be considered when recommending the use of cough and cold medicines in
children?
Select one:
A. The possible dangers.
B. The low success rate.
C. The age of the child.
3-The memo tells us that the new form

Select one:
A. replaces all previous airway forms.
B. is designed to reduce airway incidences.
C. can be used in a variety of airway situations.
4-The guidelines inform us that pregnancy testing

Select one:
A. is compulsory for any woman who suspects she may be pregnant.
B. may result in scheduled treatment being postponed or cancelled.
C. should be conducted in accordance with established procedures.
5-The policy recommends that vitamin K be given to infants
Select one:
A. by a trained health professional.
B. within the first month of birth.
C. only if they are healthy.
6-The update on cosmetic and discretionary surgery informs us
Select one:
A. who is eligible to provide surgery.
B. when surgery should be performed.
C. the process for approval of surgery.
Text: No Scientific Proof That Multivitamins Promote Heart Health
For questions 1 to 8, choose the answer (A, B, C or D) which you think fits best according to the
text.
1-Dr Joonseok Kim uses the expression ‘settle the controversy’ to suggest there is
Select one:
A. a lack of agreement about the efficacy of MVM supplement use.

B. confusion over the terms used to define cardiovascular disease.
C. a dispute over the findings from his latest published research.
D. misunderstanding about the methods used during his study.
2-What are Dr JoAnn Manson’s views on multivitamins?

Select one:
A. Far too many people take them.

B. They help fight certain illnesses.
C. We still don't know enough about them.
D. They shouldn't replace a nutritional diet.
3-The writer explains the systematic review and meta-analysis of the studies reviewed by Dr Kim
to highlight
Select one:
A. the amount of categories it covered.

B. how many people it included.
C. the age of the participants.
D. its global scope.
4-What does the word ‘they’ in the fourth paragraph refer to?
Select one:
A. Multivitamins.
B. Some vitamins.
C. Health and well-being.
D. Cardiovascular events.
5-How do Dr Haslam and Dr Prasad feel about multivitamin use for cardiovascular disease
Select one:
A. They are positive about their future application.

B. They believe that some help and some don’t.
C. Although they appear to be promising, ultimately they don’t work.
D. Scientifically speaking they are still one of the best options available.
6-What particularly concerns Dr Manson?
Select one:
A. The way some people take multivitamins instead of their prescribed medication.
B. The lack of understanding about the prolonged use of multivitamins.
C. The ineffectiveness of multivitamins in many patients.
D. The belief that multivitamins do no harm.
7-In the fifth paragraph, Dr Manson explains that supplements

Select one:
A. should be regulated for use with particular diseases.

B. do have their place as a method of treatment.
C. work better in some people than others.
D. are helpful for vegetarians.
8-The writer mentions the Physicians’ Health Study II to highlight that supplements
Select one:
A. are ineffective in most situations.

B. may work better depending on a person’s gender.
C. may work best when combined with other vitamins.
D. are still being investigated as a way of treating serious illness.
Text: Healthy Ageing
text.
1-The writer says the INTERHEART study found that stress
Select one:
A. is conditional on how much money a person earns.
B. can be affected by a person’s level of social integration.
C. affects people from some nations more than others.
D. is worse in people who already have health concerns.
2-In the second paragraph, the writer cites several studies to suggest
Select one:
A. the quality of a person’s relationships is integral to their health.
B. being on your own as you age may lead to premature death.
C. some diseases are more affected by loneliness than others
D. there are many contributing factors that lead to poor health.
3-What does the phrase ‘the effect’ refer to?

Select one:
A. Other issues that reduce mortality rates.
B. A person’s chance of staying healthy.
C. The influence of being on your own.
D. Having enough people in your life.
4-What point does the writer make in the third paragraph?
Select one:
A. The causes of social isolation differ between the US and Europe.
B. More research has been done into social isolation than social integration.
C. Social integration assists in minimising heart disease by altering nerve impulses.
D. Social isolation affects women while social integration has a greater effect on men.
5-The writer suggests the ‘package’ developed by the WHO
Select one:
A. has a strong focus on saving money.
B. encourages elderly people to take responsibility for their lives.
C. fails to acknowledge dangers beyond lifestyle choices and eating habits.
D. carefully balances a range of issues that impact on an individual’s well-being.
6-The phrase ‘in the shadows’ suggests that social participation
Select one:
A. is difficult to understand.
B. has become hidden.
C. is largely unknown.
D. has been ignored.
7-In the fifth paragraph, the writer expresses the view that
Select one:
A. the approach by the WHO is too simplistic.
B. people in low-income areas have worse health.
C. lifestyle factors are not the only cause of illness.
D. irresponsible behaviour causes most health problems.
8-The writer suggests that social participation is not encouraged in the WHO package because
Select one:
A. studies of this kind would be challenging to complete.
B. it is a new area of research with limited data to support it.
C. they have an obligation to focus on areas that promote profits.
D. there is no indication it would make any difference to a person’s health.
Questions 1 – 6
For each of the questions 1 – 6, 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
Question 1
how to approach giving advice about overweight children?
Answer:
Question 2
how often to discuss a child's weight?
Answer:
Question 3
possible causes for obesity in infants and adolescent females?
Answer:
Question 4
the standards used to measure the development of children?
Answer:
Question 5
other conditions which are associated with obesity in children?
Answer:
Question 6
strategies to help stop children's weight increasing?
Answer:
Answer each of the questions, 7-13, with a word or short phrase from one of the texts. Each
answer may include words, numbers or both.
Rules of Use:

Note: This is an automated system with a range of predetermined answers. As a result,
sometimes a correct answer choice may be marked incorrect. Therefore, please refer to the
answer key to determine if your answer is correct.
Question 7
If a mother has Answer , smokes, or is herself obese it increases the risk of obesity in her
child.
Question 8
You should discuss healthy weight in children with parents Answer at a minimum.
Question 9
Make sure to clarify the types of areas that are Answer and the reasons why.
Question 10
The family should be encouraged to participate in the use of the Answer .
Question 11
Convey information about the Answer of children in an understanding way.
Question 12
If a child is obese for a length period of time, then they are more likely to experience Answer
.
Question 13
The family needs to appreciate that Answer changes must occur in children whose
weight exceeds what is healthy.
Questions 14 – 20
Answer each of the questions, 14 – 20, with a word or short phrase from one of the texts. Each
Question 14
What influences the type of chart used to calculate a child's growth status?
Answer:
Question 15
What does the WHO and CDC assess and monitor when forming childhood growth charts?
Answer:
Question 16
What increases in children once they reach pubescence?
Answer:
Question 17
If it is already in the family, what is the likelihood that a teenager will remain obese?
Answer:
Question 18
What needs to be agreed upon and developed with the family of an obese child?
Answer:
Question 19
What psychological symptoms are known to appear early in obese children?
Answer:
Question 20
If the situation is serious enough, what might be required in some children?
Answer:
Overweight and obese children: Texts
Text A
Growth Monitoring
The monitoring of children’s growth (and weight in particular) is an important role of all health
professionals. At every consultation (or at least yearly), health professionals need to have a
conversation with families and carers around children achieving a healthy weight.
“Ask and Assess – use percentile charts to monitor growth”

Growth status in children and adolescents (age 0-18 years old) needs to be assessed using
age- and sex-specific reference values, as the appropriate ratio of weight to height varies
during development.
Reference values for assessing and monitoring weight, length/height and BMI have been developed
by the World Health Organisation (WHO) and Centres for Disease Control and Prevention (CDC) in
the form of the childhood growth charts. The choice of chart depends on the age and gender of the
child. For children aged less than two years the WHO growth charts should be used. For children
between 2 and 18 year either the WHO or the CDC growth charts can be used. However, it is
important to ensure that the same chart is used over time.
Text B
Steps for discussing weight with families or carers
1. Make the family feel welcome and at ease.

2. Ask permission to discuss growth and development with the family.
3. Normalise the discussion of growth and development. Reassure the child and family that it is
standard practice in primary care.
4. Explain what is measured and why? (Weight, Height, BMI).
5. Encourage involvement of parents/carers when measuring weight and height.
6. Explain how the child’s growth tracks against the growth of all children. Engage the family in
plotting and interpreting the growth chart, using the growth charts as a tool.
7. Advise parents or carers of child’s growth status. Be sensitive and nonjudgmental but don’t
sugar-coat it. For example: “Tom’s BMI is… which places him above the healthy weight range.”
8. Use positive terminology to reinforce key concepts and advice:
• Use “healthy eating”, “eating” or “eating plan” rather than “diet” or “dieting”.
• Do not use ‘good’ or ‘bad’ to describe food or drinks – these terms reinforce a dieting
mentality and create blame and guilt.
• Let the family do most of the talking rather than you.
• Be realistic - make sure everyone in the room understands that long term changes have to be
made if the child is above the healthy weight range and that it will take time.
• Avoid inappropriate words, such as “Tom is obese.”
9. For adolescents, if appropriate, consider speaking to them without parent or carer present.
10. Agree on and develop an action plan.
Text B
Steps for discussing weight with families or carers
1. Make the family feel welcome and at ease.

2. Ask permission to discuss growth and development with the family.
3. Normalise the discussion of growth and development. Reassure the child and family that it is
standard practice in primary care.
4. Explain what is measured and why? (Weight, Height, BMI).
5. Encourage involvement of parents/carers when measuring weight and height.
6. Explain how the child’s growth tracks against the growth of all children. Engage the family in
plotting and interpreting the growth chart, using the growth charts as a tool.
7. Advise parents or carers of child’s BMI. Be sensitive and nonjudgmental but don’t
sugar-coat it. For example: “Tom’s BMI is… which places him above the healthy weight range.”
8. Use positive terminology to reinforce key concepts and advice:
• Use “healthy eating”, “eating” or “eating plan” rather than “diet” or “dieting”.
• Do not use ‘good’ or ‘bad’ to describe food or drinks – these terms reinforce a dieting
mentality and create blame and guilt.
• Let the family do most of the talking rather than you.
• Be realistic - make sure everyone in the room understands that long term changes have to be
made if the child is above the healthy weight range and that it will take time.
• Avoid inappropriate words, such as “Tom is obese.”
9. For adolescents, if appropriate, consider speaking to them without parent or carer present.
10. Agree on and develop an action plan.
Text C
More than 25% of children and adolescents are overweight or obese. For obese children,
complications are more likely to develop because they are obese longer.
Risk factors for obesity in infants are low birth weight and maternal obesity, diabetes, and smoking.
After puberty, food intake increases; in boys, the extra calories are used to increase protein
deposition, but in girls, fat storage is increased.
For obese children, psychologic complications (eg, poor self-esteem, social difficulties, depression)
and musculoskeletal complications can develop early. Some musculoskeletal complications, such
as slipped capital femoral epiphyses, occur only in children. Other early complications may include
obstructive sleep apnea, insulin resistance, hyperlipidaemia, and non-alcoholic steatohepatitis.
Risk of cardiovascular, respiratory, metabolic, hepatic, and other obesity-related complications
increases when these children become adults.
Text D
The possibility of obesity persisting into adulthood depends partly on when obesity first develops:
• During infancy: Low possibility

• Between 6 months and 5 yrs.: 25%
• After 6 yrs.: > 50%
• During adolescence if a parent is obese: > 80%
In children, preventing further weight gain, rather than losing weight, is a reasonable goal. Diet
should be modified, and physical activity increased. Increasing general activities and play is more
likely to be effective than a structured exercise program. Participating in physical activities during
childhood may promote a lifelong physically active lifestyle. Limiting sedentary activities
(eg, watching TV, using the computer or handheld devices) can also help. Drugs and surgery are
avoided but, if complications of obesity are lifethreatening, may be warranted.
END OF PART A
Text D
The possibility of obesity persisting into adulthood depends partly on when obesity first develops:
• During infancy: Low possibility

• Between 6 months and 5 yrs.: 25%
• After 6 yrs.: > 50%
• During adolescence if a parent is obese: > 80%
In children, preventing further weight gain, rather than losing weight, is a reasonable goal.
Diet should be modified, and physical activity increased. Increasing general activities and play is more
likely to be effective than a structured exercise program. Participating in physical activities during
childhood may promote a lifelong physically active lifestyle. Limiting sedentary activities (eg, watching
TV, using the computer or handheld devices) can also help. Drugs and surgery are usually avoided but, if
complications of obesity are life threatening, may be warranted.
END OF PART A
Part B
text.
1-The instructions explain that when making emergency phone referrals

Select one:
A. GRACE must always be contacted first.
B. a referral must always be faxed right away.
C. the On-call Registrar must always grant approval.
2-To eliminate the risk of contamination from infectious agents or certain types of fluids, aprons
and gowns should be
Select one:
A. worn over all clothing.
B. changed when they become soiled.
C. discarded if they are damaged.
3-The purpose of the email about oral health clinical indicators is to
Select one:
A. explain why the reports were introduced.
B. highlight what the reports have achieved.
C. provide future details about upcoming reports.
4-The policy informs us that doctors treating athletes at sporting events in the UK
Select one:
A. must be appropriately licensed.
B. are expected to have adequate training.
C. cannot treat anyone from another country.
5-The purpose of the guidelines on remote consultations is to
Select one:
A. help practitioners decide an appropriate course of action.
B. advise practitioners about a growing trend in modern medicine.
C. recommend a series of questions for practitioners to ask their patients.
6-According to the extract, prescription medicines
Select one:
A. are often unavailable due to stock shortages.
B. can be purchased as special orders from manufacturers if required.
C. may show as being unavailable even though they can still be bought.
Part C
For questions 1 to 8, choose the answer (A, B, C or D) which you think fits best according to the text.
1-The phrase 'the first camp' refers to dental professionals who
Select one:
A. cannot agree on the effectiveness of fluoride.
B. believe keeping teeth clean prevents cavities.
C. feel that no amount of brushing reduced plaque.
D. are certain about how the entire process works.
2-Philippe Hujoel’s comments in the first paragraph indicate that he believes

Select one:
A. no one knows how to prevent plaque.
B. everyone has plaque on their teeth.
C. only fluoride can remove plaque.
D. plaque is impossible to remove.
3-What does the word 'it' in the second paragraph refer to?
Select one:
A. fluoride.
B. Hujoel's team.
C. cavity prevention.
D. the intensity of oral hygiene.
4-By examining clinical trials from the US and UK, Philippe Hujoel says his team established that
Select one:
A. fluoride should be placed in all water supplies.
B. regular brushing is the best way to reduce cavities.
C. children need to be encouraged to brush their teeth.
D. intense oral hygiene is effective at cleaning teeth only.
5-Matthew Messina from the American Dental Association suggests that
Select one:
A. scientific advances have reduced tooth decay.
B. fluoride isn’t as important as many people believe.
C. it takes a wide-ranging approach to prevent cavities.
D. increased life expectancy results in more dental disease.
6-Darryl Bosshardt’s comments indicate that he believes
Select one:
A. it is up to individuals to make their own choice about fluoride.
B. fluoride is still the best way to protect teeth.
C. there are no alternatives to fluoride.
D. fluoride is a dangerous product.
7-The writer includes the statement that fluoride-free toothpaste from Tom’s of Maine does not carry an
anti-cavity claim to suggest that
Select one:
A. this is the best toothpaste for people to buy.
B. some types of toothpaste may not prevent decay.
C. they don’t like offering this type of toothpaste.
D. it is difficult to decide which toothpaste works best.
8-In the final paragraph, the writer uses Philippe Hujoel’s words to highlight that
Select one:
A. not everyone takes the same approach to oral hygiene.
B. some food can contribute to the problem.
C. fluoride is the best option.
D. not all diets are practical.
STRESS AND BURNOUT
1-What concern does the writer express about ICM clinicians?
Select one:
A. There are not enough of them to treat the rising number of sick people.
B. The numbers of those who work with children has increased.
C. Many may not be performing effectively because of a pressured work environment.
D. They usually work longer hours than is recommended.
2-In the second paragraph, the writer suggests that burnout
Select one:
A. poses problems for the intensive care setting.
B. has become more prominent in recent years.
C. isn’t currently able to be measured.

D. is very similar to depression.
3-What does the writer say about burnout syndrome in Australian emergency medicine clinicians?
Select one:
A. Not enough emphasis is placed on ways to relieve pressure.
B. Training will help ICU staff better understand how they’re feeling.
C. The situation is made worse by of the level of responsibility placed on ICU staff.
D. The impact of the condition is dependent on a range of personal choices.
4-The writer uses the term ‘interconnected’ to indicate that burnout can
Select one:
A. make it difficult for staff to work well together.
B. impact on medical staff and patients.
C. cause some healthcare professionals to leave the industry.
D. affect clinicians for many years after they are first diagnosed.
5-What does the writer suggest about the problem of burnout in the fifth paragraph?
Select one:
A. It is being made worse by a reduction in healthcare professionals.
B. It is developing in line with broader societal issues.
C. It isn’t going to be solved any time soon.
D. It affects men more than women.
6-What point does the writer make in the sixth paragraph?
Select one:
A. It is difficult for staff to change their current behaviour.
B. The existing approach within hospitals is there for a reason.
C. Management should do more to improve working conditions.
D. There needs to be a multifaceted response to workforce welfare.
7-The writer explains that the College of Intensive Care Medicine and the Australian and New
Zealand Intensive Care Society
Select one:
A. are integral in measuring the health of practitioners.
B. should take action before the situation worsens for practitioners.
C. require assistance from other sectors in order to help practitioners reduce their workload.
D. need to educate patients about how their actions affect practitioners.
8-In the final paragraph, the writer users the word 'paucity' to suggest that
Select one:
A. not enough is being done to help practitioners.
B. practitioners need to do more to help themselves.
C. the ICU may not be a suitable place for all practitioners to work.
D. it is natural that some practitioners handle stress better than others.
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 1 – 7
For each of the questions, 1 – 7, decide which text (A, B, C or D) the information comes from.
You may use any letter more than once.
Question 1
In which text can you find information about the factors to consider when evaluating snakebite?
Answer:
Question 2
In which text can you find information about what a snakebite can look like?
Answer:
Question 3
In which text can you find information about possible types of snakebite and their reactions?
Answer:
Question 4
In which text can you find information about signs that a child may be bitten by a poisonous
snake?
Answer:
Question 5
In which text can you find information about when to release a pressure immobilisation bandage?
Answer:
Question 6
In which text can you find information about knowing when it is safe to discharge a child who has
not been envenomed?
Answer:
Question 7
In which text can you find information about what to tell parents to look for in a child having a
response to serum?
Answer:
Rules of Use:

Note: This is an automated system with a range of predetermined answers. As a result,

sometimes a correct answer choice may be marked incorrect. Therefore, please refer to the
answer key to determine if your answer is correct.
Question 8
If you suspect a snakebite has occurred, you must decide whether or not the child has
been Answer .
Question 9
Substantial pain and swelling is a likely sign that the child has been bitten by a Answer
snake.
Question 10
If clinical evidence warrants administration of antivenom, you should ensure it is done in
conjunction with a Answer .
Question 11
You will need to affix a Answer if it hasn't been done.
Question 12
When deciding how much antivenom to administer, Answer is considered sufficient for
each child irrespective of their body weight.
Questions 13 – 20
Answer each of the questions, 13 – 20, with a word or short phrase from one of the texts. Each
Question 13
What TWO signs should you look for if snakebite is suspected?
Answer:
Question 14
When assessing a child, what might indicate the presence of venom movement?
Answer:
Question 15
In cases where neurotoxicity is rare or not severe, what type of snakebite could it indicate?
Answer:
Question 16
After removing the PIB, when should you conduct another blood test if there is no evidence of
poisoning from a snakebite?
Answer:
Question 17
What TWO anti-venoms should you give to a child with signs of envenomation?
Answer:
Question 18
What quantity and strength of saline should each vial of anti-venom be diluted in?
Answer:
Question 19
What time of day should discharge occur?
Answer:
Question 20
After anti-venom is administered, how long does it usually take for serum sickness to develop?
Answer:
Snakebite in children: Texts
Text A
Background
Snakebite is uncommon in Victoria and envenomation (systemic poisoning from the bite) is rare. The bite site
may be evidenced by fang marks, one or multiple scratches. The bite site may be painful, swollen or bruised,
but usually is not for snakes in Victoria.
There are no sea snakes in Victoria, but land-based snakes can swim.
Major venomous snakes in Victoria and effects of envenomation:
Systematic Cardiovascular
Snake Coagulopathy Neurotoxicity Myotoxicity TMA
symptoms effects
- Collapse (35%)
Brown VICC Rare and mild 50% 10%
Cardiac arrest (5%)
Tiger VICC 30% 20% Common Rare 5%
Red- Mild increase - Uncommon Common - -

bellied
Text C in aPITT and Often
black INR with significant
normal bite site pain
fibrinogen, and limb
usually no swelling
significant
bleeding
VICC: Venom-induced consumptive coagulopathy (abnormal INR, high aPTT, fibrinogen very low, D-dimer
high).
Myotoxicity muscle pain, tenderness, rhabdomyolysis
Systemic Symptoms see history and examination.
TMA: thrombotic microangiography. Haemolysis with fragmented red blood cells on blood film,
thrombocytopenia and a rising creatinine.
Text B
Assessment
Focus on evidence of envenomation.
• Once the possibility of snakebite has been raised, it is important to determine whether a child
has been envenomed to establish the need for antivenom.
• This is usually done taking into consideration the combination of circumstances, symptoms,
examination and laboratory test results.
• Most people bitten by snakes in Australia do not become significantly envenomed.
History and Examination
Circumstances Symptoms Examinations
- Confirmed or witnessed - Headache - Evidence of a bite/ multiple

bite versus suspicion that - Diaphoresis bites
bite might have occurred - Evidence of venom movement
Text C - Nausea or vomiting
- Abdominal pain (e.g. sowllen or tender draining
- Were there multiple bites?
- Diarrhoea lymph nodes)
- When?
- Where? - Blurred or double vision - Neurotix paralysis (ptosis,
- First aid? - Slurring of speech ophthalmoplegia, diplopia,
- Past history? - Muscle weakness dysarthria, limb weakness,
- Medications? - Respiratory distress respiratory muscle weakness)
- Allergies? - Bleeding from the bite site or - Coagulopathy (bleeding gums,
elsewhere prolongued bleeding from
- Passing dark or red urine venepuncture sites or other
- Local pain or swelling at bite wounds, including bite site)
site - Muscle damage (muscle
- Muscle pain tenderness, pain on movement
- Pain in lymph nodes draining weakness, dark or red urine
the bite area indicating myoglobinuria)
- Loss of consciousness/collapse
and/or convulsions
Text C
Snakebite Management Flowchart

Text D
Giving Antivenom
• Antivenom is indicated in all children where there is evidence of envenomation.

• Giving antivenom should occur in consultation with a clinical toxicologist.
• Dilute one vial in 100mls of 0.9% saline and give IV over 15-30 min.
• If the child is in cardiac arrest and this is thought to be due to envenomation, then give undiluted
antivenom via rapid IV push.
• There is no weight based calculation for antivenom (the snake delivers the same amount of venom
regardless of the size of the child). One vial of antivenom is enough to neutralise the venom that can be
delivered by one snake. Clinical recovery takes time after antivenom administration and multiple vials do
not speed recovery.
At discharge, ensure that the family is given advice on how to recognise serum sickness:
• Occurs in about 30% of children given antivenom.

