Wy 22.2.7 22 DR Be a aR aa buUbbus CeddUEUuueuUd dd v TEST ‘© Look atthe four texts, A-, in the separate Text Bookie. + For each question, 1-20, ook 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. eee A62-year-old man with a 4-year progressive history of + Increasing lower urinary tract symptoms (LUTS); American Urological ‘Association (AUA) symptom score: 21 * Flowrate: 11 mis ‘+ Post-void residual: 60 ml. «Prostate volume (on transrectal ultrasonography [ TRUS] ): 65 mL ‘+ Prostate-specific antigen (PSA) level: 3.2ngimL ‘+ The patient states that he Is not bothered significantly by his symptoms and does not desire active therapy. What is his risk of progression? ‘This patient is at significant risk for benign prostatic hyperplasia BPH) progression: ‘Deterioration of symptoms ‘+ Deterioration of low rate + Risk of acute urinary retention (AUR) + Risk of surgeryWhat js the most appropriate medical therapy? 5. > ° 2 > > > > > > > > 2 2 Cs complete eachof the sentences, 15-20, witha werd or shor phrase romene ofthe texts, Each answer ma include words, number o both Your answers shoul be coreciyspeles 15 regions have a longer life expectancy 18. invasive and medical therapy options Ineatment options are superior to both minimally 117, Cause of BPH is not clear, but__ hae many points inte favor 18, __must be done in patients with BPH to rule out its progression 419. Increase in percentage of population aged 68 years of clder is in years. 20, can be used for patents wih BPH progression. END OF PART ATHIS TEXT BOOKLET WILL BE COLLECTED (ERIE In this part ofthe test there are sx short extracts relating to the work of heath professionals For questions 1-6, chaoze the answer (A, Bor C] which you thnk fs best secording to the text Write your answers on the separate Answer Shest4. The manual states that the wheelchair chould not be used A. inside buildings. without supervision ‘C.on any uneven surfaces, Manual extract: Kuschall ultradight wheelchair Intended use The active wheelchair is propelled manuelly and should only be used for independent or assisted transport ofa disabled patent with mobilly difficulties. Inthe absence of an assistant, it should only be operated by patients who are physically and mentally able to do so safely (eto propel themselves, ster, brake, etc). E ‘he wheelchair is only suitable for use on level ground and accessible terrain, This active wheelchair needs to be prescribed and fit tothe individual pation’s specific health conditon. Any other or incorrec use could lead hazardous situations te arse. 2, These guidelines contain instructions for staf wha ‘A. need to sereen patonts for MRSA B. are likely to put patients a rik from MRSA. C. intent to treat patients who are infected with MRSA. MRSA Screening guidelines I may be necessary to screen staff there isan outbreak of MRSA within 3 ward or department. Results wil normally be avalable within three days, ‘although occasionaly additional tests need to be dome in the laboratory. Staff found to have MRSA willbe given advice by the Department of Occupational Health regarding treatment. Even minor skin sepsis or skin diseases sich as eczema, psoriasis or dermatitis amongst staff can result in widespread dissemination of staphylococci. Ifa ward has an WRSA problem, staff with any of these conditions (colonised o infected) mut ‘contact Occupational Heslth prompty, so that they ean be screened for MRSA carriage. Small cuts andior abrasions must alwaye De covered with bes & nanenne SS Iai where restricted to indoor use, ° PROP OOH29N2999F9999999999 9D 9, Uiidddddddvrvvive im ‘a waterproof plaster. Staff with infected lesions must not have direct ‘Contact with patiente and must contact Occupational Heath {3 The main point ofthe notice is that hospital staff [A need tobe axnare ofthe relative risks of various bodily Mids. Bi. should regard all boll Nuids as potentially infectious CC, must review procedures for handling bodly fuids fection prevention oreo Plann ar intended ope parts, spt et ivr nr hectare sting Whitin prevention ef assoc wih rovertng vara, hse i bome pathogens, such 68 re cure gat against ter od eo rig aa ayhisend Chooes Gout, They tou be consired oe ce ance on ouster nes con esky 22iino crowded hopta esionprvenon depends upon a eystm of practzes nwa Blood ead ncuang ewabeial A sputamand seven, a te ecto Al suh ids rom al peopl ested Wi eae ctesn, oo agrees hm sy ofa peice open Hand wasting, th 8 aoe ace a ves a apron, sae haning =n a say and medal wate an rope fete, clesng 44, What do nursing staff have to do? |A. rein the patient how to control their condition with the use of en insulin pump B. determine whether the patientis capeble of using an insulin pump appropriately / © eveluate the effectiveness of an insulin pump as a long-term means of treatmentExtract from staff guidelines: Insulin pumps Many patients with diabetes sel medicate using an insulin pump. If yours ‘caring fr a hospitalised patient with an insulin pump, assess thet ability to manage eel-care whe Inthe hospitel. Patients using purnp therapy must possess good diabetes seltmenagement sks. They must also have a willngness to monitor ther blood glucose frequently and record blood ‘lucose reacings, carbohydrate intake, insulin boluses, and exercise. Besides assessing the patient's physical and mental status, review and record pump-specific information, such as the pump's make and model ‘Algo assess the type of insulin being delivered and the date when the infusion site was changed lest Assess the patient’ level of consciousness ‘and cognitive status. the patent doesnt seem competent to operate the Ipc >>> 000 aa ) nnonnone as ss wuuuus DADO Oneenannnnn UsssdsuduuE TEST2 IREADING SUB-TEST PARA ‘© 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 al the questions within the 15-minute time limit, ‘© Your answers should be correctly spelt ESS ers Terminology Cognitive difficulties Cognitive changes are normal for almost all people as they age, and assessment should focus on differentiating the normal changes of ageing from abnormal cognitive functioning. While concerns about ‘memory are common in older patients, when patients complain of memory problems, they could be referring to difficulties in a number of possible cognitive domains. Although learning and memory is often the most salient of these domains, the problems could also be in: + attention (ability to sustain or shift focus), + language (naming, producing words, comprehension, grammar or syntax), + perceptual and motor skils (construction, visual perception), + executive function decision making, mental flexibility), or + social cognition, itis thus offen more appropriate to refer to cognitive rather than memory complaints or deficitsPharmacologicaltreatments “There are currently no evidence-based recommendations on medications to reat mid cognitive impairment (MCI). If dementia fs suspected then specialist referral is recommended for confirmation of the diagnosis. If Alzheimer dieease is confirmed then pharmacological treatment can be ‘considered (e.g. acetycholinesterase inhibitors such as donepezil, ‘alantamine or vastigmine), ‘A psychiatric or psychogerlatic referral should be considered for + patients who do not respond to fist. or second: treatment + patients with alypical mental health presentations + patients with signifcant psychiatric histories, including complicated ‘Sepression andlor anxiety or comorbid severe mental illnesses such as schizophrenia and bipolar affecive disorder. Follow up If the diagnosis remains unclear after a detailed assessment then provide (general advice and watchfully walt. All patients should have a cognitive ‘eview with a screening instrument every 12 manths, or sooner if deterioration is detected by the patient or ther family. Risk factors for progression of MCI to dementia include older age, less ‘education, stroke, dabates. and hypertension. Patients who are younger, mote educated with higher baseline cognitive function and no amnesia symptom are more ikaly to revert from MCI to normal cognition. Even after 10 years, between 40 and 70% of patients with MCI may not have developed dementia a > po o ’ 2 re ae ms DAO O OOOO ANA9F9F997999979F799F9F772F PP AN ND OD u Domain Leaning and recall memory Examples of til Shortierm ‘Semantic and auoblographicat Long-term ‘memory Implicit Tearing Warring ans and questions Have yourtced that you have toon tc o someone and Sonata rgetihe cameron? Fave you ad ticity remembering tbe names of peop yeunevelustmet? | Flav you haa wouble Ko tack of detos and spponterts? Fe you ad ny ifcty remembering eves om your vant | Fave you had itcuty doing eos prevosh ough 2s Somat cre or typing Te ctermant Hash or he tron ropoting him or ere Executive function Perceptual motor function Decision making Working memory Flexibility Views perception Percoptucl metor Co lately? ~~ fbieetnarring T tave you naced any word Language | Word finding fncing ifeulies? Receptive {To informant] Has he or she had | | language oe saety understanding youlaiely? eee Pranring Hava you had more dificuty managing your finances lately? {Fo informant] Have you noticed sificulies with his or her ‘capacity to plan activities or make decisions? | Have you had trouble using day- fo-day objects, such as phone or coatlery? _ Have there been new divingol. ¢.. e ! + ‘ordaton Giiees soak assaying he e! Inwhich text can you find information about = e! 4 what to ask patents when evaluating cogivefunconing? ‘Complex attention ‘Sustained ‘xe you having dioaty folowing el 2. possible choices for pharmaceutical treatments? attention whats * ; Seocie | Goionaround you? el 2.the best way odescbe patent symptoms attention es TE HER ed . 