Oet

OET 2.
0
READING
SUB-TEST
EXERCISES
& ANSWER KEY
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PREFACE
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Unlike paper books and other e books, you don’t have to scroll or turn pages
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Contents
Ease of Access
Method of Answering
Practice Test 1
Practice Test 2
Practice Test 3
Practice Test 4
Practice Test 5
Practice Test 6
Practice Test 7
Practice Test 8
Practice Test 9
Practice Test 10
Practice Test 11
Practice Test 12
Practice Test 13
Practice Test 14
Practice Test 15
Practice Test 16
Practice Test 17
Practice Test 18
Practice Test 19
Practice Test 20
Answer Key
MORE
OET BOOKS
BY
MAGGIE RYAN
METHOD OF ANSWERING
STEP 1.
FLASH READING
Flash reading refers to high-speed reading of the whole reading
passage in few minutes, without thinking anything in your head
(not even trying to guess meaning of the unfamiliar words/phrases).
It helps to provide a vague idea about the matters that are discussed
in the reading passage. It also forms a clear map in mind showing
the order of statements as they appear in the passage, which eases
locating the extract/paragraph referred in questions while
answering.
STEP 2.
FOCUSED READING
After finishing flash reading, start answering the questions.
Eliminate all the irrelevant and impossible options from the
multiple choices. Find a quick fix on location of the
extract/paragraph referred in the questions and read the
extract/paragraph quickly (strictly not more than twice, if it is a
paragraph and not more than thrice if it is a short extract) with
complete focus. Write the answer you had found only if you are
sure enough.
If the answer is confusing (if you find more than one possible
answer for the question), write the answer you think to have more
possibility to be correct on your answer sheet, along noting the
question and two or three other possible answer for later reference.
This will avoid wastage of time due to fixating over confusing
questions.
If the question is so tough that you fail to find a proper answer to it,
then leave it blank and note the question number for later reference.
Focused reading helps to answer all easy question in the reading
test correctly, instead of losing marks on them in the last minute
rush.
STEP 3.
THOROUGH READING
After finishing all the questions in the test, you can start answering
the tough questions by reading thoroughly the referred
extract/paragraph by reading. Thorough reading refers to slow
reading with maximum concentration to find all possible meanings
between the lines, so that you arrive at a possible answer. Don’t
read more than twice.
After finishing tough questions, start answering questions with
confusing answers in the same manner. If you follow these three
steps you can spend time wisely, while attending a reading test.
Avoid wasting time by going after tips for reading, when you are
not getting desired results.
There are only two things that can improve your OET reading
score:
1. Efficient management of time
2. Practicing more and more reading sample tests.
WORK HARD, SCORE MORE!
Practice Test 1
READING SUB-TEST – QUESTION PAPER: PART A
TIME: 15 MINUTES
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.
You must answer the questions within the 15-minute time limit.
One mark will be granted for each correct answer.
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.
DO NOT remove OET material from the test room.
Text A
Aspirin Resistance
Abstract
In the last few years, the concept of aspirin resistance has been
largely emphasised in the medical literature, although its definition,
mechanism, and specific guidelines for its management remain
unclear. Aspirin displays good antithrombotic activity. Various
laboratory parameters assessing the efficacy of aspirin like
bleeding time, platelet reactivity, thromboxane-A2 (TX-A2)
production, and measurement of platelet aggregation, have
confirmed the lack of its uniform effect on the platelets. Few
studies have reported aspirin resistance to the tune of 5 - 45%.
Various extrinsic and intrinsic factors influence the resistance.
Numerous studies reveal that aspirin resistance can be overcome by
combining it with another antithrombotic agent, i.e., clopidogrel.
Further, clopidogrel resistance has also been reported. So, much is
expected in the field of diagnostic tests in order to know the true
picture of aspirin resistance.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Text B
Mechanisms of aspirin resistance
The exact mechanisms are not clear:
True aspirin resistance:
The proposed factors for this type of resistance include:
i. Decreased bioavailability of aspirin.
ii. Accelerated platelet turnover introducing newly formed, non-
aspirinated platelets into the blood stream.
iii. Competition of aspirin with other NSAIDs (like ibuprofen)
preventing aspirin access at Serine 530 of Cox-I.
iv. Transcellular formation of TxA2 by aspirinated platelets from
PGH2 released by other blood cells or vascular cells.
v. TxA2 production by aspirin insensitive Cox-2 in newly formed
platelets or other cells.
vi. (Theoretical) presence of variant Cox-I which is less sensitive to
aspirin inhibition.
vii. Poor compliance by the patient.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Text C
Aspirin dosage
According to the Antithrombotic Trialists’ Collaboration, daily
doses of aspirin (75 - 150 mg) are as effective as higher doses for
prevention of thrombotic events and are associated with low risk of
bleeding. Bornstein et al in their study have shown that even 100
mg of aspirin completely inhibits Cox-1 enzyme, thus further
substantiating the fact that patients with resistance established
during low dose aspirin therapy may respond to higher doses. The
results of this study showed that aspirin in doses of 500 mg/day
significantly prolonged the time between first and second stroke (p
= 0.002) compared with lower doses. Helgason et al revealed that
an increase in the dose of aspirin to 625 that suboptimal reduction
of urinary 11-dehydro TxB2 level during aspirin treatment is
associated with increased risk for future MI and cardiovascular
death, thereby suggesting that “true aspirin resistance” may be a
clinically relevant phenomenon. Inadequate inhibition of TxA2
biosynthesis by aspirin can be seen in patients on ibuprofen
therapy, because of competition of these 14 mg/day in five patients
who were aspirin resistant with 325 mg/day showed aspirin
sensitivity. Another study has revealed that these patients remained
resistant with aspirin 1,300 mg. This shows that inadequate dose
cannot explain aspirin resistance in all subjects.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Text D
Management of aspirin resistance
Currently there are no specific guidelines for the management of
aspirin resistance. The first step is to enquire about the patient’s
compliance. Regarding optimal aspirin dosing, it is controversial.
No convincing data are available showing that the antithrombotic
effect of aspirin is dose related. The meta-analysis by Anti-
Thrombotic Trialist’s Collaboration refuted the claim that high
doses of aspirin (500 - 1,500 mg/day) were effective than low
doses (75 - 150 mg/day). Other method to manage aspirin
resistance is by addition of another antiplatelet agent – clopidogrel,
because CAPRIE trial has shown greater benefit of combination of
aspirin and clopidogrel compared with aspirin alone. The
combination of aspirin with clopidogrel is an ideal one since
clopidogrel inhibits another pathway of platelet activation.
However, till date, it is not clear whether the superiority of a
combination of clopidogrel and aspirin over aspirin is due to
clopidogrel compensation for aspirin non-responders. Resistance to
even clopidogrel has been reported, which is associated with an
increased risk of recurrent thrombotic events in patients with acute
MI.
.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Part A
TIME: 15 minutes
• Look at the four texts, A-D, in the separate Text Booklet.
• For each question, 1-20, look through the texts, A-D, to find the
relevant information.
• Write your answers on the spaces provided in this Question
Paper.
• Answer all the questions within the 15-minute time limit.
• Your answers should be correctly spelt.
QUESTIONS
Questions 1-7
For each question, 1-7, decide which text (A, B, C or D) the information
comes from. You may use any letter more than once.
In which text can you find information about

1. what are the factors of true aspirin resistance? _____
Go to “Text A” “Text B” “Text C” “Text D”
2. how much of aspirin completely inhibits Cox-1 enzyme? _____
3. what will happen if aspirin compete with other NSAIDs? _____
4. how the the true picture of aspirin resistance is revealed? _____
5. what are the parameters for assessing the efficacy of aspirin?
_____
6. list the methods to manage aspirin resistance? _____
7. whether true aspirin resistance is a clinically relevant
phenomenon? _____
Questions 8-13
Answer each of the questions, 8-13, with a word or short phrase from one of
the texts. Each answer may include words, numbers or both.
8. How much mg of aspirin is minimum required to completely
inhibit Cox-1 enzyme?
9. Which patients show inadequate inhibition of TxA2 biosynthesis by
aspirin?
10. Name the antiplatelet agent used to manage aspirin resistance?
11. What are responsible for transcellular formation of TxA2?
12. What is the daily doses range of aspirin according to the
Antithrombotic Trialists’Collaboration?
13. Which trial has shown greater benefit of combination of aspirin
and clopidogrel?
Questions 14-20
Complete each of the sentences, 14-20, with a word or short phrase
from one of the texts. Each answer may include words, numbers or
both.
14. Aspirin displays good _____ activity.
15. Few studies have reported aspirin resistance to the tune of
_____.
16. TxA2 may be produced by aspirin insensitive _____ in newly
formed platelets or other cells.
17. Increase in the dose of aspirin to 625 is associated with
increased risk for future MI and _____.
18. Inadequate inhibition of TxA2 ______ by aspirin can be seen in
patients on ibuprofen therapy.
19. The first step in management of aspirin resistance is to enquire
about the patient’s ______.
20. The combination of _____ with clopidogrel is an ideal one.
Answer Key
“Practice Test 1”
Practice Test 2
READING SUB-TEST – QUESTION PAPER: PART B & C
TIME: 45 MINUTES

Paper.
You must answer Part B & C within the 45-minute time limit.
the Text Booklet.
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.
Anaesthetic Machines
The anaesthetic machine (or anaesthesia machine in America) is used by
anaesthesiologists and nurse anaesthetists to support the administration of
anaesthesia. The most common type of anaesthetic machine is the
continuous-flow anaesthetic machine, which is designed to provide an
accurate and continuous supply of medical gases (such as oxygen and nitrous
oxide), mixed with an accurate concentration of anaesthetic vapour (such as
halothane or isoflurane), and deliver this to the patient at a safe pressure and
flow. Modern machines incorporate a ventilator, suction unit, and patient
monitoring devices.
1. The manual is giving information about
A. how to use anaesthetic machines
B. types of anaesthetic machines
C. an overview of anaesthetic machines
Autoclaves and Sterilizers
Sterilization is the killing of microorganisms that could harm patients. It can

be done by heat (steam, air, flame or boiling) or by chemical means.
Autoclaves use high pressure steam and sterilizers use boiling water mixed
with chemicals to achieve this. Materials are placed inside the unit for a
carefully specified length of time. Autoclaves achieve better sterilization than
boiling water sterilizers. Heat is delivered to water either by electricity or
flame. This generates high temperature within the chamber. The autoclave
also contains high pressure when in use, hence the need for pressure control
valves and safety valves. Users must be careful to check how long items need
to be kept at the temperature reached.
2. Why autoclaves are better than boiling water sterilizers?
A. Heat is transferred to water by electricity or flame
B. Autoclaves use high pressure steam
C. Autoclaves generates high temperature within the chamber
ECG: How it works
The electrical activity is picked up by means of electrodes placed on the skin.

The signal is amplified, processed if necessary and then ECG tracings
displayed and printed. Some ECG machines also provide preliminary
interpretation of ECG recordings. There are 12 different types of recording
displayed depending upon the points from where the recordings are taken.
Care must be taken to make the electrode sites clean of dirt before applying
electrode jelly. Most problems occur with the patient cables or electrodes.
3. The guidelines establish that the healthcare professional should
A. aim to make patients fully aware of how ECG works .
B. carefully clean the electrode sites.
C. respect the wishes of the patient above all else.
Benefits of electronic health records
EHR systems are complex applications which have demonstrated benefits.

Their complexity makes it imperative to have good application design,
training, and implementation. Studies have evaluated EHR systems and
reported on various benefits and limitations of these systems. Benefits
included increase in immunization rates, improved data collection, increased
staff productivity, increased visitor satisfaction with services, improved
communication, quality of care, access to data, reduced medical errors, and
more efficient use of staff time. Some of the disadvantages noted were: time-
consuming data entry, slow access of data and decreased quality of patient-
doctor interaction.
4. The notice is giving information about
A. pros and cons of electronic health records
B. necessity of electronic health records
C. demonstrated benefits of electronic health records
mHealth
The use of mobile technologies for data collection about individuals and
interactive information services are a part of a growing area of eHealth called
mHealth. The GOe published a volume on this subject in 2011 which
documents the uptake of mHealth worldwide by types of initiatives and main
barriers to scale. Mobile technologies are emerging as a powerful tool for
health information transfer including making patient information portable.
Such technologies can be more fully utilized through electronic patient
information such as EMRs and EHRs. Electronic records will work best,
however, if there are standards in place for their use and interoperability.
5. The note tells us that the mHealth

A. is a published volume on the GOe
B. is a powerful tool for information transfer
C. makes patient information portable
Systematized Nomenclature of Medicine (SNOMED)
SNOMED was designed to provide a comprehensive nomenclature of clinical

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

Nomenclature of Medicine?
A. is a multi-axial and hierarchical classification system
B. is a comprehensive nomenclature of trial medicines
C. is used to described any clinical condition through axis
Answer Key
Practice Test 3
TIME: 45 MINUTES

Paper.
the Text Booklet.
Part C
In this part of the test, there are two texts about different aspects of
healthcare. Choose the answer (A, B, C or D) which you think fits
best according to the text.
All life is connected