• Tends to occur 4 – 14 days following antivenom administration.
• Consists of flu-like symptoms, fever, myalgia, arthralgia and rash.
• A letter should also be written to the child’s GP regarding this.
Part B
text.
1-The purpose of the email to hospitals about prescribing of antibiotics is to

Select one:
A. encourage them to implement appropriate procedures.
B. remind them of the seriousness of the issue.
C. advise them of upcoming changes.
2-According to the memo, when keeping records staff should ensure
Select one:
A. they reflect everything that occurred.
B. important information is written down first.
C. their colleagues will be able to understand them.
3-Why is the Queensland Bedside Audit conducted each year?
Select one:
A. to improve the quality of health service supply.
B. to find out how parties feel about their treatment.
C. to allow facilities to make advancements in technology.
4-The policy extract tells us that
Select one:
A. all haemophilia patients must be treated in a registered HTC.
B. only haemophilia patients with a factor level above 30% need to be treated in a HTC.
C. the risks of being treated in a non-HTC facility have to be conveyed to relevant haemophilia
patients.
5-
6-
Part C
text.
1-The writer uses the percentages in the first paragraph to highlight
Select one:
A. the size of the study.
B. the illnesses identified by the study.
C. the significance of the results of the study.
D. the differences between certain groups who took part in the study.
2-What does Max Griswold, the lead author of the study, say concerns him?
Select one:
A. the fact that alcohol is consumed in larger quantities now than in the past.
B. the misconception that in some instances alcohol may be good for you.
C. the lack of education available about the effects of alcohol.
D. the amount of ways alcohol has to make people sick.
3-What does the word ‘they’ in the second paragraph refer to?
Select one:
A. Types of threats.
B. New discoveries.
C. Number of drinks.
D. Previous outcomes.
4-The writer uses the expression ‘went further’ to indicate Emmanuela Gakidou
Select one:
A. would have liked the study to look at more cases.
B. wants more people to reduce the amount they are drinking.
C. believes the suggestions made by Max Griswold aren't enough.
D. isn't happy about the lack of action since the 2014 World Cancer Report.
5-Study co-author Emmanuela Gakidou suggests alcohol consumption
Select one:
A. should not be if concern if current levels are monitored.
B. must be addressed by governments immediately.
C. has been increasing at an alarming rate.
D. is an excellent source of revenue.
Part C
text.
3-What concern does the writer express in the second paragraph?
Select one:
A. Empathy isn't fully understood by some health professionals.
B. Sympathy can impede on professionalism in a clinical setting.
C. Health professionals don't equally display empathy and sympathy.
D. Empathy and sympathy are often confused by health professionals.
5-What does the word ‘it’ in the fourth paragraph refer to?
Select one:
A. Touch.
B. Oxytocin.
C. The work of a nurse.
D. Non-verbal communication.
6-The writer suggests technology has led to reduced levels of empathy because
Select one:
A. it means people don't always need to be in the same room.
B. it sometimes results in people becoming preoccupied.
C. it causes an extra level of stress for some people.
D. it can create greater distance between people.
8-In the final paragraph, the writer suggests the best way to improve empathy is to
Select one:
A. fund research into the issue.
B. utilise new lab-focussed initiatives.
C. pay greater attention to the patient.
D. undertake communication-based study.
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READING SUB-TEST – QUESTION PAPER: PART A
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
Passport Photo
OTHER NAMES: Your details and photo will be printed here.
PROFESSION:
VENUE:
TEST DATE:
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CANDIDATE SIGNATURE:
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TIME: 15 MINUTES
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INSTRUCTIONS TO CANDIDATES:
DO NOT open this Question Paper or the Text Booklet until you are told to do so.
Write your answers on the spaces provided on this Question Paper.
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15-minute
You must answer the questions within the 15 minute time limit.
limit.
One mark will be granted for each correct answer.
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Answer ALL questions. Marks are NOT deducted for incorrect answers.
At the end of the 15 minutes, hand in this Question Paper and the Text Booklet.
ep
DO NOT remove OET material from the test room.

eg
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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.
SARS outbreak 2002-2003: Questions
Questions 1-7
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For each question, 1-7,

7, decide which text (A,
( B, C or D) the information comes from. You may use
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any letter more than once.
1 Importance of data collections in epidemics?

epidemics
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2 Case fatality ratios in each region?

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3 Adjusted odds ratio of case fatalities?

fatalities?
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4 Psychological symptoms following SARS tre

treatment?
5 infection?
Symptoms associated with the infection
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6 cases?
Hong Kong being the second highest regarding number of cases
7 Modes of spread of the virus?

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Questions 8-14
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Answer each of the questions, 8-14,, with a word or short phrase from one of the texts. Each answer may
include words, numbers or both.
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8 What are the two factors that make an infected person more likely to die?
9 What is the percentage of health-care workers who were infected in Singapore?
10 How do coronaviruses look like under the microscope?
Page 26 of 121
11 How many people have died around the world in the 2002-2003 SARS outbreak?
12 What is the percentage of people who were below average for measures of general health in 2004
according to the study that took place in Canada ?
13 What variables does the abstract explore the influence of on the CFRs between the three regions?
14 How was the proportion of fatalities to cases in Hong Kong when compared to China?
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Questions 15-20
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Complete each of the sentences, 15

15-20, with a word or short phrase from one of the texts. Each answer
may include words, numbers or both.
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15. Researchers in Canada investigated the psychological and .................................... health of 40 people
who had been infected with SARS
SARS.
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ch stands for ............................................................syndrome started to affect humans in tlate

16. SARS which
2002 and the first half of 2003.
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17. The reasons for the variation in the .............................................. among the three a
areas were explored.
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18.. The ............................................... of an infected person may release droplets containing the virus into
the air.
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19. There were .............................. ....... cases in total worldwide who got infected by the organism.
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20. Symptoms of the disease include headache, ......................................., cough and shortness of breath.
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END OF PART A
THIS QUESTION PAPER WILL BE COLLECTED
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READING SUB-TEST – QUESTION PAPER: PARTS B & C
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
Passport Photo
PROFESSION:
VENUE:
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TEST DATE:
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TIME: 45 MINUTES
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DO NOT open this Question Paper until you are told to do so.
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At the end of the test, hand in this Question Paper.
Paper
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HOW TO ANSWER THE QUESTIONS:

Mark your answers on this Question Paper by filling in the circle using a 2B pencil.
eg
Example:
A
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B
C
Page 29 of 121
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. According to the extract:

A- Overall responsibility of the patient is retained by the alternative health
practitioner when the medical practitioner who has performed the procedure
is not there.
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B- The medical practitioner may formally refer the patient to another health
practitioner
practitioner.
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C- If thee medical practitioner is not qualified, responsibility of the patient will

be automatically retained by the alternative practitioner
practitioner.
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The medical practitioner is responsible for ensuring that any other

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person participating in the patient’s care has app

appropriate
qualifications, training and experience, and is adequa
adequately supervised
as required. When a medical practitioner is assisted by another
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registered health practitioner or assigns an aspect of a procedure or

ep
patient care to another registered health p practitioner,

ractitioner, the medical
practitioner retains overall responsibility for the patient. This does
eg
not apply when the medical practitioner has formally referred the
patient to another registered health practitioner
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Page 30 of 121
2. What is the exact weight that should be entered if the two reading are 70 Kg
and 70.25 Kg?
A- 70 Kg.
B- 70.02 Kg.
C- 70.13 Kg.
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The SECA model 815 floor scale is used to measure weight in this
component. It has a digital display indicator head fitted at the back
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of the platform with the connecting cable stored in the compartment

underneath the head. The scale is a load cell model with a weighing
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range of 0-136
136 kilograms (kg). It operates with a standard 9 V alkaline
battery. In order to open the battery compartment, open the battery
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lid underneath the head. Connect the battery terminals, then insert
the battery and close the cover. The reading of the scale is accurate
ep
to 0.25 kg over the entire weighing range. If two values are displayed
alternately in the 0.25 kg. range, then the exact weight is between
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the two values and the intermediate weight should be entered

entered.
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3. Based on this extract

extract:
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A- Effective post exposure prophylaxis needs to be accessible when needed.

post-exposure needed
B- OSHA requires that all employees must be vaccinated against rubella.
rubella
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C- Some agencies require that health care employers must be immunized

against measles.
measles
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A variety of measures is needed for optimal infection control among

employees, both before and during the period of employment. OSHA
mandates that all employees should
sho uld be immunized against HBV, although the
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risk of HBV infection to endoscopy

opy unit personnel is small. Other agencies and
medical societies have gone further and recommended that health care
ep
personnel should have documented immunity or be immunized against a

number of other vaccine-preventable
preventable diseases. Such vaccinations include
eg
annual influenza immunizations, measles/

asles/ mumps/rubella, varicella (if the
individual has not had chickenpox in the past), tetanus/diphtheria/pertu
tetanus/diphtheria/pertussis,
ssis,
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and meningococcus. Additionally, a majority of states have immunization laws

for health care workers with which institutions must comply. Last, an effective
and readily accessible employee health service may play a critical role in the
management of after-exposure prophylaxis.
Page 32 of 121
A- The hospital must provide the employees with the cost of coffee.
B- Employees get 90 mins of unpaid breaks every day.
day
PM
C- Some of the employees may leave the hospital after 5 PM.
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The Medical Clinic is open 0900h to 1700h, Monday through Friday. Employees
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are expected to be at their work stations logged into their compute

computers when the
doors open at 0900h. During the 8 hour work day, employees are allowed a
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one hour unpaid lunch break and two paid fifteen minute coffee breaks time
permitting each day. As staff are being paid for their coffee breaks we ask that
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they remain in the clinic and available to help doctors and patients when
required. Scheduling of breaks will be done such as to ensure continuous
service to our patients throughout the day. In the event there are still patients
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in the clinic after 1700h, at least one employee

em ployee will be required to remain in
the building until all patients have left
left..
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A- Probation period may take up to three or even four months.
B- Employee get to evaluate his physician lead during his probation period.
C- After the probation period, the employee is permanently employed.
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A new employee is considered to be on probation during the first three

months of employment. During this time, the employee will be able to
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evaluate the job and work environment, and the Clinic Manager(s) and
Physician Lead(s) (Personnel) will evaluate the suitability of the employee for
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the job. At the end of the probation period if mutually agreeable, permanent
employment will be offered. At the discretion of the Managers this period may
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be extended.
extended
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6. The contents of the INS published guidelines include:
A- Inconsistent process measures of quality based on guidelines are sometimes
non-beneficial.
B- Neurosurgical guidelines can be applied in a meaningful way to the majority
of neurosurgical practices.
guidelin
C- The quality of research determines the evidence base on which guidelines
rest.
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The evidence base on which clinical guidelines rest is determined by the quality
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and applicability of the clinical trials. Because of the profound limitations of

many prospective, randomized trials in neurosurgery (non (non-representative
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patient and surgeon selection,

selection, cross-overs
cross--overs and non-blinded
cross non evaluation of
unclear endpoints) I question whether any neurosurgical guidelines can be
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applied in a meaningful way to the majority of neurosurgical practices. Using

clinical guidelines recommendations as quality indica
indicators and holding
physicians accountable for many, sometimes contradictory, process measures
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of quality based on these guidelines is unlikely to benefit anyone. I believe that

the emphasis on such measures will divert attention from more clinically
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relevant issues, increase the cost and complexities of care, and decrease the
quality of life for our patients
patients.
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Part C
In this part of the test, there are two texts about different aspects of
healthcare. For questions, 7-22, choose the answer (A, B, C or D)
Text1: Why getting motivated is hard

As a trainer, I consider it a personal failure if I am unable to motivate a client to make
important health and lifestyle changes. Sure, there are people who just do not care,
but I can spot them from 100 meters away. I am not talking about them. I am
referring to the clients who really want to lose the weight. They actually do care, but
it just does not happen. They struggle to muster even half the motivation required to
do the work, self-sabotage
self sabotage and eventually feel so defeated that they quit. It hurts to
t
watch. On the flipside, other clients get in and get the job done. Their sights are set
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and they just plough ahead until mission accomplished. By this point, exercise and
eating healthily are non
non-negotiable parts of their lifestyle. It is who they have
ecome.
become.
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So, what separates my clients who achieve their weight loss goals from those who
do not?? Is it a difference in brain chemistry? The answer is yes … and no. "There is
a system in your brain that impacts your levels of motivation called the reward
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network" explains Fiona Kumfor for,, senior research fellow at the University of Sydney's
Kumfor,
Brain and Mind Centre. "That That involves two regions: the ventral striatum and parts of
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the pre-frontal
frontal cortex," Dr Kumfor says. "Together they're involved in our willingness
to work, our motivation to engage in behaviors
behaviors,, and our willingness to persist in that
effort over time. "Really importantly, it influences our decisions on what's working for
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us and what's not." Dopamine, a chemical messenger, is the star quarterback in this
reward network — it is released during pleasurable situations, and the ventral
striatum and pre-frontal
frontal cortex have receptors that are sensitive to it. An increase in
our dopamine levels to those areas is what gives you that sense of reward,
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regardless s of whether the stimulus is food, sex, exercise, fat loss or winning at Mario
Kart. This dopamine boost is what encourages you to repeat the activity that got you
the reward, so you get can it again. However, here is the kicker: you do not get that
ep
reward rush until after you engage in the behavior

behavior..
Getting someone to engage in the behaviour for long enough to value that dopamine
eg
rush in the first place is where I and many other well-

well-meaning
well -meaning health professionals
get stuck. What makes one person see getting healthy as achievable and another
person see it as insurmountable is the Nobel Prize-winning
winning question, Dr Kumfor
y
says, and unfortunately science isn't quite there yet. "But what we do know is that
humans are bad at focusing on distant future and less tangible rewards," she
explains. For example, studies have shown that given the choice between getting
$10 right now and $100 next month, most of us will go for the instant gratification.
That makes sense when you think of it in terms of making massive lifestyle changes:
substantial weight loss seems ages away and might not happen, whereas that
schnitzel and six schooners is tonight and guaranteed delicious.
Page 36 of 121
We're probably better off with setting short-term rewards along the way to the big
one, rather than just focusing on the far off and hard-to-imagine pot of gold at the
end of the rainbow. Maintaining goal-directed motivation behaviour is hard. Instead,
focus on creating habits that will help you along the way, suggests Dr Kumfor. "If
there's a way to harness habit, rather than forcing ourselves to be goal-directed,
that's undoubtedly going to be easier. "So, break it all down into small, manageable,
bite-sized parts." For example, if you are trying to lose weight, have your ducks in a
row well in advance. Schedule in regular times, pre-book and pay for classes, pre-
pack workout gear and have it on-hand if you are exercising after work. Do not go
home first. Train yourself to operate on autopilot so your brain does not get involved.
Otherwise, you will be veering straight onto instant gratification highway, without
stopping off in exercise city.
At the end of the day, in order to do any of that you need to decide whether your goal
is actually worth the effort. There is a complex relationship between how meaningful
a reward is and the amount of effort required to achieve it. You will only make the
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sacrifices if your goal is truly important to you. Think of motivation as a spectrum.

that some people will be highly motivated, some moderately and others will
Within that,
find it really challenging. In addition,
addition motivation can change depending on the person
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and situation. That is partly due to differences in the way our brains work. Take me
for example, while I do not (usually) have trouble being motivated to t exercise, I had
much rather clean the oven than start my statistics assignment that's due in three
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days. This is where intrinsic (internal) motivation can help. Intrinsic motivation is
when you are driven to do something purely because you find it enjoya enjoyable; it does
not matter if there is a pot of gold at the end. You are choosing to do it, rather than of
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out of obligation. Extrinsic motivation (external), on the other hand, is when you're
driven to do an activity because you're avoiding pain or punishmen
punishment, you're doing it
for someone else, or feel like it it's
's being forced on you. Sure, it might get you started,
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but it will not keep you on the wagon for long. "People who are more intrinsically
motivated tend to work at a higher intensity and are more consistent with their
exercise routine," explains exercise physiologist Alex Budlevskis.
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Text 2: How to eat more green vegetables
In Australia, less than one in 10 people eat enough vegetables. This is tragic, given high
vegetables intakes are associated with better health, including a lower risk of heart
disease, some cancers, and type 2 diabetes. For every extra 200 grams of vegetables
and fruit eaten each day, there's an 8 per cent reduction in the risk for heart disease, a
16 per cent risk reduction for stroke and a 10 per cent reduction in risk of dying from any
cause, according to research using data from 95 individual studies. When the
researchers drilled deeper into some types of vegetables and fruit, they found that
eating more apples and pears, citrus fruits, cruciferous vegetables (like bok choy,
broccoli, Brussels sprouts, cauliflower, radish, swede, turnip, and watercress), green
leafy vegetables and salads were a all associated with a lower risk for heart disease and
death. They also found a lower risk of getting any type of cancer among those with the
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highest intakes of green

green-yellow vegetables such as carrots, corn, pumpkin, zucchini,
green beans and cruciferous ve vegetables.
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Across the globe, about 7.8 million deaths are attributed to low intakes of vegetables
and fruit. But in a country like Australia, you'd think it would be easy to eat your g
greens,
as well as a range of other vegetables. Reasons for not eating them include not liking
the taste, a perceived lack of time or cooking skills, and lack of access to fresh produce.
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These are all barriers to boosting our vegetable intakes — so let's check them out in
more detail.
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If you hate vegetables, it could be because you have inherited "super

"super-taster" genes.
About 20 per cent of the population are supertasters and rate cruciferous vegetables as
tasting up to 60 per cent more bitter compared to nonnon-tasters, who make up about 30
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per cent of the population. What they are "tasting" is a naturally occurring chemical
called glucosinolate that is released more when vegetables are cut, ccooked or chewed.
Being a super-taster
taster probably offered a survival advantage in ancient times, because it
would have meant you were better able to detect poisonous substances (which tend to
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be bitter), and work out which plants were safer to eat and which to avoid. The good
news is that repeated exposure to these bitter tastes means you do learn to like them
over time. If you hang around with others eating lots of vegetables, or if your parents and
ep
household members eat a lot of vegetables, then you will end up eating more too. True
supertasters will like vegetables that are not bitter more, including beans, beetroot,
carrots, corn, eggplant, lettuce, onion, peas, pumpkin and sweet potato
potato.
eg
If vegetables are off your menu because of how they taste, it is worth a rethink on the
way you're preparing them. How you cook vegetables can improve their taste and for
y
super tasters, can mask the bitterness. Try some of these fast and easy tricks at h home:
Add a "decoy" flavor. Piperine is the 'hot' taste in black pepper. Adding it, or chilli or
other spices, distracts your taste buds from noticing the bitter taste of vegetables. Mask
the taste by using cheese sauce. Make it fast by dissolving a heaped teaspoon of
cornflour into a half cup of reduced fat milk in a microwave-proof jug. Cook on high for
30 seconds, stir and add a cheese slice broken into pieces, and cook for another 30
seconds. Stir again, cook for another 30 seconds, then stir until the melted cheese is
fully dissolved and the sauce thickens. Cook briefly by stir-frying, microwaving or
steaming, so they're still a bit crunchy.
Page 38 of 121
In some regions of Australia, getting good quality fresh vegetables at a reasonable cost
is a major challenge. Prices of vegetables can be more than double the cost of
supermarkets in cities. This is where modular farms — small indoor farms the size of a
shipping container — could potentially help in terms of access and freshness. A modular
farm can be placed just about anywhere from a busy city to a rural community, with the
caveat that these farms still need water, although the amount is conservative. However,
the power usage is high because they need to run lights 24 hours a day. Another way to
improve your access to a regular supply of vegetables, if distance or affordability is a
concern, is by using canned and frozen varieties. For canned vegetables, choose the
salt-reduced varieties where possible. Frozen vegetables on the other hand, are frozen
within hours of being harvested and can be even "fresher" that what you buy at the
supermarket.
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Text 1: Questions 7-14
7. What do we learn in the first paragraph?
‫ ׇ‬Failure to lose weight is mostly due to lack of motivation
‫ ׈‬Too much care may hinder the ability to lose weight
‫ ׉‬Acting on your goals is the way to achieve them
‫ ׊‬Even if you work very hard, you may not achieve your goals for different reasons
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8. In the second paragraph, the writer uses Fiona Kumfor's words to

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‫ ׇ‬illustrate the routine-

routine
routine-reward
-reward system loop
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‫ ׈‬Outline
utline the role of dopamine in the brain
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‫ ׉‬Prove that chemical transmitters in the brain are the ones responsible for motivation
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‫ ׊‬Inform us that dopamine level is affected by your degree of motivation

ep
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9. In the second paragraph, the word The refers to
‫ ׇ‬The brain
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‫ ׈‬The reward network
‫ ׉‬Levels of motivation
‫ ׊‬The brain's chemistry
Page 40 of 121
10. What is the main point that the writer wants to deliver by mentioning the study in the third
paragraph?
‫ ׇ‬Long-term goals need bigger rewards
‫ ׈‬Science has not been able to come up with ways to increase dopamine levels in the
brain
‫ ׉‬Goals that are far in the future are unachievable
‫ ׊‬Perceptible outcomes drive a greater motivation

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11. What advice is the writer giving in the fourth paragraph?
‫ ׇ‬Break your goals down

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‫ ׈‬Do not set long-

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long
long-term
-term goals
‫ ׉‬Stop your bad habits

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‫ ׊‬Do not set goals unless you are prepared

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12. What idea is emphasized by the phrase 'have your ducks in a row well' in the fourth
paragraph?
eg
‫ ׇ‬Get motivated
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‫ ׈‬Force yourself
‫ ׉‬Organize your thoughts
‫ ׊‬Be prepared
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13. In the fifth paragraph, the writer suggests that intrinsic motivation produces an outcome
which is
‫ ׇ‬Achievable
‫ ׈‬Durable
‫ ׉‬Enjoyable
‫ ׊‬Not forced on you to do

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14. In the final paragraph, Within that refers to

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‫ ׇ‬Challenges
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‫ ׈‬Motivation
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‫ ׉‬People
‫ ׊‬Spectrum
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Page 42 of 121
15. What do we learn about the consumption of vegetables in the first paragraph?
‫ ׇ‬People who consume 200 grams of green vegetables daily are 0.16 less likely to
develop stroke.
‫ ׈‬Those whose intake of food involve more vegetables do not suffer from heart diseases.
‫ ׉‬90% of people do not eat enough vegetables
‫ ׊‬High intake of carrots may help protect against cancer.