1¢ defining features of dementia? ef that he or she is mere easly el 6 4. the defining features of » distract? 6. the proper focus of cognitive asessren e —__| 6. diferent ypes of mental processing? Social Cogiton Recopntionof | (fo nfomant Has be or 2 fwhen a dagnsis is remain unortan? Cmotons | she been | behaving a 7 what todo when a ages Appropiteness | naporopitely in sot 1” clbshevourto” | shutonse el* Social norms | Is he or she able to recognise : Resor £14 with awordorshortphrasefrom one ofthe tens social cues? Is she or she able ele Are ann nurie ofthe both You answer should be corey to motivate him orhersel”? el spelled me -§ ! ” 8, What is the other name for dementia? s ! wntia in older people? #8. What the most common cause of dames peo Dement, now so retered os major neurocognitive dsrde inthe el to wih? Diagnostic and Statistical Manual of Mental Disorders (OSM-5). i defined I 410. Which domain of ogriton isthe skill of planning associet by te presence of substantial cognitive decine ftom a previo level of e : nats te most appropriate way to confirm a diagnosis of dementia? functioning to the degree thatthe Individual’ ability to lve independent is one aoe ‘compromised owing o the cognitive deficits. Dementia is a syndrome with ‘many possible causes, with Alzheimer's disease being the most commen in ‘older people. It is generally of cradual onset with a chronic course, athough there are exceptions. Dementia must be distinguished from delirium (acute Confusional state), which by definition is of acute or recent onset and ‘associated with oss of awareness of surroundings, a global disturbance in ‘cognition, changes in perception and the sleep- wake cycle, and other features. el 412. Whatis recommended for pationts when standard treatments are ‘unsuccessful? 413, Whatis often the most noticeable ofthe many engnitive domains? 414. How often shoulda patient ke cognitively screened if they are not getting worse? short phrase from one ofthe tents ‘complete eachof he sentences, 15-20, with a werd o short phase ft a atransuer may nies wore, umber both Your answers should Be correctly spe P ARTA QUESTION: meannann 415] Dementa differs in important ways from _ which, for o Forsach ofthe questions 17, deci which tent (A, 0,C0r 0) the Information comes trom, Youmay ute any eter more than once ‘example, has @ sudden onset * 46] Tho DSM-5 defines dementia as substantial cognitive dacine that 2% . Ved dddddddddcrsve?dcompromises the individuals 17) There are ‘medications for MCI that are recommended based on available research 418] Many symptoms deserbed as problems with memory are probably beter doscribed as complaints. 48] Social cognition includes the ability to follow accepted social rules and the 20] To assess perceptual motor functioning doctors can ask if paionts have had difcuty using objects lke krives and forks END OF PART A THIS TEXT BOOKLET WILL BE COLLECTED EDIE Inthis parva he test, there are si short extracts relating to the work of heath professionals For questions 16, choote the arswer (A, Bor C] which you think ts best according ‘tothe text, Write your answers on the separate Answer Sheet 11 The purpose of this memo isto ‘A. provide staff information on appropriate methods. B. nally staff ofa possible change in standard procedure. . remind staff ofthe importance of following best practice cal statt ‘Memo to: Department physicians and cin ‘Subject: Aseptic techniaue Aseptic techniqua protects palents during iwasive dnical procedures by ‘employing infection control measures that minimise, as far as practicably possible, the presence of pathogenic organisms. Good aseptic technique procedures help prevent and control healthcare associated infections and must be preserved. As you are aware, the aim of every procedure should be [4 Vdd ddd ddd didi deere cieesee tomaintan asepss at all times by protecting the key parts and key sites from contact contamination by microorganisms. This can be actieved through correct hand hygiene, a non-touch technique, glove use end ensuring asepsis and_steily of equipment, While the principles of aseptic technique remain constant for all procedures, the level of practice will ‘change depending upon a standart risk assessment 2. The guidlines require those administring thrombolysis to 'A. explore other options before proceesing B. contact the coronary care unit prior to transfer. CC. ensure support staf are readly available. 6.2 Thrombolysis for STEMI patients Primary percutaneous coronary intervention (PCI) is the treatment of choi for patients presenting with an acute ST Elevation Myocardial Infarction (STEMI. However. if tis not possible to transfer the patient to the cardiac catheter laboratory immediately, for whatever reason, then the need for thrombolysis to be given should be considered. The adiiting feam must atk the primary PCI operator if they are able to achieve the artval in hospital to fist balloon ination target of 120 minutes. If not, then ‘thrombolysis il bo given on the advice of he primary PCI operator swithout delay. Support fortis may be given by Coronary Care Unit (CCU) SattiChest Pain Nurses depending on the patient's location. Transter the patient with resuscitation equipment to CCU immediatoly ater thrombolysis Is administored ‘3. The guidelines specify that those performing an MRI on patients with implants of foreign bodies [A should abandon the scan unsure ofthe device. BB. have the final sayin whatherto scan a patient. C. use a lower field strength for ooncitionat items.Guidelines for the management of implants and foreign bodies during MRI scans Implantable devices or other foreign bodies may contraindicate MRI ‘scanning andlor cause signficant image artefacts, There is a growing umber of medical devices and implants that are classified as MRI Conditional, placing the responsibilty for safety on the operator. It should bo stressed that safety ata defined field strenath o for a specific MRI system is no guarantee of safety at a higher (or lower) ld strength, ora different MRI system athe same field stength.M there is any doubt as to the nature of a device then @ scan should only proceed after a careful ‘assessment of the potontialricks and benefits of tho scan with the device in situ, Tho MRI Safety Export can acsict with identifying and quantiying the risks, but the decison to scan lea clinical one, ‘4. The manual informs us thatthe AP14 syringe pump A. should be disconnected in times of power outage. B. facilitates easy cleaning by its smooth exterior. Chas a unique patient transportation feature, ‘Manual extract: Operation of AP14 Manual Syringe Pump Pump Application ‘The AP 14 syringe pump is simple to operate rellable ands of general application. Its suitable for various types of single-use syringes. BOLUS function enables quick and repeated delivery of bolus doses to the patent, with accurately established volume and within a specified infusion time, The pump can operate without connection to the maine, as iti automatically ‘supplied by the intemal battery in cases, e.g. of mains failure, It ao enadles te continue the infusion when the patient is being transported from one area of the hospital to another. Simple casing, without any parts protruding from the front panel, faciltates maintenance and disinfection 5. The notice on indweting urinary cathaters provides information about AA. the order for correct insertion B. optimal postioning ofthe patient JUGS RY vec vrow CCOOK OCCU UULEULEE hi DOOM Oee EP AAONNMANNNNANAAA299D22 . w CC. how best to avoid harming patients Indwelling urinary catheters Urethral, prostate or bladder neck injury resulting in fase tracts, strictures ‘and bleeding are related. to traumatic urethral insertion. Traumatic injury is fase likely o occur with appropriate catheter solection, lubrication, corect patient positioning and insertion into a full bladder. Retention balloons. Should only be inflated inside the bladder, which is indicated by urine return With IUG inserted tothe il. If there is any uncertainty regarding catheter placement, the balloon should nat be ifated. Ifthe patent experiences pain With inflation, deflate the balloon immeciately and reassess IUC position as this may indicate the catheter is outside the bladder. IUCs should be used with caution in pallens at risk of selfextraction, such as these with dementia or ho ate delirious, When available, ultrasonography is recommended to eveluete bladder volumes and guide SPC insertions, 6. Ths extrac from a handbook says that patients with delirium experience ‘A a similar cognitive decine as with dementia, B. a loss of interest during conversations. C. influences that may tigger the disorder. Delirium is an acute deterioration in cognition, often with altered arousal {(Growsiness, stupor, or hyperactivly) and psychotic features (e.9. parancia). “The main cognitive deficit in delirium is inattention’ eg. the patient is Aistractible, cannot consistently folow commands, and loses the thread during a verbal exchange. Delirium and dementia commonly co-exist however, with the latter there is a much slower deterioration in thinking, perceiving and understanding, ad inattention is much less prominent. Because delirium is usually ue to an interaction between multiple predisposing and precipitating factors, management should be aimed at not just finding and treating the aseumed cause, but also optimising all aspects of careEOD (EIS Inthis pert ofthe tes, there are two texts about diferent aspects of healthcare. For questions 7-2, ehoase the answer (A, 8, Cor D} which you thnk fis best according to the text. Write your answers on the separate Answer Sheet ‘Shedding Light on Complex Regional Pain Syndrome (CRPS) Eleven years ago, Debbie had a routine bunion operation that changed her life. instead of finding ree, her pain grew worse, unt it was, ‘excruciating and constant, “I became disabled and had to stop working [My foot is permanently in an air cast and I walk with a cane. Most of the time the painis a 10 out of 10," she says. Debbie's surgeon sent her to pein specialist, wha recommended a psychiatist.