Cancer in Humans and Wildlife
WILDLIFE—HUMAN LINKS
Paragraph 1
It may be that biologists, rather than physicians, will be the major
contributors to the health of our wildlife caused by the combined action of
pesticides planet and its people. It was Rachel Carson, a biologist, who
researched and wrote of the harm to wildlife caused by the combined action
of pesticides and radiation. In the tradition of the observant biologist is Theo
Colborn, who, with her colleagues, provided a significant breakthrough in
understanding the hormonal effects of environmental contaminants. In July
1991, a gathering of some of the world’s most astute, - scientists were held at
the Wingspread Conference Center in Wisconsin, where they defined the
pattern of diverse endocrine malfunction seen throughout the animal
kingdom. They revealed a gm“: picture of the Brave New World we should
m rigorously seek not to leave as a legacy to our children.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 2
The conferees, studying wildlife over the globe, described ominous findings
of disease an linked to environmental pollution. Exposure to toxic chemicals
that possess unintended h actions has resulted in anatomic, physiologic,
reproductive, carcinogenic, and behavioral abnormalities across all forms of
animal life: in mollusks, fish, birds, seals, and rodents. These creatures are to
we humans as canaries were to the miners. We must understand that the
destruction of eons of evolutionary function and development in wildlife
foreshadows destruction of the entire biosphere, humans included.
Paragraph 3
These widespread adverse effects were attributed to xenoestrogens. Xeno -
comes from a Greek origin, meaning “foreign.” Foreign itself is not bad: how
else do we share and spread culture and ideas? But xenoestrogens are less
foreigners than invaders, gaining entrance by the Trojan horse of seemingly
harmless routes: milk, meat, cheese, fish, the products we use to nourish
ourselves and families. Like the invaders of Troy, after the xenoestrogens
gain entrance to the bodies of animals and humans alike, they weaken
defenses and wreak their harm of cancer, hormonal disruption,
immunological abnormalities, and birth defects.
Paragraph 4
Xenoestrogens are an insidious enemy, but they have had help from powerful
allies: the purveyors of products and chemicals, and legislators, regulators,
and scientists reluctant to bite the money- laden hands that feed them.
Wingspread researchers found that birds exposed to xenoestrogens show
reproductive failure, growth retardation, life-threatening deformities, and
alterations in their brains and liver functions.” There is direct experimental
evidence for permanent [organizational] effects of gonadal steroids on the
brain as well as reproductive organs throughout life. This means that
offspring whose brains have been altered are unable to function as had their
parents. They become different in ability or function.
Paragraph 5
This means that the sea of hormonally active chemicals in which the fetus
develops may change forever the health and function of the adult, and in
some cases, may alter the course of an entire species. Worldwide there are
reports of declining sperm counts and reduced ratio in births of male babies.
Without the capacity to reproduce, a species ceases to exist. Extinction is
forever; a species loss has never been reversed.
Paragraph 6
The data derived from animal observations are unequivocal: breast and
genital cancers, _ ital abnormalities, interference with sexual development,
and changes in reproductive behavior all expressions of a root cause. A
possible connection between women with breast cancer and those having
children with reversed sexual orientation is a question that bears study. This
is n n. from science fiction, considering what we have learned from observing
wildlife and the effects inappropriate hormonal influence upon the breast,
brain, and reproductive organs. If an unequivocal answer were to emerge
from human observation, it could have a significant impact upon the
prevailing political and economic landscape, and may finally settle the nature
or nu issue of sexual orientation.
Paragraph 7
SILENT SPRING-SILENT WOMEN
Considering the accumulated knowledge linking chemical and radioactive
contamination environment with increasing breast cancer rates means we
must focus our energies and prevention. Early were the eloquent words and
pleas for prevention from Rachel Carson. Her book, Silent Spring, originally
published in 1962, while she herself was suffering from breast cancer, is still
a best seller. Ms. Carson documented wholesale killing of species; animals,
birds, fish, insects; the destruction of food and shelter for wild creatures;
failure of reproduction; damage to the nervous system; tumors in wild
animals; increasing rates of leukemia in children; and chronicled the
pesticides and chemicals known at that time to cause cancer. This was over
30 years ago!
Paragraph 8
Carson’s is a book for every citizen, for without understanding of our
collective actions and permissions, we cannot govern democratically. In
Australia, a citizen is required to vote. In the United States, proclaimed by
some politicians as the “greatest democracy on earth,” often fewer than 50%
bother to vote in a major election. Of those who do take the time to register
and vote, few are sufficiently alert and/or educated to vote with intelligence,
thought, and compassion. Requiring participation in the governance of one’s
own country is not a bad idea. Requiring thoughtful voting may be more
difficult, especially when it comes to such issues as cancer, pesticide use,
consumer products, nuclear radiation, toxic chemicals, and environmental
destruction. Taking this thought one step further; this democracy could do far
worse than to require reading of Silent Spring as a requirement to vote!
Radical? Perhaps. But is the ongoing cancer epidemic any less radical?
Paragraph 9
One successor to Ms. Carson has emerged in the person of Sandra
Steingraber, an ecologist, poet, and scientist. In her book, Living
Downstream, she writes eloquently of the connections between
environmental contamination and cancer. Dr. Steingraber was diagnosed with
bladder cancer at age 20, a highly unusual diagnosis in a woman, a young
woman, a nonsmoker and nondrinker. She pursued the question, why? She
realized a connection with our wild relations and she asks: Tell me, does the
St. Lawrence beluga drink too much alcohol and does the St. Lawrence
beluga smoke too much and does the St. Lawrence beluga have a bad diet. . .
is that why the beluga whales are ill? ...Do you think you are somehow
immune and that it is only the beluga whale that is being affected?
Paragraph 10
The portion of Dr. Steingraber’s book that struck me most personally was
when she says: First, even if cancer never comes back, one’s life is utterly
changed. Second, in all the years I have been under medical scrutiny, no one
has ever asked me about the environmental conditions where I grew up, even
though bladder cancer in young women is highly unusual. I was once asked if
I had ever worked with dyes or had been employed in the rubber industry.
(No and no.) Other than these questions, no doctor, nurse, or technician has
ever shown interest in probing the possible causes of my disease-even when I
have introduced the topic. From my conversations with other cancers,
patients, I gather that such lack of curiosity in the medical community is
usual.
Paragraph 11
I take her words as an indictment of the medical and scientific establishment,
whose point of view must be changed. Certainly the lack of curiosity among
physicians, scientists, policymakers, and politicians has contributed to the
epidemic of illness among humans and wildlife alike. An equally talented
woman is Terry Tempest Williams, an ecologist and wildlife researcher
whose book, Refuge: An Unnatural History of Family and Place, tells the
story of her Utah family, whom she “labels “a clan of one—breasted
women.” Ms. Williams contrasts the life-affirming awareness Great Salt Lake
wildlife refuge against the erosion-of-being, as cancer takes away the women
in her family: her mother, her grandmothers, and six aunts. She writes: “I
cannot prove that my mother Diane Dixon Tempest, or my grandmothers,
Lettie Romney Dixon and Kathryn Blackett Tempest along with my aunts,
developed cancer from nuclear fallout in Utah. But I can’t prove that didn’t.”
Paragraph 12
Times are changing. It is becoming impossible to ignore the carnage of
endocrine-disruption chemicals, nuclear radiation, and chemical carcinogens,
alone and in combination, invading nearly every family with cancer. Facing
this reality may be too much for some people, afraid to look, or afraid of
being the next victim. The story of cancer is not an easy one, and neither is
cancer. But if we do not exert our efforts to prevent this disease, we doom our
children and grandchildren to repeat our collective errors. What does it take
to change from environmental destruction and random killing to affirmation
of life? Can the protection of life for ourselves and our environment be
accomplished by women with breast cancer; the women at risk for breast
cancer; the families of breast cancer victims? Who should lead? If we citizens
can’t and don’t try, what are our alternatives?
QUESTIONS
Q1. The author’s main contention is that
a. wildlife all around the world is being linked to environmental pollution
b. fish, birds, seals and canaries are being exposed to toxic chemicals
c. humans need to understand the link between destroying the planet’s
wildlife, through exposure to toxic chemicals, and the destruction of the
entire biosphere — which includes human life itself.
d. humans need to understand the link between destroying the planet’s
wildlife, through exposure to toxic chemicals, and behavioural abnormalities
across all forms of life.
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q2. The author states that in an environment of “hormonally active
chemicals”
a. males with higher sperm counts may result ‘
b. more male babies are born
c. lower sperm count in males may result in a particular species being wiped
out ‘
d. males with more sperm count may result
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q3. Dr Sandra Steingraber, ecologist, poet and scientist:
a. realised that contracting bladder cancer was not due to her alcohol drinking
b. realised her bladder cancer was not due to her smoking
c. believed her bladder cancer was due to environmental contamination
d. doctors, nurses and technicians were very interested in her unusual cancer
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q4. The wildlife researcher, Terry Tempest Williams, sees the dichotomy
which exists in the Salt Lake wildlife refuge area:
a. many women in her family have died from breast cancer after a nuclear
fallout in Utah
b. many men in her family have died from breast cancer
c. her family have many one-breasted women — unusual for Utah
d. such wide-spread cancer is probably due to environmental, not genetic
causes
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q5. Animal observations show:
a. changes in sexual maturity are not only due to a root cause
b. genital abnormalities may be due to a root cause
c. inappropriate hormones adversely affect the development of breast, brain
and reproductive organs
d. humans are not similarly affected.
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q6. The author puts forward several ideas about governance except for one of
the following:
a. People who participate in elections are not alert and educated enough
b. Unless the wants and needs of the population are known, it is difficult for
politicians to govern democratically
c. People being required to vote, to participate in the decision making
process, is a good idea
d. Reading Carson’s book, Silent Spring, should be made compulsory for all
voters.
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q7. Rachel Carson’s book Silent Spring, written in 1962, revealed:
a. more had to be done to prevent chemical contamination of the environment
b. there was a link between pesticides, chemicals and cancer
c. chemicals were leading to an inability to reproduce leading to the
eradication of entire species of insects, birds, fish and animals
d. all of the above
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q8. Research about xenoestrogens reveals
a. they are everywhere
b. they are harmless
c. they are in our everyday foods
d. they are in our everyday foods and disrupt hormonal function
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q9. Xenoestrogens
a. lead to birth deformities
b. alter genetically inherited abilities
c. continue to be used by profiteering stakeholders
d. all of the above
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q10. The author asserts:
a. people need to be aware of the dangers of chemicals, radiation, carcinogens
b. tackling cancer should be embraced not shunned
c. change should not be left to only those suffering from breast cancer
d. all of the above
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Answer Key
Practice Test 4
TIME: 45 MINUTES

Paper.
the Text Booklet.
Part C
Does Tamiflu really work?

Paragraph 1
The British Medical Journal (BMJ) was dominated in 2009 by a cluster of
articles on oseltamivir (Tamiflu). Between them the articles conclude that the
evidence that oseltamivir reduces complications in otherwise healthy people
with pandemic influenza is now uncertain and that we need a radical change
in the rules on access to trial data.
Paragraph 2
The use of meta-analysis is governed by the Cochrane review protocol.
Cochrane Reviews investigate the effects of interventions for prevention,
treatment and rehabilitation in a healthcare setting. They are designed to
facilitate the choices that doctors, patients, policy makers and others face in
health care. Most Cochrane Reviews are based on randomized controlled
trials, but other types of evidence may also be taken into account, if
appropriate.
Paragraph 3
If the data collected in a review are of sufficient quality and similar enough,
they are summarised statistically in a meta-analysis, which generally provides
a better overall estimate of a clinical effect than the results from individual
studies. Reviews aim to be relatively easy to understand for non-experts
(although a certain amount of technical detail is always necessary). To
achieve this, Cochrane Review Groups like to work with “consumers”, for
example patients, who also contribute by pointing out issues that are
important for people receiving certain interventions. Additionally, the
Cochrane Library contains glossaries to explain technical terms.
Paragraph 4
Briefly, in updating their Cochrane review, published in late 2009. Tom
Jefferson and colleagues failed to verify claims, based on an analysis of 10
drug company trials, that oseltamivir reduced the risk of complications in
healthy adults with influenza. These claims have formed a key part of
decisions to stockpile the drug and make it widely available.
Paragraph 5
Only after questions were put by the BMJ and Channel 4 News has the
manufacturer Roche committed to making “full study reports” available on a
password protected site. Some questions remain about who did what in the
Roche trials, how patients were recruited, and why some neuropsychiatric
adverse events were not reported. A response from Roche was published in
the BMJ letters pages and their full point by point response is published
online.
Paragraph 6
Should the BMJ be publishing the Cochrane review given that a more
complete analysis of the evidence may be possible in the next few months?
Yes, because Cochrane reviews are by their nature interim rather than
definitive. They exist in the present tense, always to be superseded by the
next update. They are based on the best information available to the
reviewers at the time they complete their review. The Cochrane reviewers
have told the BMJ that they will update their review to incorporate eight
unpublished Roche trials when they are provided with individual patient data.
Paragraph 7
Where does this leave oseltamivir, on which governments around the world
have spent billions of pounds? The papers in last years journal relate only to
its use in healthy adults with influenza. But they say nothing about its use in
patients judged to be at high risk of complications- pregnant women, children
under 5, and those with underlying medical conditions; and uncertainty over
its role in reducing complications in healthy adults still leaves it as a useful
drug for reducing the duration of symptoms. However, as Peter Doshi points
out on this outcome it has yet to be compared in head to head trials with non-
steroidal inflammatory drugs or paracetamol. And given the drug’s known
side effects, the risk-benefit profile shifts considerably if we are talking only
in terms of symptom relief.
Paragraph 8
We don’t know yet whether this episode will turn out to be a decisive battle
or merely a skirmish in the fight for greater transparency in drug evaluation.
But it is a legitimate scientific concern that data used to support important
health policy strategies are held only by a commercial organisation and have
not been subject to full external scrutiny and review. It can’t be right that the
public should have to rely on detective work by academics and journalists to
patch together the evidence for such a widely prescribed drug. Individual
patient data from all trials of drugs should be readily available for scientific
scrutiny.
QUESTIONS
Q1. A cluster of articles on oseltamivir in the British Medical Journal
conclude__________
a. complication are reduced in healthy people by oseltamivir
b. the efficacy of Tamiflu in now in doubt
c. complications from pandemic influenza are currently uncertain
d. a series of articles supporting Tamiflu
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q2. Cochrane Reviews are designed to __________
a. set randomized controlled trials to specific values
b. compile literature meta-analysis
c. peer review articles
d. influence doctors choice of prescription
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q3. According to the article, which one of the following statements about
Tamiflu is FALSE?
a. The use of randomized controls is suspect
b. The efficacy of Tamiflu is certain
c. Oseltamivir induces complications in healthy people
d. Cochrane reviews are useful when examining the efficacy of Tamiflu
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q4. According to the article, Cochrane Review Groups __________
a. like to work for “consumers”.
b. are being overhauled.
c. use language suitable for expert to expert communication.
d. evaluate a clinical effect better than individual studies.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q5. Which would make the best heading for paragraph 4?
a. Analysis of 10 drug company trials
b. The stockpiling of Oseltamivir
c. Risk of complications in healthy adults
d. Tamiflu claims fail verification
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Roche is TRUE?
a. Full study reports were made freely available on the internet
b. Patients were recruited through a double blind trial
c. The identities and roles of researcher in the Roche trials are not fully
accounted for
d. Not all neuropsychiatric adverse events were reported
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q7. Cochrane reviews should __________
a. use a more complete analysis
b. not be published until final data is available
c. be considered interim rather than definitive advice
d. be superseded by a more reliable method of reporting results
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q8. Which would make the best heading for paragraph 7?
a. Risk-benefit profile of Tamiflu
b. Studies limited to healthy adults
c. High risk of complications
d. Oseltamivir only for high risk patients
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q9. Which one of the following is given as THE LEAST CERTAIN
application of oseltamivir?
a. All of the below
b. Healthy adults with influenza
c. Patients judged to be at high risk of complications
d. In terms of symptom relief
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q10. From the article, it can be inferred that __________
a. Research on Tamiflu needs to be re-evaluated and more transparent
b. There is no need to stockpile Tamiflu
c. The studies by Roche may have been falsified
d. The effectiveness of Tamiflu in healthy adults is validated
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Answer Key
Practice Test 5
TIME: 15 MINUTES

Paper.
the Text Booklet.
Text A
Morgellons disease
lf you have fatigue, skin lesions, aches and pains and a sensation that insects
are crawling around under your skin, you most probably have Morgellons
disease. But this disease may actually not exist. Whether or not Morgellons is
a real disease, no one knows. Something like the symptoms described above,
supplemented by the appearance of strange fibres or filaments growing on or
just beneath the skin, was reported by the 17th-century physician Thomas
Browne. There were no other reported cases, and the disease seemed to
disappear. Then, in 2002, the mother of a child with a skin ailment
championed its comeback. Her child, she insisted, had Morgellons.
Delve into the medical literature, though, and Morgellons disease is
frequently described as “unexplained dermopathy” or “delusional parasitosis”
- a psychiatric illness that results in people mistakenly believing their skin to
be infested with parasites. We may soon find out more. The US Centers for
Disease Control and Prevention (CDC) is in the middle of a large, systematic
study into Morgellons. The study aims to determine whether there is actually
a physiological basis to the disease. The CDC is keeping an open mind on
Morgellons, says Michele Pearson, who is leading the study. “CDC has
approached this as an unexplained condition,” she says.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Text B
CDC, Kaiser to study puzzling illness
The Centers for Disease Control and Prevention and Kaiser Permanente‘s
Northern California Division of Research announced they are launching a
study to learn more about an unexplained skin condition called Morgellons
disease. The CDC will identify patients with the condition in Kaiser‘s
Northern California health plan. The study is expected to take at least 12
months. Reports of cases have been made in every state and 15 countries.
Many reported cases have been clustered in California, Texas and Florida,
according to the Mayo Clinic.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Text C
Delusional Parasitosis
Delusional Parasitosis is an uncommon psychiatric disorder presented by
persons with an unremitting false belief that they are infested with
ectoparasites or infected with endoparasites. The delusion is usually long-
standing and well integrated into the patient’s persona. Patients with the
disorder are predominantly older women, although younger people and men
can be affected. Most cases involve patient beliefs that the skin has been
invaded by insects, but some involve delusions that internal parasites are the
cause of their condition.
The causes for the disorder are not clear, but sufferers are generally of
average or higher intelligence and are otherwise functional. Patients with
delusional parasitosis generally have a long history of visiting physicians
seeking information of their diagnosis and help with their condition. The
patients have certain characteristics or exhibit behaviors that strongly suggest
the presence of the disorder. Moreover, these patients can be antagonistic and
relentless in their need to find someone who will agree with their self-
diagnosis and help them. Because these delusional patients may seek help
from non-physician medical professionals, such as parasitologists, clinical
microbiologists, entomologists, or biologists, such individuals should be
aware of this disorder. Delusional parasitosis can be treated with
antipsychotic medication and psychiatric consultations but generally does not
respond well to such treatment.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Part A
TIME: 15 minutes
Paper.
QUESTIONS
Questions 1-7