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16. Drilled deeper in the first paragraph implies that scientists looked into the matter in a
more ……………………… manner.
m 21
‫ ׇ‬Frequent
/O 66
‫ ׈‬Specific
ET 26
‫ ׉‬Sensational
pr 3
‫ ׊‬Serious
ep
eg
17. According to the second paragraph, which of the following is mentioned as a reason for
people's decreased intake of vegetables?
y
‫ ׇ‬Not being able to fit it into their schedule
‫ ׈‬Vegetables being unavailable in the market
‫ ׉‬Their bad taste
‫ ׊‬The lack of time to cook
Page 43 of 121
18. Which of the following is mentioned in the third paragraph?
‫ ׇ‬6 out of 10 of the cruciferous vegetables have a bitter taste
‫ ׈‬2 out of 10 people have stronger tasting abilities
‫ ׉‬3 out of 10 people do not find cruciferous vegetables to be of a bitter taste
‫ ׊‬Vegetables which are cut produce more glucosinolate.

fb 01
19. It in the third paragraph refers to

.co 03
‫ ׇ‬Being able to survive

m 21
‫ ׈‬Being a super-taster
super taster
/O 66
‫ ׉‬Living in ancient times

ET 26
‫ ׊‬Eating poisonous chemicals

pr 3
ep
20. In the third

ird paragraph, what does the writer consider as a pleasant fact?
‫ ׇ‬Increased tolerance is produced following more frequent exposure.

eg
y
‫ ׈‬Having a family that eat a lot of vegetables
‫ ׉‬Eventually, everybody is going to like vegetables
‫ ׊‬Those with stronger tasting abilities tend to like certain types of vegetables
Page 44 of 121
21. The main aim behind what the writer is saying in the fourth paragraph is
‫ ׇ‬To teach us how to make cheese sauce
‫ ׈‬To illustrate the effects of spicy food on the taste buds
‫ ׉‬To question the effectiveness of certain food when used as a method to help people
tolerate the bitter taste of some vegetables
‫ ׊‬Provide solutions to a problem

fb 01
22. In the final paragraph, This is where refers to certain

.co 03
‫ׇ‬ Time
m 21
‫׈‬ Regions
/O 66
‫׉‬ Cities
ET 26
‫׊‬ Circumstances
pr 3
ep
eg
y
Page 45 of 121
y
eg
ep
pr 3
,ĞŵŽƌƌŚŽŝĚƐ͗ 7H[WV
ET 26
Page 47 of 121
/O 66
m 21
.co 03
fb 01
y
eg
ep
pr 3
ET 26
Page 48 of 121
/O 66
m 21
.co 03
fb 01
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
Passport Photo
PROFESSION:
VENUE:
TEST DATE:
fb 01
.co 03
m 21
TIME: 15 MINUTES
/O 66
ET 26
15-minute
You must answer the questions within the 15 minute time limit.
limit.
pr 3
ep

eg
y
Page 49 of 121
Part A
TIME: 15 minutes
Hemorrhoids: Questions
Questions 1-7
fb 01

7, decide which text (A,
( B, C or D) the information comes from. You may use
.co 03
1 Importance of abdominal examination

examination?
m 21
2 Indications of surgery in hemorrhoids

hemorrhoids?
/O 66
3 Factors precipitating for blood vessels swelling

swelling?
ET 26
4 piles?
Role of chemicals injection in treating pil es?
5 piles?
Ethics of examining a patient with piles
pr 3
6 hemorrhoids?
Symptoms associated with hemorrhoids
7 Advantages of ligasure hemorrhoidectomy?

ep
Questions 8-14
eg
y
8 What does ligasure hemorrhoidectomy help reduce when compared with other methods?
9 How do the lumps protruding from the anus look and feel like?
10 What are the dietary habits that should be adopted to reduce the risk of
piles?
Page 50 of 121
11 What is the mean operating time when performing ligasure hemorrhoidectomy?
12 What do surgeons use to snare hemorrhoids?
13 What does abdominal examination help us rule out?
14 What is the color of blood that you may notice on the toilet paper in cases of
complicated piles?
fb 01
Questions 15-20
.co 03
Complete each of the sentences, 15-20

m 21
15. .......................... out of every ten people aged over 40 have some degree of hemorrhoidal disease.
/O 66
16. Hemorrhoids develop from pads of ........................... around the anal canal.
ET 26
17. An ............................ examination should be done to exclude other possible co

conditions.
18. ................................. of chemicals is used to reduce the size of hemorrhoids.

pr 3
19. People who are overweight, pregnant or .......................... are more liable to develop hemorrhoids.
ep
20. Surgical intervention is indicated in cases of ............................. and .............................. degree

hemorrhoids.
eg
y
END OF PART A
Page 51 of 121
y
eg
ep
pr 3
ET 26
Page 52 of 121
/O 66
m 21
.co 03
fb 01
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
Passport Photo
PROFESSION:
VENUE:
fb 01
TEST DATE:
.co 03
m 21
TIME: 45 MINUTES
/O 66
ET 26

Paper
pr 3

ep

eg
Example:
A
y
B
C
Page 53 of 121
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)
1. The guidelines establish that:

A- The student should always be under supervision when performing high risk
procedure.
B- The student should not be under supervision when performing naso
naso-gastric
fb 01
tube insertion.
insertion
C- A student who is uncomfortable with performing a simple procedure, should
.co 03
be forced to do it in order to learn properly

properly.
m 21
/O 66
Students performing high risk and most moderate risk procedures

should always be supervised. Exceptions would be NNG tube
ET 26
placement and suturing. A student who wants to be supervised for

any procedure should be, and no student who feels uncomfortable
pr 3
should ever be made to feel pressured to do it without supervision

supervision.
ep
eg
y
Page 54 of 121
A- Only the patient has the right to or not to perform the procedure.
B- The doctor should advice the patient against performing the procedure.
C- Refusing to do the procedure is a decision that a doctor can make even if
the patient is refusing this decision.
fb 01
The medical practitioner who will perform the procedure should

.co 03
discuss other options with the patient, including medical procedures

or treatment offered by other health practitioners and the option of
not having the procedure. A medical practitioner should decline to
m 21
perform a cosmetic procedure if they believe that it is not in the best

/O 66
interests of the patient

patient.
ET 26
pr 3
ep
eg
y
Page 55 of 121
3. This policy states that in case of overpayment by the organization:
A- Initiation of recovery should be made within 45 days.
B- A refund should be made within 24 months.
C- The organization may overcharge you on the next payment you make.
fb 01
In the event of any overpayment, duplicate payment, or other

.co 03
payment by us in excess of the member's benefits payable

according to the member's benefit plan ("Overpayment") and all
Blue Cross NC policies, you shall promptly remit the
m 21
overpayment to Blue Cross NC. In addition to other remedies, if

/O 66
within forty-five (45) days of a request for a refund by us, the

requested refund has not been made we may recover the
ET 26
overpayment amount by offset of future amounts payable to

you. Neither Blue Cross NC nor you may initiate recovery of
overpayments or underpayments, respectively, any later than
pr 3
twenty-four (24) months after the date of the original claim

payment with the following exceptions: Fraud,
ep
misrepresentations and other intentional misconduct

eg
y
Page 56 of 121
4. The allowance is:
A- 100% for the first lower limb X-ray performed for the patient.
B- 80% for the third ECHO performed for the patient.
C- 75% for the second fundoscopy performed for the patient.
fb 01
When multiple diagnostic cardiovascular services are performed during

.co 03
the same outpatient patient session, the allowance for the technical
component of the primary procedure is 100%. The allowance for the
technical component of the second and each subsequent imaging
m 21
procedure is 75%. When multiple diagnostic ophthalmology services are

performed during the same outpatient patient session, the allowance for
/O 66
the technical component of the primary procedure is 100%. The

allowance for the technical component of the second and each
ET 26
subsequent imaging procedure is 80%. The multiple procedure payment

reduction on diagnostic imaging applies when multiple services are
furnished by the same physician or physicians in the same group
pr 3
practice, to the same patient, in the same session, on the same day. The
allowance for the technical component of the primary procedure is
100%. The allowance for the technical component of the second and
ep
each subsequent imaging procedure is 50%.

eg
y
Page 57 of 121
A- The device automatically downloads your HR and BP to the computer.
B- The device automatically measures your HR and BP when turned on.
C- When measured, systolic BP number flashes on the top left corner of the
monitor.
fb 01
.co 03
780 is an automated electronic heart rate and blood pressure

The Colin STBP-780
m 21
(BP) monitor capable of accurate readings at rest and during exercise. The unit
assesses heart rate via wires connected to four electrodes placed on the thorax
/O 66
and abdomen. Blood pressure

pressure is assessed during deflation of the cuff via two
microphones in the cuff. The front display provides clear, easy to read
ET 26
measurements of heart rate, systolic and diastolic BP, elapsed time, and error
messages. When turning the system on, a Self Self-Check is performed
automatically. The field for the systolic blood pressure at the top left corner of
pr 3
the blood pressure monitor displays an estimate of systolic BP during deflation.

This number flashes as the measurement is being taken. Once the systolic and
ep
diastolic blood pressure and the heart rate are measured, all three values are
displayed on the monitor and downloaded to the computer screen and system
database during the test.
test
eg
y
Page 58 of 121
6. According to the extract, choose in INCORRECT answer:
A- The endoscope cannot withstand repeated cycles of sterilization.
B- Flexible endoscopes are easier to clean when compared to fixed ones.
C- Data that is available to assess the efficiency of sterilization over HLD is not
enough. .
fb 01
.co 03
Traditionally, sterilization of endoscopes and accessories has been indicated

for the rare occasions when they are to be used as critical medical devices,
when there is a potential for contamination of an open surgical field.
m 21
Sterilization can be achieved by using a variety of methods, including ethylene

oxide gas treatment, and it can be achieved with appropriately long exposure
/O 66
to liquid chemical germicides. Because of the complexity of the instrument

channel design, sterilization of flexible endoscopes iis difficult to accomplish. In
ET 26
addition, endoscope durability and function are potentially compromised with

repeated cycles of sterilization. Users report that endoscopes experience a
shortened use life because of material degradation issues when processed
pr 3
repeatedly in ethylene oxide. Because of these factors as well as a lack of data

for demonstrable benefits to the further reduction in endoscope bacterial
ep
spore counts achieved by sterilization instead of HLD, sterilization with

ethylene oxide is not recommended
mended over HLD for standard GI endoscopes.
eg
However, an FDA-cleared
cleared liquid chemical sterilant processing system has been
approved to provide sterilization of cleaned, immersible, reusable, and heatheat-
y
sensitive critical and semi critical medical devices.
Page 59 of 121
Part C
Text1: Building a human heart in a dish

Stem cell transplants smell like creamed corn, apparently. Petras learned this as he
was undergoing treatment for non-Hodgkin's lymphoma. He'd already received
chemotherapy to kill the cancerous cells coursing through his lymphatic system, but
the disease had bounced back. The best option to save his life was to carpet-bomb
his immune system — killing the cancer-ridden cells alongside the healthy ones —
then reboot it with a transplant of healthy bone marrow stem cells harvested before
the treatment. The approach is a modern take on the oldest form of stem cell
fb 01
therapy, namely bone marrow transplants, the first of which was performed nearly
half a century ago. Since then, stem cell scientists have been working to understand
just what stem cells are, how to control the
them, and — most importantly — what can
.co 03
be done with them.
At the recent International Society for Stem Cell Research conference in Melbourne,
stem cells showed they are ready for prime time. "There was a big buzz because it
m 21
was really clear that this is now moving to translation, and that's very exciting," says
Melissa Little, program leader of Stem Cells Australia and head of the Kidney
/O 66
Research laboratory at the Murdoch Children's Research Institute. "I'm really

pleased to see over the 16 years that this so
society
ciety has existed, that we've moved from
a fundamental fascination with what a stem cell is, and what it can do, to clinical
ET 26
trials, which is an amazing outcome in a pretty short period of time."
Stem cells are the cells from which every other cell in the body originates. They are
the progenitors of every cell type including heart muscle cells, neurons, bone marrow
pr 3
sensitive cells at the back of your eye. For a long

cells, skin cells — even the light-sensitive
time, embryos were the only source of stem cells. Then in a Nobel prizeprize-winning
discovery in 2006, Japanese scientist Shinya Yamanaka and colleagues took
ep
ordinary adult skin cells and reprogrammed them back into the most basic form of
stem cell — a pluripotent stem cell. This discovery opened up the field of ste
stem cell
science. Now stem cells could be created from adult skin cells, then turned into
eg
whatever cell type was needed, such as cardiomyocytes for hearts, glial cells for
brains, islet cells for the pancreas, even the cells that make teeth and bone. But
y
contrary
trary to the promises made by the countless unregulated clinics that have
sprung up like mushrooms after rain,, offering a host of untested and dubious
treatments, stem cell medicine is still very much in its infancy. Well-tested and
research-proven stem cell-based treatments are only just beginning to emerge on
the market. But not far behind are potentially game-changing treatments for
everything from age-related macular degeneration and Parkinson's disease to type 1
diabetes and HIV infection.
Page 60 of 121
So-called "autologous" stem cell transplants — transplants using a patient's own
stem cells, such as bone marrow stem cells — are well-established as part of
treatment for cancers such as lymphoma and myeloma. But these transplants are
also being taken in extraordinary new directions with gene-editing technologies. Last
year, Italian doctors treated a young Syrian refugee with skin grafts derived from his
own stem cells. However, the cells had also been engineered to correct the genetic
mutation responsible for a devastating blistering disease called junctional
epidermolysis bullosa. At the time of treatment, the boy had lost around 80 per cent
of the skin on his body because of the disease. But the skin grafts took, grew and
now behave just like healthy skin should. In the United States, a trial is currently
underway in people with HIV. The aim is to reboot their immune systems with their
own harvested stem cells. But these cells have been engineered to resist infection
with HIV by introducing a genetic mutation to the receptor that HIV uses to gain
access to the cells.
Autologous stem cell treatments, however, are very costly and labour labour-intensive, as
fb 01
they require effectively creating a new treatment for every single patient. A more
attractive possibility is allogene
allogeneic stem cell treatments, which use donor cells that are
selected or engineered so as not to trigger the recipient's immune response.
.co 03
Australian biotech company Mesoblast has developed a donor stem cell-based cell
graft versus
versus--host disease, a potentially
treatment for graft-versus-host poten deadly side effect of organ and
bone marrow transplants. Their product, which is licensed in Japan and recently
m 21
completed advanced clinical trials for the US Food and Drug Administration (FDA),
uses a class of stem cells that are invisible to the immune
im system. One effect of
these mesenchymal stem cells, as they're known, is to dampen down the patient's
/O 66
immune reaction against their transplant. One of the most exciting medical
los to disease,
applications for stem cells is to replenish adult cells that have been lost
damage or simply old age. Earlier this year, British scientists managed to grow cells
ET 26
from the back of the eye in a dish, using stem cells derived from embryos. These
retinal cells were implanted into the eyes of two people with age-related
age macular
degeneration, a leading cause of blindness. The patches grafted successfully, and
both patients showed significant improvements in their eyesight. Another application
pr 3
insulin
still a few years from clinical trials is using stem cells to regrow the insulin-producing
cells of the pancreas in people with type 1 diabetes, a disease in which the body's
immune system attacks and destroys those cells. Researchers are also working on
ep
how to use stem cells to replace damaged heart muscle cells, and regrow injured or
defective brain cells or liver cells, to name just a few examples. Further down the
eg
track, it's even foreseeable that a patient with a new diagnosis will have some skin
cells taken, stem cells grown from them, and a model of the affected system or
organ developed in a dish so that it can be used to test which drug that person is
y
most likely to respond well to.
Page 61 of 121
Text 2: Anxiety has a cost, but can also be a power for good
fb 01
Anxiety doesn't recognize class or race. It ignores age and gender. And it gives no
deference to talent, wealth or perceived success. A popular blogger, a media celebrity,
.co 03
t
but still at odds with the demands of the life she has chosen, Sarah talked of the terrible
toll taken by modern life: "Anxiety is on the increase. We are overstimulated. "We used
to have boundaries, and we had cultural mores and structures that protected us from
these kinds of primal blowouts. "We had a Sabbath because we all had an
m 21
understanding
rstanding that we needed a day of rest just to be able to cope with the toil of hoeing
a field, and also to spend time with family; and we had set bedtime hours and we had
/O 66
set work hours. There were boundaries that were placed by our culture and structures.
structures
That has gone out the window in literally less than a generation." In the past Sarah shut
herself away, taking time off from the outside world — a forced retreat. But her new way
of dealing with her anxiety is to embrace it. To acknowledge its dangers, to t be wary, and
ET 26
then to try to harness it to her advantage as a tool for positive change.
A bit of anxiety in the right place at the right time could be a positive thing, agreed Black
Dog Institute clinical director Josephine Anderson — within limits. "A little anxiety, for
pr 3
example, will generally improve our performance — whether it's running a race, working
to a deadline or performing at a writers' festival — and of course, the flight or fight
response saves lives every day. "Butt too much anxiety can reall reallyy get in the way of our
ep
doing what we want or need to do. "When anxiety threatens to overwhelm our minds,
then doing something mindful — meditating, exercising, writing, for example — can help
anxiety-driven
us focus, calm and filter out distracting, distressing anxiety-
anxiety -driven thoughts."
eg
For acclaimed British novelist, Matt Haig, catastrophic thinking, brought on by anxiety,
has been a lifelong burden. "It's a total vicious circle, this is a total mental illness
illness thing.
y
The human brain, said Haig, struggles to make sense off our frenetic and chaotic world,
where enough is never enough. "We are still essentially cave people. We haven't
actually evolved for 30,000 years, and we are all trying to run the software of 21st
century society on our systems and we need to switch ourselves off-and-on again a few
times. We live ever more unnatural lives, he said, and often the best solution is to
declutter, to undertake what he calls a "life-edit". "We are in an overloaded world and an
overloaded culture and we've got overloaded lives," he said. When people look for a
solution to things, they are often wanting something to be added into their life, but if you
are in an overloaded culture, the solution is often just taking things away.
Page 62 of 121
For first-time novelist Jarrah Dundler, being a finalist in this year's Vogel Australian
literary award brought pain, as well as a sense of achievement. A feeling of anxiety
along with the accolade. But that was to be expected. His novel Hey Brother centers on
a cast of characters dealing with the complexities and frustrations of mental illness; and
as a peer-support mental-health worker, he has his own and others' experiences to draw
upon. His personal experience of anxiety centers on fixation, where thoughts get "stuck
in his head" and become so exaggerated and urgent that they often lead to physical, as
well as mental illness: "I can be stuck on something for a week, and that's the only thing
I can focus on. "For whole days that's all I'm thinking of. Insane stuff and really getting
completely worked up about it." Jarrah lives and works in regional northern New South
Wales. He acknowledged a change in the way society now deals with mental illness, but
there's still a stigma. For Jarrah, like Sarah and Matt, writing about mental illness is as
much a form of therapy as it is a literary decision. "I can't write when I'm depressed, I
can't write when I'm anxious. I can try but ... so it helps for me because I get a lot out of
activity. When
writing, like the buzz from when you are writing. "It's also a very mindful activit
you are in the flow of writing, you are lost, and your mind is occupied on something,
focused on something." But anxiety, he said, is never far away. A last last-minute decision by
fb 01
catastrophism.
his publisher to change the name of his book saw him spiral into catastr
Michael Abelman comes from a farming background, but his career has morphed over
.co 03
the years into what his website calls "social enterprise" work. It's the largest such urban
farming scheme in North America. And as he told it, it's about producing he healthy,
affordable food, reconnecting with the environment and helping the disadvantaged deal
m 21
with their anxiety and mental health. "It's where the term 'Skid Row' was actually
coined," he explained. "It's about 20 square blocks, entirely inhabited by folks who are
term addiction, mental illness and material poverty." "I'm not a mental
dealing with long-term
/O 66
health professional, addiction expert or social worker," said Abelman. "We produce 25
tons of food on four acres of pavement, and we do it with the hands of people that no
one ever expected could accomplish anything. These are the untouchables. "These are
ET 26
people that you see in broad daylight on the sidewalks with a needle in their arm or
work has provided a
pirouetting in the middle of the street high on crack. And yet, this wor
reason for people to get out of bed each day, kind of a touchstone, a place to go."
oing the words of Sarah Wilson, he described anxiety as a gift: "For me anxiety has
Echoing
pr 3
been the trigger, the thing that gets me up every day and gets me ou out there doing good
work. "And d if I didn't feel that way, I probably would not get out of bed." Dr Anderson
from the Black Dog Institute urged people not to try to weather anxiety disorders alone.
ep
"It's important to remember that anxiety disorders are commo

common n and can be severe and
impairing," she said. "If, despite your best efforts, anxiety is interfering with your life or
your relationships, then it's important to get help. There are many effective treatments
eg
available so don't delay — speak to your GP and or your mental health professional."
y
Page 63 of 121
7. In the first paragraph, what was the best option that was used to save Petras' life?
⡥ Repeated cycles of chemotherapy
⡦ Sacrificing his immune cells to achieve a greater purpose
⡧ Targeting the cancerous cells more aggressively
⡨ Bone marrow transplantation from a donor

fb 01
.co 03
8. In the second paragraph, the reason behind Melissa Little cheering up is

m 21
⡥ The application of theoretical concepts

/O 66
⡦ The great impact of the use of stem cells

ET 26
⡧ The international co-operation

operation
⡨ Exciting cure rates and outcomes

pr 3
ep
eg
9. In the third paragraph, what do we learn about stem cells?
⡥ Skin is the only source to harvest them

y
⡦ Pluripotent stem cells are highly specialized
⡧ Embryos are no longer used as sources of stem cells
⡨ Stem cells are precursors for skin cells
Page 64 of 121
10. The writer uses the phrase sprung up like mushrooms after rain to state that these
clinics are emerging
⡥ Suddenly and rapidly
⡦ without certain plans
⡧ illegally
⡨ in a way that is not organized

fb 01
11. According to the fourth paragraph, gene-editing

gene technologies had already been used is
.co 03
the field of
⡥ Trans-species
species bone marrow transplantation
m 21
⡦ Preventive medicine
/O 66
⡧ Infection control
ET 26
⡨ Dermatology
pr 3
ep
12. In the fifth paragraph, the writer states that using the patient's own stem cells is
eg
⡥ Unaffordable
y
⡦ Non-effective
⡧ Non-efficient
⡨ unavailable
Page 65 of 121
13. In the fifth paragraph, the writer is particularly impressed by
⡥ The ability to renew damaged cells
⡦ Implanting embryonic derived stem cells into a diseased eye
⡧ Our ability to treat type 1 DM
⡨ Our ability to replace damaged cardiac tissues
14. In the final paragraph, The word foreseeable means
⡥ unexpected
01
⡦ hoped
0
⡧ needless to say
32
⡨ being studied
16
6 26
3
Page 66 of 121
15. In the first paragraph, What does Sarah think is the reason behind the increased
prevalence of anxiety in society?
⡥ Increased life demands.
⡦ Loss of consistent cultural structure.
⡧ Lack of sufficient rest.
⡨ Not spending enough time with family

family.
fb 01
.co 03
16. in the first paragraph , The word it refers to

m 21
⡥ The new way

/O 66
⡦ Dangers
ET 26
⡧ Anxiety
⡨ Advantages
pr 3
ep
eg
17. In the second paragraph, Josephine Anderson believes that anxiety might be vital to
⡥ Win at sport competitions

y
⡦ Finish duties on time
⡧ Get to a hyperarousal protective state
⡨ None of the above
Page 67 of 121
18. Matt Haig believes that the best way to solve the problem is by
⡥ Addressing the problem more clearly
⡦ Changing the approach that we adopt to solve it

⡧ Seeking perfection
⡨ Not trying to fight it.

fb 01
19. That in the fourth paragraph refers to

.co 03
⡥ winning the award

m 21
⡦ his sense of achievement

/O 66
⡧ being a finalist
ET 26
⡨ being anxious
pr 3
20. According to Jarrah, what is it about writing can temporarily relieve anxiety
anxiety?
ep
⡥ Writing down the thoughts that bother you.

eg
⡦ Providing a way to divert attention.

y
⡧ Providing a sense of purpose
⡨ A way to escape the stigma brought on by society.
Page 68 of 121
21. In the final paragraph, we learn that those who often become addicted lack
⡥ Money.
⡦ Healthy food.
⡧ Sincere guidance.
⡨ Reasons to live.
fb 01
22. According to the final paragraph, both Michael and Dr Anderson believe that
⡥
.co 03
Anxiety is not entirely a bad thing
⡦
m 21
Sufferers of anxiety should seek professional help
⡧
/O 66
Anxiety is a common disorder
⡨
ET 26
Different types of treatment are available for this condition

pr 3
ep
eg
y
Page 69 of 121
.co 03
m 2
01
/O
E
Page 71 of 121
gy
Page 72 of 121
/O
m
co 0
b. 0 1
READING SUB-TEST QUESTION PAPER: PART A
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
Passport Photo
OTHER NAMES:
PROFESSION:
VENUE:
TEST DATE:
fb
.co 03
m 21
TIME: 15 MINUTES
01
/O 6 6
ET 2 6
You must answer the questions within the 15

15-minute
minute time lilimit.
mit.
pr 3
ep

eg
y
Page 73 of 121
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.
Skin-Lightning Creams: Questions
Questions 1-7
fb

7, decide which text ((A, B, C or D) the information comes from. You may use
.co 03
1 Studies about the effects of steroids on pregnancy?

m 21
01
2 Sun exposure and cancer

cancer?
/O 6 6
3 What to do if you are concerned that you have a problem

problem?
ET 2 6
4 Comparison
omparison between hydroquinone an
and
d steroids
steroids?
5 Malignant
alignant melanoma in Wales
Wales?
pr 3
6 Effects of radiation on the eyes?
7 Dermatologists stating the dangers of skin creams?

ep
Questions 8-14
eg
y
8 What should be done when encountering a problem with a skin-lightning cream?
9 How many people die in Wales each year as a result of malignant melanoma?
10 What are the short term effects of radiation on the skin?
[CANDIDATE NO.] READING QUESTION PAPER PART A 02/04
Page 74 of 121
11 What is the cause of tanning of human skin?
12 What is the effect of steroids on the placenta?
13 Who has done the survey about the opinions of dermatologists on the matter?
14 How was the incidence rate of malignant melanoma in Wales in 1996 in comparison to
2006?
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Questions 15-20
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Complete each of the sentences, 15-20

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15. Some sorts

rts of skin lighteners may have .................. systemic effects.
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16. Steroids can be useful in treating some skin conditions such as ................. and ........................
ET 2 6
17. Over exposure to .................... through sunbeds increases th

the risk of developing skin cancer.
18. Mutation to the ................... through UV radiation can cause cancer.