“I knew the pain wasn't in my head, she says, but the medical community didn’t believe her. ‘waza't until she met neurologist Anne Louise Osklander that she finally received a diagnosis: Complex Regional Pain Syndrome, or CRPS, ‘CRPS is a chronie pain contiton that develops folowing trauma to a limb, such as surgery or a fracture. As Debbie learned, “his is a very ‘controversial condition that not alot of doctors understand,” says Oaklander. “Historically, the field of medicine has been very sceptical of patients with CRPS. On top of thei ness, pationts have had to navigate ‘9 medical eystem that is suspicious of them and hasn't had effective treatment to offer. It ace insult injury” But those who treat CRPS are hopeful the tde is turning. Recent attempts to better comprehend CCRPS have produced conseneus guidelines for which patient outcomes shouldbe included in ture research, as well as internationally agreed upon diagnostic erteria, Investigators are also learning more about the ‘causes of CRPS from laboratory studies. CCRPS etarts off with a surprising amount of pain that doesnt match the inal trauma Inthe first few months, instead of the expected healing, patients describe an increase in pain levels. They ften ropor that s cast vous a eeeicees AAAOAEEREAANADANAAD DAD ADADADA DADA DDD? Pr a a hi con the affected limb feels excessively tight and the sensation that the limb might “explode,” says Candy McCabe, a CRPS cfniion and researcher at the University of the West of England, Bristol, UK. The fb ‘ton swells, changes colour to red or purple, and is perceived by the patient as ether very cold ar very ol. Changes in hair and nail growth, Sind sweating are also common. Research from Oakiander's lab has identied persistent problems wilh certain neurons inpatient injured limbs, These nerve cells camty pain messages, bul also control the small ‘blood vessels and sweat glands, explaining why patients have @ constellation of symploms in addition to chrenie nerve pain. Many patients report that within afew days or weeks the mb feels Complately alien, and ofa very diffrent size and shape than itreallys Many also describe very negative feeings toward the lm and a strong este 1 have it amputated. “In CRPS, the brain's perception of the li changes pretty quicky,” McCabe says, The good news i that, wile ia ome cases CRPS becomes persistent, about 75% of people get beter without intervention, by six months toa year. “Geting a CRPS diagnosis does not necessarily equate toa fete of disabily.” she emphasises, Wile thé features mentioned above describe the “average” CRPS patient, not everyone experiences the disease in the same wey. Beyond bitferences inthe length and severity of the syndrome, diferent patients report different symptoms as the most prominent and bothersome, For tome, movement problems cause the most diffculty, while for others. the bain they experience may take centre stage. "The presentation of CRPS is variable within a common picture, but unfortunately we don't yet know ‘why these different scenarios happen,” says MeCabe. ’As reflected in the original name for CRPS, Reflex Sympathetic Dystrophy, one of the eatiest ideas about the biological underpinnings of the condition isthe presence of dysfunction ofthe sympathetic nervous system, the network of neurons that governs the body's automat "fight orfight response. Currently, researchers believe that such alterations: {are important inthe inal generation and acute phase of CRPS. For‘example, studies suggest that in the tibial fracture model, sympathetic neurons release an immune system protein called interloukin-6 that ‘stimulates inflammation and pain. Andreas Goebel, a clinician and pain researcher atthe University of Liverpool, UK has identified @ number of autoantibodies, which are immune system proteins directed against a person's own tissues or organs, in he blood of people with chronic RPS, ‘The fist CRPS trial is underway, to evaluate the efficacy and safety of neridronate, a new bisphosphonate, which isa class of drugs already ‘widely used to prevent and treat osteoperesis. This Is a placebo- controlled clinical trial and has completed enrolment of 230 patients at 59 sites in the US and Europe, Debbie is one of the tial participants, and has received several intravenous infusions, Neither she nor Oaklander ‘are aware as ye if she received neridronate or a placebo." this lal finds neridronate tobe safe and effective and receives approval to be ‘marketed for CRPS, i will be historic’, says Oaklander. ‘Its only when there's an approved crug that there's advertising, which inoreases public, awareness, and spurs doctors to learn more.” she adds.“ fltit was important to particpate inthis vial because itrmakes a statement tothe world that CRPS isa real medical disease that deserves high quality trials, This could bo a landmark val.” 7. Inthe first paragraph, the writer uses Debbie's case to convey ‘A. The dangers of having even minor surgery B. Alack of awareness of CRPS amang the medical ratemity, . The psychological causes of pain experienced by CRPS sufferers. 1. That specialist attention is warranted in such instances 8. Whats meant by the phrase the tide is turning in the seoond paragraph? AA. Doctors now believe Inthe existence of CRPS, B. Beneficial treatment is now mors realy availabe i 5b Ou « et Te POO OO OOOO AADDNANNDNNNADAADADDAD 99212220099 Cr ee ee Wy fi isin sight (C. Recant investigations are indicating a cure isin sight, . Possible reasons for the multitude of symptoms experienced. 9 Evidence mentioned inthe third paragraph na revesiod etter postoperalv care of ibs is neaded Bae tue atime ema constr troughout cass Frere etchsequrod othe posse causes of an 5. Feel communis understandings Begin oS 40, What do we leam abaut CRPS In the fourth paragraph? 'A. Patients respond very differently to available treatment. B. Preessionl agnosis necessary to eee nproverent. . Profound psychological impacts are often reporte 5. amputation should only be performed when al else hes failed ‘inthe fftn paragraph, what point is made about the symptoms of CRPS? ‘A Tne lngtn and sevety of CRPS ar quit const A eee dominart symptom for ORPS steer. 2 Bebe posers toot ina Sverco curber of wa. 42. What points made about the eympatheti nervous system inthe sith paragraph? ‘ony fot CAPS ine very oaty sages. hemes GRPS tolomin fared the 8: nhae a eal rir tho outset of CRPS Shae cejuanca on CRP than ly oleved 418, Anne Louise Caklander values the tials highly because |A.Ofthe inclusion ofthe recently created neridrorate B. They may help validate the authenticity of CRPS. C. She gets to b0 a part of ground-breaking research 1 itis the fst time a cohort ofthis size has been use114. The final paragraph mentions that confirmation has yet to be received regarding ‘A, Whether Debbio was given the neridronate infusion. The final number of participant enrolments forthe ta, (Caving the backing ofthe entico medical community D. The approval for public advertising campaign Antibiotic Resistance now a global threat to public health | 1945, Alexander Fleming, the man who discovered the fist antibiotic said in his Nobel Prize acceptance speech, "The time may come when Penicilin can be bought by anyone in the shops. Then there is the danger that the ignorant may easily under dose themselves and by ‘exposing their microbes to nomethal quantities of the drug, making them resistant.” A recent report from the Centres for Disease Control and Prevention (CDC) reveated that more than 2 milion people in the US ‘lone become il every year as a resut of antibicticresistant infections, and 23,000 gi ftom euch infections. ‘The World Heath Organization (WHO) has recenlly published ther fist slobal report on the issue, looking at data from 114 counties. WHO focused on determining the rate of antibiotic resistance to seven bacteria responsible for many common infections, including pneumoni, diane, Uurnary traet infections, gonothosa and sepsis. Their findings were Wworying. The report revealed that resistance to commen bacteria has reached “alarming” levels in many parts of the werld, wth some areas ‘ready out of treatment options fer common infections. For example, they found resistance to carbapenem antbioles used to tackle ‘Klebsiella pneumoniae - the bacteria responsible for hospitakacquired infections such as pneumonia and infections In newborns -has spread to all parts of the lobe, nannannonnnnn AHAAM A ais ials u Dr Keii Fukuda, WHO's assistant cirector-general for health securiy, said of the reports findings: "Elective antibiotics have been one of the pillars of recent generations, and unless we take significant actions to improve efforts to provent infections and algo change how we produce, prescribe and use antibotos, the