1. what is the minimum expected time period for CDC’s study to learn more
about Morgellons disease? _____
Go to “Text A” “Text B” “Text C”
2. what are the treatments for Morgellons disease? _____
3. name the places where Morgellons disease reported so far? _____
4. what is the aim for CDC’s study to learn more about Morgellons disease?
_____
5. which are the age groups predominantly affected by Morgellons
disease? _____
6. what is the current approach of CDC’s towards Morgellons disease?
_____
7. what are the other names of Morgellons disease? _____
Questions 8-13
8. Who reported a medical condition similar to Morgellons disease

for the first time?
9. Name the person who leads CDC’s study to learn more about Morgellons
disease?
10. Name the type of medications used to treat Morgellons disease?
11. How many countries reported Morgellons disease?
12. Name the type of illness under which the Morgellons disease is
classified?
13. what is the popular delusion of the people affected by Morgellons
disease?
Questions 14-20
both.
14. Morgellons disease is frequently described as _____ or “delusional
parasitosis”.
15. Morgellons disease is a psychiatric illness that results in people
mistakenly believing their skin to be infested with _____.
16. Many reported cases have been clustered in California, Texas and
Florida, according to the _____.
17. The _____ will identify patients with the condition in Kaiser‘s Northern
California health plan.
18. The delusion is usually long- standing and well integrated into the
patient’s _____.
19. Patients with delusional parasitosis generally have a long history of
visiting ______.
20. Patients with delusional parasitosis can be antagonistic and ______.
Answer Key
Practice Test 6
TIME: 45 MINUTES

Paper.
the Text Booklet.
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.
Electronic Diagnostic Equipment

There are many items of equipment in a hospital that use electronics for
operation. The maintenance of such equipment is a task for specialised and
trained staff. However, regular inspection and cleaning will help such
equipment last for a long time and deliver safe function. These are tasks that
the equipment user can carry out and should be done regularly, as laid out on
the checklists on the next pages. The types of equipment that might be
included in this category are for instance audiometers, blood gas analyzers,
cardiac monitors, cryoprobes, infusion pumps and stimulators. The steps in
this section can also be applied to most laboratory equipment, although it
should be noted that the WHO publication Maintenance Manual for
Laboratory Equipment deals with these in much better detail.
1. The type of equipment that might not be included in the category of
Electronic Diagnostic Equipment is
A. cardiac analyzers
B. stimulators
C. audiometers
Electrosurgical Units (ESU) and Cautery Machines
Electrosurgery is the application of a high-frequency electric current to

biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue.
Its benefits include the ability to make precise cuts with limited blood loss in
hospital operating rooms or in outpatient procedures. Cautery, or
electrocautery, is the application of heat to tissue to achieve coagulation.
Although both methods are sometimes referred to as surgical diathermy , this
chapter avoids the term as it may be confused with therapeutic diathermy,
which generates lower levels of heat within the body.
2. What does this manual tell us about electrocautery?
A. make precise cut with limited blood loss
B. uses high-frequency electric current
C. application of heat to tissue to achieve coagulation
Endoscopy
Endoscopy means looking inside the body using an endoscope, an instrument

used to examine the interior of a hollow organ or cavity of the body.
Endoscopes are inserted directly into the organ. An endoscope can consist of
a rigid or flexible tube, a light delivery system (light source), an optical fibre
system, a lens system transmitting the image to the viewer, an eyepiece and
often an additional channel to allow entry of medical instruments, fluids or
manipulators. There are many different types of endoscopy, including
arthroscopy, bronchoscopy, colonoscopy, colposcopy, cystoscopy,
laparoscopy and laryngoscopy.
3. What does this extract from a handbook tell us about endoscopes?
A. are inserted directly into the organ
B. used to examine the exterior of a hollow organ or cavity of the body
C. there are mainly 7 types
Messaging standards
Messaging is the electronic communication of health information from the

point of collection or storage to a point of use. This can be a short distance
such as within a clinic or larger distances across facilities or districts.
Messages can be used to retrieve historical data as well as current data. A
health message includes health data that is expressed in a standard
vocabulary. It may also include metadata about the definitions or
environment of the data. The message itself is in a precisely defined format
so that it can be received by a computer program which will understand its
meaning.
4. The email is reminding staff that the
A. health message should include health data expressed in a standard
vocabulary
B. health message should include metadata about the definitions or
environment of the data
C. health message should be precise in any format to be received by a
computer program
Communication skills during medical examination
An appropriate contact with the patient requires applying professional

knowledge about psychological aspects of interpersonal relations. While
examining the patient, most doctors apply just the experience or abilities to
establish interpersonal contacts that have been acquired on a social level. This
knowledge would definitely be insufficient in unusual and problematic
situations. For many years, clinical and social aspects of doctors’
psychological education have been neglected. The ability of conversation
should be based on appropriate education, not only on personal intuition or
own experience.
A. necessity of communication based on appropriate psychological education
B. necessity of establishing interpersonal contacts with patient
C. necessity of appropriate contact based on personal experience
Liver Palpation
Liver palpation is performed with the right hand placed flat under right costal
chest border, parallel to the long body axis, then applying pressure at the
depth of inspiration in an attempt to move under the costal border in the right
middle clavicular line and towards its right side. In normal conditions, the
lower liver border is not touched. During the respiration, the lower liver
border is slightly moving down and upwards.
If the liver edge can be detected on palpation, some additional features have
to be determined as there are various abnormalities related with specific
diseases.
6. What must all staff involved in liver palpation do?
A. should place right hand flat under right chest
B. should apply pressure at the depth of aspiration
C. should place left hand flat under right chest
Answer Key
Practice Test 7
TIME: 45 MINUTES

Paper.
the Text Booklet.
Part C
Tufts University faculty debunks common dental myths
Paragraph 1
Brushing, flossing, and twice-yearly dental check-ups are standard for oral
health care, but there are more health benefits to taking care of your pearly
whites than most of us know. In a review article, a faculty member at Tufts
University School of Dental Medicine (TUSDM) debunks common dental
myths and outlines how diet and nutrition affects oral health in children,
teenagers, expectant mothers, adults and elders.
Paragraph 2
Myth 1: The consequences of poor oral health are restricted to the
mouth
Expectant mothers may not know that what they eat affects the tooth
development of the fetus. Poor nutrition during pregnancy may make the
unborn child more likely to have tooth decay later in life. “Between the ages
of 14 weeks to four months, deficiencies in calcium, vitamin D, vitamin A,
protein and calories could result oral defects,” says Carole Palmer, EdD, RD,
professor at TUSDM and head of the division of nutrition and oral health
promotion in the department of public health and community service. Some
data also suggest that lack of adequate vitamin B6 or B12 could be a risk
factor for cleft lip and cleft palate formation
Paragraph 3
In children, tooth decay is the most prevalent disease, about five times more
common than childhood asthma. “If a child’s mouth hurts due to tooth decay,
he/she is less likely to be able to concentrate at school and is more likely to
be foods that are easier to chew but that are less nutritious. Foods such as
donuts and pastries are often lower in nutritional quality and higher in sugar
content than nutritious foods that require chewing, like fruits and vegetables,”
says Palmer. Oral complications combined with poor diet can also contribute
to cognitive and gr problems and can contribute to obesity
Paragraph 4
Myth 2: More sugar means more tooth decay
It isn’t the amount of sugar you eat; it is the amount of time that the sugar has
contact with the teeth. “Foods such as slowly-dissolving candies and soda are
in the mouth for longer periods of time. This increases the amount of time
teeth are exposed to the acids formed by oral bacteria from the sugars,” says
Palmer.
Paragraph 5
Some research shows that teens obtain about 40 percent of their carbohydrate
intake from soft drinks. This constant beverage use increases the risk of tooth
decay. Sugar-free carbonated drinks and acidic beverages, such as lemonade,
are often considered safer for teeth than sugared beverages but can also
contribute to demineralization of tooth enamel if consumed regularly.
Paragraph 6
Myth 3: Losing baby teeth to tooth decay is okay
It is a common myth that losing baby teeth due to tooth decay is insignificant
because baby teeth fall out anyway. Palmer notes that tooth decay in baby
teeth can result in damage to the developing crowns of the permanent teeth
developing below them. If baby teeth are lost prematurely, the permanent
teeth may erupt mal-positioned and require orthodontics later on.
Paragraph 7
Myth 4: Osteoporosis only affects the spine and hips
Osteoporosis may also lead to tooth loss. Teeth are held in the jaw by the face
bone, which can also be affected by osteoporosis. “So, the jaw can also suffer
the consequences of a diet lacking essential nutrients such as calcium and
vitamins D and K,” says Palmer. “The jawbone, gums, lips, and soft and hard
palates are constantly replenishing themselves throughout life. A good diet is
required to keep the mouth and supporting structures in optimal shape.”
Paragraph 8
Myth 5: Dentures improve a person’s diet
If dentures don’t fit well, older adults are apt to eat foods that are easy to
chew and low in nutritional quality, such as cakes or pastries. First, denture
wearers should make sure that dentures are fitted properly. In the meantime,
if they are having difficulty chewing or have mouth discomfort, they can still
eat nutritious foods by having cooked vegetables instead of raw, canned fruits
instead of raw, and ground beef instead of steak. Also, they should drink
plenty of fluids or chew sugar-free gum to prevent dry mouth,” says Palmer.
Paragraph 9
Myth 6: Dental decay is only a young person’s problem
In adults and elders, receding gums can result in root decay (decay along the
roots of teeth). Commonly used drugs such as antidepressants, diuretics,
antihistamines and sedatives increase the risk of tooth decay by reducing
saliva production. “Lack of saliva means that the mouth is cleansed more
slowly. This increases the risk of problems,” says Palmer. “In this case,
drinking water frequently can help cleanse the mouth.”
Paragraph 10
Adults and elders are more likely to have chronic health conditions, like
diabetes, which are risk factors for periodontal disease (which begins with an
inflammation of the gums and can lead to tooth loss). “Type 2 diabetes
patients have twice the risk of developing periodontal disease of people
without diabetes. Furthermore, periodontal disease exacerbates diabetes
mellitus, so meticulous oral hygiene can help improve diabetes control,” says
Palmer.
QUESTIONS
Q1. This article is about
a. how the nutritional needs of children, teenagers and expectant mothers has
an effect on oral health
b. how the oral health is affected by nutritional needs of children, teenagers,
expectant mothers and other groups.
c. how diet and nutritional needs of children, teenagers, mothers-to-be, and
adults affects one’s oral health
d. disproving some long held beliefs
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q2. Carole Palmer observes that
a. pies and pastries have low food value and require more chewing
b. lower nutritional quality food needs more chewing
c. nutritious foods like fruits and vegetables have less sugar and require more
chewing
d. too much vitamin B6 or B12 could lead to problems with cleft palate
formation
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q3. According to Palmer
a. asthma is five times less common in childhood than tooth decay
b. school kids with tooth decay pain may have concentration problems at
school
c. mouth and dental problems plus a poor diet can affect thinking abilities and
be a factor later on in obesity
d. all of the above
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q4. According to the article :
a. it’s important to make sure you retain baby teeth
b. It’s important that teeth are not exposed for a long time to acids formed by
oral bacteria as a result of eating sugary foods
c. it’s important to look after your baby teeth
d. it’s important that teeth are not exposed to acids formed by oral bacteria
from sugary foods
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q5. According to the article, baby teeth
a. are dispensable
b. develop to help eat food
c. if lost prematurely, may result in poor development of permanent teeth
d. help with correct development of permanent teeth
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q6. Dental health in older people requires
a. properly fitting dentures
b. a calcium rich diet
c. nutritious food containing vitamins D and K
d. all of the above
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q7. The article says that Osteoporosis
a. may prevent loss of teeth
b. may affect jaw bones
c. jaw bone health may be affected by chewing sugar-free gum
d. none of the above
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q8. Lack of saliva
a. all of the following
b. results in mouth being cleansed more slowly
c. can be addressed by chewing sugar-free gum
d. may increase the risk of tooth decay
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q9. Palmer says that Type 2 Diabetics
a. have the same amount of tooth decay as the rest of the population
b. develop periodontal disease twice as fast as the rest of the population
c. develop periodontal disease twice as fast as people without Type 2
Diabetes
d. can help themselves by watching their sugar intake
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q10. Dental decay is up to us
a. Teenagers obtain almost half their daily carbohydrate requirements from
soft drinks increasing the risk of tooth decay — so they should drink less
sugary drinks
b. Older adults with ill fitting dentures, often eat easily-chewable food, low in
nutritional quality — which leads to tooth decay — so they should get their
dentures fixed
c. If baby teeth are not looked after, they may need to come out prematurely,
thus affecting correct development of erupting permanent teeth — so parents
should make sure their children’s baby teeth are kept clean by regular
brushing
d. all of the above
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Answer Key
Practice Test 8
TIME: 45 MINUTES