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19. The use of high dose steroids can cause a lot of problems if its use is .......................
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20. .........................................
..... infants may be a consequence of using steroids.
eg
END OF PART A
y
Page 75 of 121
y
eg
ep
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READING SUB-TEST QUESTION PAPER: PARTS B & C
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
Passport Photo
OTHER NAMES:
PROFESSION:
VENUE:
fb
TEST DATE:
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TIME: 45 MINUTES
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Paper
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ep

eg
Example:
A
y
B
C
Page 77 of 121
Part B
questions, 1-6 A B C
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ep
eg
y
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y
eg
ep
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fb 01
fb
"When not Covered" section revised to state: "Other uses of ambulatory

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event monitors, including outpatient cardiac telemetry and mobile

applications, are considered investigational, including but not limited
to monitoring asymptomatic patients with risk factors for
m 21
arrhythmia, monitoring effectiveness of antiarrhythmic therapy and

01
detection of myocardial ischemia by d etecting ST segment changes."

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Policy guidelines and references updated. Policy noticed 6/8/18 for

effective date 8/10/18. Medical Director review.
ET 2 6
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ep
eg
y
Page 80 of 121
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Cimzia (certolizumab pegol) for subcutaneous injection may be

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considered medically necessary for adult patients to reduce signs and

symptoms of Crohn's disease and to m aintain clinical response in adults
with moderately to severely active disease who have had inadequate
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response to conventional therapy; for treatment of adults with

01
moderately to severely active rheumatoid arthritis, active psoriatic

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arthritis or active ankylosing spondylitis.

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eg
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y
eg
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Part C
Obsessive-Compulsive Disorder (OCD) is a surprisingly common psychological

problem. Only 25 years ago, it was believed to be a relatively rare condition. In part,
owing to newer and more effective treatments for it, OCD is now known to affect
many millions of people at any given time. If left untreated, in most cases, OCD can
straightjacket a person's life with immobilizing anxiety. What's worse, many people
with OCD will develop depression that not only intensifies suffering, but often
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complicates and lengthens treatment. Nevertheless, as debilitating as it can be,

when treated with skillfully done, cognitive-behavior therapy (CBT) that
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emphasizes a crucial method called exposure and response or ritual prevention

(ERP), OCD's anxiety and depression producing grip can be significantly loosened.
In general terms, the main features of OCD are intrusive, horrific, and relentless
m 21
irrational thoughts or images (obsessions) that drive tremendous anxiety and

01
specific, usually excessive, repetitive, or unrelated behaviors (compulsions) that are

/O 6 6
performed in an effort
effo rt to neutralize or reduce the anxious thoughts, feelings and
sensations.
In essence, when someone has OCD his or her brain's danger detection region is
ET 2 6
hypersensitive and dramatically overreacts to certain triggers thus launching a

massive, often panic level,vel, anxiety attack (i.e., an exaggerated or inappropriate fight
or flight reaction). At the same time, the brain region that usually indicates safety is
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very sluggish, and slow to signal the "all's clear." Hence, the OCD sufferer will
experience needless or greatly exaggerated surges of intense anxiety related to
terrifying, irrational thoughts that drive him/her to engage in rituals in an effort to
ep
drive down anxiety and restore feelings and sensations of safety. In other words,
since the person's "automatic"
matic" safety signaler is very slow to relieve anxiety, he or
she will try to do it "manually" with a ritual. In the long run, however, rituals don't
eg
work consistently to reduce anxiety due to a process called "negative reinforc

reinforcement"
that, ironically, further energize the brain's anxiety triggers and makes its safety
signaler even weaker and slower.
y
Neuroimaging studies using PET scans have identified several hypermetabolic, brain
structures that are almost always associated with OCD. Specifically,
a neural pathway referred to as the supraorbital-cingulate-thalamic circuit - the
SOCT circuit - appears overactive in brain scans of people with OCD. Interestingly,
when OCD sufferers were randomly given either an SSRI or underwent intensive
CBT for OCD with exposure and ritual prevention, those who improved significantly
had follow up PET scans that showed much less activity in their SOCT circuit. Thus,
regardless of whether or not the person got better through CBT or took medication,
both therapies produced essentially the same result on brain activity.
Page 84 of 121
As it was with our remote ancestors, our recognition of danger and safety involves at
least three psychological dimensions - namely, cognitive appraisal (thoughts and
images about the situation), emotional activation (feelings of danger and/or safety),
and sensory stimulation (viscerally sensing the danger or the safety). Usually,
people are good at discriminating between the psychological experience of danger
and safety. That is, we typically experience congruence among these psychological
zones. Therefore, when we perceive safety, we have no significant anxious or
intrusive thoughts, dreadful emotions, or anxious sensations. Our minds, moods,
and sensations are all in alignment and reflect a deep feeling of safety and security
in the situation. And when we perceive actual danger, we usually have worries
about the situation, fearful feelings, and a lot of nervous system arousal that results
in various physical sensations of anxiety, such as muscle tension, clenching gut, dry
mouth, racing heart, rapid breathing, shaking, sweating, etc.
People
eople suffering with OCD try to achieve a specific, physical sensation of safety and
have great difficulty grasping factual safety. For example, a person who feels dirty or
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contaminated might wash extensively, far beyond the point of actual

cleanliness. Thus, someone with [this specific type of] OCD will wash (and wash,
and wash) until he/she senses and feels clean even if takes a long, long time to
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achieve the desired sensation

sensation. In most cases, especially when the illness is first
developing, the person will eventually feel clean enough (i.e., safe from germs,
disease, toxins, etc.) at which time the ritual stops. Unfortunately, as mentioned
m 21
above, this only strengthens anxiety and other OCD symptoms because of a process
01
called negative reinforcement.

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pr 3
ep
eg
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Page 85 of 121
Tuberculosis (TB) is the leading cause of infectious disease mortality and continues to
be a major challenge to global health. Each day, roughly 5000 people die of TB disease,
resulting in nearly 2 million deaths in 2016 alone. More than 1 billion people died from
TB during the last 200 years, more deaths than from malaria, influenza, smallpox,
HIV/AIDS, cholera, and plague combined. Recently, the global health community
intensified efforts to end TB as a global health scourge. The broad global strategy to
confronting and halting the TB epidemic involves a multifaceted approach, and
biomedical research is a key component of that strategy. Despite considerable progress
in preventing, diagnosing, and treating TB using the current armamentarium of tools
(most are decades old), substantial gaps exist in the current understanding of the
pathogenesis of TB disease and in applying modern scientific advances to the goal of
ending this global health scourge. Although the pathogenesis of this ancient disease
has been studied
tudied for 200 years, current TB drugs and the only available vac
vaccine are
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inadequate.
Diagnosing TB remains a significant challenge, and each year an estimated 4 million

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new TB cases remain undiagnosed.1 Current diagnostics typically require expensive

equipment and highly trained personnel unavailable in many high
high-burden TB areas and
may be unsuitable for diagnosis in some populations, including children and PLWH.
Current tests are also generally unable to detect drug
drug-resistant and nonpulmonary TB
m 21
cases or infections with low numbers of MTB

MTB. In addition, a clear understanding of TB
01
latency and what drives progression to active disease is lacking, as are data on host
host-
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pathogen dynamics underlying pathogenesis or the pharmacokinetic and

pharmacodynamics properties of existing drugs.
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To address these and other gaps and to facilitate the development and application of
emerging technologies to TB, the National Institute o of Allergy and Infectious Diseases
(NIAID) at the US National Institutes of Health has developed a TB research strategic
plan outlining a multipronged effort to address fundamental TB research questions and
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to stimulate applied research and the clinical tra

translation
nslation of promising diagnostic,
therapeutic, and vaccine candidates. Developed to complement the World Health
Organization End TB Strategy, the US Government Global TB Strategy, and the National
ep
Action Plan for Combating Multidrug-Resistant

Resistant Tuberculosis, the NIAID Strategic Plan
for Tuberculosis Research builds on current efforts and focuses on some strategic
priorities critical to giving TB research a 21st century footing.
eg
There is a compelling need to develop rapid, accurate, and inexpensive point point-of-care
point-of-
of care
diagnostics for different forms of TB and for use in all populations. NIAID will support
y
research on state-of-the
the art approaches and emerging technologies and will identify host
and microbial biomarkers or biosignatures that can be integrated into platforms that
diagnose infection, indicate risk of progression, or predict disease recurrence. These
efforts will leverage existing clinical infrastructure, study protocols, and clinical cohorts.
Page 86 of 121
Expanding the existing repertoire of TB research resources will play a major role in the
implementation of the NIAID Strategic Plan for Tuberculosis Research. Access to
biosafety level 3 facilities and infrastructure as well as databases to facilitate the analysis
approaches are critical to answering fundamental questions in TB research. NIAID will

foster opportunities for early-stage investigators to assume their role as the next
generation of TB researchers, ensure continuity, and bring fresh perspective to the field.
NIAID also will support improved animal models that recapitulate human disease and will
promote expansion of preclinical and clinical capacity, including human cohorts. In
addition, NIAID will facilitate the development of assays, reagents, and other tools to
assess diagnostic, therapeutic, and vaccine candidates in the developmental pipeline.
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m 21
01
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pr 3
ep
eg
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7. What do we learn about OCD in the first paragraph?
Its prevalence has been increasing for the past 25 years
Greater awareness of its significance has developed recently.
Its manifestations take time to become apparent
OCD is the reason why people develop anxiety

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8. In the second paragraph, the writer is saying that compulsions are

m 21
01
solution to the problem

/O 6 6
intrusive thoughts
ET 2 6
part of the problem

pr 3
behavioral treatment
ep
eg
9.
a functional
y
a structural
a sensational
an overestimated
Page 88 of 121
10. In the third paragraph, the word its refers to
Anxiety
Triggers
The brain
Safety signaler
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11. What particularly impressed the writer regarding the study in the fourth paragraph
paragraph?
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The importance of medication in treating OCD

m 21
The anatomical changes of a region of the brain

01
/O 6 6
The brain's response to treatment

ET 2 6
The almost equal effectiveness of both medication and psychotherapy

pr 3
12. What do we learn about danger and safety in the fifth paragraph
paragraph??
ep
How to act when we perceive danger

eg
The exact mechanism that the brain uses to respond to safety

y
The exposure response prevention cycle
Typical psychological patterns
Page 89 of 121
13. In general, the desired sensation to an OCD patient is being
safe
clean
anxious
dirty
14. In the final paragraph, excessive washing as an act is considered to be
an obsession
a compulsion
01
a delusion
03
the process of negative reinforcement

21
66
26
3
Page 90 of 121
15. In the first paragraph, what does the writer believe to be the cause behind the inability to
end this epidemic
Lack of understanding of the disease's nature.
The need for more advanced tools.
The high rate of mortality that is associated with the disease.
The disease being untreatable with the current medication

medication.
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16. In the first paragraph, the word scourge was mentioned twice. What does it mean?
Plan
m 21
01
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Initiative
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Affliction
Interest
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ep
17. In the second paragraph, which of the following is NOT mentioned as a reason why a
large number of TB cases remain undiagnosed?
eg
Lack of complete understanding of the pathophysiology of the disease

y
Lack of complete understanding of the effect of the drug on the organism
Socioeconomic barriers
The organism being resistant to treatment
Page 91 of 121
18. The NIAID research aims to
build a strategy to compact drug-resistant TB
develop technologies to halt the prevalence of infectious diseases
go for the clinical application of some theoretical data
eradicate TB by the end of the 21st century.

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19. Developed in the third paragraph refers to

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the US Government Global TB Strategy

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the NIAID Strategic Plan

01
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the National Action Plan for Combating Multidrug

Multidrug-Resistant Tuberculosis
Multidrug-
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the World Health Organization End TB Strategy

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20. According to the fourth paragraph, improved diagnostic tools are important to develop
ep
greater awareness of
eg
The prognosis of the disease.

y
The established modern technologies
The demographic distribution of TB
The best approach to develop study protocols
Page 92 of 121
21. In the final paragraph, the writer is
Listing drawbacks
Assigning responsibilities
Enumerating achievements
Outlining a strategy
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22. In the final paragraph, The word repertoire

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quantity
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quality
01
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efforts
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infrastructure
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eg
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Page 93 of 121
E2 Language Reading Part A.1
 Look at the four texts, A-D, in the (printable) 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 the ANSWER SHEET.
Iron Deficiency: Questions
Questions 1-7
For each of the questions, 1-7, decide which text (A, B, C or D) the information comes from.
1 considerations when treating children with iron deficiency?
2 essential steps for identifying iron deficiency?
3 evaluating iron deficiency by testing for blood in stool?
4 risk factors associated with dietary iron deficiency?
5 different types of iron solutions?
6 a treatment for iron deficiency that is no longer supported?
7 appropriate dosage when administering IV iron infusions?
Questions 8-14
Your answers should be correctly spelled.
8 What level of serum ferritin leads to a diagnosis of iron deficiency?
9 What is the most likely cause of iron deficiency in children?
10 Which form of iron can also be injected into the muscle?
11 What should a clinician do if iron stores are normal and anaemia is still present?
12 How long after iron replacement therapy should a patient be re-tested?

13 Which form of iron is presented in a vial?
14 What is the first type of treatment iron deficient patients are typically given?
Questions 15-20
Complete each of the sentences, 15-20, with a word or short phrase from one of the texts.
Each answer may include words, numbers or both.
Your answers should be correctly spelled.
In comparison to breast milk and infant formula, cows’ milk is (15).........................
Special procedures should be used because (16)........................ may be poisonous for

children.
Men over 40 and women over 50 with a recurring iron deficiency should have an
(17).........................
Iron sucrose can be given to a patient no more than (18).........................
Although serum ferritin level is a good indication of deficiency, interpreting the results is
sometimes difficult (19).........................
IV iron infusions are a safe alternative when patients are unable to (20).........................
Practice test
READING SUB-TEST – TEXT BOOKLET: PART A

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
OTHER NAMES: Passport Photo
PROFESSION:
VENUE:
TEST DATE:
CANDIDATE SIGNATURE
www.e2language.com
Sedation: Iron deficiencies
Text A

Iron deficiency and iron deficiency anaemia are common. The serum ferritin level is the most useful
indicator of iron deficiency, but interpretation can be complex. Identifying the cause of iron
deficiency is crucial. Oral iron supplements are effective first-line treatment. Intravenous iron
infusions, if required, are safe, effective and practical.

Key Points
• Measurement of the serum ferritin level is the most useful diagnostic assay for detecting iron
deficiency, but interpretation may be difficult in patients with comorbidities.
• Identifying the cause of iron deficiency is crucial; referral to a gastroenterologist is often
required.
• Faecal occult blood testing is not recommended in the evaluation of iron deficiency; a
negative result does not impact on the diagnostic evaluation.
• Oral iron is an effective first-line treatment, and simple strategies can facilitate patient
tolerance.
• For patients who cannot tolerate oral therapy or require more rapid correction of iron
deficiency, intravenous iron infusions are safe, effective and practical, given the short
infusion times of available formulations.
• Intramuscular iron is no longer recommended for patients of any age.
Text B
Treatment of infants and children
Although iron deficiency in children cannot be corrected solely by dietary change, dietary advice
should be given to parents and carers. Cows’ milk is low in iron compared with breast milk and
infant formula, and enteropathy caused by hypersensitivity to cows’ milk protein can lead to
occult gastrointestinal blood loss. Excess cows’ milk intake (in lieu of iron-rich solid foods) is the
most common cause of iron deficiency in young children. Other risk factors for dietary iron
deficiency include late introduction of or insufficient iron-rich foods, prolonged exclusive
breastfeeding and early introduction of cows’ milk.
Adult doses of iron can be toxic to children, and paediatric-specific protocols on iron
supplementation should be followed. The usual paediatric oral iron dosage is 3 to 6mg/kg
elemental iron daily. If oral iron is ineffective or not tolerated then consider other causes of
anaemia, referral to a specialist paediatrician and use of IV iron.
Text C
AN ALGORITHM FOR THE IDENTIFICATION AND MANAGEMENT OF ADULTS WITH IRON DEFICIENCY
Patient presents with clinically suspected iron deficiency

• member of high-risk population (infants, children, menstruating or pregnant
women, vegetarians)
• clinical or laboratory evidence of iron deficiency or anaemia
• micocytosis or hypochromasia (MCV or MCH below laboratory lower limit of
normal)
• Evaluate clinically for

- potential contributors and risk factors for iron deficiency
- inflammatory states or other disorders that may influence interpretation of FBC or iron studies
• Measure serum ferritin level if not already measured
Serum ferritin <30mcg/L Serum ferritin 30-100 mcg/L Serum ferritin >100 mcg/L
Iron deficiency • Borderline iron stores • Iron deficiency unlikely

• Iron deficiency not excluded as serum • If anaemia present then consider
ferritin level may be raised because of functional iron deficiency; specialist input
inflammation may be required
Evaluate for cause (see If iron deficiency felt If inflammatory state

Box 2) to be contributory identified
• Replace iron • Correct inflammatory state

- give oral iron preparation • Selected patients may still
- if rapid correction required (poorly tolerated anaemia) benefit from iron replacement;
or oral therapy unsuccessful then give intravenous iron specialist input advised
• Re-evaluate 1 to 2 weeks after therapy to ensure iron stores are replete and anaemia improving
• Re-evaluate 3 to 6 months after therapy to ensure iron repletion is maintained and anaemia resolved
If iron deficiency recurs If anaemia identified

• repeat evaluation for additional or recurrent source of blood loss; with normal iron stores
consider all diagnoses in Box 2 • evaluate for other
• refer men aged over 40 years and women over 50 years for causes of anaemia
endoscopy and colonoscopy regardless of gastrointestinal symptoms
Text D
END OF PART A
THIS TEXT BOOKLET WILL BE COLLECTED
READING SUB-TEST – QUESTION PAPER: PART B
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
PROFESSION:
VENUE:
TEST DATE:
CANDIDATE SIGNATURE
At the end of this test, hand in this Question Paper.
Example:
A
B
A
C
www.e2language.com
www.e2language.com

Part B
In this part of the test, there are six short extracts relating to the work of health professionals. For
questions 1-6, choose answer (A, B or C) which you think fits best according to the text.
1. The code of conduct applies to
A doctors friending patients on Facebook.
B privacy settings when using social media.
C electronic and face to face communication.
Professional obligations
The Code of conduct contains guidance about the required standards of

professional behaviour, which apply to registered health practitioners whether
they are interacting in person or online. The Code of conduct also articulates
standards of professional conduct in relation to privacy and confidentiality of
patient information, including when using social media. For example, posting
unauthorised photographs of patients in any medium is a breach of the
patient’s privacy and confidentiality, including on a personal Facebook site or
group, even if the privacy settings are set at the highest setting (such as for a
closed, ‘invisible’ group).

www.e2language.com

2. Why does dysphagia often require complex management?
A Because it negatively influences the cardiac system.
B Because it is difficult contrast complex and non-complex cases.
C Because it seldom occurs without other symptoms.
6.1 General principles
Dysphagia management may be complex and is often multi-factorial in nature. The

speech pathologist’s understanding of human physiology is critical. The swallowing
system works with the respiratory system. The respiratory system is in turn influenced
by the cardiac system, and the cardiac system is affected by the renal system. Due to
the physiological complexities of the human body, few clients present with dysphagia in
isolation.
6.2 Complex vs. non-complex cases
Broadly the differentiation between complex and non-complex cases relates to an

appreciation of client safety and reduction in risk of harm. All clinicians, including new
graduates, should have sufficient skills to appropriately assess and manage non-
complex cases. Where a complex client presents, the skills of an advanced clinician are
required. Supervision and mentoring should be sought for newly graduated clinicians or
those with insufficient experience to manage complex cases.
www.e2language.com

3. The main point of the extract is
A how to find documents about infection control in Australia.
B that dental practices must have a guide for infection control.
C that dental infection control protocols must be updated.
1 Documentation
1.1 Every place where dental care is provided must have the following documents in
either hard copy or electronic form (the latter includes guaranteed Internet access).
Every working dental practitioner and all staff must have access to:
a). a manual setting out the infection control protocols and procedures used in that
practice, which is based on the documents listed at sections 1.1(b), (c) and (d) of
these guidelines and with reference to the concepts in current practice noted in the
documents listed under References in these guidelines
b). The current Australian Dental Association Guidelines for Infection Control
(available at: http://www.ada.org.au)
www.e2language.com

4. Negative effects from prescription drugs are often
A avoidable in young people.

B unpredictable in the elderly.
C caused by miscommunication.