werld wil lose more and more of these global public heslth {900d that allow us fo live longer, healthier ves, and tho implications wil be devastating. We're haading for a post-antbiotic era effectively wiping out ‘hat is a marvel of moder medicine.” Bacteria have shown the sbilty to become resistant to an antibiotic with great speed. “Ite tre that they've saved millions of lives over the years, and there'é algo undoubtedly a growing worldwide need. But their use at any ‘ima in any sotting puts biological proscure on bacteria that promotes the ‘development of resistance, That's whers tho blame lies, and only the medical officer assumes this responsibly,” says Or Steve Solomon, Director of the CDC's Office of Antimicrobial Resistance, “When antibitles ‘are needed to prevent or treat disease, they should always be used. But research hes shown that as much os 50% of tho time, antibiotics are prescribed when theyre not needed or theyre dispensed Incorectly, such fas when @ patient is given the wrong dose, Whether i's a lack of ‘experience or knowledge, or just the easier option, | realy cat say.” Dr Charles Penn, coordinator of antimicrobial resistance at WHO, takes a slightly diferent vewpolnt from his peers. "One of many reasons why antibiotic use is so high is that there is @ poor understanding of the Aiferences between bacteria, vituses and other pathogens, and also of the value of antbioties” he said. "Too many antibiotics are prescived for viral infections such as colds, fu and ciarrhoea. Unfortunately, these public misconceptions sre offen perpetuated by marketing and advertising ‘campaigns through the use of generic terms such as ‘germs’ and ‘bugs: It's dificult to ty and narrow down the blame to a single origin.”Dr Penn noted that reliance on antibiotics fer modern macical benefis has Contributed to drug resistance. “Surgery, cancer treatment, intensive care, transplant surgery, even simple wound management would all become ‘much riskier, more difeult options i we could not use antibioties to prevent infection, or treat infections if hey occurred," he said, “Sinilary, we now take it for granted that many infections are treatable with antbictics, such as tonsilitis, gonorhoea and bacterial pneumonia, But some of these are now becoming untrealable.” Add to this the excessive and incorrect use of antibiotics In food-producing animals since resistant bacteria can be transmitted to humans through the food we eat, and you literally have a recipe for disaster. r Penn goss on to say, “Although mary warnings about resistance were issued, physicians, that sto say prescribers, became somewhat complacent about preserving the effectiveness of antibiotics - new drugs always seemed to be available, However, the pipeline for discovery of new antibiotics has diminished in the past 30 years and has now run dry.” He noted, however, that health care providers have now started to become more Vigilant in prescribing antibictes. “Greater awareness of the urgency of the problem has given new impetus to carelul stewardship of existing antibiotics. Medical practioners are now heeding the warning that the pioneer of the antibiotic gave all those years ago. ni VSD) 418. The writer quotes Alexander Fleming inthe first paragraph to ‘A. Emphasise the impressive history of antibiotics, B, Reveal the ease at which people may purchase antibiotics ©. Compare current usage of medication to an eater time 1D. Show that his prediction of antibiotic resistance was accurate 16. In the second paragraph, what does the writer find particularly ‘A. One particular antibiotic no longer provides resistance anywhere . e « e « e e « « > > > 2 = 2 2 ~ . 2 2 > 2 2 2 2 2 ° ° 2 2 2 ° > 2 2 2 2 > > 2 2 ° 2 2 3 nnnnnnee non 2a999ans hi B, Now boms are quickly becoming resistant to al antibiotics CC. Resistance is at an el-time low for the most common infections 117. What is meant by one of the pillars in the third paragraph? ‘A. An innovation that changed the heather industry B.A permanent fixture in the faid of medicine C. An essential component of the medical system D. A remedy that is arnong the greatest inventions 418, According to Dr Steve Solomon, what Is utimately cesponsible for anibiotic resistance? A. Their everyday use for common diseases B. The presetiber's lack of experience C. The increase in global demand . The medical professionals misuse 48. In the fifth paragraph, Dr Charles Penn argues that when it comes to aniibiote resistance |A Increasing the cost would deter overuse 8, The general pubic should be held responsible C. Mass media plays @ crucial roe in its demand 1. More understanding is needed to overcome it28. nto sith pargraph, Dr Peon gives examples of our dependence ‘on antibiotics to * = A. Stress thal substitute medications are needed, 6. Justify the need to change our habits C. Show that’s too late to reverse the damage D. Highlight our lack of appreciation for current treatments 21. In the final paragraph, Dr Penn makes the point that medical Practitioners: ‘A. Have depleted the supply of antbiatis through overuse 8. Were reluctant to take advice regarding antibotes, ©. Once believed there was an endless supply of antbiotios D. Are yet to understand tne damage caused by thar actions. 22. Inthe final paragraph, the phrase heeding the warning refers to A. Prescibers being atentive fo the problem, B. Doctors now issuing warnings to pationts CC. The medical community regretting ther carelessness. . Practitoners looking ahead toa brighter future SEDDON OHO M OOO NEO 1NN OAD AAD Ce a SO i . Take the samples and send them to the appropriate laboratory TEST3 BSL et the eur as, 0h the separa Tent Botlt re cach qe, 17 obthougi the ssa, sh lace Porir 5 Anwerall the questons within the 15minte time int DEER INVESTIGATING ACUTE TRANFUSION REACTIONS Immediately report all acute transfusion reactions with the exceptions of mild hypersensitivity and non-haemolytic febrile transfusion reactions, to the appropriate departments. Record the followina information on the patient's notes: Type of transfusion reaction * Length oftime ate the stat ofthe transfusion and when the reaction occurre + Volume, type and pack numbers of the blood components transfused immediate post-transfusion blood samples from a vein in the opposite arm ‘+ Group & Antibody Screen ‘+ Direct Antigiobutin Test ‘* Blood unit and giving set should contain residues of the transfused donor blood Take the following samples and send them to the Haematoloay/ Clinical hemistry Laboratory for: * Full blood count © Urea * Coagulation screen * Electrolytes * Creatinine * Blood cutture in an appropriate blood culture bottle Complete a transfusion reaction report form. Record the results of the investigations in the patient's records for future follow-up, if requiredRELEVANT neu DRUGS & DOSES ores Tae Roe RDO Oa 00% Tae ‘Broncnaor Sinica re Atwenaine | sepeseganers mansit| Astin TigaaiT | — Gas |Terms ae Redace fever and Tats Meee | rete Oral orcad avid spin cosig — Tomeig | produc patents rmedateesponses | (Chlophetanine) | "V4 whe 2atine i fo Salted seontnrpam | Arminoptioe | Meunier Voamaan | Railing ia = ‘wooed Toda sine | Uoronbyender epee sm deueae (6%) uidance Guanes or cognition and manapenent oF eae Tanto FCO oly “T o> oT as I er ——) els els els = els el, el, el, cts es el, el, el, el, el, el, el, el, el. el el el el UVSEEEEETS im Ciscoe Easiness tomoa [Category 1: |Localised [Pris Hypersensivity Mild cutaneous Febrile nor-haemolytic © reactions: ‘transfusion reactions: + Urticaria * Antbodies to white + Rash blood cots, platelets + Mid Fever + Antibodies to proteins, incuding IgA [Category 2 | Flushing [Ancety Fiypersensitly Moderately |» Urticaria IPrutis (tmoderate-severe) Severe + Rigors [Palpitations | Febrile non-haemolytic + Fever Mild dyspnoea | transfusion reactions: Restlessness [Headache | + Antibodies to white + Tachypnoea blood cells, pateets + Tachycardia + Antibodies to proteins, incluging IgA Possible contamination ‘with pyrogens and/or bacteria Category &: | Rgors Janxety ‘Route avascular Life + Fever \Chest pain | haemolysis Threatening |» Restlessress Pain near | Bacterial contamination + Hypotension infusion site} and septic shock (fal of 2036 in [Respiratory | Fluid overioad systolic BP) distress! Anaphylaxis + Tachypnoea +++ |shoriness of | Transfusion related + Tachycardia |bveath acute lung injury TAL) (jise of >20%6 in [Loin/back pain | Transfusion associated hheartrate) [Headache | Graft versus Host + Haemoglobin Dyspnoeadisease + Unexplained (AGH) bleeding DIC)-Wintan away and eve Figh concenraton oxygen by mask ————— STOP the lanstusion: Replace the giving set and keep the IV Bre open + Manage as anaphylaxis protocol and ensure help is coming: stridor, ‘wheeze and hypotension require trealment with oxygen and adrenaline. Critical Care admission, + Netiyconsianthaemstoogist nd Hospital Transusion Laboratory immediately + Send the blood unit withthe giving se, freshly collected blood samples with appropriate request form to the Hospital Transfusion Laboratory ‘or investigations, +, Shecks es ire sample visual or ine cf haercpebinuin ormmence une collection (28 hors) and record al ini and tp + Assess for bleeding from puncture sites or wounds. 1 Reassess: 1. teal bronchospasm and shock as per protocol. 2 ‘Acute renal failure or hyperkalaemia may require urgent renal replacement therapy. EE For acho the questions, 1-7, decide whch text (A 8, Coro) he information comes trom. Youmay ure any ltr more thn once In which text can you id information about 1. the corract route forthe administration of chlorphenamine? 