Paper.
the Text Booklet.
Global Health Care Workforce
Paragraph 1
Health care systems worldwide continue to be plagued by difficulties in
recruiting and retaining health workers, resulting in a shortage of health care
professionals that is now considered a global crisis. However, although the
gap between the need for health care workers and the supply is experienced
globally, it widens disproportionately, so that the regions with the greatest
need have the fewest workers. For example sub-Saharan Africa and south-
east Asia together have 53% of the global disease burden but only 15% of the
world’s health care workforce. Moreover, the shortage experienced by
countries that can least afford it is exacerbated by health worker migration to
high-income countries. South Africa, for example, has fewer than 7 doctors
per 10,000 people, but reported in 2002 that 14% of the physicians who had
trained there had emigrated to the US or to Canada.
Paragraph 2
And the problem is not going away as in the UK, US, Canada and Australia,
23% C: to 28% of all physicians are international graduates. Efforts to reduce
migration usually focus on reducing recruitment by high-income countries,
and these efforts are gaining a higher profile. Improving the working
conditions in source countries has not received the same attention, however,
even though this would help counter the factors that push health professionals
to seek better conditions elsewhere. It would also make work healthier for
those who remain in lo income countries, and thereby reduce occupational
concerns such as injuries violence and stress, and exposure to biological,
chemical and physical hazards.
Paragraph 3
Although concerns about healthy work conditions exist to varying degrees
around the world, they are greatest in nations with few resources, and
particularly in Africa, where work conditions are the most challenging. It is
we] documented that health workers in low and middle-income countries
experience fear and frustration when caring for patients with tuberculosis and
blood—borne diseases, and that they do so often in difficult work
environments. Health workers may also be ostracised by their own
communities due to the ever present stigma associated with exposure. It is
now also well established that health workers are indeed at higher risk of
acquiring numerous infectious diseases.
Paragraph 4
International organizations are recognizing the importance of promoting and
protecting the health of the global health care workforce, which is
conservatively estimated to be 59 million, and are undertaking constructive
initiatives to do so. The World Health Organization (WHO) has explicitly
recognized the need to improve the environment of health care workers in
order to increase retention and is promoting the use of workplace audit
checklists to help guide the reduction of infectious disease transmission in
health care. WHO is also promoting the immunization of all health care
workers against hepatitis B, and, is working to move forward specific
Healthy Hospital Initiatives, which include projects that involve both
infection control and occupational health practitioners, and that train
practitioners along with health and safety representatives in conducting
workplace inspections.
Paragraph 5
Canada and other countries that receive health care workers from low
resource settings compromise the workforce in the source country as they
supplement their own. The situation is inequitable and, over time, will
undermine those low resources further, worsening the already challenging
working conditions and creating even more pressure for health care workers
to emigrate. To offset this effect, high-income countries can reciprocate by
improving working conditions in source countries. British Columbia, which
attracts the highest number of South African physicians of all Canadian
provinces, has taken a step in this positive direction by sharing expertise in
occupational health and infectious p disease transmission control through the
Pelonomi Hospital project.
Paragraph 6
At the university level, researchers and practitioners can contribute to this
knowledge exchange by partnering with their colleagues in low-income
countries. Such collaborations are essential. Also needed are intensified
efforts to promote further integration of worker safety and patient safety. To
ensure information systems being developed support this goal, we need to
promote evidence based decision making and share our information with
those who can; benefit from it. That way, each region will not need to find
millions of dollars annually to design, implement and maintain separate
systems that could b easily shared and reproduced.
Paragraph 7
To achieve this aim, we need international collaboration in order to reach
consensus on a data dictionary and complete the programming of non-
proprietary information systems such as OHASIS, which can be tailored to
different technological environments and made widely available using
Creative Commons licensing. Much of what needs to be done can be
accomplished with simple and effective solutions that benefit both patients
and workers. What it will take is commitment from high-income countries to
assist in the development, refinement and implementation of these tools in
collaboration with low-income countries. Such endeavours can be made
possible by making them a priority at the national funding level.
QUESTIONS
Q1. The main idea presented in paragraph 1 is__________
a. Recruiting health care workers is a problem in most countries
b. There is a shortage of health care workers in Sub-Saharan Africa and
Southeast Asia
c. There are not enough health care Workers in places which have the highest
need for medical treatment
d. A significant number of South African doctors are migrating to the US and
Canada
Paragraphs “1” “2” “3” “4” “5” “6” “7”
Q2. The main point raised by the authors in paragraph 2 is that__________
a. there are too many international graduates in UK, US, Canada and
Australia
b. high income countries must reduce recruitment of overseas heal
professionals
c. more effort is required to improve work conditions in source
d. work conditions in poorer countries are dangerous
Paragraphs “1” “2” “3” “4” “5” “6” “7”
Q3. According to paragraph 3 which of the following is false regarding
conditions in low & middle income countries?
a. Work conditions are most difficult in Africa
b. Health Workers fear exposure to contagious diseases
c. Health Workers feel frustration towards patients
d. Being exposed to infectious diseases may lead to shame within local
communities.
Paragraphs “1” “2” “3” “4” “5” “6” “7”
Q4. Regarding the size of the global health care workforce, we can infer
paragraph 4 that__________
a. there may be more than 59 million Workers
b. there may be less than 59 million workers
c. there are exactly 59 million Workers
d. the number of health care workers in unknown
Paragraphs “1” “2” “3” “4” “5” “6” “7”
Q5. According to paragraph 4, which of the following statements is true
regarding WHO?
a. WHO realises that improvements in the working environment of healthcare
workers is necessary
b. WHO wants to increase immunisation rates of health care workers against
hepatitis B
c. WHO is advancing Healthy Hospital Initiatives including training and
infection control
d. All of the above
Paragraphs “1” “2” “3” “4” “5” “6” “7”
Q6. In paragraph 5 the authors infer that__________
a. High-income countries have a responsibility to help build better working
conditions in low-income countries
b. High income countries should not recruit health professionals from low-
income countries
c. The working conditions in low-income countries is improving
d. British Columbia has stopped recruiting South African doctors
Paragraphs “1” “2” “3” “4” “5” “6” “7”
Q7. Which of the following is closest in meaning to the word reciprocate?
a. help
b. give back
c. support
d. take back
Paragraphs “1” “2” “3” “4” “5” “6” “7”
Q8. According to paragraph 6, which of the following statements is true?
a. Researchers and medical pracitioners in low & high income countries have
expressed a desire to work together
b. Improved safety of health workers and patients is a priority
c. Millions of dollars are needed to develop information systems that can be
shared between countries
d. None of the above
Paragraphs “1” “2” “3” “4” “5” “6” “7”
Q9. According to paragraph 7 which best describes OHASIS?
a. An information system which is available now
b. An information system with a non-commercial purpose
c. An information system which is privately owned
d. An information system which is easy to programme
Paragraphs “1” “2” “3” “4” “5” “6” “7”
Q10. Which of the following would the the best alternative title for this
essay?
a. The challenges faced by health professionals working in low-income
countries
b. The benefits enjoyed by health professionals who work in high-income
countries
c. Increasing migration of health professionals from high income to income
countries
d. Improving working conditions for health care professionals in low income
countries
Paragraphs “1” “2” “3” “4” “5” “6” “7”
Answer Key
Practice Test 9
TIME: 15 MINUTES

Paper.
the Text Booklet.
Tuberculosis, AIDS, and Death among Substance Abusers on Welfare in
New York City
Text A
Background
In New York City, the incidence of tuberculosis has more than doubled
during the past decade. We examined the incidence of tuberculosis and the
acquired immunodeficiency syndrome (AIDS) and the rate of death from all
causes in a very-high-risk group —indigent subjects who abuse drugs,
alcohol, or both.
Methods
In 2009 we began to study prospectively a cohort of welfare applicants and
recipients 18 to 64 years of age who abused drugs or alcohol. The incidence
rates of tuberculosis, AIDS, and death for this group were ascertained
through vital records and New York City’s tuberculosis and AIDS registries.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Text B
Results
The cohort was followed for eight years. Of the 858 subjects;
tuberculosis developed in 47 (5.5 percent),

84 (9.8 percent) were given a diagnosis of AIDS, and
183 (21.3 percent) died.
The rates of incidence per 100,000 person- years were
744 for tuberculosis,
1323 for AIDS, and
2842 for death.
In this group of welfare clients,
the rate of newly diagnosed tuberculosis was 14.8 times that of the
age matched general population of New York City;
the rate of AIDS was 10.0 times as high;
the death rate was 5.2 times as high.
no significant difference in the rate of new cases of tuberculosis
between subjects with positive skin tests and those with negative
skin tests at examination in 2009.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19”
Text C
Deaths in the cohort
There were 183 deaths in the cohort during follow-up (21.3 percent) of the
subjects, a rate of 2842 deaths per 100,000 person-years, 5.2 times that of the
age-matched general population.
Causes of death - Table 3
CAUSES OF DEATH IN THE STUDY GROUP
Causes of death No. of subjects Average Age at Death

(%) (years)
AIDS 66 (36.1%) 40
Infectious diseases 18 (9.8%) 43
Cirrhosis of the liver 16 (8.7%) 43
TB 11 (6%) 42
Coronary artery disease 10 (5.5%) 47
Pneumonia 9 (4.9%) 42
Cancer 8 (4.4%) 54
Overdose of non- narcotic 8 (4.4%) 42

substance
Other heart disease 7 (3.8%) 43
Drug dependence 4 (2.2%) 37
Alcohol abuse 3 (1.6%) 43
Cerebrovascular disease 3 (1.6%) 47
Diabetes 3 (1.6%) 53
Upper gastrointestinal bleeding 3 (1.6%) 44
Wound 3 (1.6%) 47
Chronic renal failure 2(1.1%) 59
Respiratory arrest 2(1.1%) 46
Other 7 (3.8%) 48
Total 183 43
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Text D
Conclusions
Of the 47 subjects with tuberculosis, 21 (44.7 percent) died before

the end of 2017;
12 (57.1 percent) of those who died also had AIDS.
Of 15 persons with both tuberculosis and AIDS, 12 (80.0 percent)
died before the end of 2017 and 8 died before completing anti-TB
therapy.
Of the 84 study subjects with AIDS, 68 (81.0 percent) died before
the end of 2017.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19”
Part A
TIME: 15 minutes
Paper.
QUESTIONS
Questions 1-7

1. what was the percentage of deaths caused by diabetes in the study group?
_____
2. what was the rate of incidence per 100,000 person per years for
tuberculosis? _____
3. name the city where the study was conducted? _____
4. how the incidence rates of diseases and death for the study group were
ascertained? _____
5. how many died before the end of 2017 without completing anti-TB
therapy? _____
6. what was the average age of subjects died due to other causes in the study
group? _____
7. how many years the cohort was followed? _____
Questions 8-13
8. How many of the study subjects with only AIDS died before the end of
2017?
9. In how many of the study subjects wound was the cause of death?
10. What was the age limits of the study subjects?
11. When did the study begin?
12. What was the total number of deaths in the study group?
13. What was the percentage of deaths caused by respiratory arrest in the
study group?
Questions 14-20
both.
14. The study shows that number of the incidence of tuberculosis in
New York City has more than _____ during the past decade.
15. In conclusion, 12 of those who died had both AIDS and _____.
16. In the cohort during follow-up of the subjects, rate of deaths was 5.2
times that of the _____ general population..
17. In the group of welfare clients, the rate of ____ was 10.0 times as high.
18. The study was conducted among _____ who abuse drugs, alcohol,
or both.
19. ______ subjects died suffering from coronary artery disease.
20. There were _____ subjects in the study group.
Answer Key
Practice Test 10
TIME: 45 MINUTES

Paper.
the Text Booklet.
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.
Incubators for Infant
The general principle is that air is processed before it reaches baby.

An electric fan draws room air through a bacterial filter which
removes dust and bacteria. The filtered air flows over an electric
heating element. The filtered and heated air then passes over a
water tank where it is moistened. It then flows on to the incubator
canopy. The incubator canopy is slightly pressurized. This allows
expired carbon dioxide to pass back into the room via the vent
holes and most of the air to be re-circulated. It also prevents
unfiltered air entering the system.
1. The extract informs us that the incubators
A. is likely to circulate most of the air again.
B. may not work correctly in close proximity to some other
devices.
C. prevents filtered air entering the system.
Nebulizers
A nebulizer is a device used to administer medication in the form

of a mist inhaled into the lungs. Nebulizers are commonly used for
treatment of cystic fibrosis, asthma and other respiratory diseases.
The reason for using a nebulizer for medicine to be administered
directly to the lungs is that small aerosol droplets can penetrate into
the narrow branches of the lower airways. Large droplets would be
absorbed by the mouth cavity, where the clinical effect would be
low. The common technical principle for all nebulizers is to use
oxygen, compressed air or ultrasonic power as means to break up
medical solutions or suspensions into small aerosol droplets.
A. ways of checking that a nebulizer has been placed correctly.
B. how the use of nebulizer is authorised.
C. why nebulizer are being used.
Oxygen Concentrators
Atmospheric air consists of approximately 80% nitrogen and 20%

oxygen. An oxygen concentrator uses air as a source of oxygen by
separating these two components. It utilizes the property of zeolite
granules to selectively absorb nitrogen from compressed air.
Atmospheric air is gathered, filtered and raised to a pressure of 20
pounds per square inch (psi) by a compressor. The compressed air
is then introduced into one of the canisters containing zeolite
granules where nitrogen is selectively absorbed leaving the residual
oxygen available for patient use. After about 20 seconds the supply
of compressed air is automatically diverted to the second canister
where the process is repeated enabling the output of oxygen to
continue uninterrupted.
3. What does this manual tell us about zeolite granules?
A. leave residual oxygen for patient use
B. selectively absorb nitrogen from air
C. absorb only nitrogen from compressed air
Arterial blood pressure
The arterial blood pressure (BP) is connected with the force, which is exerted
by the blood volume on the walls of the arteries. The level of BP is dependent
on two factors: the heart minute ejection volume and the elasticity of arterial
walls. Other factors affecting BP include: the volume and viscosity of the
blood, body position and emotional state. The BP at the top of pulse wave
(due to the constriction of heart ventricles) is called systolic BP, whereas the
respective one during the diastole is called diastolic BP. The difference
between systolic and diastolic BP is defined as amplitude or pulse pressure.
4. Which is the main factor behind BP level?
A. the heart minute rejection volume
B. volume and viscosity of the blood
C. elasticity of the arterial wall
Basic Life Support
Basic Life Support means saving lives by maintaining airway, supplying
ventilation (rescue breathing by blowing air to the victim’s mouth) and
supplying circulation (external cardiac massage – chest compressions)
performed without additional equipment. It is the first step in cardio-
pulmonary resuscitation (CPR) that should be initiated by bystanders and
continued until qualified help arrives. Next step is Advanced Life Support
(ALS), which is performed by medical services. People with cardiac arrest
(CA) need immediate CPR. First aid means BLS that is started by witnesses
before the emergency service arrival and is the key action in achieving patient
survival.
5. What does this manual tell us about cardio-pulmonary resuscitation?
A. should be initiated by bystanders
B. should be initiated immediately only for cardiac arrest
C. should be performed by medical services
Types of surgical threads
Materials, which the threads are made of, are divided into absorbable and
non- absorbable ones or natural and synthetic sutures. Non-absorbable
sutures are applied on the skin and in septic wounds. Absorbable threads,
depending on their structure are divided into monofilament, polifilament,
braided, plaits, coated and uncoated ones. Time of their absorbing is varied
and depends on material properties; it can take from 14 days to 6 months.
Absorbing progresses due to enzymatic disintegration and hydrolysis.
6. What does this extract from a handbook tell us about absorbable threads?
A. absorbing progresses due to enzymatic integration and hydrolysis
B. absorbing time is varied and depends on material properties
C. are divided into monofilament, polifilament, braided, plaits and uncoated
ones
Answer Key
Practice Test 11
TIME: 45 MINUTES