Reasons for Drug-Related Problems: Manual for Geriatrics Specialists

Adverse drug effects can occur in any patient, but certain characteristics of the elderly
make them more susceptible. For example, the elderly often take many drugs
(polypharmacy) and have age-related changes in pharmacodynamics and
pharmacokinetics; both increase the risk of adverse effects.
At any age, adverse drug effects may occur when drugs are prescribed and taken
appropriately; e.g., new-onset allergic reactions are not predictable or preventable.
However, adverse effects are thought to be preventable in almost 90% of cases in the
elderly (compared with only 24% in younger patients). Certain drug classes are commonly
involved: antipsychotics, antidepressants, and sedative-hypnotics.
In the elderly, a number of common reasons for adverse drug effects, ineffectiveness, or
both are preventable. Many of these reasons involve inadequate communication with
patients or between health care practitioners (particularly during health care transitions).
www.e2language.com

5. The guideline tries to use terminology that
A presents value-free information about different social groups.
B distinguishes disadvantaged groups from the traditional majority.
C clarifies the proportion of each race, gender and culture.
Terminology
Terminology in this guideline is a difficult issue since the choice of terminology used
to distinguish groups of persons can be personal and contentious, especially when
the groups represent differences in race, gender, sexual orientation, culture or other
characteristics. Throughout the development of this guideline the panel endeavoured
to maintain neutral and non-judgmental terminology wherever possible. Terms such
as “minority”, “visible minority”, “non-visible minority” and “language minority” are used
in some areas; when doing so the panel refers solely to their proportionate numbers
within the larger population and infers no value on the term to imply less importance
or less power. In some of the recommendations the term “under-represented groups”
is used, again, to refer solely to the disproportionate representation of some citizens
in those settings in comparison to the traditional majority.

www.e2language.com

6. What is the purpose of this extract?
A To illustrate situations where patients may find it difficult to give negative feedback.
B To argue that hospital brochures should be provided in many languages.
C To provide guidance to people who are victims of discrimination.
Special needs
Special measures may be needed to ensure everyone in your client base is aware of your consumer feedback
policy and is comfortable with raising their concerns. For example, should you provide brochures in a
language other than English?
Some people are less likely to complain for cultural reasons. For example, some Aboriginal people may be
culturally less inclined to complain, particularly to non-Aboriginal people. People with certain conditions such
as hepatitis C or a mental illness, may have concerns about discrimination that will make them less likely to
speak up if they are not satisfied or if something is wrong.
www.e2language.com

READING SUB-TEST – QUESTION PAPER: PART C
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
PROFESSION:
VENUE:
TEST DATE:
CANDIDATE SIGNATURE
Example:
A
B
A
C
www.e2language.com
Part C
In this part of the test, there are two texts about different aspects of healthcare. For questions 7-22,
choose the answer (A, B, C or D) which you think fits best according to the text.
Text 1: Difficult-to-treat depression
Depression remains a leading cause of distress and disability worldwide. In one country’s
survey of health and wellbeing in 2007, 7.2% of people surveyed had experienced a mood
(affective) disorder in the previous 12 months. Those affected reported a mean of 11.7
disability days when they were “completely unable to carry out or had to cut down on their
usual activities owing to their health” in the previous 4 weeks. There was also evidence of
substantial under-treatment: amazingly only 35% of people with a mental health problem had
a mental health consultation during the previous 12 months. Three-quarters of those seeking
help saw a general practitioner (GP). In the 2015–16 follow-up survey, not much had
changed. Again, there was evidence of substantial unmet need, and again GPs were the
health professionals most likely to be providing care.
While GPs have many skills in the assessment and treatment of depression, they are often
faced with people with depression who simply do not get better, despite the use of proven
psychological or pharmacological therapies. GPs are well placed in one regard, as they often
have a longitudinal knowledge of the patient, understand his or her circumstances, stressors
and supports, and can marshal this knowledge into a coherent and comprehensive
management plan. Of course, GPs should not soldier on alone if they feel the patient is not
getting better.
In trying to understand what happens when GPs feel “stuck” while treating someone with
depression, a qualitative study was undertaken that aimed to gauge the response of GPs to
the term “difficult-to-treat depression”. It was found that, while there was confusion around
the exact meaning of the term, GPs could relate to it as broadly encompassing a range of
individuals and presentations. More specific terms such as “treatment-resistant depression”
are generally reserved for a subgroup of people with difficult-to-treat depression that has
failed to respond to treatment, with particular management implications.
One scenario in which depression can be difficult to treat is in the context of physical illness.
Depression is often expressed via physical symptoms, however it is also true is that people
with chronic physical ailments are at high risk of depression. Functional pain syndromes
where the origin and cause of the pain are unclear, are particularly tricky, as complaints of
pain require the clinician to accept them as “legitimate”, even if there is no obvious physical
cause. The use of analgesics can create its own problems, including dependence. Patients
with comorbid chronic pain and depression require careful and sensitive management and a
long-term commitment from the GP to ensure consistency of care and support.
It is often difficult to tackle the topic of depression co-occurring with borderline personality
disorder (BPD). People with BPD have, as part of the core disorder, a perturbation of affect
associated with marked variability of mood. This can be very difficult for the patient to deal
with and can feed self-injurious and other harmful behaviour. Use of mentalisation-based
techniques is gaining support, and psychological treatments such as dialectical behaviour
therapy form the cornerstone of care. Use of medications tends to be secondary, and
prescription needs to be judicious and carefully targeted at particular symptoms. GPs can
play a very important role in helping people with BPD, but should not “go it alone”, instead
ensuring sufficient support for themselves as well as the patient.
Another particularly problematic and well-known form of depression is that which occurs in
the context of bipolar disorder. Firm data on how best to manage bipolar depression is
surprisingly lacking. It is clear that treatments such as unopposed antidepressants can make
matters a lot worse, with the potential for induction of mania and mood cycle acceleration.
However, certain medications (notably, some mood stabilisers and atypical antipsychotics)
can alleviate much of the suffering associated with bipolar depression. Specialist psychiatric
input is often required to achieve the best pharmacological approach. For people with bipolar
disorder, psychological techniques and long-term planning can help prevent relapse. Family
education and support is also an important consideration.
7. In the first paragraph, what point does the writer make about the treatment of depression?
A 75% of depression sufferers visit their GP for treatment.
B GPs struggle to meet the needs of patients with depression.
C Treatment for depression takes an average of 11.7 days a month.
D Most people with depression symptoms never receive help.
8. In the second paragraph, the writer suggests that GPs
A are in a good position to conduct long term studies on their patients.
B lack training in the treatment and assessment of depression.
C should seek help when treatment plans are ineffective.
D sometimes struggle to create coherent management plans.
9. What do the results of the study described in the third paragraph suggest?
A GPs prefer the term “treatment resistant depression” to “difficult-to-treat depression”.
B Patients with “difficult-to-treat depression” sometimes get “stuck” in treatment.
C The term “difficult-to-treat depression” lacks a precise definition.
D There is an identifiable sub-group of patients with “difficult-to-treat depression”.
10. Paragraph 4 suggests that
A prescribing analgesics is unadvisable when treating patients with depression.
B the co-occurrence of depression with chronic conditions makes it harder to treat.
C patients with depression may have undiagnosed chronic physical ailments.
D doctors should be more careful when accepting pain complaints as legitimate.

11. According to paragraph 5, people with BPD have
A depression occurring as a result of the disorder
B noticeable mood changes which are central to their disorder.
C a tendency to have accidents and injure themselves.
D problems tackling the topic of their depression.
12. In paragraph 5, what does the phrase ‘form the cornerstone’ mean regarding BPD treatment?
A Psychological therapies are generally the basis of treatment.
B There is more evidence for using mentalisation than dialectical behaviour therapy.
C Dialectical behaviour therapy is the optimum treatment for depression.

.
D In some unusual cases prescribing medication is the preferred therapy.
13. In paragraph 6, what does the writer suggest about research into bipolar depression management?
A There is enough data to establish the best way to manage bipolar depression.
B Research hasn’t provided the evidence for an ideal management plan yet.
C A lack of patients with the condition makes it difficult to collect data on its management.
D Too few studies have investigated the most effective ways to manage this condition.
14. In paragraph 6, what does the writer suggest about the use of medications when treating bipolar
depression?
A There is evidence for the positive and negative results of different medications.
B Medications typically make matters worse rather than better.
C Medication can help prevent long term relapse when combined with family education.
D Specialist psychiatrists should prescribe medication for bipolar disorder rather than GPs.
Text 2: Are the best hospitals managed by doctors?
Doctors were once viewed as ill-prepared for leadership roles because their selection and
training led them to become “heroic lone healers.” However, the emphasis on patient-
centered care and efficiency in the delivery of clinical outcomes means that physicians are
now being prepared for leadership. The Mayo Clinic is America’s best hospital, according to
the 2016 US News and World Report (USNWR) ranking. Cleveland Clinic comes in second.
The CEOs of both — John Noseworthy and Delos “Toby” Cosgrove — are highly skilled
physicians. In fact, both institutions have been physician-led since their inception around a
century ago. Might there be a general message here?
A study published in 2011 examined CEOs in the top-100 hospitals in USNWR in three key
medical specialties: cancer, digestive disorders, and cardiovascular care. A simple question
was asked: are hospitals ranked more highly when they are led by medically trained doctors
or non-MD professional managers? The analysis showed that hospital quality scores are
approximately 25% higher in physician-run hospitals than in manager-run hospitals. Of
course, this does not prove that doctors make better leaders, though the results are surely
consistent with that claim.
Other studies find a similar correlation. Research by Bloom, Sadun, and Van Reenen
revealed how important good management practices are to hospital performance. However,
they also found that it is the proportion of managers with a clinical degree that had the
largest positive effect; in other words, the separation of clinical and managerial knowledge
inside hospitals was associated with more negative management outcomes. Finally, support
for the idea that physician-leaders are advantaged in healthcare is consistent with
observations from many other sectors. Domain experts – “expert leaders” (like physicians in
hospitals) — have been linked with better organizational performance in settings as diverse
as universities, where scholar-leaders enhance the research output of their organizations, to
basketball teams, where former All-Star players turned coaches are disproportionately
linked to NBA success.
What are the attributes of physician-leaders that might account for this association with
enhanced organizational performance? When asked this question, Dr. Toby Cosgrove, CEO
of Cleveland Clinic, responded without hesitation, “credibility … peer-to-peer credibility.” In
other words, when an outstanding physician heads a major hospital, it signals that they have
“walked the walk”. The Mayo website notes that it is physician-led because, “This helps
ensure a continued focus on our primary value, the needs of the patient come first.” Having
spent their careers looking through a patient-focused lens, physicians moving into executive
positions might be expected to bring a patient-focused strategy.
In a recent study that matched random samples of U.S. and UK employees with employers,
we found that having a boss who is an expert in the core business is associated with high
levels of employee job satisfaction and low intentions of quitting. Similarly, physician-leaders
may know how to raise the job satisfaction of other clinicians, thereby contributing to
enhanced organizational performance. If a manager understands, through their own
experience, what is needed to complete a job to the highest standard, then they may be
more likely to create the right work environment, set appropriate goals and accurately
evaluate others’ contributions.
Finally, we might expect a highly talented physician to know what “good” looks like when
hiring other physicians. Cosgrove suggests that physician-leaders are also more likely to
tolerate innovative ideas like the first coronary artery bypass, performed by René Favaloro at
the Cleveland Clinic in the late ‘60s. Cosgrove believes that the Cleveland Clinic unlocks
talent by giving safe space to people with extraordinary ideas and importantly, that
leadership tolerates appropriate failure, which is a natural part of scientific endeavour and
progress.
The Cleveland Clinic has also been training physicians to lead for many years. For example,
a cohort-based annual course, “Leading in Health Care,” began in the early 1990s and has
invited nominated, high-potential physicians (and more recently nurses and administrators)
to engage in 10 days of offsite training in leadership competencies which fall outside the
domain of traditional medical training. Core to the curriculum is emotional intelligence (with
360-degree feedback and executive coaching), teambuilding, conflict resolution, and
situational leadership. The course culminates in a team-based innovation project presented
to hospital leadership. 61% of the proposed innovation projects have had a positive
institutional impact. Moreover, in ten years of follow-up after the initial course, 48% of the
physician participants have been promoted to leadership positions at Cleveland Clinic.
15. In paragraph 1, why does the writer mention the Mayo and Cleveland Clinics?
A To highlight that they are the two highest ranked hospitals on the USNWR
B To introduce research into hospital management based in these clinics
C To provide examples to support the idea that doctors make good leaders
D To reinforce the idea that doctors should become hospital CEOs
16. What is the writer’s opinion about the findings of the study mentioned in paragraph 2?
A They show quite clearly that doctors make better hospital managers.
B They show a loose connection between doctor-leaders and better management.
C They confirm that the top-100 hospitals on the USNWR ought to be physician-run.
D They are inconclusive because the data is insufficient.
17. Why does the writer mention the research study in paragraph 3?
A To contrast the findings with the study mentioned in paragraph 2
B To provide the opposite point of view to his own position
C To support his main argument with further evidence
D To show that other researchers support him
18. In paragraph 3, the phrase ‘disproportionately linked’ suggests
A all-star coaches have a superior understanding of the game.
B former star players become comparatively better coaches.
C teams coached by former all-stars consistently outperform other teams.
D to be a successful basketball coach you need to have played at a high level.

19. In the fourth paragraph, what does the phrase “walked the walk,” imply about physician-
leaders?
A They have earned credibility through experience.
B They have ascended the ranks of their workplace.
C They appropriately incentivise employees.
D They share the same concerns as other doctors.
20. In paragraph 6, the writer suggests that leaders promote employee satisfaction because
A they are often cooperative.
B they tend to give employees positive evaluations.
C they encourage their employees not to leave their jobs.
D they understand their employees’ jobs deeply.
21. In the seventh paragraph, why is the first coronary artery bypass operation mentioned?
A To demonstrate the achievements of the Cleveland clinic
B To present René Favaloro as an exemplar of a ‘good’ doctor
C To provide an example of an encouraging medical innovation
D To show how failure naturally contributes to scientific progress
22. In paragraph 8, what was the outcome of the course “Leading in Health Care”?
A The Cleveland Clinic promoted almost half of the participants.
B 61% of innovation projects lead to participants being promoted.
C Some participants took up leadership roles outside the medical domain.
D A culmination of more team-based innovations.

E2 Language Part A.2

Managing Opioid Dependence
Questions 1-7
In which text can you find information about...
1 what GPs should say to patients requesting codeine?
2 basic indications of an opioid problem?
3 different medications used for weaning patients off opioids?
4 decisions to make before beginning treatment of dependence?
5 defining features of a use disorder?
6 the development of a common goal for both prescriber and patient?
7 sources of further information on pain management?
Questions 8-14
answer may include words, numbers or both. Your answers should be correctly spelled.
8 What will reduced doses of opioids lead to a reduction of?
9 What is the most effective medication for tapering opioid dependence?
10 How long should over the counter codeine analgesics be used for?
11 When should doctors consider referring a patient to a pain expert or clinic?
12 What might a patient give permission to before starting treatment?
13 What might be increasingly neglected as a result of opioid use?
14 How many Buprenorphine patches are needed to taper from codeine tablets?
Questions 15-20
Each answer may include words, numbers or both. Your answers should be correctly spelled.
The use of Buprenorphine-naxolone requires a (15)........ before treatment.
The use of symptomatic medications for the treatment of opioid dependence has been found
to have (16)........ than tramadol.
Different definitions of opioid dependence share the same (17).........
Once it is decided that opioid taper is a suitable treatment the doctor and patient should create
a (18).........
Recent research indicates that (19)........ can work as well as combination analgesics including
codeine and oxycodone.
The ICD-10 defines a patient as dependent if they have (20)........ key symptoms
simultaneously.
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Opioid dependence
Text A
Identifying opioid dependence
The International Classification of Disease, Tenth Edition [ICD-10] is a coding system created
by the World Health Organization (WHO) to catalogue and name diseases, conditions, signs
and symptoms.

The ICD-10 includes criteria to identify dependence. According to the ICD-10, opioid
dependence is defined by the presence of three or more of the following features at any one
time in the preceding year:

● a strong desire or sense of compulsion to take opioids
● difficulties in controlling opioid use
● a physiological withdrawal state
● tolerance of opioids
● progressive neglect of alternative interests or pleasures because of opioid use
● persisting with opioid use despite clear evidence of overtly harmful consequences.

There are other definitions of opioid dependence or ‘use disorder’ (e.g. the Diagnostic and
Statistical Manual of Mental Disorders, 5th edition, [DSM-5]), but the central features are the
same. Loss of control over use, continuing use despite harm, craving, compulsive use, physical
tolerance and dependence remain key in identifying problems.
Text B
WHY NOT JUST PRESCRIBE CODEINE OR ANOTHER OPIOID?
Now that analgesics containing codeine are no longer available OTC (over the counter), patients may
request a prescription for codeine. It is important for GPs to explain that there is a lack of evidence
demonstrating the long-term analgesic efficacy of codeine in treating chronic non-cancer pain. Long-term
use of opioids has not been associated with sustained improvement in function or quality of life, and there
are increasing concerns about the risk of harm.
GPs should explain that the risks associated with opioids include tolerance leading to dose escalation,
overdose, falls, accidents and death. It should be emphasised that OTC codeine-containing analgesics
were only intended for short-term use (one to three days) and that longer-term pain management requires
a more detailed assessment of the patient's medical condition as well as clinical management.
New trials have shown that for acute pain, nonopioid combinations can be as effective as combination
analgesics containing opioids such as codeine and oxycodone. If pain isn’t managed with nonopioid
medications then consider referring the patient to a pain specialist or pain clinic.
Patient resources for pain management are freely available online to all clinicians at websites such as:
• Pain Management Network in NSW - www.aci.health.nsw.gov.au/networks/pain-management
• Australian and New Zealand College of Anaesthetists Faculty of Pain Medicine -
www.fpm.anzca.edu.au
Text C
Text D
Preparation for tapering

As soon as a valid indication for tapering of opioid analgesics is established, it is important to have a
conversation with the patient to explain the process and develop a treatment agreement. This agreement
could include:
• time frame for the agreement
• objectives of the taper
• frequency of dose reduction
• requirement for obtaining the prescriptions from a designated clinician
• scheduled appointments for regular review
• anticipated effects of the taper
• consent for urine drug screening
• possible consequences of failure to comply.
Before starting tapering, it needs to be clearly emphasised to the patient that reducing the dose of opioid
analgesia will not necessarily equate to increased pain and that it will, in effect, lead to improved mood
and functioning as well as a reduction in pain intensity. The prescriber should establish a therapeutic
alliance with the patient and develop a shared and specific goal.
END OF PART A
E2 Language Reading Part B.2
1. According to the guidelines nurses must
advise the practice as soon as they get to the next home visit.
call the patient to confirm a time before they make a home visit.
inform fellow staff members when they return from a home visit.
Home Visit Guidelines

The nurse will complete all consultation notes in the patient’s home (unless not appropriate),
prior to beginning the next consultation. With a focus on nurse safety, the nurse will call the
practice at the end of each visit before progressing to the next home visit and will also
communicate any unexpected circumstances that may delay arrival back at the practice (more
than one hour).
Calling from the patient’s home to make a review appointment with the GP is sufficient and
can help minimise time making phone calls. On return to the practice the nurse will
immediately advise staff members of their return. This time will be documented on the patient
visit list, scanned and filed by administration staff.
2. In progressive horizontal evacuation
patients are evacuated through fire proof barriers one floor at a time.
patients who can't walk should not be moved until the fire is under control.
patients are moved to fire proof areas on the same level to safely wait for help.
Progressive horizontal evacuation

The principle of progressive horizontal evacuation is that of moving occupants from an area
affected by fire through a fire-resisting barrier to an adjoining area on the same level, designed
to protect the occupants from the immediate dangers of fire and smoke (a refuge). The
occupants may remain there until the fire is dealt with or await further assisted onward
evacuation by staff to a similar adjoining area or to the nearest stairway. Should it become
necessary to evacuate an entire storey, this procedure should give sufficient time for non-
ambulant and partially ambulant patients to be evacuated vertically to a place of safety.
3. The main purpose of the extract is to
provide information of the legal requirements for disposing of animal waste.
describe rules for proper selling and export of animal products.
define the meaning of animal by-products for healthcare researchers.
Proper disposal of animal waste

Animal by-products from healthcare (for example research facilities) have specific legislative
requirements for disposal and treatment. They are defined as “entire bodies or parts of animals
or products of animal origin not intended for human consumption, including ova, embryos and
semen.” The Animal By-Products Regulations are designed to prevent animal by-products
from presenting a risk to animal or public health through the transmission of disease. This aim
is achieved by rules for the collection, transport, storage, handling, processing and use or
disposal of animal byproducts, and the placing on the market, export and transit of animal by-
products and certain products derived from them.
4. According to the extract, what is the outcome of reusing medical equipment meant to
be used once?
The maker will take no legal responsibility for safety.
Endoscopy units will save on equipment costs.
There is a higher incidence of cross infection.
Cleaning and disinfection of endoscopes should be undertaken by trained staff in a dedicated

room. Thorough cleaning with detergent remains the most important and first step in the
process. Automated washer/disinfectors have become an essential part of the endoscopy unit.
Machines must be reliable, effective, easy to use and should prevent atmospheric pollution by
the disinfectant if an irritating agent is used. Troughs of disinfectant should not be used unless
containment or exhaust ventilated facilities are provided.
Whenever possible, “single use” or autoclavable accessories should be used. The risk of
transfer of infection from inadequately decontaminated reusable items must be weighed against
the cost. Reusing accessories labelled for single use will transfer legal liability for the safe
performance of the product from the manufacturer to the user or his/her employers and should
be avoided unless Department of Health criteria are met.
5. According to the extract what is the purpose of the guidelines?
To present statistics on the incidence of melanoma in Australia and New Zealand.
To support the early detection of melanoma and select the best treatments.
To explain the causes of melanoma in populations of Celtic origin.
Foreword
Australia and New Zealand have the highest incidence of melanoma in the world.
Comprehensive, up-to-date, evidence-based national guidelines for its management are
therefore of great importance. Both countries have populations of predominantly Celtic origin,
and in the course of day-to-day life their citizens are inevitably subjected to high levels of solar
UV exposure. These two factors are considered predominantly responsible for the very high
incidence of melanoma (and other skin cancers) in the two nations. In Australia, melanoma is
the third most common cancer in men and the fourth most common in women, with over 13,
000 new cases and over 1, 750 deaths each year.
The purpose of evidence-based clinical guidelines for the management of any medical
condition is to achieve early diagnosis whenever possible, make doctors and patients aware of
the most effective treatment options, and minimise the financial burden on the health system
by documenting investigations and therapies that are inappropriate.
6. What should employees declare?
Every item received from one donor.
Each item from one donor valued at over $50.
Every item from one donor if the combined value is more than $50.
Reporting of Gifts and Benefits

Employees must declare all non-token gifts which they are offered, regardless of whether or
not those gifts are accepted. If multiple gifts, benefits or hospitality are received from the same
donor by an employee and the cumulative value of these is more than $50 then each individual
gift, benefit or hospitality event must be declared.
The Executive Director of Finance will be responsible for ensuring the gifts and benefits
register is subject to annual review by the Audit Committee. The review should include analysis
for repetitive trends or patterns which may cause concern and require corrective and preventive
action. The Audit Committee will receive a report at least annually on the administration and
quality control of the gifts, benefits and hospitality policy, processes and register.
E2 Language Reading Part C.2
Extract 1
Text 1: The case for and against e-cigarettes

Electronic cigarettes first hit European and American markets in 2006 and 2007, and their
popularity has been propelled by international trends favouring smoke-free environments.
Sales reportedly have reached $650 million a year in Europe and were estimated to reach $3. 6
billion in the US in 2018.
Although research on e-cigarettes is not extensive, a picture is beginning to emerge. Surveys

suggest that the vast majority of those who use e-cigarettes treat them as smoking-cessation
aides and self-report that they have been key to quitting. Data also indicate that e-cigarettes
help to reduce tobacco cigarette consumption. A 2011 survey, based on a cohort of first-time
e-cigarette purchasers, found that 66. 8 percent reported reducing the number of cigarettes they
smoked per day and after six months, 31 percent reported not smoking. These results compare
favorably with nicotine replacement therapies (NRTs) like the patch and nicotine gum.
Interestingly, a randomized controlled trial found that even e-cigarettes not containing nicotine
were effective both in achieving a reduction of tobacco cigarette consumption and longer term
abstinence, suggesting that “factors such as the rituals associated with cigarette handling and
manipulation may also play an important role. ” Some tobacco control advocates worry that
they simply deliver an insufficient amount of nicotine to ultimately prove effective for
cessation.
Nevertheless, the tobacco control community has embraced FDA approved treatments—NRTs,
as well as the drugs bupropion and varenicline —that have relatively low success rates. In a
commentary published in the Journal of the American Medical Association, smoking cessation
experts Andrea Smith and Simon Chapman of the University of Sydney said that smoking
cessation drugs fail most of those who try them. “Sadly, it remains the case that by far the most
common outcome at 6 to 12 months after using such medication in real world settings is
continuing smoking. Few, if any, other drugs with such records would ever be prescribed, ”
they wrote.
Amongst smokers not intending to quit, e-cigarettes—both with and without nicotine—
substantially reduced consumption in a randomized controlled trial, not only resulting in
decreased cigarette consumption but also in “enduring tobacco abstinence. ” In a second study
from 2013, the authors reported that after 24 months, 12. 5 percent of smokers remained
abstinent while another 27. 5 percent reduced their tobacco cigarette consumption by 50
percent. Finally, a third study commissioned in Australia has come to the same conclusion,
though a high dropout rate (42 percent) makes these findings questionable.
Users widely perceive e-cigarettes to be less toxic. While the FDA has found trace elements of
carcinogens, levels are comparable to those found in nicotine replacement therapies. Results
from a laboratory study released in 2013 found that that while e-cigarettes do contain
contaminants, the levels range from 9 to 450 times lower than in tobacco cigarette smoke.
These are comparable with the trace amounts of toxic or carcinogenic substances found in
medicinal nicotine inhalers. A prominent anti-tobacco advocate, Stanton Glantz, has warned of
the need to protect people from secondhand emissions. While one laboratory study indicates
that passive “vaping, ” as smoking an e-cigarette is commonly known, releases volatile organic
compounds and ultrafine particles into the indoor environment, it noted that the actual health
impact is unknown and should remain a chief concern. A 2014 study concluded that e-cigarettes
are a source of second hand exposure to nicotine but not to toxins. Nevertheless, bystanders
are exposed to 10 times less nicotine exposure from e-cigarettes compared to tobacco
cigarettes.
There are a number of interesting points of agreement among proponents and skeptics of e-
cigarettes. First, all agree that regulation to ensure the quality of e-cigarettes should be
uniform. Laboratory analyses have found sometimes wide variation across brands, in the level
of carcinogens, the presence of contaminants, and the quality of nicotine. Second, proponents
and detractors of e-cigarettes tend to agree that — considered only at the individual level—e-
cigarettes are a safer alternative to tobacco cigarette consumption. The main concern is how e-
cigarettes might shape tobacco use patterns at the population level. Proponents stress the
evidence base that we have reviewed. Skeptics remain worried that e-cigarettes will become
“dual use” products. That is, smokers will use e-cigarettes, but will not reduce their smoking
or quit.
Perhaps most troubling to public health officials is that e-cigarettes will "renormalize"
smoking, subverting the cultural shift that has occurred over the past 50 years and transforming
what has become a perverse habit into a pervasive social behaviour. In other words, the fear is
that e-cigarettes will allow for re-entry of the tobacco cigarette into public view. This would
unravel the gains created by smoke-free indoor (and, in some scientifically-unwarranted
instances) outdoor environments. Careful epidemiological studies will be needed to determine
whether the individual gains from e-cigarettes will be counteracted by population-level harms.
For policy makers, the challenge is how to act in the face of uncertainty.
1. What does the writer suggest about the research into e-cigarettes?
Not enough research is being carried out.
Early conclusions are appearing from the evidence.
Too much of the available data is self-reported.
An extensive picture of e-cigarette use has emerged.
2. What explanation does the writer offer for the effect of non-nicotine e-cigarettes?
They deliver an insufficient volume of nicotine to help smoking cessation.
They compare well with patches, nicotine gum and other NRT's.
First time e-cigarette buyers tend to use them
Behavioural elements are significant in quitting smoking.
3. What is the attitude of Andrea Smith and Simon Chapman to the use of smoking
cessation drugs?
They approve of and embrace these treatments.
They consider them largely unsuccessful as treatments.
They think they should be replaced with other treatments.
They believe they should never be prescribed as treatment.
4. What problem with one of the studies is mentioned in paragraph 4?
The research questions the study asked.
The number of participants who left the study.
The similarity of the conclusion to other studies.
The study used e-cigarettes without nicotine.
5. What is "these" in paragraph 5 referring to?
Laboratory study results
Nicotine inhalers
Contamination levels
Tobacco cigarettes
6. Research mentioned in paragraph 5 suggests that
E-cigarettes release dangerous toxins into the air.
E-cigarettes should be banned from indoor environments.
E-cigarettes are more toxic than nicotine replacement therapies
cigarettes present a far greater risk of secondhand exposure to toxins
7. The word uniform in paragraph 7 suggests that e-cigarettes should
Be clearly regulated against.
Only come in one brand.
Be of a standard quality.
Contain no contaminants.
8. What do both critics and supporters of e-cigarettes agree?
Available research evidence must be reviewed.
E-cigarette use may not result in quitting.
Smoking tobacco is more dangerous than vaping.
E-cigarettes are shaping the public's tobacco use.