2 the likely cause of rigors and fever? DO OOO OOOO MADAM AAAANAAAAAAAAAAANAOOLES TRESS SEES SSVI DVVEOUEDELUUELLECCCCE 3. the best way to describe patient symptoms? A inital steps to take when treating a excl il patient? 5. the various symptoms of patients who have hada transfusion reaction? 6. where to document the findings ofthe appropiate investigaions? the effecte of various medications for managing patients symptoms? ‘Answer each of the questions, 8-13, with a word or short phrase from one ofthe texts Each anevrer may include words, numberof the both. Your answors should be corecly spelled 8. For how long should a patient's urine be collected and documented? 9, What should be used to appropriately transport a blood culture? 410, How long should 0.9% saline be given ithe patients hypotensive? 114. What ype of admission is warranted for a patient experiencing stridor? 412. What might a category 3 patient show more than a twenty percent drop 13, Whats best voided the patent has alow pale count? Complete each othe sentence, 14-20, wih a word or short pra rm one ofthe texts. Each answer may inlide words, number or both. Your answers should be correctly spelled 14] A vein from the_ should be used for sample collection fa reaction occu Tolowing transfusion 415] Ifa patient experiences pain close tothe cit of infusion, i's Bkely to welaacied at B readin ” 16] A nebuliser should be used to administer at Singvuusedcdddd 17] An assessment for bleeding from conducted in an emergency situation 16] There is no need to report they do indeed oour should be transfusion reactions if 418] Visual confirmation is sufcient to check for _ in a patient's recent urine samp. 20] A pationt may be considered pruritus accompanied by a headache, END OF PART A THIS TEXT BOOKLET WILL BE COLLECTED ifthey experience TI Inthe part ofthe tes, there are six short extract relating tothe werk of health professionals For questions 1-6, choose the answer (A, 6 or C] which you think fits best according to the text Write your answers onthe separate Answer Sheet 4. The guidelines fr infection contol require dentists to ‘A. sticty abide by the rules set out within the document 8. use their own judgement when puting the strategies into practice. ©. follow the example of well-established dental cnics. 1.12 Guidelines for Infection Control for Dental Practitioners ‘The routine work practises outined here are designed to reduce the ‘number o infectious agents in the dental practice environment: prevent (oF reduce the likethood of transmission af these infectious agents from 1A OPPOOOMMMAAAAAAAAAADANAAAAABODDO EEE SRS Sk Sk hele ee) - ee o se5555 baS $5558 ‘one person or itenviocation fo another; and make items and areas as free as possible from infectious agents, Itis important to acknowledge that professional discernment is essential in datermining the ‘pplication ofthese guidelines to the situation ofthe individual dental practice environment, Individual dental practices must have their own infection contrl procedures in place, which ar tailored to their Particular deily routines. Professional awarences is tical when plying these guidelines tothe partioular ereumstances of each individual éental practice, Each dental. practioner is responsible for implementing these guidelines in their clinical practice and for ensuring their clinical support staf are familar with and able to epply them, 2. The email informs physiotherapists that ‘A. the option of consent uitimately les wth the patient B. information provided by the patiant is confidential ©. patient consent forms are a legally binding document. To: Adpinsionersists From: Ken Macarthur, Heed Phstatberapst Subject: Patent consent forms This isa courtesy email minding all staff that iti standard practice to ‘ot only provide the patient consent forme, but to also verbally go through all aspecis ofthe frm withthe patient prior tothe ‘commencement of treatment. The purpose ofthis isto inform the pationt oftheir rights and how we address the issue of 2 oallaborative decision ‘making and informed consent between physiotherapist and patient ‘The patient's condition and options for treatment must be discussed so they are appropriately informed and are in a poston to make decsions Felating to thei treatment, They must also be informed that thoy may, choose to consent or refuse any form of ttealment for any reason, including religious or personal grounds, Once they have given consent they may withdraw that consent at any time 3. What does the policy for manual handling equipment tel employers? A. All areas of the hospital should be fitted with overhead tracking,B. Assistance devices should be used over physically handling the patient . Patients have the final decision on how they should be assisted. Policy for manual handling equipment ‘The provision of coling hoist technology and air assisted patient iting {equipment should be considered as the first line handing ald by ‘employers as significant evidence exists that their use reduces operator and patient injuries. Overhead tracking should be installed in all new or refurbighed faciltios. This should cover beds as a minimum, but should fextend to ensuites and other areas of the fecllty where patients are likely to requie assistance. Once an assessment has been made that ‘equipment should be used for safe paiont handing then equipment should be made availabla and used, even in stustions whore tha pation! andor familys preference is for not to be used, 4. The purpose ofthe notice isto explain o cccupational therapists that [A confirmation of equipment is subject to availabilty atthe time of request BB. mattresses are of standard size 50 may nat be suitable forall bed types. C. patient factors must be considered prior to lodging a request frm, Equipment Request Form (ERF) for Pressure Care Mattresses Itis the responsi ofthe occupational therapist attending to the individual patent to submit an Equipment Request Form (ERF) based fon equipment eligibility criteria. A proscure mattress may bo appropriate when someone is at risk ofa pressure injury as evidenced by documented sound clinical reasoning and their pressure injury risk is unlikely to significantly change. Environmental and equipment Considerations must be confirmed such es theta patient's woight is ‘within the safe workload of the equipment requested. The size of the mattress must also be compatible with other bed equipment and ‘ccessories and the patient has been informed regarding the contraindication of placing items (e.g. antinence product, sheepskins, electric blankets, l-fiting bed sheets) on top of tho mattress. Only aftr this confirmation should an ERF be submited, GOSS e See SSE SEHR EHH HULU LECC CCE JEP EEPEPEER EERE Eee ee ee SaaS IMOAPOMOMMNAMAANAANAAANADAAAAAAOO NOE ESSE 5, The memo about use of smart phones during surgery tells staff that A. their use may be a violation of patient confidentiality B. they are to be used only by the surgeon ©. they can potentially lead to patient harm, Memo: Resticted use of smart phones duiing surgery ‘As smart phone technology has become increasingly common, is now ‘cause for concern when used within the operating rooms, especially as 1 major source of distraction. For this reason, the use of smart phones within tKe operating rooms wil now be recticted. The undisciplined use of smart phones - whether for telephone, omall or data communication, and whether by the surgeon or ether members of th surgical team may compromise patient care ‘Whenever possible, members of the operating suite team should only lengage in urgent outside communication during surgery. Personal and routine cas should be minimised and be kept as biet as possible. Incoming calls should be forwarded to voicemail or tothe reception desk to be communicated promply. Any use of a devioe or its accessories ‘must not compromise the intecity of the stele field and special care should be taken to avoid eanetive communications within the hearing of awake or sedated patents, 6. The main point ofthe extract on subcutaneous cannula isto explain ‘A. the vereaity of their design and function, B. that they must only be used by regictorec nurses. C. the neod for a backup cannula in case of malfunction. Subcutaneous cannulas A subcutaneous cannula is small plastic tube designed to carry ‘medication into a pereon’s body. One end, inserted by a registered ure, ets just undar the persons ekin. Tha other end divides into. two Parts and is shaped lke a Y. One part of the Y-arm can be connected to a sytinge driver or infusion pump; the other can be used for subeutanous injections, The nurse may insert a second cannula in a difforent part ofthe body. This i in case the exginal cannula stops working and ensures that there wil be no delay in giving medications tothe person you are caring for. Itcan be especially useful the original cannula stops working at night when nurses may not readily available or have the same level of support as during the day. TIES Inthis parcof the test, there are two texts about diferent aspects of healtheare For questions 7-22, chacee the answer (A, 8, Cor O) hich you think Fs batt, according to the tet, Write your answers onthe separate Answer Sheet Witnessed resuscitation attempts -2 question of support. ‘The idea of supporting relatives who witness resuscitation is nothing new, with research and reports going’ back to the 1960s. In 1996, the Research Gouncis UK (RCUK) published a