Paper.
the Text Booklet.
Targeting two important risk factors for cardiovascular disease and
other major risk factors that can be lowered by modification, treatment
or control
Paragraph 1
(ARA) - It’s well known that the prevalence of diabetes is on the rise.
According to the Centers for Disease Control and Prevention (CDC), about
23.6 million, or nearly 8 percent of people in the United States, have diabetes,
and 1.6 million new cases are diagnosed each year in people aged 20 and
older. Type 2 diabetes is the most common form, accounting for about 90 to
95 percent of those diagnosed, and occurs when the body either does not
produce enough insulin or does not respond to insulin.
Paragraph 2
But something that many people may not know is that in addition to having
diabetes, 70 percent of adults with type 2 diabetes also have high LDL
cholesterol (LDL-C), the “bad” cholesterol that can cause build-up in the
arteries, greatly increasing their risk for cardiovascular disease. Cholesterol is
needed for the body to function normally, but when there is too much LDL-C
in the bloodstream, it is deposited in arteries, including those of the heart,
which can limit blood flow and lead to heart disease.
Paragraph 3
The American Diabetes Association (ADA) and the American College of
Cardiology (ACC) emphasize that it is critical to control both cholesterol and
blood sugar Ievels. The ADA recommends that patients with type 2 diabetes
aim for an A1C level which reflects your average blood sugar level for the
past two to three months, of less than 7 percent. The National Cholesterol
Education Program (NCEP) ATP lll recommends that patients with type 2
diabetes target an LDL-C goal of less than 100 mg/dL.
Paragraph 4
Treating these two diseases can take a combination of efforts, including a
healthy diet and increased exercise. Medications are also sometimes needed.
While there are many drugs approved by the U.S. Food and Drug
Administration (FDA) to treat type 2 diabetes and others available to lower
LDL-C, a drug called Welchol (colesevelam HCI) is the first and only
medication approved as an adjunct to diet and exercise to reduce both A1C in
adults with type 2 diabetes and LDL-C in adults with elevated cholesterol.
Welchol addresses both of these chronic health conditions with one
medication and offers the convenience of two formulations, Welchol tablets
and Welchol for Oral Suspension. Welchol can be taken alone or with other
cholesterol lowering medications known as statins and can be added to other
anti-diabetic medications (metformin, sulfonylureas, or insulin).
Paragraph 5
“For patients with type 2 diabetes and high LDL cholesterol, it is important to
manage both conditions,” said Yehuda Handelsman, MD, FACP, FACE,
Medical Director of the Metabolic Institute of America in Tarzana, Calif.
“Welchol reduces these two risk factors for cardiovascular disease in adults
with type 2 diabetes by significantly lowering A1C and LDL-C or ‘bad’
cholesterol, providing a unique therapeutic option.” It is important to note
that the affect of Welchol on cardiovascular morbidity and mortality has not
been determined.
Paragraph 6
What are the major uncontrollable risk factors for coronary heart
disease?
The American Heart Association has identified several risk factors for
coronary heart disease. Some of them can be modified, treated or controlled,
and some can’t. The more risk factors a person has, the greater the chance
that he or she will develop heart disease. Also, the greater the level of each
risk factor, the greater the risk. For example, a person with a total cholesterol
of 300 mg/dL has a greater risk than someone with a total cholesterol of 240
mg/dL, even though all people with a total cholesterol of 240 or higher are
considered high risk.
Paragraph 7
Increasing age — About 82% of people who die of coronary heart disease
are 65 or older.
Male sex (gender) — The lifetime risk of developing CHD after age 40 is
49% for men and 32% for women. The incidence of CHD in women lags
behind men I years for total CHD and by 20 years for more serious clinical
events such as sudden death.
Paragraph 8
Heredity (including Race) — Children of parents with heart disease are
more likely to develop it themselves. African Americans have more severe
high blood pressure than Caucasians and a higher risk of heart disease. Heart
disease is also higher among Mexican Americans, American Indians, native
Hawaiians and some Asian Americans. This is partly due to higher rates of
obesity and diabetes. Most people with a strong family history of heart
disease have one or more other risk factors. Just as you can’t control your
age, sex and race, you can’t control your family history. Therefore, it’s even
more important to treat and control any other risk factors you have.
Paragraph 9
Other major risk factors that can be lowered by modification, treatment
or control
Tobacco smoke — Smokers’ risk of developing CHD is two to four times
that nonsmokers‘. Smokers who have a heart attack are more likely to die and
die suddenly (within an hour) than nonsmokers. Cigarette smoking also acts
with other risk factors to greatly increase the risk for coronary heart disease.
People who smoke cigars or pipes seem to have a higher risk of death from
coronary heart disease (and possibly stroke), but their risk isn’t as great as
cigarette smokers‘. Constant exposure to other people’s smoke — called
environmental tobacco smoke, secondhand smoke or passive smoking —
increases the risk of heart disease even for nonsmokers.
Paragraph 10
High blood cholesterol levels — The risk of coronary heart disease rises as
blood cholesterol levels increase. When other risk factors (such as high blood
pressure and tobacco smoke) are present, this risk increases even more. A
person’s cholesterol level is also affected by age, sex, heredity and diet.
High blood pressure — High blood pressure increases the heart’s workload,
causing the heart to enlarge and weaken over time. It also increases the risk
of stroke, heart attack, kidney failure and heart failure. When high blood
pressure exists with obesity, smoking, high blood cholesterol levels or
diabetes, the risk of heart attack or stroke increases several times.
Paragraph 11
Physical inactivity — An inactive lifestyle is a risk factor for coronary heart
disease. Regular, moderate-to-vigorous physical activity is important in
preventing heart and blood vessel disease.
Obesity and overweight — People who have excess body fat — especially
if a lot of it is in the waist area — are more likely to develop heart disease
and stroke even if they have no other risk factors. Excess weight increases the
strain on the heart, raises blood pressure and blood cholesterol and
triglyceride levels, and lowers HDL (good) cholesterol levels. It can also
make diabetes more likely to develop. Many obese and overweight people
have difficulty losing weight. If you can lose as little as 10 to 20 pounds, you
can help lower your heart disease risk.
Paragraph 12
Diabetes mellitus — Diabetes seriously increases the risk of developing
cardiovascular disease. Even when glucose levels are under control, diabetes
greatly increases the risk of heart disease and stroke. From two-thirds to three
—quarters people with diabetes die of some form of heart or blood vessel
disease.
Paragraph 13
What other factors contribute to heart disease risk?
Stress — Individual response to stress may be a contributing factor. Some
scientists have noted a relationship between coronary heart disease risk and
stress in a person’s life, their health behaviors and socioeconomic status.
These factors may affect established risk factors. For example, people under
stress may overeat, start smoking or smoke more than they otherwise would.
Paragraph 14
Excessive alcohol intake — Drinking too much alcohol can raise blood
pressure, cause heart failure and lead to stroke. It can contribute to high
triglycerides, cancer and other diseases, and produce irregular heartbeats. It
also contributes to obesity, alcoholism, suicide and accidents. The risk of
heart disease in people who drink moderate amounts of alcohol (an average
of one drink for women or two drinks for men per day) is lower than in
nondrinkers. One drink is defined as 1-1/2 fluid ounces (fl oz) of 80-proof
spirits (such as bourbon, Scotch, vodka, gin, etc.), 1 fl oz of 100- proof
spirits, 4 fl oz of wine, or 12 fl oz of beer. It’s not recommended that
nondrinkers start using alcohol or that drinkers increase their intake.
QUESTIONS
Q1. According to paragraph 1 of the article states that__________
a. Diabetes has stabilised
b. 1.6 million people aged 20 and older have diabetes
c. Type 2 diabetes is the most common
d. Type 2 diabetes occurs when there is an over-production of insulin
Para- “1” “2” “3” “4” “5” “6” “7”
graphs “8” “9” “10” “11” “12” “13” “14”
Q2. In addition to having diabetes__________
a. 30% of adult with Type 2 diabetes do not have high counts of low density
lipids
b. 70% of adults with Type 2 diabetes do have high counts of low density
lipids
c. Too many LDLs in the bloodstream go straight to the heart
d. LDLs in the bloodstream cannot hinder blood flow
Para- “1” “2” “3” “4” “5” “6” “7”
graphs “8” “9” “10” “11” “12” “13” “14”
Q3. According to the ADA and the ACC__________
a. Both blood sugar levels and cholesterol levels need to be controlled if
diabetes is avoided
b. Blood sugar levels need to be controlled if diabetes is to be avoided
c. ACA believes less than 7% average blood sugar level over a one month
period indicates diabetes risk
d. The NCEP does not recommend Type 2 diabetics aim for less than 100
mg/dL of low density lipids
Para- “1” “2” “3” “4” “5” “6” “7”
graphs “8” “9” “10” “11” “12” “13” “14”
Q4. Welchol, a drug to lower the level of LDLs in the blood__________
a. has not been approved by the U.S. FDA
b. Welchol must be taken with other statins
c. Welchol should not be added to medications such as metformin,
sulfonylureas or insulin.
d. Welchol needs to be taken together with a healthy diet and an exercise
program to reduce A1C in Type 2 diabetics and LDL-C in adults with
elevated cholesterol levels.
Para- “1” “2” “3” “4” “5” “6” “7”
graphs “8” “9” “10” “11” “12” “13” “14”
Q5. Welchol’s affect on cv mobidlty and mortality..
a. is supported by the evidence
b. has not been positively established
c. has been positively established
Para- “1” “2” “3” “4” “5” “6” “7”
graphs “8” “9” “10” “11” “12” “13” “14”
Q6. Some risk factors can be controlled, or lowered; some cannot be
controlled: such as advancing age, one’s gender, and one’s genetic
inheritance. However, there are some major risk factors that can be lowered
— by modifying one’s lifestyle - or by medical intervention.
Risk factors such as__________
a. high blood pressure
b. high cholesterol levels
c. obesity
d. all of the above
Para- “1” “2” “3” “4” “5” “6” “7”
graphs “8” “9” “10” “11” “12” “13” “14”
Q7. The article states that stress __________
a. causes overeating and/or habitual smoking
b. does not interact with lifestyle and socioeconomic status
c. depends on how one reacts to it
d. may depend on how one reacts to it
Para- “1” “2” “3” “4” “5” “6” “7”
graphs “8” “9” “10” “11” “12” “13” “14”
Q8. Alcohol contributes to heart failure and strokes;
a. if you drink very less amount
b. moderate alcohol intake leads to less risk of heart disease
c. but not contribute to high triglycerides
d. is not a factor in developing cancer
Para- “1” “2” “3” “4” “5” “6” “7”
graphs “8” “9” “10” “11” “12” “13” “14”
Q9. To have just “one drink” of alcohol, means __________
a. to consume no more than 1½ fluid ounces
b. to consume 4 fluid ounces
c. to consume 12 fluid ounces
d. depends on the type of alcohol
Para- “1” “2” “3” “4” “5” “6” “7”
graphs “8” “9” “10” “11” “12” “13” “14”
Q10. High blood pressure and physical inactivity__________
a. are contributing factors for coronary heart disease
b. people with high blood pressure should not do physical activities
c. people with high blood pressure have no risk of renal failure
d. to prevent heart disease, one should have regular mild physical activity
Para- “1” “2” “3” “4” “5” “6” “7”
graphs “8” “9” “10” “11” “12” “13” “14”
Answer Key
Practice Test 12
TIME: 45 MINUTES

Paper.
the Text Booklet.
Fluoride
Paragraph 1
Globalization has provoked changes in many facets of human life,
particularly in diet. Trends in the development of dental caries in population
have traditionally followed developmental patterns where, as economies
grow and populations have access to a wider variety of food products as a
result of more income and trade, the rate of tooth decay begins to increase.
As countries become wealthier, there is a trend to greater preference for a
more “western” diet, high in carbohydrates and refined sugars. Rapid
globalization of many economies has accelerated this process. These dietary
have a substantial impact on diseases such as diabetes and dental caries.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9”
Paragraph 2
The cariogenic potential of diet emerges in areas where fluoride
supplementation is inadequate. Dental caries is a global health problem and
has a significant negative impact on quality of life, economic productivity,
adult and children’s general health and development. Untreated dental caries
in pre-school children is associated with poorer quality of life, pain and
discomfort, and difficulties in ingesting food that can result in failure to gain
weight and impaired cognitive development. Since low-income countries
cannot afford dental restorative treatment and in general the poor are most
vulnerable to the impacts of illness, they should be afforded a greater degree
of protection.
Paragraph 3
By WHO estimates, one third of the world‘s population have inadequate
access to needed medicines primarily because they cannot afford them.
Despite the inclusion of sodium fluoride in the World Health Organization‘s
Essential Medicines Model List, the global availability and accessibility of
fluoride for the prevention of dental caries remains a global problem. The
optimal use of fluoride is an essential and basic public health strategy in the
prevention and control of dental caries, the most common non-
communicable disease on the planet. Although a whole range of effective
fluoride vehicles are available for fluoride use (drinking water, salt, milk,
varnish, etc.), the most widely used method for maintaining a constant low
level of fluoride in the oral environment is fluoride toothpaste.
Paragraph 4
More recently, the decline in dental caries amongst school children in Nepal
has been attributed to improved access to affordable fluoride toothpaste. For
many low-income nations, fluoride toothpaste is probably the only realistic
population strategy for the control and prevention of dental caries since
cheaper alternatives such as water or salt fluoridation are not feasible due to
poor infrastructure and limited financial and technological resources. The use
of topical fluoride e.g. in the form of varnish or gels for dental caries
prevention is similarly impractical since it relies on repeated applications of
fluoride by trained personnel on an individual basis and therefore in terms of
cost cannot be considered as part of a population based preventive strategy.
Paragraph 5
The use of fluoride toothpaste is largely dependent upon its socio-cultural
integration in personal oral hygiene habits, availability and the ability of
individuals to purchase and use it on a regular basis. The price of fluoride
toothpaste is believed to be too high in some developing countries and this
might impede equitable access. In a survey conducted at a hospital dental
clinic in Lagos, Nigeria 32.5% of the respondents reported that the cost of
toothpaste influenced their choice of brands and 54% also reported that the
taste of toothpastes influenced their choice.
Paragraph 6
Taxes and tariffs on fluoride toothpaste can also significantly contribute to
high prices, lower demand and inequity since they target the poor.
Toothpastes are u; classified as a cosmetic product and as such often highly
taxed by governments. For example, various taxes such as excise tax, VAT,
local taxes as well as taxation on the ingredients and packaging contribute to
25% of the retail cost of toothpaste in Ne and India, and 50% of the retail
price in Burkina Faso. WHO continues to recommend the removal taxes and
tariffs on fluoride toothpastes. Any lost revenue can be rest by higher taxes
on sugar and high sugar containing foods, which are common risk factors for
dental caries, coronary heart disease, diabetes and obesity.
Paragraph 7
The production of toothpaste within a country has the potential to make
fluoride toothpaste more affordable than imported products. In Nepal,
fluoride toothpaste was limited to expensive imported products. However,
due to successful advocacy locally manufactured fluoride toothpaste, the least
expensive locally manufactured fluoride toothpaste is now 170 times less
costly than the most expensive imported Philippines, local manufacturers are
able to satisfy consumer preferences and compete against multinationals by
discounting the price of toothpaste by as much as 55% against global brands;
and typically receive a 40% profit margin compared to 70% for multinational
producers.
Paragraph 8
In view of the current extremely inequitable use of fluoride throughout
countries and regions, all efforts to make fluoride and fluoride toothpaste
affordable and accessible must be intensified. As a first step to addressing the
issue of affordability of fluoride toothpaste in the poorer countries in-depth
country studies should be undertaken to analyze the price of toothpaste in the
context of the country economies.
QUESTIONS
Q1. Which of the following would be the most appropriate heading for the
paragraph 1?
a. High sugar intake and increasing tooth decay
b. Globalisation, dietary changes and declining dental health
c. Dietary changes in developing nations
d. Negative health effects of a western diet
Para- “1” “2” “3” “4”
graphs “5” “6” “7” “8”
Q2. Which of the following is not mentioned as a negative effect of untreated
dental caries in pre-school children?
a. Decreased mental alertness
b. Troubling chewing and swallowing food
c. Lower life quality
d. Reduced physical development
Para- “1” “2” “3” “4”
graphs “5” “6” “7” “8”
Q3. According to paragraph 3, which of the following statement is correct?
a. Dental caries is the most contagious disease on earth.
b. Fluoride in drinking water is effective but rarely used
c. Fluoride is too expensive for a large proportion of the global population.
d. Fluoride toothpaste is widely used by 2/3 of the world’s population.
Para- “1” “2” “3” “4”
graphs “5” “6” “7” “8”
Q4. Fluoride toothpaste is considered the most effective strategy to reduce
dental caries in low income countries because.....
a. it is the most affordable.
b. topical fluoride is unavailable.
c. it does not require expensive infrastructure or training.
d. it was effective in Nepal.
Para- “1” “2” “3” “4”
graphs “5” “6” “7” “8”
Q5. Which of the following is closest in meaning to the word impede?
a. stop
b. prevent
c. hinder
d. postpone
Para- “1” “2” “3” “4”
graphs “5” “6” “7” “8”
Q6. Regarding the issue of taxation in paragraph 6 which of the following
statements is most correct?
a. Income tax rates are higher in Burkina Faso than India or Nepal.
b. WHO recommends that tax on toothpaste be reduced.
c. Governments would like to reduce tax on toothpastes but can’t as it is
classified as a cosmetic.
d. WHO suggests taxing products with a high sugar content instead of
toothpastes.
Para- “1” “2” “3” “4”
graphs “5” “6” “7” “8”
Q7. Which of the following is closest in meaning to the word advocacy?
a. marketing
b. demand
c. development
d. support
Para- “1” “2” “3” “4”
graphs “5” “6” “7” “8”
Q8. Statistics in paragraph 7 indicate that....
a. local products can’t compete with global products and make a profit at the
same time.
b. Philippine produced toothpaste is profitable while being less than half the
price of global brands.
c. in Nepal, fluoride toothpaste is limited to imported products which are very
expensive
d. toothpaste produced in the Philippines has a higher profit margin than
internationally produced toothpaste.
Para- “1” “2” “3” “4”
graphs “5” “6” “7” “8”
Q9. What would make the most suitable alternative title for the article
a. Globalisation and declining dental health
b. Best practice in global fluoride supplementation
c. Increased dental problems in developing countries
d. Global affordability of fluoride toothpaste
Para- “1” “2” “3” “4”
graphs “5” “6” “7” “8”
Answer Key
Practice Test 13
TIME: 15 MINUTES