Extract 2
Text 2: Vivisection
In 1875, Charles Dodgson, under his pseudonym Lewis Carroll, wrote a blistering attack on
vivisection. He sent this to the governing body of Oxford University in an attempt to prevent
the establishment of a physiology department. Today, despite the subsequent evolution of one
of the most rigorous governmental regulatory systems in the world, little has changed. A report
sponsored by the UK Royal Society, “The use of non-human primates in research”, attempts
to establish a sounder basis for the debate on animal research through an in-depth analysis of
the scientific arguments for research on monkeys.
In the UK, no great apes have been used for research since 1986. Of the 3000 monkeys used in
animal research every year, 75% are for toxicology studies by the pharmaceutical industry.
Although expenditure on biomedical research has almost doubled over the past 10 years, the
number of monkeys used for this purpose (about 300) has tended to fall. The report, which
mainly discusses the use of monkeys in biomedical research, pays particular attention to the
development of vaccines for AIDS, malaria, and tuberculosis, and to the nervous system and
its disorders. The report assesses the impact of these issues on global health, together with
potential approaches that might avoid the use of animals in research. Other research areas are
also discussed, together with ethics, animal welfare, drug discovery, and toxicology.
The report concludes that in some cases there is a valid scientific argument for the use of
monkeys in medical research. However, no blanket decisions can be made because of the speed
of progress in biomedical science (particularly in molecular and cell biology) and because of
the available non-invasive methods for study of the brain. Every case must be considered
individually and supported by a fully informed assessment of the importance of the work and
of alternatives to the use of animals.
Furthermore, the report asks for greater openness from medical and scientific journals about
the amount of animal suffering that occurred in studies and for regular publication of the
outcomes of animal research and toxicology studies. It calls for the development of a national
strategic plan for animal research, including the dissemination of information about alternative
research methods to the use of animals, and the creation of centres of excellence for better care
of animals and for training of scientists. Finally, it suggests some approaches towards a better-
informed public debate on the future of animal research.
Although the report was received favourably by the mass media, animal-rights groups thought
that it did not go far enough in setting priorities for development of alternatives to the use of
animals. In fact, it investigates many of these approaches, including cell and molecular biology,
use of transgenic mice (an alternative to use of primates), computer modelling, in-silico
technology, stem cells, microdosing, and pharmacometabonomic phenotyping. However, the
report concludes that although many of these techniques have great promise, they are at a stage
of development that is too early for assessment of their true potential.
The controversy of animal research continues unabated. Shortly after publication of the report,
two highly charged stories were published in the media. A study that used systematic reviews
to compare treatment outcome from clinical trials of animals with those of human beings
suggested that discordance in the results might have been due to bias, poor design, or
inadequacies of animals for modelling of human disease. Although the study made some
helpful suggestions for the future, its findings are not surprising. The imperfections of animals
for study of human disease and of drug trials are documented widely.
The current furore about the UK Government's ban on human nuclear-transfer experiments
involving animals should not surprise us either. This area of research had a bad start when this
method of production of stem cells was labelled as therapeutic cloning, thus confusing it with
reproductive cloning - a problem that, surely, licensing bodies and the scientific community
should have anticipated. The possibilities that insufficient human eggs will be available, and
that insertion of human nuclei into animal eggs might be necessary, have been discussed by the
scientific community for several years, but have been aired rarely in public, leaving much room
for confusion
Biomedical science is progressing so quickly that maintenance of an adequate level of public

debate on ethical issues is difficult. Hopefully the sponsors of the recent report will now
activate its recommendations, not least how better mechanisms can be developed to broaden
and sustain interactions between science and the public. Although any form of debate will
probably not satisfy the extremists of the antivivisection movement, the rest of society deserves
to receive the information it needs to deal with these extremely difficult issues.
1. How does the writer characterise Lewis Carroll's attitude to vivisection?
He was in favour of clear regulations to control it.
He felt the Royal Society should not support it.
He was strongly opposed to it.
He supported its use in physiology.
2. The word rigorous in paragraph 1 implies that the writer thinks UK vivisection laws
are
Strict and severe
Careful and thorough
Ambiguous and unhelpful
Accurate and effective

3. What is the major focus of the report mentioned in paragraph 2?
Animal experimentation in the pharmaceutical industry
Recent increases in spending on Biomedical research
Testing new treatments for serious disease on monkeys
Possible alternatives to testing new drugs on animals
4. What is the main conclusion of the report?
Scientific experimentation on monkeys is justified.
Rapid development in biomedicine makes it hard to draw conclusions.
Non-invasive techniques should be preferred in most cases.
Research that requires monkeys should be evaluated independently.
5. What conclusion is drawn about alternative techniques to vivisection?
Developing alternatives should be prioritised.
Transgenic mice are a viable alternative to monkeys.
Many alternative techniques are more promising than animal testing.
They aren't well enough understood yet to adopt for research.
6. What does the writer claim about the use of animals in medical research?
The limitations of using animals in research are well understood.
Results from too many animal trials are biased.

Human studies are known to be more reliable.
Strong media reaction has kept up the controversy.
7. The phrase a problem in paragraph 6 refers to the
Government licensing of animal experiments.
Confusion between the names of two different methods.
Chortage of human embryos available for experiments.
Prohibition against human nuclear transfer in the UK.
8. The author thinks it is hard to keep the public adequately informed about this research
because
The report sponsors have not activated the recommendations.
Of the rapid evolution of biomedical technologies.
Scientists don't interact with the public enough.
Extreme views from opponents cloud the debate.

E2 Language Reading Part A.3
ADHD
Questions 1-7
In which text can you find information about...
1 different types of ADHD medication?
2 possible side effects of medication?
3 conditions which may be present alongside ADHD?
4 a doctor’s control over a patient’s medication?
5 positive perspectives on having ADHD?
6 when patients should take their ADHD medicine?
7 figuring out a patient’s optimal dosage of medication?
Questions 8-14
answer may include words, numbers or both. Your answers should be correctly spelled.
8 What is the maximum recommended dose of Dexamfetamine?
9 What is typically needed to get the best results from ADHD treatment?
10 How can GP’s collect information about their patient’s collateral history?
11 What causes symptoms such as palpitations and anxiety in some patients?
12 What proportion of children with ADHD will carry symptoms into adulthood?
13 What positive personality traits are sometimes associated with ADHD?

14 Which medication has dose recommendations related to patient weight?
Questions 15-20
Each answer may include words, numbers or both. Your answers should be correctly spelled.
Sleep, exercise and nutrition comprise the (15)......... of further ADHD treatment.
When diagnosing ADHD, it is important to ask if the issues arose recently or are (16)..........
It is possible to move to (17)......... after one month of immediate-release methylphenidate.
Signs of ADHD can be disguised by (18)......... which GPs are more likely to recognise.
GPs should regularly check the (19)......... of patients prescribed stimulant medication.
Establishing the ideal dose of ADHD medication needs (20)......... by an expert psychiatrist.
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ADHD
Text A
The GP’s role in the management of ADHD
It helps to remind patients that ADHD is not all bad. ADHD is associated with positive attributes
such as being more spontaneous and adventurous. Some studies have indicated that people
with ADHD may be better equipped for lateral thinking. It has been suggested that explorers or
entrepreneurs are more likely to have ADHD.
In addition, GPs can reinforce the importance of developing healthy sleep–wake behaviours,
obtaining adequate exercise and good nutrition. These are the building blocks on which other
treatment is based. For patients who are taking stimulant medication, it is helpful if the GP
continues to monitor their blood pressure, given that stimulant medication may cause elevation.
Once a patient has been stabilised on medication for ADHD, the psychiatrist may refer the
patient back to the GP for ongoing prescribing in line with state-based guidelines. However, in
most states and territories, the GP is not granted permission to alter the dose.
Text B

ADHD: Overview

Contrary to common belief, ADHD is not just a disorder of childhood. At least 40 to 50% of
children with ADHD will continue to meet criteria in adulthood, with ADHD affecting about one in
20 adults. ADHD can be masked by many comorbid disorders that GPs are typically good at
recognising such as depression, anxiety and substance use. In patients with underlying ADHD,
the attentional, hyperactive or organisational problems pre-date the comorbid disorders and are
not episodic as the comorbid disorders may be. GPs are encouraged to ask whether the
complaints are of recent onset or longstanding. Collateral history can be helpful for developing a
timeline of symptoms (e.g. parent or partner interview). Diagnosis of underlying ADHD in these
patients will significantly improve their treatment outcomes, general health and quality of life.
Text C
Text D
Treatment of ADHD
It is very important that the dosage of medication is individually optimised. An analogy may be made
with getting the right pair of glasses – you need the right prescription for your particular
presentation with not too much correction and not too little. The optimal dose typically requires
careful titration by a psychiatrist with ADHD expertise. Multiple follow-up appointments are usually
required to maximise the treatment outcome. It is essential that the benefits of treatment outweigh
any negative effects. Common side effects of stimulant medication may include:
• appetite suppression
• insomnia
• palpitations and increased heart rate
• feelings of anxiety
• dry mouth and sweating
END OF PART A
E2 Language Reading Part B.3
1. According to the extract, to prevent the spread of infection, emergency department

isolation rooms
should be placed away from the main entry doors.
are more numerous than those of other departments.
ought to be situated near where people enter the unit.
DESIGN PRINCIPLES FOR ISOLATION ROOMS
The aim of environmental control in an isolation room is to control the airflow, thereby
reducing the number of airborne infectious particles that may infect others within the
environment.
This is achieved by:
 controlling the quality and quantity of intake and exhaust air;

 diluting infectious particles in large volumes of air;
 maintaining differential air pressures between adjacent areas; and
 designing patterns of airflow for particular clinical purposes.
The location and design of isolation rooms within a particular department or inpatient unit
should ideally enable their separation from the rest of the unit. Multiple isolation rooms should
be clustered and located away from the main entrance of the unit. An exception is an emergency
department where it is recommended that designated isolation rooms be located near the entry
to prevent spread of possible airborne infection throughout the unit.
2. What do staff need to be conscious of when working in Anterooms?
Keeping used and unused medical clothing apart.
Ensuring the ambient pressure in the room is a minimum 15 Pascal.
Keeping the door closed at all times.

ANTEROOMS
Anterooms allow staff and visitors to change into, and dispose of, personal protective
equipment used on entering and leaving rooms when caring for infectious patients. Clean and
dirty workflows within this space should be considered so that separation is possible.
Anterooms increase the effectiveness of isolation rooms by minimising the potential escape of
airborne nuclei into a corridor area when the door is opened.
For Class N isolation rooms the pressure in the anteroom is lower than the adjacent ambient
(corridor) pressure, and positive with respect to the isolation room. The pressure differential
between rooms should be not less than 15 Pascal.
Anterooms are provided for Class N isolation rooms in intensive care units, emergency
departments, birthing units, infectious diseases units, and for an agreed number of patient
bedrooms within inpatient units accommodating patients with respiratory conditions.
3. What is the basic principle of flexible design?
Creating systems which match current policy and can adjust to other possible
guidelines.
Designing healthcare facilities which strictly adhere to current policy.
Changing healthcare policies regularly to match changes in the marketplace.
FLEXIBLE DESIGN
In healthcare, operational policies change frequently. The average cycle may be as little as five
years. This may be the result of management change, government policy, and turnover of key
staff or change in the marketplace. By contrast, major healthcare facilities are typically
designed for 30 years, but may remain in use for more than 50 years. If a major hospital is
designed very tightly around the operational policies of the day, or the opinion of a few
individuals, who may leave at any time, then a significant investment may be at risk of early
obsolescence. Flexible design refers to planning models that can not only adequately respond
to contemporary operational policies but also have the inherent flexibility to adapt to a range
of alternative, proven and forward-looking policies.
4. When prescribing antibiotics for a human bite, what should the medical professional
remember?
Not all patients should be given antibiotics given the nominal infection risk.
The bacterium Streptococcus spp. is the most common in bite patients.
Eikenella corrodens is not susceptible to several antibiotics often used for skin
infections.
Human bites
Human bite injuries comprise clenched-fist injuries, sustained when a closed fist strikes the
teeth of another person, and occlusive bites, resulting from direct closure of teeth on tissue.
Clenched-fist injuries are more common than occlusive bites, particularly in men, with most
human bites occurring on the hands. Human bites result in a greater infection and complication
rate than animal bites. Cultures of human bites are typically polymicrobial. Mixed aerobic and
anaerobic organisms are common, with the most common isolates including Streptococcus spp.
and Eikenella corrodens, which occurs in up to one-third of isolates.
Some authors suggest that all patients with human bites should be commenced on antibiotic
prophylaxis, given the high risk of infection. The choice of antibiotic therapy should cover E.
corrodens, which is resistant to first-generation cephalosporins (such as cefalexin),
flucloxacillin and clindamycin, antibiotics that are often used for skin and soft tissue infections.
5. The extract informs us that a model of care
is only implemented at certain times and places.
should include its own application and assessment.
involves the development of a project management tool.
What is a MoC?
A “Model of Care” broadly defines the way health services are delivered. It outlines best
practice care and services for a person, population group or patient cohort as they progress
through the stages of a condition, injury or event. It aims to ensure people get the right care, at
the right time, by the right team and in the right place.
When designing a new MoC, the aim is to bring about improvements in service delivery
through effecting change. As such creating a MoC must be considered as a change management
process. Development of a new MoC does not finish when the model is defined, it must also
encompass implementation and evaluation of the model and the change management needed
to make that happen. Developing a MoC is a project and as such should follow a project
management methodology.
6. What is the basic difference between delegation, referral, and handover?
How many practitioners are involved in each part of the process.
How much authority is attributed to each practitioner.
How long each of the processes take a practitioner to complete.
4.3 Delegation, referral and handover
Delegation involves one practitioner asking another person or member of staff to provide
care on behalf of the delegating practitioner while that practitioner retains overall
responsibility for the care of the patient or client.
Referral involves one practitioner sending a patient or client to obtain an opinion or
treatment from another practitioner. Referral usually involves the transfer in part of
responsibility for the care of the patient or client, usually for a defined time and a particular
purpose, such as care that is outside the referring practitioner’s expertise or scope of practice.
Handover is the process of transferring all responsibility to another practitioner.
Text 1: Personal devices and hearing loss

Most of us have experienced walking past someone and being able to hear every sound coming
from their headphones. If you’ve ever wondered whether this could be damaging their hearing,
the answer is yes. In the past, noise-induced hearing loss typically affected industrial workers,
due to prolonged exposure to excessive levels of noise with limited or non-existent protective
equipment. There are now strict limits on occupational noise exposure and many medico-legal
claims have been filed as a result of regulation. The ubiquitous use of personal music players
has, however, radically increased our recreational noise exposure, and research suggests there
may be some cause for concern.
The problem is not just limited to children and teenagers either; adults listen to loud music too.
According to the World Health Organization, hearing loss is already one of the leading causes
of disability in adults globally, and noise-induced hearing loss is its second-largest cause. In
Australia, hearing loss is a big public health issue, affecting one in six people and costing
taxpayers over A$12 billion annually for diagnosis, treatment, and rehabilitation.
When sounds enter our ear, they set in motion tiny frequency-specific hair cells within the
cochlea, our hearing organ, which initiate the neural impulses which are perceived by us as
sounds. Exposure to high levels of noise causes excessive wear and tear, leading to their
damage or destruction. The process is usually gradual and progressive; as our cochlea struggles
to pick up sounds from the damaged frequencies we begin to notice poorer hearing.
Unfortunately, once the hair cells are gone, they don’t grow back.
A number of US studies have shown the prevalence of noise-induced hearing loss in teenagers
is increasing, and reports from Australia have suggested there’s an increased prevalence of
noise-induced hearing loss in young adults who use personal music players. This is a worrying
trend considering the widespread usage of these devices. Even a slight hearing loss can
negatively affect a child’s language development and academic achievement. This is of
significant concern considering some studies have reported a 70% increased risk of hearing
loss associated with use of personal music players in primary school-aged children.
Some smartphones and personal music players can reach up to 115 decibels, which is roughly
equivalent to the sound of a chainsaw. Generally, 85 decibels and above is considered the level
where noise exposure can cause permanent damage. Listening at this level for approximately
eight hours is likely to result in permanent hearing loss. What’s more, as the volume increases,
the amount of time needed to cause permanent damage decreases. At 115 decibels, it can take
less than a minute before permanent damage is done to your hearing.
In Australia a number of hearing education campaigns, such as Cheers for Ears, are teaching
children and young adults about the damaging effects of excessive noise exposure from their
personal music players with some encouraging results. Hopefully, this will lead to more
responsible behaviour and prevent future cases of noise-induced hearing loss in young adults.
Currently, there are no maximum volume limits for the manufacturers of personal music
players in Australia. This is in stark contrast to Europe, where action has been taken after it
was estimated that 50 and 100 million Europeans were at risk of noise-induced hearing loss
due to personal music players. Since 2009, the European Union has provided guidance to limit
both the output and usage time of these devices. Considering the impact of hearing loss on
individuals and its cost to society, it’s unclear why Australia has not adopted similar guidelines.
Some smartphones and music players allow you to set your own maximum volume limits.
Limiting the output to 85 decibels is a great idea if you’re a regular user and value preserving
your hearing. Taking breaks to avoid continued noise exposure will also help reduce your risk
of damaging your hearing.
Losing your hearing at any age will have a huge impact on your life, so you should do what
you can to preserve it. Hearing loss has often been referred to as a “silent epidemic”, but in this
case it is definitely avoidable.
1. The writer suggests that the risks from exposure to excessive industrial noise
Have become better regulated over time.
Have increased with the spread of new media devices.
Were limited or non-existent in the past.
Are something most people have experienced.
2. The word 'ubiquitous' in paragraph 1 suggests that use of personal media players is
Getting out of control.
Radically increasing.
Extremely common.
A serious health risk.
3. In the second paragraph, the writer aims to emphasise the
Impacts of hearing loss on young people.
Significant global effect of noise related hearing loss.

WHO's statistical information on hearing loss.
Huge cost of hearing loss treatment in Australia.
4. What does the word 'their' in paragraph 3 refer to?
Smart phones and music players
People with hearing loss
Neural impulses entering our ear
Tiny hair cells in the ear
5. What does the research mentioned in paragraph four show?
A higher prevalence of personal music devices in primary schools.
The negative impact of device related hearing loss on academic and linguistic
skills.
An increasing number of teens and young adults suffering noise related hearing
loss.
The widespread trend for increased use of personal music devices.
6. In paragraph 5, the writer suggests that
Chainsaws and smartphones are negatively impacting the public's hearing
Listening to music on a smartphone will damage your hearing.
Smartphones are designed to play music at dangerously high volumes.
More rules should be in place to control how loud smartphones can go.
7. Why does the writer mention the Australian education programs in paragraph 6?
To encourage schools to adopt the Cheers for Ears program.
To suggest that education could lead to safer behaviour in young people
To criticise governments for not educating youths on the danger of excessive

noise.
To highlight a successful solution to the issue of hearing loss in young people.
8. What is the writer's attitude to the lack of manufacturing guidelines for music devices
in Australia?
There is no clear reason why Australia has not created guidelines.
The implementation of guidelines in Australia is unnecessary.
Guidelines probably won't be created in Australia.
It will be difficult to create guidelines in Australia.

Text 2: What is herd immunity?

A recent outbreak of chickenpox is a reminder that even in countries where immunisation rates
are high, children and adults are still at risk of vaccine-preventable diseases. Outbreaks occur
from time to time for two main reasons. The first is that vaccines don’t always provide complete
protection against disease and, over time, vaccine protection tends to diminish. The second is
that not everyone in the population is vaccinated. This can be for medical reasons, by choice,
or because of difficulty accessing medical services. When enough unprotected people come
together, infections can spread rapidly. This is particularly the case in settings such as schools
where large numbers of children spend long periods of time together.
When a high proportion of a community is immune it becomes hard for diseases to spread from
person to person. This phenomenon is known as herd immunity. Herd immunity protects people
indirectly by reducing their chances of coming into contact with an infection. By decreasing
the number of people who are susceptible to infection, vaccination can starve an infectious
disease outbreak in the same way that firebreaks can starve a bushfire: by reducing the fuel it
needs to keep spreading. If the immune proportion is high enough, outbreaks can be prevented
and a disease can even be eliminated from the local environment. Protection of “the herd” is
achieved when immunity reaches a value known as the “critical vaccination threshold”. This
value varies from disease to disease and takes into account how contagious a disease is and
how effective the vaccine against it is.
For a disease outbreak to “grow”, each infected person needs to pass their disease on to more
than one other person, in the same way that we think about population growth more generally.
If individuals manage only to “reproduce” themselves once in the infectious process, a full-
blown outbreak won’t occur. For example, on average someone with influenza infects up to
two of the people they come into contact with. If one of those individuals was already fully
protected by vaccination, then only one of them could catch the flu. By immunising half of the
population, we could stop flu in its tracks.
On the other hand, a person with chickenpox might infect five to ten people if everyone were
susceptible. This effectively means that we need to vaccinate around nine out of every ten
people (90% of the population) to prevent outbreaks from occurring. As mentioned earlier,
vaccines vary in their ability to prevent infection completely, particularly with the passing of
time. Many vaccines require several “booster” doses for this reason. When vaccine protection
is not guaranteed, the number of people who need to be vaccinated to achieve herd immunity
and prevent an outbreak is higher. Chickenpox vaccine is one such example: infections can
occur in people who have been vaccinated. However, such cases are typically less severe than
in unimmunised children, with fewer spots and a milder symptom course.
In Australia, overall vaccine coverage rates are high enough to control the spread of many
infectious diseases. Coverage shows considerable geographic variation, though, with some
communities recording vaccination levels of less than 85%. In these communities, the
conditions necessary for herd immunity may not be met. That means localised outbreaks are
possible among the unvaccinated and those for whom vaccination did not provide full
protection. In the Netherlands, for example, high national measles vaccine uptake was not
enough to prevent a very large measles outbreak (more than 2, 600 cases) in orthodox Protestant
communities opposed to vaccination.
Australia’s National Immunisation Strategy specifically focuses on achieving high vaccine

uptake within small geographic areas, rather than just focusing on a national average. Although
uptake of chickenpox vaccine in Australia was lower than other infant vaccines, coverage is
now comparable.
Media attention has emphasised those who choose not to vaccinate their children due to
perceived risks associated with vaccination. However, while the number of registered
conscientious objectors to vaccination has increased slightly over time, these account for only
a small fraction of children. A recent study found only 16% of incompletely immunised
children had a mother who disagreed with vaccination. Other factors associated with under
vaccination included low levels of social contact, large family size and not using formal
childcare.
Tailoring services to meet the needs of all parents requires a better understanding of how
families use health services, and of the barriers that prevent them from immunising. To ensure
herd immunity can help protect all children from preventable disease, it’s vital to maintain
community confidence in vaccination. It’s equally important the other barriers that prevent
children from being vaccinated are identified, understood and addressed.
1. According to the writer what causes occasional outbreaks of preventable diseases?
A high prevalence of disease.
Limited access to vaccination.
A low prevalence of vaccination.
Attitudes towards vaccination.
2. Why does the writer mention bushfires in paragraph 2?
To emphasise the effectiveness of herd immunity.
To describe a method for eliminating disease.
To warn of the risks of of vaccination.
To highlight the severity of the flu.