booklet called Should Relatives Witness Resuscitation? Since then, practice has moved on, but many of ils core elements are stil considered valid today. it was ‘suggested that family members who witness the resuscitation process may have a healthier bereavement, as they vil find it easiar to come to terms with the realy of thei relatve's death, end may fee! reassured thal everything possible has been done. It acknowledged that the realy of CPR may be dietressing, but argued that i is "more distressing for a relative to be ceparated from their family member" at this ericl time. In the latest edition of ts Advanced Life Support manual, the RCUK remains adamant that ‘many relatives want the opportunity tobe present during the attompted resuscitation of their loved one.” But do they have the right to demand? “The resuscitation teary and the nurse caring for the pationt have the responsiilly of deciding whether to offer ralatives the opporturity to witnoss a resuscitation atterst’ says Judith Goldman, atnician and researcher at the University of Michigan, USA, ‘Sometimes resuscitation teams may decide not to offer relatives the ‘option of witnessing resuscitation; but this should never be based on their own anxieties rather than on evidence-based practic! sane MAPOMMMOMMAMIAAAAAAAANAAA EE BAEoOe ee a VSSSEES ESS SSFEVHFUEEEUUUUUUUUUCCECE ‘When a patiant is admited to intensive care the question may be asked by the medical tam whether the patent would want CPR. This would also provide an opportunity for witnessed resuscitation to be discussed with patients and relatives upon admission. ‘The subject would have to be ‘approached sensitively, but ascertaining patients’ and/or relatives’ wishes before an admission to intensive care would certainly help’ says Frank Lang, researcher for the European Resuscitation Council. ‘Recent studies show both public support for witnessed resuscitation and a desire to be included inthe resuscitation process and of those who have had this experience; over 90% would wish do so again” he says, ‘Stil, the decision regarding whether to be present during resuscitation shoulé be left to the individual person because its certainly not for ‘everyone,’ he adds, “Medical teams also need to gauge whether Witnessed resuscitation would have benefits for the patient andlor the felatives, which can only be done through a holistic assessment of the specific situation at the time. It neads to remain a personal approach’ he says. What this way of thinking suggests is that regardless of researc, ‘witnessing resusctation can be traumatic for al involved, particularly for family members, 0 it seems appropriate that health professionals, explain everything that is happening. Even more so that a momber of the team, ideally the nurse caring for the patient in cardiac arrest, be designated for that role and remain with the famiy during the whole process, Nurses need to ciecues the wishes of the patient andor reatives 28 soon as possible to act in the best interests of both whila romaining non: |udgemental whatever the rolatves decide, whether they choose to be present or not, and support them in making the decision’ says. Juith Goldman. ‘Once it has been established that relatives want to be present, the nurse should inform the resuscitation toam leader, seek their approval and ask them when the relatives should enter the, resuscitation area, The leam who are providing dract care retains the ‘option to request that the family be escorted away from the bedside andor cut of the roomIt deemed appropriate, she says. ‘Such decisions to request femily removal are not taken fighty. ‘There are the more obvious occasions that family memibers must be removed, for Instance, if they dlsrupt the work ofthe resuscitation team either through excessive grief, loss of self-control, exhibit violent or aggressive behaviour oF try to become physically involved in the CPR attempt she says, Bul the team also need to consider times when during a resuscitation attempt all members of staff are fully occupied and there is ‘one availabe fo stay with the family. This is especially hard for them to take. It the family do remain present, and regardless of patient outcome, providing assistance is crucial for families to get through such a stressful and shocking event. Frank Lang recommends that the nurse who is Sredting the family should point them towards all or any available support service within the hospital as well as towards. professional bereavement counseling outside of the hospital, The latter provides distance from the scene and can help with symptoms of post-traumatic stress disorder’ Throughout any decision-making, however, itis clear that the patent's welfare, privacy and cigity must remain the utmost priority of the resuscitation team, on EREWC MTT In the first paragraph, the writer quotes the RCUK in order to A. stress the significance of family involvement in resuscitation attempts. B. chow the significant bonofts of family presence during resusctation, C. highight that many now onsider witnessed resuscation outdated. . demonstrate that boing witnoss toa resuscitation attempt is traumatic 8. Inthe second paragraph, Judith Goldman says that witnessed resuscitation should nat be the sole decision of the resuscitation team. [A needs to be made available to all amles « © © © « € e e e e « e e e e e e e e e e e e e e e e e e e e e e « e ace e 2 2 2 2 2 2 > 3 VESESEEE FDI DIF DVODDDDE B, must not be denied because of personal feelings. C. fe requested by a large number of relatives, 8. Inthe second paragraph, the phrase remains adamant is usedto |. argue that relatives should have the ultimate decision, BB show that the opinion af the RCUK has not changed. express that greater understanding needed from staff . emphasise RCUKs opposition to excluding family. 410. nthe third paragraph, Frank Lang suggests that patients and family members ‘A. would struggle to comprehend the process of CPR. B. require olow up supper ror resuscitation teams. . have a good understanding of witnessed resuscitation, 1 would benef from early consultation with stat 114 In paragraph four, the writer believes that a team member present at resuscitation attempts should provide the family with constant reassurance, \ilfind the experience as stressful as family members. should focus onthe patient ather than the relatives. feeds to explain the process 1 each individual family member. pomp 412, What doa Judith Goldman regard as important during resuscitation? ‘A establishing that the resuscttation team are in charge. 8. that relatives are inetructed on whather to be present or not. C. the point at which family members enter or leave the scene . remaining courteous when requesting relatives to leave. 418.In the sith paragraph, Judith Goldman suggests that families who Wish to be present‘A. must understand thal extra staff may not always be available, 8. atimes struggle to understand why they cannot enter. CC: prefer to remain with the allocated member of staf. D. are sometimes concerned about witnessing the resuscitation. 14. Inthe fil paragraph, Frank Lang inlets that despite the outcome ofthe resusiiation attempt families ‘A. ate required to seek counselling as soon as appropriate B, should ullise the hosptal network before outside assistance. : sometimes regret thelr decision fo remain present. . wil stil often stuggle to overcome the experience es Assmoker’s rightto surgery Smokers who do not try or do not succeed in quiting should not be offered @ wide range of elective surgical proeadures, according to an cediterial pubished in The Medical Journal of Australia, The authors acknowledge this would be a controversial overty discriminatory ‘approach, but they say iti also evidence-based. Dr Matthew Peters and colleagues from Concord Repatiaion General Hospital say smokers who undergo surgery have substantially higher risks, poorer surgical outcomes ‘and therefore consume more healthcare resources than non-smokers Surprisingly, these new concems are not based on cardiac and respiratory "icks, but increased wound infection, "A randomised study examining smoking cessation intervention before Joint replacement surgery, saw wound infection rales reduced from 27 Ber cent in continuing smokers to zero in those who quit smoking.” Dr Polers said. “Ammost 8 per cont of breast reconstruction patients who 2AM AMAAAAA AM MAMMA AAAADOO CES ee a a 2227277990 r Veeeeee ee eV ESV EEE EEE EELS LLC ee smoke experience abdominal wall site necrosis, compared with 1. per ent of non-smokers. These results are obviously significant" He believes that ts much better that the prorisation occurs on the basis of geod evidence rather than on awhim or some politcal infuence, "If there was a heath care system that had everything patients need and want immediately, there wouldn't be a problem. But we don't have that and as far as I'm aware no country tuly does. You have to determine proses,” Poters says. - However, not everyone agrees. Professor Andrew Coats, dean of the University of Syneys faclly of medicine beleves this is not accepted medical Wealment. You do rot arrange patents based on them being more deserving of less desesing, You give treatment based on need and how a person wil benef, Its the urgency ofthat need that's the iain factor” Coats says West facors should onl fect treatment in ‘ory Iimted coumetances.