Paper.
the Text Booklet.
Text A
Economy Class Syndrome
International flights are suspected of contributing to the formation of DVT in
susceptible people, although the research evidence is currently divided. Some
airlines prefer to err on the side of caution and offer suggestions to
passengers on how to reduce the risk of DVT. Suggestions include:
Wear loose clothes

Avoid cigarettes and alcohol
Move about the cabin whenever possible
Don’t sit with your legs crossed
Perform leg and foot stretches and exercises while seated
Consult with your doctor before travelling
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19”
Text B
Previous research
Venous thrombosis was first linked to air travel in 1954, and as air travel has
become more and more common, many case reports and case series have
been published since. Several clinical studies have shown an association
between air travel and the risk of venous thrombosis. English researchers
proposed, in a paper published in the Lancet, that flying directly increases a
person’s risk. The report found that in a series of individuals who died
suddenly at Heathrow Airport, death occurred far more often in the arrival
than in the departure area.
Two similar studies reported that the risk of pulmonary embolism in air
travelers increased with the distance traveled. In terms of absolute risk, two
studies found similar results: one performed in New Zealand found a
frequency of 1% of venous thrombosis in 878 individuals who had traveled
by air for at least 10 hours. The other was a German study which found
venous thrombotic events in 2.8% of 964 individuals who had traveled for
more than 8 hours in an airplane. In contrast, a Dutch study found no link
between DVT and long distance travel of any kind.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Text C
Symptoms
Pain and tenderness in the leg

Pain on extending the foot
Tenderness in calf (the most important sign)
Swelling of the lower leg, ankle and foot
Redness in the leg
Bluish skin discoloration
Increased warmth in the leg
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19”
Text D
Travel-Related Venous Thrombosis: Results from a Large Population-
Based Case Control
Study
Background
Recent studies have indicated an increased risk of venous thrombosis after air
travel. Nevertheless, questions on the magnitude of risk, the underlying
mechanism, and modifying factors remain unanswered.
Methods
We studied the effect of various modes of transport and duration of travel on
the risk of venous thrombosis in a large ongoing case-control study on risk
factors for venous thrombosis in an unselected population. We also assessed
the combined effect of travel in relation to body mass index, height, and oral
contraceptive use. Since March 2015, consecutive patients younger than 70
years of age with a first venous thrombosis have been invited to participate in
the study, with their partners serving as matched control individuals.
Information has been collected on acquired and genetic risk factors for
venous thrombosis.
Results
Of 1,906 patients, 233 had traveled for more than 4 hours in the 8 weeks
preceding the event. Traveling in general was found to increase the risk of
venous thrombosis. The risk of flying was similar to the risks of traveling by
bus or train. The risk was highest in the first week after traveling. Travel by
bus, or train led to a high relative risk of thrombosis in individuals with factor
V Leiden, in those who had a body mass index of more than 30, those who
were more than 190 cm tall, and in those who used oral contraceptives. For
air travel these people shorter than 160 cm had an increased risk of
thrombosis after air travel as well.
Conclusions
The risk of venous thrombosis after travel is moderately increased for all
modes of travel. Subgroups exist in which the risk is highly increased.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Part A
TIME: 15 minutes
Paper.
QUESTIONS
Questions 1-7

1. what are the symptoms of DVT? _____
2. how much risk of DVT is there in the first week after traveling? _____
3. what is the most important sign of DVT? _____
4. when did DVT was first linked to air travel? _____
5. what are the safe practices to reduce the risk of DVT? _____
6. which exercises reduce the risk of DVT? _____
7. what were the conclusions of the Dutch study on DVT? _____
Questions 8-13
8. What is the type of skin discolouration seen in DVT patients?
9. What type of clothes reduce the risks of DVT?
10. Which type of flights are more suspected of contributing to the formation
of DVT?
11. Name the physical activity which was found to increase the risk of
DVT in general?
12. Which type of population was the subject for travel related
DVT study?
13. Name the body part/s were tenderness was observed as a symptom of
DVT?
Questions 14-20
both.
14. The risk of flying was similar to the risks of traveling by _____.
15. Recent studies have indicated an increased risk of venous thrombosis
after _____.
16. _____ of the lower leg, ankle and foot is a symptom of DVT.
17. Several _____ have shown an association between air travel and the risk
of venous thrombosis.
18. _____ in general was found to increase the risk of venous thrombosis.
19. Venous thrombosis was first linked to air travel in ______.
20. Some airlines offer _____ to passengers on how to reduce the risk of
DVT.
Answer Key
Practice Test 14
TIME: 45 MINUTES

Paper.
the Text Booklet.
Part B
text.
Flowmeter
A flowmeter is an instrument used to measure the flow rate of a
liquid or a gas. In healthcare facilities, gas flowmeters are used to
deliver oxygen at a controlled rate either directly to patients or
through medical devices. Oxygen flowmeters are used on oxygen
tanks and oxygen concentrators to measure the amount of oxygen
reaching the patient or user. Sometimes bottles are fitted to
humidify the oxygen by bubbling it through water.
1. The purpose of bottles that are fitted with flowmeter is to
A. humidify the oxygen tanks by bubbling it through water
B. humidify the oxygen reaching the patient or user
C. dehumidify the gas in the flowmeter
Pulse Oximeters: Non-invasive monitors
The coloured substance in blood, haemoglobin, is carrier of oxygen
and the absorption of light by haemoglobin varies with the amount
of oxygenation. Two different kinds of light (one visible, one
invisible) are directed through the skin from one side of a probe,
and the amount transmitted is measured on the other side. The
machine converts the ratio of transmission of the two kinds of light
into a % oxygenation. Pulse oximeter probes can be mounted on
the finger or ear lobe.
2. What does this notes tell us about pulse oximeters?
A. levels varies with amount of oxygenation
B. converts percent of light into a % oxygenation
C. probes can be mounted either on finger or earlobe
Measuring Patient Weight
Measuring patient weight is an important part of monitoring health

as well as calculating drug and radiation doses. It is therefore vital
that scales continue to operate accurately. They can be used for all
ages of patient and therefore vary in the range of weights that are
measured. They can be arranged for patients to stand on, or can be
set up for weighing wheelchair bound patients. For infants, the
patient can be suspended in a sling below the scale or placed in a
weighing cot on top of the scale.
3. These notes are reminding staff that the
A. importance of precise reading of scales to monitor health of
patient
B. infants should stand in a weighing cot on top of the scale
C. wheelchair bound patients should be suspended in a set up
Breast Examination
Detection of changes in the breast depends on routine medical
check-ups, especially by an oncologist, regular breast scanning and
mammography, and women’s self-examination. If early detected, a
tumor is usually small, and the smaller it is, the less probability of
metastases. Early detection considerably improves prognosis in
women with breast cancer. Mammography enables detection of
breast cancer at least one year ahead of its manifestations. The
smallest clinically palpable tumor is about 1 cm in size.
4. The purpose of these notes about mammography is to

A. help maximisie awareness about its efficiency
B. give guidance on early detection and prognosis
C. decrease probability of metastases
Catheterization
Regardless of the instrumental examination carried out in the

urinary tract, it is obligatory to maintain perfectly sterile
conditions, to apply analgesic and sedative drugs in order to
alleviate patient’s suffering, and to use gel substances that facilitate
the introduction of the instrument into the urinary tract. While
introducing instruments into the bladder, it is necessary to
remember about overcoming the resistance of the urethral sphincter
gently.
5. What must all staff involved in the catheterization process do?

A. maintain perfect aseptic conditions
B. use non lubricant substances
C. inhibit analgesic and sedative drugs
Ophthalmoscopy
Direct ophthalmoscopy is the most common method of examining
the eye fundus. It provides a 15x magnified upright image of the
retina. Ophthalmoscopy is much easier through a dilated pupil.
Tropicamide 1% drops (0.5% for children) are recommended. The
pupil mydriasis starts 10 to 20 minutes after installation and lasts
for 6-8 hours. There is a small risk of angle closure glaucoma
caused by mydriasis in eyes with shallow anterior chambers,
particularly in elderly patients.

A. recommend 1% drops of Tropicamide for elderly patients
B. recommend 5% drops of Tropicamide for children
C. recommend 10% drops of Tropicamide for elderly patients
Answer Key
Practice Test 15
TIME: 45 MINUTES

Paper.
the Text Booklet.
Is ADHD a valid diagnosis in adults?
Paragraph 1
Attention deficit hyperactivity disorder (ADHD) is well established in
childhood, with 3.6% of children in the United Kingdom being affected.
Most regions have child and adolescent mental health or paediatric services
for ADHD. Follow-up studies of children with ADHD find that 15% still
have the full diagnosis at 25 years, and a further 50% are in partial remission,
with some symptoms associated with clinical and psychosocial impairments
persisting.
Paragraph 2
ADHD is a clinical syndrome defined in the Diagnostic and Statistical
Manual of Mental Disorders, fourth edition, by high levels of hyperactive,
impulsive, and inattentive behaviours in early childhood that persist over
time, pervade across situations, and lead to notable impairments. ADHD is
thought to result from complex interactions between genetic and
environmental factors.
Paragraph 3
Proof of validity. Using the Washington University diagnostic criteria, the
National Institute for Health and Clinical Excellence (NICE) reviewed the
validity of the system used to diagnose ADHD in children and adults.
Paragraph 4
Symptoms of ADHD are reliably identifiable. The symptoms used to define
ADHD are found to cluster together in both clinical and population samples.
Studies in such samples also separate ADHD symptoms from conduct
problems and neuro developmental traits. Twin studies show a distinct
pattern of genetic and environmental influences on ADHD compared with
conduct problems, and overlapping genetic influences between ADHD and
neuro developmental disorders such as autism and specific reading
difficulties. Disorders that commonly, but not invariably, occur in adults with
ADHD include antisocial personality, substance misuse, and depression.
Paragraph 5
Symptoms of ADHD are continuously distributed throughout the population.
As with anxiety and depression, most people have symptoms of ADHD at
some time. The disorder is diagnosed by the severity and persistence of
symptoms, which are associated with high levels of impairment and risk for
developing co—occurring disorders. ADHD should not be diagnosed to
justify the use of stimulant drugs to enhance performance in the absence of a
wider range of impairments indicating a mental health disorder.
Paragraph 6
ADHD symptoms have been tracked from childhood through adolescence
into adult life. They are relatively stable over time with a variable outcome in
which around two thirds show persistence of symptoms associated with
impairments. Current evidence defines the syndrome as being associated with
academic difficulties, impaired family relationships, social difficulties, and
conduct problems. Cross sectional and longitudinal follow-up studies of
adults with ADHD have reported increased rates of antisocial behaviour, drug
misuse, mood and anxiety disorders, unemployment, poor work performance,
lower educational performance, traffic violations, crashes, and criminal
convictions.
Paragraph 7
Several genetic, environmental, and neurobiological variables distinguish
ADHD from non-ADHD cases at group level, but are not sufficiently
sensitive or specific to diagnose the syndrome. A family history of ADHD is
the strongest predictor—parents of children with ADHD and offspring of
adults with ADHD are at higher risk for the disorder. Heritability is around
76%, and genetic associations have been identified. Consistently reported
associations include structural and functional brain changes, and
environmental factors (such as maternal stress during pregnancy and severe
early deprivation).
Paragraph 8
The effects of stimulants and atomoxetine on ADHD symptoms in adults are
similar to those seen in children. Improvements in ADHD symptoms and
measures of global function are greater in most studies than are reported in
drug trials of depression. The longest controlled trial of stimulants in adults
showed improvements in these response measures over six months.
Stimulants may enhance cognitive ability in some people who do not have
ADHD, although we are not aware of any placebo controlled trials of the
effects of stimulants on work or study related performance in healthy
populations. This should not, however, detract from their specific use to
reduce symptoms and associated impairments in adults with ADHD.
Paragraph 9
Psychological treatments in the form of psychoeducation, cognitive
behavioural therapy, supportive coaching, or help with organising daily
activities are thought to be effective. Further research is needed because the
evidence base is not strong enough to recommend the routine use of these
treatments in clinical practice.
Paragraph 10
Conclusions. ADHD is an established childhood syndrome that often (in
around 65% of cases) persists into adult life. NICE guidelines are a milestone
in the development of effective clinical services for adults with ADHD.
Recognition of ADHD in primary care and referral to secondary or tertiary
care specialists will reduce the psychiatric and psychosocial morbidity
associated with ADHD in adults.
QUESTIONS
Q1. The article reports what proportion of diagnosed children present with
ADHD in adulthood?
a. Half
b. 3.6%
c. A quarter
d. 15%
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q2. According to the article __________
a. ADHD is triggered by genetic factors
b. ADHD is the result of environmental factors
c. both A and B.
d. neither A nor B.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q3. According to the article symptoms __________
a. vary across clinical and population samples.
b. varies across situational factors.
c. need to pervade across time and situations for a diagnosis to be made.
d. are not reliably identifiable.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q4. Which co-occurring disorders does ADHD frequently present with?
a. Antisocial personality disorder.
b. Substance misuse.
c. Depression.
d. All of the above.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
ADHD is FALSE?
a. The use of stimulants is justified in the absence of a wider range of
impairments.
b. Symptoms of ADHD are evenly prevalent throughout the population.
c. The criteria for diagnosis measure the severity and persistence of
symptoms.
d. High levels of impairment and risk for developing co-occurring disorders
are related with ADHD.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q6. Which heading would best describe paragraph 6?
a. Symptoms associated with impairments.
b. ADHD and outcomes in adulthood.
c. Further definition of the syndrome.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q7. The strongest predictor of ADHD is__________
a. Diagnostic and Statistical Manual of Mental Disorders, fourth edition.
b. Social and academic impairment.
c. Heritability.
d. Family environment.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q8. The effectiveness of atomoxetine on ADHD symptoms is __________
a. less than described in drug trials of depression.
b. greater when measured over six months.
c. reduced in adults with ADHD.
d. known to improve measures of global functioning.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q9. Which heading would best describe paragraph 9?
a. Recommendations.
b. Use of alternative treatments.
c. Programs thought to be effective.
d. Psychological treatments.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q10. It can be inferred from the article the author believes, __________
a. ADHD is a non-persistent syndrome.
b. The majority of children with ADHD will go on to display symptoms in
adulthood.
c. Psychological treatments should replace drug treatment.
d. There is a need to develop clinical services for adults with ADHD.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Answer Key
Practice Test 16
TIME: 45 MINUTES