3. The phrase "stop flu in its tracks" in paragraph 3 refers to the
Prevention of flu spreading.
Eradication of the flu virus.
Minimisation of flu victims.
Reduction in severity of flu symptoms.
4. Information in paragraph 4 implies that
The chickenpox vaccine is highly unreliable.
Chickenpox is more contagious than the flu.
Booster vaccines should be given in schools.
Outbreaks of chickenpox are on the rise.
5. In paragraph 5, the writer emphasises the importance of
How geographical variation contributes to outbreaks.
Differences in global vaccination guidelines.
The influence of religious beliefs on vaccination.
Enforcing high vaccine coverage rates.
6. Why does the writer mention Australia's National Immunisation Strategy?
To serve as a counter argument.
To engage Australian readers.

To reinforce a previous point.
To introduce a new topic.
7. The research quoted in paragraph 7 reinforces that
The media presents vaccination negatively.
Many factors contribute to under vaccination.
Parental objections account for most unvaccinated children.
The number of conscientious objectors has increased over time.
8. In the final paragraph, the writer focuses on
The importance of widespread faith in vaccination.
The difficulty of tailoring health services to all parents.
The identification of barriers to overcoming under vaccination.
The different kinds of preventable disease that need to be overcome.

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[CANDIDATE NO.] READING TEXT BOOKLET PART A 01/04

Sedation: Texts
Text A
Procedural sedation and analgesia for adults in the emergency department
Patients in the emergency department often need to undergo painful, distressing or unpleasant
diagnostic and therapeutic procedures as part of their care. Various combinations of analgesic,
sedative and anaesthetic agents are commonly used for the procedural sedation of adults in the
emergency department.
Although combinations of benzodiazepines and opioids have generally been used for procedural
sedation, evidence for the use of other sedatives is emerging and is supported by guidelines
based on randomised trials and observational studies. Patients in pain should be provided with
analgesia before proceeding to more general sedation. The intravenous route is generally the
most predictable and reliable method of administration for most agents.
Local factors, including availability, familiarity, and clinical experience will affect drug choice, as
will safety, effectiveness, and cost factors. There may also be cost savings associated with
providing sedation in the emergency department for procedures that can be performed safely in
either the emergency department or the operating theatre.
Text B
Levels of sedation as described by the American Society of Anesthesiologists
Non-dissociative sedation
• Minimal sedation and analgesia: essentially mild anxiolysis or pain control. Patients respond
normally to verbal commands. Example of appropriate use: changing burns dressings
• Moderate sedation and analgesia: patients are sleepy but also aroused by voice or light
touch. Example of appropriate use: direct current cardioversion
• Deep sedation and analgesia: patients require painful stimuli to evoke a purposeful response.
Airway or ventilator support may be needed. Example of appropriate use: major joint
reduction
• General anesthesia: patient has no purposeful response to even repeated painful stimuli.
Airway and ventilator support is usually required. Cardiovascular function may also be
impaired. Example of appropriate use: not appropriate for general use in the emergency
department except during emergency intubation.
Dissociative sedation
Dissociative sedation is described as a trance-like cataleptic state characterised by profound
analgesia and amnesia, with retention of protective airway reflexes, spontaneous respirations,
and cardiopulmonary stability. Example of appropriate use: fracture reduction.

Text C
Drug administration: General principles

International consensus guidelines recommend that minimal sedation – for example, with 50% nitrous oxide-
oxygen blend – can be administered by a single physician or nurse practitioner with current life support
certification anywhere in the emergency department. Guidelines recommend that for moderate and
dissociative sedation using intravenous agents, a physician should be present to administer the sedative, in
addition to the practitioner carrying out the procedure.
For moderate sedation, resuscitation room facilities are recommended, with continuous cardiac and oxygen
saturation monitoring, non-invasive blood-pressure monitoring, and consideration of capnography (monitoring
of the concentration or partial pressure of carbon dioxide in the respiratory gases).
During deep sedation, capnography is recommended, and competent personnel should be present to provide
cardiopulmonary rescue in terms of advanced airway management and advanced life support.
Text D
Drugs used for procedural sedation and analgesia in adults in the emergency department
Class Drug Dosage Advantages Cautions
Opioids Fentanyl 0.5-1 µg/kg over 2 Short acting analgesic; May cause apnoea,
mins reversal agent (naloxone) respiratory depression,
available bradycardia, dysphoria,
muscle rigidity, nausea and
vomiting
Morphine 50-100 µg/kg then Reversal agent (naloxone); Slow onset and peak effect
0.8-1 mg/h prolonged analgesic time; less reliable
Remifentanil 0.025-0.1 µg/kg/ Ultra-short acting; no solid Difficult to use without an
min organ involved in infusion pump
metabolic clearance
Benzodiazepines Midazolam Small doses of Minimal effect on No analgesic effect; may
0.02-0.03 mg/kg respiration; reversal agent cause hypotension
until clinical effect (flumazenil)
achieved; repeat
dosing of 0.5-1 mg
with total dose ≤
5mg
Volatile agents Nitrous oxide 50% nitrous oxide - Rapid onset and recovery; Acute tolerance may
50% oxygen cardiovascular and develop; specialised
mixture respiratory stability equipment needed
Propofol Propofol Infusion of 100 Rapid onset; short-acting; May cause rapidly
µg/kg/min for 3-5 anticonvulsant properties deepening sedation, airway
min then reduce obstruction, hypotension
to~50 µg/kg/min
Phencyclidines Ketamine 0.2-0.5 mg/kg Rapid onset; short-acting; Avoid in patients with
over 2-3 min potent analgesic even at history of psychosis; may
low doses; cardiovascular cause nausea and vomiting
stability
Etomidate Etomidate 0.1-0.15 mg/kg Rapid onset; short-acting; May cause pain on
may re-administer cardiovascular stability injection, nausea, vomiting;
caution when using in
patients with seizure
disorders/epilepsy – may
induce seizures
END OF PART A


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Part A
TIME: 15 minutes
Sedation: Questions
Questions 1-7
For each question, 1-7, decide which text (A, B, C or D) the information comes from. You may use
1 the point at which any necessary pain relief should be given? ____________________
2 the benefits and drawbacks of specific classes of drugs? ____________________
3 financial considerations when making decisions about sedation? ____________________
4 typical procedures carried out under various sedation levels? ____________________
5 measures to be taken to ensure a patient’s stability under sedation? ____________________
6 reference to research into alternative sedative agents? ____________________
7 patients’ levels of sensory awareness when sedated? ____________________
Questions 8-14
Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer
8 What class of drug is traditionally administered together with opioids for the purpose of
procedural sedation?
____________________________________________________________________
9 What level of sedation is appropriate for changing burns dressings?

____________________________________________________________________

10 What is the only emergency department procedure for which it is appropriate to use
general anaesthesia?
____________________________________________________________________
11 What procedure may be carried out under dissociative sedation?
____________________________________________________________________
12 What class of drugs is unsuitable for patients who have a history of psychosis?

____________________________________________________________________
13 What opioid drug should be administered using specific equipment?
____________________________________________________________________
14 What is the maximum overall dose of Midazolam which should be given?
____________________________________________________________________
Questions 15-20
Complete each of the sentences, 15-20, with a word or short phrase from one of the texts. Each
15 The majority of sedative drugs are administered via the _________________________.
16 General anaesthesia is the one form of sedation under which patients may have reduced
_________________________.
17 Patients under minimal sedation will react if they are given ___________________________.
18 Care should be taken when administering Etomidate to patients who are likely to have
_______________________.
19 It may be helpful to use capnography to keep track of patients’ ________________________

levels during moderate sedation.
20 Fentanyl, Morphine and Midozolam each have a ________________________, which is used to

cancel out the effects of the drug.
END OF PART A


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[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 1/16

Part B
In this part of the test, there are six short extracts relating to the work of health professionals. For
questions 1-6, choose answer (A, B or C) which you think fits best according to the text.
1. The manual states that the wheelchair should not be used
A inside buildings.
B without supervision.
C on any uneven surfaces.
Manual extract: Kuschall ultra-light wheelchair
Intended use
The active wheelchair is propelled manually and should only be used for independent or assisted
transport of a disabled patient with mobility difficulties. In the absence of an assistant, it should only
be operated by patients who are physically and mentally able to do so safely (e.g., to propel
themselves, steer, brake, etc.). Even where restricted to indoor use, the wheelchair is only suitable
for use on level ground and accessible terrain. This active wheelchair needs to be prescribed and fit
to the individual patient’s specific health condition. Any other or incorrect use could lead hazardous
situations to arise.


2. These guidelines contain instructions for staff who
A need to screen patients for MRSA.
B are likely to put patients at risk from MRSA.
C intend to treat patients who are infected with MRSA.
MRSA Screening guidelines
It may be necessary to screen staff if there is an outbreak of MRSA within a ward or department.
Results will normally be available within three days, although occasionally additional tests need to
be done in the laboratory. Staff found to have MRSA will be given advice by the Department of
Occupational Health regarding treatment. Even minor skin sepsis or skin diseases such as
eczema, psoriasis or dermatitis amongst staff can result in widespread dissemination of
staphylococci. If a ward has an MRSA problem, staff with any of these conditions (colonised or
infected) must contact Occupational Health promptly, so that they can be screened for MRSA
carriage. Small cuts and/or abrasions must always be covered with a waterproof plaster. Staff with
infected lesions must not have direct contact with patients and must contact Occupational Health.

3. The main point of the notice is that hospital staff
A need to be aware of the relative risks of various bodily fluids.
B should regard all bodily fluids as potentially infectious.
C must review procedures for handling bodily fluids.
Infection prevention
Infection control measures are intended to protect patients, hospital workers and others in the
healthcare setting. While infection prevention is most commonly associated with preventing HIV
transmission, these procedures also guard against other blood borne pathogens, such as hepatitis B and
C, syphilis and Chagas disease. They should be considered standard practice since an outbreak of
enteric illness can easily occur in a crowded hospital.
Infection prevention depends upon a system of practices in which all blood and bodily fluids, including
cerebrospinal fluid, sputum and semen, are considered to be infectious. All such fluids from all people
are treated with the same degree of caution, so no judgement is required about the potential infectivity
of a particular specimen. Hand washing, the use of barrier protection such as gloves and aprons, the
safe handling and disposal of ‘sharps’ and medical waste and proper disinfection, cleaning and
sterilisation are all part of creating a safe hospital.


4. What do nursing staff have to do?
A train the patient how to control their condition with the use of an insulin pump
B determine whether the patient is capable of using an insulin pump appropriately
C evaluate the effectiveness of an insulin pump as a long-term means of treatment
Extract from staff guidelines: Insulin pumps
Many patients with diabetes self-medicate using an insulin pump. If you're caring for a hospitalised
patient with an insulin pump, assess their ability to manage self-care while in the hospital. Patients
using pump therapy must possess good diabetes self-management skills. They must also have a
willingness to monitor their blood glucose frequently and record blood glucose readings,
carbohydrate intake, insulin boluses, and exercise. Besides assessing the patient's physical and
mental status, review and record pump-specific information, such as the pump's make and model.
Also assess the type of insulin being delivered and the date when the infusion site was changed
last. Assess the patient's level of consciousness and cognitive status. If the patient doesn't seem
competent to operate the device, notify the healthcare provider and document your findings.

5. The extract states that abnormalities in babies born to mothers who took salbutamol are
A relatively infrequent.
B clearly unrelated to its use.
C caused by a combination of drugs.
Extract from a monograph: Salbutamol Sulphate Inhalation Aerosol
Pregnant women
Salbutamol has been in widespread use for many years in humans without apparent ill
consequence. However, there are no adequate and well controlled studies in pregnant women and
there is little published evidence of its safety in the early stages of human pregnancy.
Administration of any drug to pregnant women should only be considered if the anticipated benefits
to the expectant woman are greater than any possible risks to the foetus.
During worldwide marketing experience, rare cases of various congenital anomalies, including cleft
palate and limb defects, have been reported in the offspring of patients being treated with
salbutamol. Some of the mothers were taking multiple medications during their pregnancies.
Because no consistent pattern of defects can be discerned, a relationship with salbutamol use
cannot be established.

6. What is the purpose of this extract?
A to present the advantages and disadvantages of particular procedures
B to question the effectiveness of certain ways of removing non-viable tissue
C to explain which methods are appropriate for dealing with which types of wounds
Extract from a textbook: debridement
Debridement is the removal of non-viable tissue from the wound bed to encourage wound healing. Sharp
debridement is a very quick method, but should only be carried out by a competent practitioner, and may
not be appropriate for all patients. Autolytic debridement is often used before other methods of
debridement. Products that can be used to facilitate autolytic debridement include hydrogels,
hydrocolloids, cadexomer iodine and honey. Hydrosurgery systems combine lavage with sharp
debridement and provide a safe and effective technique, which can be used in the ward environment. This
has been shown to precisely target damaged and necrotic tissue and is associated with a reduced
procedure time. Ultrasonic assisted debridement is a relatively painless method of removing non-viable
tissue and has been shown to be effective in reducing bacterial burden, with earlier transition to secondary
procedures. However, these last two methods are potentially expensive and equipment may not always be
available.

Part C
In this part of the test, there are two texts about different aspects of healthcare. For questions 7-22,
choose the answer (A, B, C or D) which you think fits best according to the text.
Text 1: Cardiovascular benefits of exercise
Cardiovascular disease (CVD) is the leading cause of death for both men and women in the United
States. According to the American Heart Association (AHA), by the year 2030, the prevalence of
cardiovascular disease in the USA is expected to increase by 9.9%, and the prevalence of both heart
failure and stroke is expected to increase by approximately 25%. Worldwide, it is projected that CVD
will be responsible for over 25 million deaths per year by 2025. And yet, although several risk factors
are non-modifiable (age, male gender, race, and family history), the majority of contributing factors
are amenable to intervention. These include elevated blood pressure, high cholesterol, smoking,
obesity, diet and excess stress. Aspirin taken in low doses among high risk groups is also
recommended for its cardiovascular benefits.
One modifiable behaviour with major therapeutic implications for CVD is inactivity. Inactive or
sedentary behaviour has been associated with numerous health conditions and a review of several
studies has confirmed that prolonged total sedentary time (measured objectively via an
accelerometer) has a particularly adverse relationship with cardiovascular risk factors, disease, and
mortality outcomes. The cardiovascular effects of leisure time physical activity are compelling and well
documented. Adequate physical leisure activities like walking, swimming, cycling, or stair climbing
done regularly have been shown to reduce type 2 diabetes, some cancers, falls, fractures, and
depression. Improvements in physical function and weight management have also been shown, along
with increases in cognitive function, quality of life, and life expectancy.
Several occupational studies have shown adequate physical activity in the workplace also provides
benefits. Seat-bound bus drivers in London experienced more coronary heart disease than mobile
conductors working on the same buses, as do office-based postal workers compared to their
colleagues delivering mail on foot. The AHA recommends that all Americans invest in at least 30
minutes a day of physical activity on most days of the week. In the face of such unambiguous
evidence, however, most healthy adults, apparently by choice it must be assumed, remain
sedentary.
The cardiovascular beneficial effects of regular exercise for patients with a high risk of coronary
disease have also been well documented. Leisure time exercise reduced cardiovascular mortality
during a 16-year follow-up study of men in the high risk category. In the Honolulu Heart Study, elderly
men walking more than 1.5 miles per day similarly reduced their risk of coronary disease. Such
people engaging in regular exercise have also demonstrated other CVD benefits including decreased
rate of strokes and improvement in erectile dysfunction. There is also evidence of an up to 3-year
increase in lifespan in these groups.

Among patients with experience of heart failure, regular physical activity has also been found to help
improve angina-free activity, prevent heart attacks, and result in decreased death rates. It also
improves physical endurance in patients with peripheral artery disease. Exercise programs carried out
under supervision such as cardiac rehabilitation in patients who have undergone percutaneous
coronary interventions or heart valve surgery, who are transplantation candidates or recipients, or
who have peripheral arterial disease result in significant short- and long-term CVD benefits.
Since data indicate that cardiovascular disease begins early in life, physical interventions such as
regular exercise should be started early for optimum effect. The US Department of Health and Human
Services for Young People wisely recommends that high school students achieve a minimum target of
60 minutes of daily exercise. This may be best achieved via a mandated curriculum. Subsequent
transition from high school to college is associated with a steep decline in physical activity. Provision
of convenient and adequate exercise time as well as free or inexpensive college credits for
documented workout periods could potentially enhance participation. Time spent on leisure time
physical activity decreases further with entry into the workforce. Free health club memberships and
paid supervised exercise time could help promote a continuing exercise regimen. Government
sponsored subsidies to employers incorporating such exercise programs can help decrease the
anticipated future cardiovascular disease burden in this population.
General physicians can play an important role in counselling patients and promoting exercise.
Although barriers such as lack of time and patient non-compliance exist, medical reviews support the
effectiveness of physician counselling, both in the short term and long term. The good news is that the
percentage of adults engaging in exercise regimes on the advice of US physicians has increased from
22.6% to 32.4% in the last decade. The empowerment of physicians, with training sessions and
adequate reimbursement for their services, will further increase this percentage and ensure long-term
adherence to such programmes. Given that risk factors for CVD are consistent throughout the world,
reducing its burden will not only improve the quality of life, but will increase the lifespan for millions of
humans worldwide, not to mention saving billions of health-related dollars.

7. In the first paragraph, what point does the writer make about CVD?
A Measures to treat CVD have failed to contain its spread.
B There is potential for reducing overall incidence of CVD.
C Effective CVD treatment depends on patient co-operation.
D Genetic factors are likely to play a greater role in controlling CVD.
8. In the second paragraph, what does the writer say about inactivity?
A Its role in the development of CVD varies greatly from person to person.
B Its level of risk lies mainly in the overall amount of time spent inactive.
C Its true impact has only become known with advances in technology.
D Its long-term effects are exacerbated by certain medical conditions.
9. The writer mentions London bus drivers in order to
A demonstrate the value of a certain piece of medical advice.
B stress the need for more research into health and safety issues.
C show how important free-time activities may be to particular groups.
D emphasise the importance of working environment to long-term health.
10. The phrase 'apparently by choice' in the third paragraph suggests the writer
A believes that health education has failed the public.
B remains unsure of the motivations of certain people.
C thinks that people resent interference with their lifestyles.
D recognises that the rights of individuals take priority in health issues.

11. In the fourth paragraph, what does the writer suggest about taking up regular exercise?
A Its benefits are most dramatic amongst patients with pre-existing conditions.
B It has more significant effects when combined with other behavioural changes.
C Its value in reducing the risks of CVD is restricted to one particular age group.
D It is always possible for a patient to benefit from making such alterations to lifestyle.
12. The writer says 'short- and long-term CVD benefits' derive from
A long distance walking.
B better cardiac procedures.
C organised physical activity.
D treatment of arterial diseases.
13. The writer supports official exercise guidelines for US high school students because
A it is likely to have more than just health benefits for them.
B they are rarely self-motivated in terms of physical activity.
C it is improbable they will take up exercise as they get older.
D they will gain the maximum long-term benefits from such exercise.
14. What does the writer suggest about general physicians promoting exercise?
A Patients are more likely to adopt effective methods under their guidance.
B They are generally seen as positive role models by patients.
C There are insufficient incentives for further development.
D It may not be the best use of their time.

Text 2: Power of Placebo
Ted Kaptchuk is a Professor of Medicine at Harvard Medical School. For the last 15 years, he and
fellow researchers have been studying the placebo effect – something that, before the 1990s, was
seen simply as a thorn in medicine’s side. To prove a medicine is effective, pharmaceutical
companies must show not only that their drug has the desired effects, but that the effects are
significantly greater than those of a placebo control group. However, both groups often show healing
results. Kaptchuk’s innovative studies were among the first to study the placebo effect in clinical trials
and tease apart its separate components. He identified such variables as patients’ reporting bias (a
conscious or unconscious desire to please researchers), patients simply responding to doctors’
attention, the different methods of placebo delivery and symptoms subsiding without treatment – the
inevitable trajectory of most chronic ailments.
Kaptchuk’s first randomised clinical drug trial involved 270 participants who were hoping to alleviate
severe arm pain such as carpal tunnel syndrome or tendonitis. Half the subjects were instructed to take
pain-reducing pills while the other half were told they’d be receiving acupuncture treatment. But just two
weeks into the trial, about a third of participants - regardless of whether they’d had pills or acupuncture -
started to complain of terrible side effects. They reported things like extreme fatigue and nightmarish
levels of pain. Curiously though, these side effects were exactly what the researchers had warned
patients about before they started treatment. But more astounding was that the majority of participants -
in other words the remaining two-thirds - reported real relief, particularly those in the acupuncture group.
This seemed amazing, as no-one had ever proved the superior effect of acupuncture over standard
painkillers. But Kaptchuk’s team hadn’t proved it either. The ‘acupuncture’ needles were in fact retractable
shams that never pierced the skin and the painkillers were actually pills made of corn starch. This study
wasn’t aimed at comparing two treatments. It was deliberately designed to compare two fakes.
Kaptchuk’s needle/pill experiment shows that the methods of placebo administration are as important as
the administration itself. It’s a valuable insight for any health professional: patients’ feelings and beliefs
matter, and the ways physicians present treatments to patients can significantly affect their health. This is
the one finding from placebo research that doctors can apply to their practice immediately. Others such
as sham acupuncture, pills or other fake interventions are nowhere near ready for clinical application.
Using placebo in this way requires deceit, which falls foul of several major pillars of medical ethics,
including patient autonomy and informed consent.

Years of considering this problem led Kaptchuk to his next clinical experiment: what if he simply told
people they were taking placebos? This time his team compared two groups of IBS sufferers. One group
received no treatment. The other patients were told they’d be taking fake, inert drugs (from bottles
labelled ‘placebo pills’) and told also, at some length, that placebos often have healing effects. The
study’s results shocked the investigators themselves: even patients who knew they were taking placebos
described real improvement, reporting twice as much symptom relief as the no-treatment group. It hints at
a possible future in which clinicians cajole the mind into healing itself and the body – without the drugs
that can be more of a problem than those they purport to solve.
But to really change minds in mainstream medicine, researchers have to show biological evidence – a
feat achieved only in the last decade through imaging technology such as positron emission tomography
(PET) scans and functional magnetic resonance imaging (MRI). Kaptchuk’s team has shown with these
technologies that placebo treatments affect the areas of the brain that modulate pain reception. ‘It’s those
advances in “hard science”’, said one of Kaptchuk’s researchers, ‘that have given placebo research a
legitimacy it never enjoyed before’. This new visibility has encouraged not only research funds but also
interest from healthcare organisations and pharmaceutical companies. As private hospitals in the US run
by healthcare companies increasingly reward doctors for maintaining patients’ health (rather than for the
number of procedures they perform), research like Kaptchuk’s becomes increasingly attractive and the
funding follows.
Another biological study showed that patients with a certain variation of a gene linked to the release of
dopamine were more likely to respond to sham acupuncture than patients with a different variation –
findings that could change the way pharmaceutical companies conduct drug trials. Companies spend
millions of dollars and often decades testing drugs; every drug must outperform placebos if it is to be
marketed. If drug companies could preselect people who have a low predisposition for placebo response,
this could seriously reduce the size, cost and duration of clinical trials, bringing cheaper drugs to the
market years earlier than before.