“f, because of fest factor, a teatment netikey to wer oritwl be harm, then obviously it should nt procoed But wo don't take thoco factor into aceount in posing; that woud bo tha end ofthe healthcare system ae wo know i” He says Ha doctor Deleves a patont could give up emoking and. therefore cedice complication fates, hey should encourage the patent to ql, but he saye you cannat wield an opertion as punishment or not ging up "Many Bop ae table to give up clgsretes. tis a eal chemical contin." Dr Mike Kramer, the Royal College of Surgeons representative agrees that smokers need to be treated diferenlly. "You need to take risk into ‘account. The risks of procedure versus the benefis, and that is affected by the smoking status of the palien” ne sys, Kramer, a catdlothoracie surgeon, says complications associated with smoking are 0 significant he wi delay an operation for the removal of = king cancer so 4 patient can stop smoking for a minimum of four weeks before an operation, "This is: not & moral judgement or an ethical Judgement. itis @ pure ¢Enical judgement for the benefits of a patients outcome,” he says, There is also the heavy burden of financial pressure that must beconsidered when dealing with the limited heath dollar. Reverend Norman Ford, the director of the Caroline Chisholm Cente for Health Ethics, says while there should be no blanket ban of refusal for any surgery, the allocation of public health funds needs to be taken into ‘account, ‘Why should nén- smokers fork out for smokers?” Ford says the addtional costs of wound infection complications should be caloulated and smokers who refuse to quit before surgery should pay the adeitonal expense if wound infections occu.“ they give up smoking they should be treated the same as non-smokers. f they cont give up ‘moking they should pay the difference," he cays. “Youve got to motivate them to stop smoking and the pocket is a great motvatot~ if theyve got. So thelr ability to pay should be means tested.” ‘The eseence of this argument comes down to the question of wether People who are knowingly doing things that may be harmful to their health are enttied to health care. Surgery Is routinely performed on abate, who algo are at risk of increased postoperative complications It surgery can be denied to smokers, or even delayed, should the same treatment, of lack thereof be given diabetics with poor glycaemic control because they don't comply with diet or medications? Refusing to operate on smokers could land us on a very slippery slope, eventually allowing surgeons to choose to operate only on low risk pationts. Perhaps it would be more prudent for physicians to educate their patients about the risks of smoking, as well as other risk factors, prior to surgery and entite patients to make an informed decision about their healthcare, =a CIS x 415, What possible reason does the writer give for refusing currant smokers the opportunity for surgery? {A the negative effects seen in systematic research B. the overal increased costs to the hospital system 6. the known impact on the patient’s heart and lungs the highar possibilty of post-operative infection eee ccded o° e eee sd a a poo a SPSS EEEEEEUUULG 2299999999779 9AAAAAAAAADAD PVseSCECE VG o 46. In the second paragraph, Dr Pelers says thot prioritising pationts [Ais unfortunately necessary. Bis less expensive in the long run. . should start at a government level 17. In the second paragraph, the writer uses the term ‘on a whim to show DrPeters belt that A furor esearch shouldbe cariedout 6. current heatheare systems are not adequate. ©. the findings of recent research are remarkable. D. careful consideration is extremely important 48. In the third paragraph, Professor Coates says that treatment should be provided ‘Ato all patients based on. system of met £8 according tothe necessity ofthe ndivcual patient ©. regress of patents Hany ctor. . once 2 patient has reduced ther intake of oigareties. . To wnat doos Dr Mike Kramer regard as a signfieant factor when treating a emoker? ‘th lrg of tie a patina tales from smking 8 provid an unbiased assessment ofeach dual eng no etal mpieaton of each case 5. the patents atte towards smoking cessation 20. In the fifth paregraph, Reverend Norman Ford says that when considering he fancial burden of healthcare |A. smokers should fund their wn operations '8, mare public funding fs needed to help smokers quit. ©. making a smoker pay incentivises change. . patients who smoke should not be held aocountable,24. In the fi 21, nt hy aera, what cbinion'¢hahighiea by te btade Yor A. Patients that continue to smoke should Q still have righ B, Those that dont emoke have less complications. "s . The pubic should net bear the cost of smokers’ heathcare jon-smokers are less of a burden on public funding. 22. In the final par 22 Inthe fal paragraph, he wnter argues that veatng skers As fair as other patients haven't fen't made such poor lifestyle choices. B.. could in turn lead o por decisions coneeming cher pain. may ultimately cause such palin o avoid having heath checks ay lead surgeons to discriminate against patients with diabetes. SENS TEST 4 Rrrrarrie ourters, 0, inthe separate Tex Sooke. soa an ton na, look through he tents, X-D,tfndthe relevant __iermatonecsonthe spaces proved nth Question Pet + Mie re nostone with -ninut eit 5 Weesrduer sould be caret spe De NE Text A Tobacco “Tobacco smoking is also an important isk factor for cardiovascular diseases. Currently, an estimated 967 milion of the world's 7.6 bilion Smokers ive in the developing world. Tobacco smoking increased among ren, followed by women, in industrialized nations in the last century, and Tree subsequently deciined in some nations such as Canada, the United States, and the United Kingdom. Descriptive models based on historical pattems inthe industrialized world predict a reduction in the number of male smokers and Srincrease in the number of female smokers in the developing world over the coming decades. However, there have been major recent transformations in global tobacco trade, marketing, and regulatory control. ‘Kea result, tobacco consumption among men and women In most nations is primarily determined by opposing industry efforts and tobacco control measures, and by the socio- cultural context, rather than national income. Text B BMI “The observed rapid BM! increase with national income indicates that preventing obesity, which may be more effective than reacting ater it has erourred, should be a priority-during economic growth and urbanization of {2 nation, Overweight and obesity are also Important because they cause @umber of non- cardiovascular outcomes including cancers, diabetes, and ‘osteoarthritis which cannot be addressed by reducing risk factors such as blood pressure and cholesterol. Current intervention options for obesity in Principle include those that reduce calorie intake and increasing energy expenditure of a population through urban design which incorporates space {or outdoor activities, Text Current Research (WHO, 2018) Background Cardiovascular diseases and their nutritional risk factors—including overweight and obesity, elevated blood pressure, and cholesterol—are ‘among the leading causes of global mortality and morbidity, and have been predicted to rise with economic development in countries and societies throughout the world, Methods and Findings We examined age-standardized mean population levels of body mass index (BMI), systolic blood pressure, and total cholesterol in relation to National income, food share of household expenditure, and urbanization in 4 cross- country analysis. Data were from a total of over 100 countries and were obtained from systematic reviews of published literature, and from ‘ational and international health agencies. BMI and cholesterol increased rapidly in relation to naticnal income, then flattened, and eventually declined. BMI increased most rapidly unti an income of about IS 5,000 (intemational doliars) and peaked at about IS 12,500 for females and I$ 17,000 for males. Cholesterot's point of inflection and peak were at higher income levels than those of BMI (about I$ 8,000 and IS 18,000, espectively). There was an inverse relationship between BMl/cholesterol and the food share of household expenditure, and a positive relationship with proportion of population in urban areas. Mean population blood pressure was not significantly affected by the economic factors considered. Conclusions When considered together with evidence on shifts in income—risk relationships within developed countries, the results indicate that cardiovascular disease risks are expected to systematically shift to low and middle income countries and, together with the persistent burden of infectious diseases, further increase global health inequaities. Preventing obesity should be a priority from early stages of economic development, accompanied by measures to promote awareness of the causes of high blood pressure and cholesterol rpeoge 42772722 MAAAMANAAAAAA AMAA ' +4 SoSH DVTFTVVIVS Text = Health Repercussions of Wester Lifestyle {these ilnesses sppear to orited wit he increase of 2 Facto scaly, dunge which mary people woud regard © lifestyle Improvements. They include: ‘« Less strenuous physical exercise, often through increased use of acer «any ecoessibity sotto large amounts low-cost 08 5 Mvb food general, wih much less physical exertion exp to obtain a moderate amount of food 7 «More high fat and high suger foods in the det ae common inthe bfuent developed economies «Higher consumption of meat and dairy products -Higher daurmpton of gains and white bread 4 commercial = which reprocessed, cooked a Mors ont tare seasonal, es ood prepares ely at time of eating) PEs For each ofthe questions, 1-7, decide which text (A,B, or) the information comes from. You may use any letter more than onet jon about In which text can you find information at : 1. trom where did the data for the research were collected 2 2, name one important risk factor for cardiovascular diseases’ 3, what does the observed rapid BMI increase with national income indicate? 