Paper.
the Text Booklet.
Risks and Benefits of Hormone Replacement Therapy
Paragraph 1
Several recent large studies have provoked concern amongst both health
professionals and the general public regarding the safety of hormone
replacement therapy (HRT). This article provides a review of the current
literature surrounding the risks and benefits of HRT in postmenopausal
women, and how the data can be applied safely in everyday clinical practice.
Paragraph 2
Worldwide, approximately 47 million women will undergo the menopause
every year for the next 20 years. The lack of circulating oestrogens which
occurs during the transition to menopause presents a variety of symptoms
including hot flushes, night sweats, mood disturbance and vaginal atrophy,
and these can be distressing in almost 50% of women.
Paragraph 3
For many years, oestrogen alone or in combination with progestogens,
otherwise known as hormone replacement therapy (HRT), has been the
treatment of choice for control of problematic menopausal symptoms and for
the prevention of osteoporosis. However, the use of HRT declined worldwide
following the publication of the first data from the Women’s Health Initiative
(WHI) trial in 2002.
Paragraph 4
The results led to a surge in media interest surrounding HRT usage, with the
revelation that there was an increased risk of breast cancer and, contrary to
expectation, coronary heart disease (CHD) in those postmenopausal women
taking oestrogen plus progestogen HRT. Following this, both the Heart and
Estrogen/Progestin Replacement Study Follow-up (HERS II) and the Million
Women Study published results which further reduced enthusiasm for HRT
use, showing increased risks of breast cancers and venous thromboembolism
(VTE), and the absence of previously suggested cardioprotective effects in
HRT users. The resulting fear of CHD and breast cancer in HRT users left
many women with menopausal symptoms and few effective treatment
options.
Paragraph 5
Continued analysis of data relating to these studies has been aimed at
understanding whether or not the risks associated with HRT are, in fact,
limited to a subset of women. A recent publication from the International
Menopause Society has stated that HRT remains the first-line and most
effective treatment for menopausal symptoms. In this article we examine the
evidence that has contributed to common perceptions amongst health
professionals and women alike, and clarify the balance of risk and benefit to
be considered by women using HRT.
Paragraph 6
One of the key messages from the WHI in 2002 was that HRT should not be
prescribed to prevent age-related chronic disease, in particular CHD. This
was contradictory to previous advice based on observational studies.
However, recent subgroup analysis has shown that in healthy individuals
using HRT in the early postmenopausal years (age 50-59 years), there was no
increased CHD risk and HRT may potentially have a cardioprotective effect.
Paragraph 7
Recent WHI data has suggested that oestrogen-alone HRT in compliant
women under 60 years of age delays the progression of atheromatous disease
(as assessed by coronary arterial calcification). The Nurses Health Study, a
large observational study within the USA, demonstrated that the increase in
stroke risk appeared to be modest in younger women, with no significant
increase if used for less than five years.
Paragraph 8
Hormone replacement therapy is associated with beneficial effects on bone
mineral density, prevention of osteoporosis and improvement in osteoarthritic
symptoms. The WHI clearly demonstrated that HRT was effective in the
prevention of all fractures secondary to osteoporosis. The downturn in HRT
prescribing related to the concern regarding vascular and breast cancer risks
is expected to cause an increase in fracture risk, and it is predicted that in the
USA there will be a possible excess of 243,000 fractures per year in the near
future.
Paragraph 9
The WHI results published in 2002 led to a significant decline in patient and
clinician confidence in the use of HRT. Further analysis of the data has
prompted a re-evaluation of this initial reaction, and recognition that many
women may have been ‘denied’ treatment. Now is the time to responsibly
restore confidence regarding the benefit of HRT in the treatment of
menopausal symptoms when used judiciously. Hormone replacement therapy
is undoubtedly effective in the treatment of vasomotor symptoms, and
confers protection against osteoporotic fractures.
Paragraph 10
The oncologic risks are relatively well characterised and patients considering
HRT should be made aware of these. The cardiovascular risk of HRT in
younger women without overt vascular disease is less well defined and
further work is required to address this important question. In the interim,
decisions regarding HRT use should be made on a case—by—case basis
following informed discussion of the balance of risk and benefit. The lowest
dose of hormone necessary to alleviate menopausal symptoms should be
used, and the prescription reviewed on a regular basis.
QUESTIONS
Q1. Which statement is the closest match to the description of the recent
studies in Paragraph1?
a. They demand a prompt review of current HRT practices.
b. They have shown that HRT can be used safely in clinical practice.
c. They have decreased the confidence of doctors and the public in HRT.
d. They have given menopausal women a new confidence to undergo HRT.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q2. Which statement is the closest match to the description of projected
menopause figures in Paragraph 2?
a. 47 international women will enter menopause annually for the next 20
years.
b. All women are likely to go through menopause if they live long enough.
c. 47 million women globally will enter menopause each year for the next 20
years.
d. Most women will succumb to menopause if they do not undertake HRT.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q3. What cause does the article cite for the symptoms of menopause?
a. Lack of circulation
b. Age
c. Low progesterone levels
d. Low circulating estrogen levels
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q4. What has been the effect of the 2002 WHI study?
a. HRT has become less popular.
b. HRT has increased in popularity as the treatment of choice for problematic
menopause symptoms.
c. There has been an increase in combined estrogen and progesterone therapy.
d. The women’s health initiative has since been established to investigate
HRT.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q5. Why were many women left with menopausal symptoms and no
effective treatment?
a. They were unable to afford HRT treatments.
b. They were concerned about coronary heart disease and breast cancer.
c. They were concerned about breast cancer and venous thromboembulism.
d. They were concerned about breast cancer and the cardioprotective effects.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q6. Which of these statements is a TRUE summary of Paragraph 5?
a. Surveys since WHI have attempted to find out if the WHI results are
representative
b. Results of past surveys are only valid for a subset of women, whether or
not the public is aware of this.
c. The present study aims to show that HRT is safer than previously believed.
d. Women should ask their doctors to clarify the balance of risks and benefits
of HRT
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q7. Which study showed an increased risk of VTE?
a. The Nurses Health Study
b. The Million Women Study
c. The Women‘s Health Initiative Study
d. The WISDOM Study
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q8. Which of the following does the article recommend HRT should NOT be
used to treat’?
a. Vasomotor symptoms
b. Atheromatous disease
c. Age-related chronic disease
d. Osteoarthritic symptoms
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q9. Why were women “denied treatment”? (Paragraph 9)
a. Due to the decline in patient confidence in HRT
b. Due to the results of studies including the WHI study
c. Due to judicious use of HRT
d. Due to a re-evaluation of this initial reaction
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Q10. Which statement is NOT a recommendation of the present article?
a. Further study should be made into oncological risks ot HRT
b. Further study should be made into cardio vascular risks of HRT
c. Doctors should now reassure their patients that HRT can be safe
d. Doctors should prescribe the lowest effective dose for menopause
symptoms
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Answer Key
Practice Test 17
TIME: 15 MINUTES

Paper.
the Text Booklet.
Text A
START ‘EM YOUNG — ‘CIGARETTE WITH YOUR MORNING
BREAST MILK?’
US researchers have found altered sleep patterns amongst breastfed infants of
mothers who smoke. Julie Mannella from the Monell Chemical Senses
Centre in Philadelphia recruited 15 breastfeeding mothers who smoked. Sleep
and activity patterns in their babies, which were aged between two and six
months, were monitored on two occasions over a three-hour period after the
children were fed. On both occasions the mothers were asked to abstain from
smoking for 12 hours before the study, but on one of the two occasions they
were allowed to smoke just before they fed their babies. The women were
also asked to avoid caffeinated drinks during the study.
Tests on the milk from mothers who had recently smoked confirmed that the
babies were receiving a significant increase in nicotine dose, and the team
found that the amount of sleep taken during the following three hours by
these babies fell from an average of 85 minutes to 53 minutes, a drop of
almost 40%. This is probably due to the neuro-stimulatory effects of nicotine,
which has been shown to inhibit regions of the brain which are concerned
with controlling sleep. It may also, suggests Manella, explain why neonatal
nicotine exposure has been linked in the past with long-term behavioural and
learning deficits, since these could be the consequence of sleep disturbance.
In light of these findings, mothers who smoke might want to consider
planning their smoking around their breastfeeding. Nicotine levels in milk
peak 30-60 minutes after smelting, but take three hours to return to baseline,
so this might be feasible.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Text B
Cigarette smoke
What is in smoke?
Scientific studies show that there can be around 4000 chemicals in cigarette
smoke. They can be breathed in by anyone near a smoker. They can also stick
to clothes, hair, skin, walls and furniture.
Some of these chemicals are:
tar - which has many chemicals in it some of which cause cancer

carbon monoxide - reduces the oxygen in blood - so people can
develop heart disease
poisons - including arsenic, ammonia and cyanide.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19”
Text C
Passive smoking and respiratory function in very low birth weight
children
Abstract
Aim
To determine if an adverse relationship exists between passive smoking and
respiratory function in very low birth weight (VLBW) children at 11 years of
age.
Setting
The Royal Women’s Hospital. Melbourne.
Patients
154 consecutive surviving children of less than 1501 g birth weight born
during the 18 months from 1 October 2006.
Methods
Respiratory function of 120 of the 154 children (77.9%) at 11 years of age
was measured. Exposure to passive smoking was established by history; no
children were known to be actively smoking. The relationships between
various respiratory function variables and the estimated number of cigarettes
smoked by household members per day were analysed by linear regression
Results
Most respiratory function variables reflecting airflow were significantly
diminished with increasing exposure to passive smoking. In addition,
variables indicative of air-trapping rose significantly with increasing
exposure to passive smoking.
Conclusions
Passive smoking is associated with adverse respiratory function in surviving
VLBW children at 11 years of age. Continued exposure to passive smoking,
or active smoking, beyond 11 years may lead to further deterioration in
respiratory function in these children.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Part A
TIME: 15 minutes
Paper.
QUESTIONS
Questions 1-7
1. how many chemicals are there in cigarette smoke? _____
2. which chemical/s in cigarette smoke cause/s cancer? _____
3. when does nicotine levels in breast milk reach at peak? _____
4. How does exposure to passive smoking was established in the study?
_____
5. what happened to respiratory function variables reflecting airflow in the
study? _____
6. what are the side effects of neonatal nicotine exposure? _____
7. what are the poisons in cigarette smoke? _____
Questions 8-13
8. How much percentage does the sleep drop in the babies who had
significant nicotine dose?
9. How much percentage of children at 11 years of age was measured for
respiratory function?
10. What was the maximum birth weight of babies who were considered for
the study?
11. Which chemical component in cigarette smoke reduces the
oxygen in blood?
12. Who recruited subjects for the study conducted by Monell
Chemical Senses Centre?
13. Which chemical component in cigarette smoke is responsible for
heart disease?
Questions 14-20
both.
14. If children are continually exposed to active smoking, it can lead to
_____ in respiratory function.
15. Cigarette smoke can be breathed in by anyone near a _____.
16. During the study some women were asked to avoid _____.
17. _____ can also stick to clothes, hair, skin, walls and furniture.
18. Variables indicative of _____ rose significantly with increasing exposure
to passive smoking.
19. _____ of nicotine can inhibit regions of the brain which control sleep.
20. The relationships between respiratory function variables and number of
cigarettes smoked per day were analysed by _____.
Answer Key
Practice Test 18
TIME: 45 MINUTES

Paper.
the Text Booklet.
Part B
text.
B.P. sets: Functioning
The cuff on the arm is inflated until blood flow in the artery is
blocked. As the cuff pressure is decreased slowly, the sounds of
blood flow starting again can be detected. The cuff pressure at this
point marks the high (systolic) pressure of the cycle. When flow is
unobstructed and returns to normal, the sounds of blood flow
disappear. The cuff pressure at this point marks the low (diastolic)
pressure.
1. When should one note the diastolic pressure of patient?
A. blood flow is limited to make the sound disappear
B. blood flow is normal and the sound disappear
C. blood flow is obstructed and the sound disappear
Aspirators
Suction is generated by a pump. This is normally an electrically

powered motor, but manually powered versions are also often
found. The pump generates a suction that draws air from a bottle.
The reduced pressure in this bottle then draws the fluid from the
patient via a tube. The fluid remains in the bottle until disposal is
possible. A valve prevents fluid from passing into the motor itself.
2. The purpose of bottle in aspirator is to

A. deliver suction that draws air
B. draw the fluid from the patient
C. keep pressure stable if valve prevents fluid
Operating Theatre and Delivery Tables
Where the table has movement, this will be enabled by unlocking a

catch or brake to allow positioning. Wheels have brakes on the rim
or axle of the wheel, while locks for moving sections will normally
be levers on the main table frame. Care should be taken that the
user knows which lever applies to the movement required, as injury
to the patient or user may otherwise result. The table will be set at
the correct height for patient transfer from a trolley then adjusted
for best access for the procedure.
3. The email is reminding user that the

A. importance of lever for the required movements
B. locks of moving wheels are on main table frame
C. table should be set at correct height of the patient
Methods of reporting hospital infection
A mass outbreak of a hospital infection, which can result in severe

injury or death, must be reported without delay, by telephone, fax
or e-mail to the local public health protection authority (usually to
the regional hygiene departments). The following cases are subject
to the reporting of hospital infections:
• Severe injury, as a result of hospital infection
• A mass outbreak
• An infection that led to the death of a patient

A. report a mass outbreak of hospital infection immediately
B. report severe injury, as a result of hospital infection with delay
C. report an infection that led to the death of a patient only
Admission and treatment in medical and social care facilities
Hygiene requirements for the admission and treatment of patients

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

A. determined by the healthcare professional
B. implemented by the healthcare provider
C. written in the operating rules of the facilities
Treatment of used contagious and surgical linen
The healthcare provider and the laundry contractually agree on a

system for classifying and labelling containers according to the
content (e.g. in colour or numerical) and the procedure in terms of
the quantity, deadlines and handling is documented. Linen is sorted
at the place of use but it is not counted. The linen is not to be
shaken before placing into the containers in the ward. It is sorted
into bags according to the degree of soiling, type of material and
colour.
6. The purpose of this email is to

A. report on a rise in used contagious and surgical linen in
healthcare facility
B. explain the background to a change healthcare provider and the
laundry contract
C. remind staff about procedures for treatment of used contagious
and surgical linen
Answer Key
Practice Test 19
TIME: 45 MINUTES