15. The phrase ‘a thorn in medicine’s side’ highlights the way that the placebo effect
A varies from one trial to another.
B affects certain patients more than others.
C increases when researchers begin to study it.
D complicates the process of testing new drugs.
16. In the first paragraph, it’s suggested that part of the placebo effect in trials is due to
A the way health problems often improve naturally.
B researchers unintentionally amplifying small effects.
C patients’ responses sometimes being misinterpreted.
D doctors treating patients in the control group differently.
17. The results of the trial described in the second paragraph suggest that
A surprising findings are often overturned by further studies.
B simulated acupuncture is just as effective as the real thing.
C patients’ expectations may influence their response to treatment.
D it’s easy to underestimate the negative effect of most treatments.
18. According to the writer, what should health professionals learn from Kaptchuk’s studies?
A The use of placebos is justifiable in some settings.
B The more information patients are given the better.
C Patients value clarity and honesty above clinical skill.
D Dealing with patients’ perceptions can improve outcomes.

19. What is suggested about conventional treatments in the fourth paragraph?
A Patients would sometimes be better off without them.
B They often relieve symptoms without curing the disease.
C They may not work if patients do not know what they are.
D Insufficient attention is given to developing effective ones.
20. What does the phrase ‘This new visibility’ refer to?
A improvements in the design of placebo studies
B the increasing acceptance of placebo research
C innovations in the technology used in placebo studies
D the willingness of placebo researchers to admit mistakes
21. In the fifth paragraph, it is suggested that Kaptchuk’s research may ultimately benefit from
A the financial success of drug companies.
B a change in the way that doctors are paid.
C the increasing number of patients being treated.
D improved monitoring of patients by healthcare providers.
22. According to the final paragraph, it would be advantageous for companies to be able to use
genetic testing to
A understand why some patients don’t respond to a particular drug.
B choose participants for trials who will benefit most from them.
C find out which placebos induce the greatest response.
D exclude certain individuals from their drug trials.
END OF READING TEST

THIS BOOKLET WILL BE COLLECTED


Part A: Texts A - D
Text A
Primary Clinical Care Guidelines: Management of Head Injuries

▪ Monitor observations including BP (blood pressure) and GCS (level of
consciousness according to the Glasgow Coma Scale 1 – 15 ) .
▪ Notify MO (Medical Officer) immediately if level of consciousness alters.
▪ Prepare for intubation if GCS is 8 or less.
▪ Maintain BP as advised by MO.
▪ Keep patient warm.
▪ If there is a rapid deterioration in GCS of 2 or more and/or if one pupil
becomes fixed and dilated, this may indicate expanding (intracranial)
haemorrhage. Consult MO immediately.
▪ Give opioids with caution to patients with head injuries.
▪ If the skin is broken, check tetanus vaccination status. Administer tetanus
containing vaccine/ immunoglobulin as appropriate.
▪ Assume all head injuries have an associated neck injury.
Text B
Text C
Intermediate High risk

Head injury clinical features – child
risk factors factors
Age < 1 year
Witnessed loss of consciousness < 5 minutes > 5 minutes
Anterograde or retrograde amnesia Possible > 5 minutes
Mild agitation or Abnormal
Behaviour
altered behaviour drowsiness
Episodes of vomiting without other cause 3 or more
Seizure in non-epileptic patient Impact only Yes
Non-accidental injury is suspected/parental
No Yes
history is inconsistent with injury
History of coagulopathy, bleeding disorder
No Yes
or previous intracranial surgery
Comorbidities Present Present
Persistent or
Headache Yes
increasing
Motor vehicle accident < 60 kph > 60 kph
Fall 1-3 metres > 3 metres
Moderate impact High speed /
Force or unclear heavy projectile or
mechanism object
Glasgow Coma Scale 14-15 < 14
Focal neurological abnormality Nil Present
Penetrating injury
Haematoma,
/ Possible
Injury swelling or
depressed skull
laceration > 5 cm
fracture.
Text D
Advice for patients who have received an injury to the head

● Rest quietly for the day.
● Use ‘ice packs’ over swollen or painful areas. Wrap ice cubes, frozen peas or a sports
ice pack in a towel. Do not put ice directly on the skin.
● Take simple painkillers for any headache.
● If an injured patient is discharged in the evening, make sure they are woken several
times during the night.
● Do not let the injured patient drive home.
● Do not leave them alone for the next 24 hours.
● Do not let them drink alcohol for at least 24 hours.
● Do not let them eat or drink for the first six to 12 hours (unless advised otherwise by
the MO). Then offer them food and drink in moderation.
● Do not let them take sedatives or other medication unless instructed.
● Return to the clinic immediately if the patient has repeated vomiting, ‘blacks out’,
has a seizure/fit or cannot be woken or is not responsive.
● Patient to return to clinic if they have any symptoms they or the carer are concerned
about.
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.
Head injuries: Questions
Questions 1-5
For each question, 1-5, decide which text (A, B, C or D) the information comes from.
1 what patients should and shouldn’t do when they return home? _____
2 the possible cause of abnormality apparent in a patient’s eyes? _____
3 reasons why patients should seek medical attention after being discharged?
_____
4 procedures to follow dependent on the type of head injury? _____
5 past interventions and conditions to be considered when assessing risk?

_____
Questions 6 – 11
Answer each of the questions, 6-11, with a word or short phrase from one of the
texts. Each answer may include words, numbers or both.
Children presenting with head injuries are assessed as high risk if they have:
had memory loss lasting (6) ____________ or more
fallen (7) ____________ or more
been hit by a weighty object or one moving at (8) ____________
unusual levels of (9) ____________
a (10) ____________ which gets worse over time
Escalation: Children assessed as intermediate or high risk should undergo a (11)

____________
Questions 12 – 16
Complete the sentences below by using a word or short phrase from the text. Each
All patients presenting with (12) ________________________ head injuries must be
referred straight to the MO.
Patients with GCS below 8 may need (13) ________________________.
The MO should be informed without delay if there is a drop in BP or change in a
patient's level of (14) ________________________.
Staff should be especially careful when administering (15) _______________ to
head injury patients.
Head injury patients may also have an injury to their (16) _______________.
Questions 17 – 20
Answer the questions below. For each answer use a word or short phrase from the
text. Each answer may include words, numbers or both.
17 If there are no significant risk factors, how long after a head injury can you
discharge a patient?
________
18 What should you provide head injury patients with when you discharge them?
________
19 What should you advise patients to take to control headaches?
________
20 What can patients use to avoid contact between ice packs and their skin?
________
Part B
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. The purpose of the memo about IV solution bags is to remind health practitioners
A of the procedures to follow when using them.

B of the hazards associated with faulty ones.
C why they shouldn’t be reused.
Memo to staff - Intravenous solution bags

IV fluids are administered via a plastic IV solution bag which collapses on itself
as it empties. When a bag is disconnected by removing the giving set spike, air
can enter the bag. If it is then reconnected to an IV line, air can potentially
enter the patient’s vein and cause an air embolism. For this reason, partially
used IV bags must never be re-spiked. All IV bags are designed for single use
only - for use in one patient and on one occasion only. All registered large
volume injections, including IV bags, are required to have this warning (or
words to the same effect) clearly displayed on the labelling. In addition to the
potential risk of introducing an air embolus, re-spiking can also result in
contamination of the fluid, which may lead to infection and bacteraemia.
2. What do we learn about the use of TENS machines?
A Evidence for their efficacy is unconfirmed.

B They are recommended in certain circumstances.
C More research is needed on their possible side effects.
Update on TENS machines

The Association of Chartered Physiotherapists in Women’s Health has an expert panel which
could not find any reports suggesting that negative effects are produced when TENS has
been used during pregnancy. However, in clinical practice, TENS is not the first treatment of
choice for women presenting with musculoskeletal pain during pregnancy. The initial
treatment should be aimed at correcting any joint or muscle dysfunction, and a rehabilitation
programme should be devised. However, if pain remains a significant factor, then TENS is
preferable to the use of strong medication that could cross the placental barrier and affect
the foetus. No negative effects have been reported following the use of this modality during
any of the stages of pregnancy. Therefore, TENS is preferable for the relief of pain.
3. If surgical instruments have been used on a patient suspected of having prion

disease, they
A must be routinely destroyed as they cannot be reused.

B may be used on other patients provided the condition has been ruled out.
C should be decontaminated in a particular way before use with other
patients.
Guidelines: Invasive clinical procedures in patients with suspected prion disease

It is essential that patients suspected of suffering from prion disease are identified prior to any
surgical procedure. Failure to do so may result in exposure of individuals on whom any surgical
equipment is subsequently used. Prions are inherently resistant to commonly used
disinfectants and methods of sterilisation. This means that there is a possibility of transmission
of prion disease to other patients, even after apparently effective methods of decontamination
or sterilisation have been used. For this reason, it may be necessary to destroy instruments
after use on such a patient, or to quarantine the instrument until the diagnosis is either
confirmed, or an alternative diagnosis is established. In any case, the instruments can be used
for the same patient on another occasion if necessary.
4. The email suggests that POCT devices
A should only be used in certain locations.

B must be checked regularly by trained staff.
C can produce results that may be misinterpreted.
To: All Staff
Subject: Management of Point of Care Testing (POCT) Devices
Due to several recent incidents associated with POCT devices, staff are requested to read
the following advice from the manufacturer of the devices.
The risks associated with the use of POCT devices arise from Management of Point of Care
Testing Devices Version 4 January 2014, the inherent characteristics of the devices
themselves and from the interpretation of the results they provide. They can be prone to
user errors arising from unfamiliarity with equipment more usually found in the laboratory.
User training and competence is therefore crucial.
5. It’s permissible to locate a baby’s identification band somewhere other than the ankles
when
A the baby is being moved due to an emergency.

B the bands may interfere with treatment.
C the baby is in an incubator.
Identification bands for babies

The identification bands should be located on the baby’s ankles with correct identification
details unless the baby is extremely premature and/or immediate vascular access is
required. If for any reason the bands need to be removed, they should be relocated to the
wrists or if this is not possible, fixed visibly to the inside of the incubator. Any ill-fitting or
missing labels should be replaced at first check. Identity bands must be applied to the
baby’s ankles at the earliest opportunity as condition allows and definitely in the event of
fire evacuation or transportation.
6. What is the memo doing?
A providing an update on the success of new guidelines
B reminding staff of the need to follow new guidelines
C announcing the introduction of new guidelines
Memo: Administration of antibiotics
After a thorough analysis and review, our peri-operative services, in conjunction with the
Departments of Surgery and Anaesthesia, decided to change the protocols for the
administration of pre-operative antibiotics and established a series of best practice
guidelines. This has resulted in a significant improvement in the number of patients
receiving antibiotics within the recommended 60 minutes of their incision. A preliminary
review of the total hip and knee replacements performed in May indicates that 88.9% of
patients received their antibiotics on time.
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.
Detecting Carbon Monoxide Poisoning
Carbon Monoxide (CO) poisoning is the single most common source of poisoning injury
treated in US hospital emergency departments. While its presentation is not uncommon, the
diverse symptoms that manifest themselves do not lead most clinicians to consider
carboxyhemoglobinemia when attempting a diagnosis. The symptoms can be mistaken for
those of many other illnesses including food poisoning, influenza, migraine headache, or
substance abuse.
What's more, in an attempt to find the causative agent for the symptoms, many
unnecessary, and sometimes resource-intensive, diagnostics may be ordered, to no avail.
For example, because the symptoms of CO poisoning may mimic an intracranial bleed, the
time needed to obtain a negative result may hold up a proper diagnosis as well as
needlessly increasing healthcare costs. Of even greater concern, however, is that during
such delays patients may find that their symptoms abate and their health improves as the
hidden culprit, CO, is flushed from the blood during the normal ventilation patterns.
Indeed, multiple reports have shown patients being discharged and returned to the very
environment where exposure to CO took place. Take the case of a 67-year-old man who
sought medical help after three days of lightheadedness, vertigo, stabbing chest pain,
cough, chills and headache. He was admitted, evaluated and discharged with a diagnosis of
viral syndrome. Ten days later, he returned to the Emergency Department with vertigo,
palpitations and nausea but was sent home for outpatient follow-up. Four days later, he
presented again with diarrhea and severe chest pain, collapsing to the floor. This time, he
was admitted to the Coronary Care Unit with acute myocardial infarction. Among the results
of a routine arterial blood gas analysis there, it was found that his carboxyhemoglobin
(COHb) levels were 15.6%. A COHb level then obtained on his wife was 18.1%. A rusted
furnace was found to be the source.
There are two main types of CO poisoning: acute, which is caused by brief exposure to a
high level of carbon monoxide, and chronic or subacute, which results from long exposure to
a low level of CO. Patients with acute CO poisoning are more likely to present with more
serious symptoms, such as cardiopulmonary problems, confusion, syncope, coma, and
seizure. Chronic poisoning is generally associated with the less severe symptoms. Low-level
exposure can exacerbate angina and chronic obstructive pulmonary disease, and patients
with coronary artery disease are at risk for ischemia and myocardial infarction even at low
levels of CO.
Patients that present with low COHb levels correlate well with mild symptoms of CO
poisoning, as do cases that register levels of 50-70%, which are generally fatal. However,
intermediate levels show little correlation with symptoms or with prognosis. One thing that is
certain about COHb levels is that smokers present with higher levels than do non-smokers.
The COHb level in non-smokers is approximately one to two percent. In patients who
smoke, a baseline level of nearly five percent is considered normal, although it can be as
high as 13 percent. Although COHb concentrations between 11 percent and 30 percent can
produce symptoms, it is important to consider the patient's smoking status.
Regardless of the method of detection used in emergency department care, several other
variables make assessing the severity of the CO poisoning difficult. The length of time since
CO exposure is one such factor. The half-life of CO is four to six hours when the patient is
breathing room air, and 40-60 minutes when the patient is breathing 100 percent oxygen. If
a patient is given oxygen during their transport to the emergency department, it will be
difficult to know when the COHb level hit its highest point. In addition, COHb levels may not
fully correlate with the clinical condition of CO-poisoned patients because the COHb level in
the blood is not an absolute index of compromised oxygen delivery at the tissue level.
Furthermore, levels may not match up to specific signs and symptoms: patients with
moderate levels will not necessarily appear sicker than patients with lower levels.
In hospitals, the most common means of measuring CO exposure has traditionally been
through the use of a laboratory CO-Oximeter. A blood sample, under a physician order, is
drawn from either venous or arterial vessel and injected into the device. Using a method
called spectrophotometric blood gas analysis, this then measures the invasive blood
sample. Because the CO-Oximeter can only yield a single, discrete reading for each aliquot
of blood sampled, the reported value is a non-continuous snapshot of the patient's condition
at the particular moment that the sample was collected. It does, however, represent a step in
the right direction. One study found that in hospitals lacking such a device, the average time
it took to receive results of a blood sample sent to another facility was over fifteen hours,
compared to a ten-minute turnaround in CO-Oximeter equipped hospitals.
Text 1: Questions 7 to 14
1 In the first paragraph, what reason for the misdiagnosis of CO poisoning is highlighted?
A the limited experience physicians have of it
B the wide variety of symptoms associated with it
C the relative infrequency with which it is presented
D the way it is concealed by pre-existing conditions
2 In the second paragraph, the writer stresses the danger of delays in diagnosis leading to
A the inefficient use of scarce resources.
B certain symptoms being misinterpreted.
C a deterioration in the patient's condition.
D the evidence of poisoning disappearing.
3 The 67-year-old man's CO poisoning was only successfully diagnosed as a result of
A attending an outpatient clinic.
B his wife being similarly affected.
C undergoing tests as an inpatient.
D his suggesting the probable cause.
4 In the fourth paragraph, confusion is given as a symptom of
A short-term exposure to high levels of CO.
B repeated exposure to varying levels of CO.
C a relatively low overall level of exposure to CO.

D sustained exposure to CO over an extended period.
5 In the fifth paragraph, what point is made about COHb levels?
A They fail to detect CO poisoning in habitual smokers.
B They are a generally reliable indicator of CO poisoning.
C They correlate very well with extreme levels of CO poisoning.
D They are most useful in determining intermediate levels of CO poisoning.
6 The phrase 'one such factor' in the sixth paragraph refers to
A a type of care.
B a cause of difficulty.
C a method of detection.
D a way of making an assessment.
7 One result of administering oxygen to CO poisoned patients in transit is that
A it becomes harder to ascertain when the COHb level peaked.
B it may lead to changes in the type of symptoms observed.
C it could artificially inflate the COHb level in the short term.
D it affects the ability to assess the effects at tissue level.
8 What reservation about the CO-Oximeter does the writer express?
A It does not always give an immediate result.
B Its use needs to be approved by a physician.
C It requires a skilled analyst to interpret the readings.
D It does not show variations in the patient's condition.

Practice test

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LAST NAME:
FIRST NAME:
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PROFESSION:
VENUE:
TEST DATE:
CANDIDATE SIGNATURE
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Evaluating Cognitive Function
Text A
Terminology
Cognitive difficulties
Cognitive changes are normal for almost all people as they age, and assessment
should focus on differentiating the normal changes of ageing from abnormal
cognitive functioning. While concerns about memory are common in older patients,
when patients complain of memory problems, they could be referring to difficulties in
a number of possible cognitive domains. Although learning and memory is often the
most salient of these domains, the problems could also be in:
● attention (ability to sustain or shift focus),
● language (naming, producing words, comprehension, grammar or syntax),
● perceptual and motor skills (construction, visual perception),
● executive function (decision making, mental flexibility), or
● social cognition.
It is thus often more appropriate to refer to cognitive rather than memory complaints
or deficits.
Text B
Pharmacological treatments
There are currently no evidence-based recommendations on medications to treat mild
cognitive impairment (MCI). If dementia is suspected then specialist referral is recommended
for confirmation of the diagnosis. If Alzheimer’s disease is confirmed then pharmacological
treatment can be considered (e.g. acetylcholinesterase inhibitors such as donepezil,
galantamine or rivastigmine).
A psychiatric or psychogeriatric referral should be considered for:

● patients who do not respond to first- or second-line treatment
● patients with atypical mental health presentations
● patients with significant psychiatric histories, including complicated depression and/or
anxiety or comorbid severe mental illnesses such as schizophrenia and bipolar affective
disorder.
Follow up
If the diagnosis remains unclear after a detailed assessment then provide general advice
and watchfully wait. All patients should have a cognitive review with a screening instrument
every 12 months, or sooner if deterioration is detected by the patient or their family.
Risk factors for progression of MCI to dementia include older age, less education, stroke,
diabetes and hypertension. Patients who are younger, more educated with higher baseline
cognitive function and no amnesia symptoms are more likely to revert from MCI to normal
cognition. Even after 10 years, between 40 and 70% of patients with MCI may not have
developed dementia.
Text C
Domain Examples of Warning signs and questions
skills
Learning Short-term Have you noticed that you have been talking
and recall to someone and soon after forget the
memory Semantic and conversation?
autobiographical Have you had difficulty remembering the
Long-term names of people you have just met?
memory Have you had trouble keeping track of dates
Implicit learning and appointments?
Have you had any difficulty remembering
events from your past?
Have you had difficulty doing activities
previously thought as automatic, like driving
or typing?
[To informant] Has he or she been repeating
him or herself lately?
Language Object naming Have you noticed any word-finding
Word finding difficulties?
Receptive [To informant] Has he or she had more
language difficulty understanding you lately?
Executive Planning Have you had more difficulty managing your
function Decision making finances lately?
Working [To informant] Have you noticed difficulties
memory with his or her capacity to plan activities or
Flexibility make decisions?
Perceptual Visual Have you had trouble using day-to-day

motor perception objects, such as phone or cutlery?
function Perceptual- Have there been new driving difficulties such
motor Co- as staying in the lane?
ordination
Complex Sustained Are you having difficulty following what’s
attention attention going on around you?
Selective [To informant] Have you noticed that he or
attention she is more easily distracted?
Social Recognition of [To informant] Has he or she been behaving
Cognition emotions inappropriately in social situations?
Appropriateness Is he or she able to recognise social cues? Is
of behaviour to she or she able to motivate him or herself?
social norms
Text D
Dementia, now also referred to as ‘major neurocognitive disorder’ in

the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is defined by the
presence of substantial cognitive decline from a previous level of functioning to
the degree that the individual’s ability to live independently is compromised
owing to the cognitive deficits. Dementia is a syndrome with many possible
causes, with Alzheimer’s disease being the most common in older people. It is
generally of gradual onset with a chronic course, although there are exceptions.
Dementia must be distinguished from delirium (acute confusional state), which by
definition is of acute or recent onset and associated with loss of awareness of
surroundings, a global disturbance in cognition, changes in perception and the
sleep–wake cycle, and other features.
END OF PART A

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 Look at the four texts, A-D, in the separate Reading

 Spell all words correctly.

Pain Assessment Tools

Three ways of measuring pain:

• Self report – what the child says (the gold standard)

Wong-Baker faces pain scale

FLACC: Face, Legs, Activity, Cry and Consolability

1-The special access scheme should be used when

A. the patient requires specialised treatment.

3-The memo tells us that the new form

4-The guidelines inform us that pregnancy testing

A. a lack of agreement about the efficacy of MVM supplement use.

2-What are Dr JoAnn Manson’s views on multivitamins?

A. Far too many people take them.

A. the amount of categories it covered.

A. They are positive about their future application.

7-In the fifth paragraph, Dr Manson explains that supplements

A. should be regulated for use with particular diseases.

A. are ineffective in most situations.

3-What does the phrase ‘the effect’ refer to?

 Spell all words correctly.

The family should be encouraged to participate in the use of the Answer .

Convey information about the Answer of children in an understanding way.

“Ask and Assess – use percentile charts to monitor growth”

Steps for discussing weight with families or carers

1. Make the family feel welcome and at ease.

Steps for discussing weight with families or carers

1. Make the family feel welcome and at ease.

• During infancy: Low possibility

• During infancy: Low possibility

1-The instructions explain that when making emergency phone referrals

2-Philippe Hujoel’s comments in the first paragraph indicate that he believes

C. isn’t currently able to be measured.

 Look at the four texts, A – D, in the separate Text Booklet.

 Spell all words correctly.

Note: This is an automated system with a range of predetermined answers. As a result,

Major venomous snakes in Victoria and effects of envenomation:

Tiger VICC 30% 20% Common Rare 5%

Red- Mild increase - Uncommon Common - -

Myotoxicity muscle pain, tenderness, rhabdomyolysis

Systemic Symptoms see history and examination.

Focus on evidence of envenomation.

History and Examination

Circumstances Symptoms Examinations

- Confirmed or witnessed - Headache - Evidence of a bite/ multiple

Snakebite Management Flowchart

• Antivenom is indicated in all children where there is evidence of envenomation.

• Occurs in about 30% of children given antivenom.

1-The purpose of the email to hospitals about prescribing of antibiotics is to

DO NOT remove OET material from the test room.

• Look at the four texts, A-D, in the separate Text Booklet.

• 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.

SARS outbreak 2002-2003: Questions

For each question, 1-7,

any letter more than once.

In which text can you find information about

1 Importance of data collections in epidemics?

2 Case fatality ratios in each region?

3 Adjusted odds ratio of case fatalities?

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