Paper.
the Text Booklet.
Pancreatic Islet Transplantation
Paragraph 1
The pancreas, an organ about the size of a hand, is located behind the lower
part of the stomach. It makes insulin and enzymes that help the body digest
and use food. Spread all over the pancreas are clusters of cells called the
islets of Langerhans. Islets are made up of two types of cells: alpha cells,
which make glucagon, a hormone that raises the level of glucose (sugar) in
the blood, and beta cells, which make insulin.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10” “Q11”
Paragraph 2
Islet Functions
Insulin is a hormone that helps the body use glucose f energy. If your beta
cells do not produce enough insulin, diabetes will develop. In type 1 diabetes,
the insulin shortage is caused by an autoimmune process in which the body’s
immune system destroys the beta cells.
Paragraph 3
Islet Transplantation
In an experimental procedure called islet transplantation, islets are taken from
a donor pancreas and transferred into another person. Once implanted, the
beta cells in these is begin to make and release insulin. Researchers hope that;
transplantation will help people with type 1 diabetes live without daily
injections of insulin.
Paragraph 4
Research Developments
Scientists have made many advances in islet transplantation recent years.
Since reporting their findings in the June issue of the New England Journal of
Medicine, researchers the University of Alberta in Edmonton, Canada, have
continued to use a procedure called the Edmonton protocol to transplant
pancreatic islets into people with type 1 diabetes. According to the Immune
Tolerance Network (ITN), as of June 2003, about 50 percent of the patients
have remained insulin—free up to g 1 year after receiving a transplant.
Researchers use specialized enzymes to remove islets from the pancreas of a
deceased donor. Because the islets are fragile, transplantation occurs soon
after they are removed.
Paragraph 5
During the transplant, the surgeon uses ultrasound to guide placement of a
small plastic tube (catheter) through the upper abdomen and into the liver.
The islets are then injected through the catheter into the liver. The patient will
receive a local anesthetic. If a patient cannot tolerate local anesthesia, the
surgeon may use general anesthesia and do the transplant through a small
incision. Possible risks include bleeding or blood clots. It takes time for the
cells to attach to new blood vessels and begin releasing insulin. The doctor
will order many tests to check blood glucose levels after the transplant, and
insulin may be needed until control is achieved.
Paragraph 6
Transplantation: Benefits, Risks, and Obstacles
The goal of islet transplantation is to infuse enough islets to control the blood
glucose level without insulin injections. For an average—size person (70 kg),
a typical transplant requires about 1 million islets, extracted from two donor
pancreases. Because good control of blood glucose can slow or prevent the
progression of complications associated with diabetes, such as nerve or eye
damage, a successful transplant may reduce the risk of these complications.
But a transplant recipient will need to take immunosuppressive drugs that
stop the immune system from rejecting the transplanted islets.
Paragraph 7
Researchers are trying to find new approaches that will allow successful
transplantation without the use of immunosuppressant drugs, thus eliminating
the side effects that may accompany their long—term use. Rejection is the
biggest problem with any transplant. The immune system is programmed to
destroy bacteria, viruses, and tissue it recognizes as “foreign,” including
transplanted islets. Immunosuppressive drugs are needed to keep the
transplanted islets functioning.
Paragraph 8
Immunosuppressive Drugs
The Edmonton protocol uses a combination of immunosuppressive drugs,
also called antirejection drugs, including daclixrm (Zenapax), sirolimus
(Rapamune), and tacrolimus (Prograf). Dacliximab is given intravenously
right after the transplant and then discontinued. Sirolimus and tacrolimus, the
two drugs that keep the immune system from destroying the transplanted
islets, must be taken for life.
Paragraph 9
These drugs have significant side effects and their long—term effects are still
not known. Immediate side effects of immunosuppressive drugs may include
mouth sores and gastrointestinal problems, such as stomach upset or diarrhea.
Patients may also have increased blood cholesterol levels, decreased white
blood cell counts, decreased kidney function, and increased susceptibility to
bacterial and viral infections. Taking immunosuppressive drugs increases the
risk of tumors and cancer as well.
Paragraph 10
Researchers do not fully know what long—term effects this procedure may
have. Also, although the early results of the Edmonton protocol are very
encouraging, more research is needed to answer questions about how long the
islets will survive and how often the transplantation procedure will be
successful. Before the introduction of the Edmonton Protocol, few islet cell
transplants were successful. The new protocol improved greatly on these
outcomes, primarily by increasing the number of transplanted cells and
modifying the number and dosages of immunosuppressants. Of the 267
transplants performed worldwide from 1990 to 1999, only 8 percent of the
people receiving them were free of insulin treatments one year after the
transplant. The CITR’s second annual report, published in July 2005,
presented data on 138 patients. At six months after patients’ final infusions,
67 percent did not need to take insulin treatments. At one year, 58 percent
remained insulin independent. The recipients who still needed insulin
treatment after one year experienced an average reduction of 69 percent in
their daily insulin needs.
Paragraph 11
A major obstacle to widespread use of islet transplantation will be the
shortage of islet cells. The supply available from deceased donors will be
enough for only a small percentage of those with type 1 diabetes. However,
researchers are pursuing avenues for alternative sources, such as creating islet
cells from other types of cells. New technologies could then be m employed
to grow islet cells in the laboratory.
QUESTIONS
Q1. The pancreas is
a) in the hand
b) in the stomach
c) above the stomach
d) behind the lower part of the stomach
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10” “11”
Q2. What is the main purpose of insulin?
a) It is a hormone
b) to destroy beta cells
c) to assist in energy production
d) to stimulate the auto immune process
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10” “11”
Q3. According the article, is islet transplantation common practice?
a) Yes, it’s frequently used
b) No, it’s still being trialed
c) Not stated in the article
d) Yes, but only in Canada
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10” “11”
Q4. What is the Edmonton Protocol?
a) A trade agreement
b) The journal of Alberta University
c) A way to transplant pancreatic islets
d) Not stated in the article
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10” “11”
Q5. What’s the source of the pancreatic islets that are in the transplant
operation?
a) They are donated by relatives
b) They come from people who have recently died
c) They are grown in a laboratory
d) They come from foetal tissue
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10” “11”
Q6. Which one of the sentences below is true?
a) A local anaesthetic is preferred where possible.
b) A general anaesthetic is preferred where possible.
c) A general anaesthetic is too risky due to the possibility of blood clots and
bleeding.
d) An anaesthetic is not necessary if ultrasound is used
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10” “11”
Q7. How soon after the operation can the patient abandon insulin injections?
a) Immediately
b) After about two weeks
c) When the blood glucose levels are satisfactory
d) After the first year
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10” “11”
Q8. How many islets are required per patient?
a) About a million
b) 70 kg
c) Whatever is available is used
d) it depends on the size of the patient
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10” “11”
Q9. Immediately after the operation the patient must take
a) insulin
b) immunosuppressive drugs
c) both a and b
d) nothing
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10” “11”
Q10. Patients on immunosuppressive drugs may experience
a) mouth sores
b) gastro—intestinal problems
c) increased cholesterol levels and decreased kidney function
d) All of the above
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10” “11”
Q11. Twelve months after the operation, how many more patients were still
independent of insulin after the introduction of the Edmonton Protocol
compared with before its introduction?
a) 8%
b) 50%
c) 58%
d) 67%
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9” “10” “11”
Answer Key
Practice Test 20
TIME: 45 MINUTES

Paper.
the Text Booklet.
Seasonal Influenza Vaccination and the H1N1 Virus
Paragraph 1
As the novel pandemic influenza A (H1N1) virus spread around the world in
late spring 2009 with a well-matched pandemic vaccine not immediately
available, the question of partial protection afforded by seasonal influenza
vaccine arose. Coverage of the seasonal influenza vaccine had reached 30%-
40% in the general population in 2008-09 in the US and Canada, following
recent expansion of vaccine recommendations.
Paragraph 2
Unexpected Findings in a Sentinel Surveillance System
The spring 2009 pandemic wave was the perfect opportunity to address the
association between seasonal trivalent inactivated influenza vaccine (TIV)
and risk of pandemic illness. In an issue of PLoS Medicine, Danuta
Skowronski and colleagues report the unexpected results of a series of
Canadian epidemiological studies suggesting a counterproductive effect of
the vaccine. The findings are based on Canada’s unique near-real-time
sentinel system for monitoring influenza vaccine effectiveness. Patients with
influenza-like illness who presented to a network of participating physicians
were tested for influenza virus by RT-PCR, and information on
demographics, clinical outcomes, and vaccine status was collected.
Paragraph 3
In this sentinel system, vaccine effectiveness may be measured by comparing
vaccination status among influenza-positive “case” patients with influenza
negative “control” patients. This approach has produced accurate measures of
vaccine effectiveness for TIV in the past, with estimates of protection in
healthy adults higher when the vaccine is well-matched with circulating
influenza strains and lower for mismatched seasons. The sentinel system was
expanded to continue during April to July 2009, as the H1N1 virus defied
influenza seasonality and rapidly became dominant over seasonal influenza
viruses in Canada.
Paragraph 4
Additional Analyses and Proposed Biological Mechanisms
The Canadian sentinel study showed that receipt of TIV in the previous
season (autumn 2008) appeared to increase the risk of H1N1 illness by 1.03-
to 2.74-fold, even after adjustment for the comorbidities of age and
geography. The investigators were prudent and conducted multiple sensitivity
analyses to attempt to explain their perplexing findings, importantly, TIV
remained protective against seasonal influenza viruses circulating in April
through May 2009, with an effectiveness estimated at 56%, suggesting that
the system had not suddenly become flawed. TIV appeared as a risk factor in
people under 50, but not in seniors—although senior estimates were
imprecise due to lower rates of pandemic illness in that age group.
Interestingly, if vaccine were truly a risk factor in younger adults, seniors
may have fared better because their immune response to vaccination is less
rigorous.
Paragraph 5
Potential Biases and Findings from Other Countries
The Canadian authors provided a full description of their study population
and carefully compared vaccine coverage and prevalence of comorbidities in
controls with national or province-level age-specific estimates—the best can
do short of a randomized study. In parallel, profound bias in observational
studies of vaccine effectiveness does exist, as was amply documented in
several cohort studies overestimating the mortality benefits of seasonal
influenza vaccination in seniors.
Paragraph 6
Given the uncertainty associated with observational studies, we belie would
be premature to conclude that TIV increased the risk of 2009 pandemic
illness, especially in light of six other contemporaneous observational studies
in civilian populations that have produced highly conflicting results. We note
the large spread of vaccine effectiveness estimates in those studies; indeed,
four of the studies set in the US an Australia did not show any association
whereas two Mexican studies suggested a protective effect of 35%-73%.
Paragraph 7
Policy Implications and a Way Forward
The alleged association between seasonal vaccination and 2009 H1N1
remains an open question, given the conflicting evidence from available
research. Canadian health authorities debated whether to postpone seasonal
vaccination in the autumn of 2009 until after a second pandemic wave had
occurred, but decided to follow normal vaccine recommendations instead
because of concern about a resurgence of seasonal influenza viruses during
the 2009-10 season.
Paragraph 8
This illustrates the difficulty of making policy decisions in the midst of a
public health crisis, when officials must rely on limited and possibly biased
evidence from observational data, even in the best possible scenario of a
well-established sentinel monitoring system already in place. What happens
next? Given the timeliness of the Canadian sentinel system, data on the
association between seasonal TIV and risk of H1N1 illness during the autumn
2009 pandemic wave will become available very soon, and will be crucial in
confirming or refuting the earlier Canadian results.
Paragraph 9
In addition, evidence may be gained from disease patterns during the autumn
2009 pandemic wave in other countries and from immunological studies
characterizing the baseline immunological status of vaccinated and
unvaccinated populations. Overall, this perplexing experience in Canada
teaches us how to best react to disparate and conflicting studies and can aid in
preparing for the next public health crisis.
QUESTIONS
Q1. The question of partial protection against H1N1 arose__________
a. before spring 2009
b. during Spring 2009
c. after spring 2009
d. during 2008-09
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9”
Q2. According to Danuta Skowronski__________
a. the inactivated influenza vaccine may not be having the desired effects.
b. Canada’s near-real-time sentinel system is unique.
c. the epidemiological studies were counterproductive
d. the inactivated influenza vaccine has proven to be ineffective.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9”
Q3. The vaccine achieved higher rates of protection in healthy adults when
__________
a. it was supported by physicians.
b. the sentinel system was expanded.
c. used in the right season.
d. it was matched with other current influenza strains.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9”
Q4. Which one of the following is closest in meaning to the word prudent?
a. anxious
b. cautious
c. busy
d. confused
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9”
Q5. The Canadian sentinel study demonstrated that __________
a. age and geography had no effect on the vaccine’s effectiveness.
b. vaccinations on senior citizens is less effective than on younger people
c. the vaccination was no longer effective.
d. the risk of H1N1 seemed to be higher among people who received the TIV
vaccination.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9”
Q6. Which of the following sentences best summarises the writers’ opinion
regarding the uncertainty associated with observational studies?
a. More studies are needed to determine whether TIV increased the risk of the
2009 pandemic illness.
b. It is too early to tell whether the risk of catching the 2009 pandemic illness
increased due to TIV.
c. The Australian and Mexican studies prove that there is no association
between TIV and increased risk of catching the 2009 pandemic illness.
d. Civilian populations are less at risk of catching the 2009 pandemic illness.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9”
Q7. Which one of the following is closest in meaning to the word alleged?
a. reported
b. likely
c. suspected
d. possible
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9”
Q8. Canadian health authorities did not postpone the Autumn 2009 seasonal
vaccination because __________
a. of a fear seasonal influenza viruses would reappear in the 2009-10 season.
b. there was too much conflicting evidence regarding the effectiveness of the
vaccine.
c. the sentinel monitoring system was well established.
d. observational data may have been biased.
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9”
Q9. What would make the most suitable alternative title for the article?
a. Current research on H1N1 and other influenza strains
b. Errors in Canadian health policy
c. Possible link between influenza vaccination and increased risk of H1N1
illness.
d. Unreliable H1N1 and influenza vaccination research
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8” “9”
Answer Key
Answer Key
Practice Test 1
1. B
2. C
3. B
4. A
5. A
6. D
7. C
8. 100 mg
9. ibuprofen therapy patients
10. clopidogrel
11. aspirinated platelets
12. 75 - 150 mg
13. CAPRIE
14. antithrombotic
15. 5 - 45%`
16. Cox-2
17. cardiovascular death
18. biosynthesis
19. compliance
20. aspirin
Practice Test 2
1. C
2. B
3. B
4. A
5. C
6. A
Practice Test 3
1. C
2. C
3. C
4. D
5. C
6. A
7. D
8. D
9. D
10. D
Practice Test 4
1. B
2. B
3. B
4. D
5. D
6. A
7. C
8. A
9. D
10. A
Practice Test 5
1. B
2. C
3. B
4. A
5. C
6. A
7. A
8. Thomas Browne
9. Michele Pearson
10. antipsychotic
11. 15
12. psychiatric illness
13. infested by parasites
14. unexplained dermopathy
15. parasites
16. Mayo Clinic
17. CDC
18. persona
19. physicians
20. relentless
Practice Test 6
1. A
2. C
3. A
4. A
5. A
6. B
Practice Test 7
1. C
2. C
3. D
4. B
5. C
6. D
7. B
8. A
9. C
10. D
Practice Test 8
1. C
2. C
3. C
4. A
5. D
6. A
7. B
8. B
9. B
10. D
Practice Test 9
1. C
2. B
3. A
4. A
5. D
6. C
7. B
8. 68
9. 3
10. 18 to 64 years
11. 2009
12. 183
13. 1.1%
14. doubled
15. tuberculosis
16. age-matched
17. AIDS
18. indigent subjects
19. 10
20. 858
Practice Test 10
1. A
2. C
3. C
4. C
5. A
6. B
Practice Test 11
1. C
2. B
3. A
4. D
5. B
6. D
7. D
8. B
9. D
10. A
Practice Test 12
1. B
2. A
3. C
4. C
5. C
6. D
7. D
8. B
9. D
Practice Test 13
1. C
2. D
3. C
4. B
5. A
6. A
7. B
8. bluish
9. loose
10. international flights
11. traveling
12. large
13. calf and leg
14. bus or train
15. air travel.
16. swelling
17. clinical studies
18. traveling
19. 1954
20. suggestions
Practice Test 14
1. B
2. C
3. A
4. A
5. A
6. A
Practice Test 15
1. D
2. C
3. C
4. D
5. A
6. B
7. C
8. D
9. A
10. D
Practice Test 16
1. C
2. C
3. D
4. B
5. C
6. D
7. B
8. C
9. A
10. A

Practice Test 17
1. B
2. B
3. A
4. C
5. C
6. A
7. B
8. almost 40%
9. 77.9%
10. 1500g
11. carbon monoxide
12. Julie Mannella
13. carbon monoxide
14. deterioration
15. smoker
16. caffeinated drinks
17. cigarette smoke
18. air-trapping
19. neuro-stimulatory effects
20. linear regression
Practice Test 18
1. B
2. B
3. A
4. A
5. C
6. C
Practice Test 19
1. D
2. C
5. B
4. C
5. B
6. A
7. C
8. D
9. B
10. D
11. B
Practice Test 20
1. B
2. A
3. D
4. B
5. D
6. B
7. C
8. A
9. C
FOR MORE
OET 2.0 READING
EXERCISES & ANSWERS
GET OET 2.0 READING
VOL. II & VOL. III
BY
MAGGIE RYAN

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OET 2.

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6. What does this extract from a handbook tell us about Systematized

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Electronic Diagnostic Equipment

Electrosurgery is the application of a high-frequency electric current to

Endoscopy means looking inside the body using an endoscope, an instrument

Messaging is the electronic communication of health information from the

An appropriate contact with the patient requires applying professional

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tuberculosis developed in 47 (5.5 percent),

Causes of death No. of subjects Average Age at Death

Infectious diseases 18 (9.8%) 43

Cirrhosis of the liver 16 (8.7%) 43

Coronary artery disease 10 (5.5%) 47

Overdose of non- narcotic 8 (4.4%) 42

Other heart disease 7 (3.8%) 43

Drug dependence 4 (2.2%) 37

Alcohol abuse 3 (1.6%) 43

Cerebrovascular disease 3 (1.6%) 47

Upper gastrointestinal bleeding 3 (1.6%) 44

Chronic renal failure 2(1.1%) 59

Respiratory arrest 2(1.1%) 46

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The general principle is that air is processed before it reaches baby.

A nebulizer is a device used to administer medication in the form

Atmospheric air consists of approximately 80% nitrogen and 20%

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Wear loose clothes

Pain and tenderness in the leg

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