2 Which types of foods are common in the affiuent developed economies! 5, what can cause a number of non- cardiovascular outcomes? an population 6. what was the influence of economic factors on the mean populationblood pressure? 7. how many smokers are there in the developing world? Answer each ofthe questions, 8-13, witha word or sh witha word or soit phrase fom one ofthe tots. Sen tia ey ir ie be eran ‘8, Who conducted the current research on diseases of affuence? 9. How many countries contributed the data for the research?” 10. Whatis the effclent way to minimize diseases of affuence? 11 What are the basis of desertion model that pres numberof 12. What s the estimated population of the world? 18, Where dd tobacco smokers increased inthe last century? ‘Complete each ofthe sentences, 1-20 lth awordor short phrase from one ofthe texts. Each answer may incase words, number orboth. Your enswers shoul speed Ul be correcty 44 Cholesterol is one among the leading causes ales ng the leading causes of and 18 Current intervention option fer In principle include reducing calorie intake 16. Overweight and obesity can cause including cancers, diabetes, and osteoarihris bigs 417, Proventing obesity should be a: sreing chy shoud be a prorty dang econo roth and nag anoogegas es SEFTTS é POPPAMAMANMANANAANAAANAA Yous 418, Thore have been major recent transformations in global marketing, and regulatory control +19, There was an inverse relaionship betweon BWl/cholostrol and the ctshare of Sen +20. Factors of these inesses are things which many people would regard as [END OF PART A THIS TEXT BOOKLET WILL BE COLLECTED (ETE inthis part of the test, there re sixshort extracts profesional For questions 16, choos othe teat, Write your arswerson the se 11. The manual informs us thet the ultrasound machines "A. are used to give imagos of structures withthe body. BB, have a printer attached for recording images. C. poses negligible danger to the human body. releting tthe work of heath se the anewer (A, Bo C) whieh you hints best according arate Answer Sheet Uttrasound Machines Diagnostic ulrasound machines are usod fo give images of stuctres Pig tha body, The diagnostic machine probes, which produce the ultrasound, come in a variety of sizes ard sles, enc YP Pos cauced fora parteular special use. Some require @ large ey Png Pre pars ofthe unt, while the smallest come in a small Box with iva sudo loudspeaker as ouput. Tey ray be found in cardoleoy.matemity, outpationts and radiology departments and wil often have a biter attached for recording images. Unlike X-rays, ultrasound poses no danger to the human body, 2. The guidelines establish thatthe healthcare professional should ‘A. must ensure proper safety protocols, B. evelucte the radiation absorbed by bones and tissues. C. respect the wishes of the patint above al ele. X-Ray Machines rays are high energy elactromagnetic waves. The transformer produces 2 high voltage that directs electrons onto a target in the machine head. X- rays are produced by the target and are rected into beams by a collimator towards the human body. Soft body tissue absorbs lees X-rays, ite, passes more ofthe radiation, whereas bone and other solids prevent most ofthe X-rays from going trough. Users must ensure proper radiation safety protocols and supervision are in place, 3. The purpose of this email isto ‘A. inform biomedical waste rules are framed by the Central Pollution Control Board, BB. inform users must beware of the systems that exlst and follow local procedures. . inform users must keep biomedical waste separate from other waste. Biomedical waste Biomedical waste is all waste tissue and body uid, including clinical items contaminated with these. It is coverad under the rues framed by the Central Polltion Control Board. Hospital ‘management must take steps to segregate, manage and safely dispose ofthis waste, Equipment ucere must be aware ofthe systoms that exist for this and foliow jocal procedures. Most importantly, users must Keep biomedical waste separate from other waste, 4 2 GLbticed 227277272 AMDAANANANAAANANAAAAARE OO OES EE Pee ee U DEES EEE UHEED DY ee ee sf; s 4. The manual informs us that the Intensive care unis ‘Aare cleaned thrice a day BB. are wat cleaned more frequently . frequency of eleaning corresponds to nature of operation Hygienic requirements for cleaning [theatre and social cre faites ae wet leaned day and een Move requoniyf evossary. Acaring othe nar fhe oparaion the Me mete utube forts method stleaning. mn peratng eats ¢sing‘Inesve procedures, caring’ cared ot bth pre and pst saipboytor each pens none care unte and ho rooms for colecng Sokgiat mater are cleaned hee times a day. The aqucnoy of Sloan otter worslaces corespondto the nt ofthe operat, n Dail ther than the health N facility Seaning by a subject tor than the eaticare or soil ar fai prove, he oskgnaed ware must proceed according tthe cota Seto ane ocean res 5, The notice is giving information about ‘A. cleaning process before disinfection process B, cleaning process before decontamination process . cleaning process aftor disinfection process. Decontamination Decortaminaton procedures nude mechanical dasig. hich ramoves orto andes no pesos cmaorganae ata et ‘Srtrmaton bia ato, te neossry to elo mocharial Sqiegbtore he drocon process Detergents wn a dean fen Se app rarualy ory washing er larg rechnes, Protege sorio devant Atos and equpos tba etead Conn. macine a oer equipment are sedin Seardncewiihe manufacturers nsuctons, dung checks othe Seon owe6. What must all staff involved in the physical disinfection process do? A. Boil under atmospheric pressure for at least 20 minutes BBall under atmospheric pressure for atleast 30 minutes. Boll in pressurized containers for atleast 30 minutes Physical disinfection + Bolling under atmospheric pressure for at leas} 30 rrinutes, + Boiling in pressurized containers for atleast 20 minutes. + Disinfection in equipment at a temperature determined by parameter A. The equipment must guarantee to redueo living microorganisms on the disinfected object st a given temperature to a predetermined love suitable for furher use. EADING SUB-TEST PART In this partof the tos, there ae two texts about diferent aspects of heakhear, For questions 7-22, choose the answer (A,B, Cor O) whieh you think ts best accordingto the text. Write our answers onthe separate Answer Sheet Breast Cancer and the Elderly Breast cancer is one ofthe highest-profle diseases in women in developed countries. Although the risk for women younge: than 30 years is minimal, this risk increases with ago. One-third of all breast cancer patients in Sweden, for example, ae 70 years or olde at diagnosis Despite thesa statistics, few breast cancer rials take these alder women Into account. Considering that nowadays a 70-year-old woman ean ‘expect to lve for atleast another 12-16 years, this is a serious gap in clinical knowledge, not least because in older women breast oancer is ‘more Ikely to be present with other diseases, and doctors need to know wether cancer treatment wil affect or increase the risk for these diseases, P2APPFPAMMAANANAANAANAANAHAAB ANE HON EES aL PERE eee GESeeee Sees eETHD EEE DUUUUULECCCEEE? In 1992, guidelines were issued to the Uppsalal®rebro region in Sweden (uth @ population of 1.9 milion) that all women with breast cancer should be able to receive equal treatment. At the same time, abreast cancer register was set up to record details about patients inthe region, to tencure thatthe guidelines were being followed, Sonja Eaker and colleagues set out to assess data from the register to see whether ‘women ofall ages were receiving equal cancer treatment. They compared the 5-year relative survival for 9,059 women with breast cancer aged 50-64 years. They divided them into two ago groups: 50-69 years, and 70-84 years. They also categorized the women according to the slage of breast cancer. They looked at diferences between the proliferative abilty of breast cancer cals, estrogen recepior status, the ‘number of lymph nodes examined, and lymph node involvement. The researchers also compared types of treatment, surgical, oncological (radiotherapy, chemotherapy, or hormonel}-—and tha type of clinic the patlents were treated in, ‘They found that women aged 70-84 years had up to @ 13% lower chance: ‘of surviving breast cancer than those aged §0-69 years. Records for ‘older women tended to have less information on their disease, and these women were more Ikely fo have unknown preliferaton and estrogen receptor status. Older women were less likely to have thei canoer detected by mammography screening and to have the stage of disease identified, and they had larger tumours. They also had fewer lymph nodes: ‘examined, and had radiotherapy and chemotherapy less often than younger patentsCurrent guidelines are vague about the use of chemotherapy in older women, since studies have included only afew older women so far, but this didnot explain why these women received radiotherapy less often ‘Older women were also loss ike tobe offered breast-conserving gery, but they were more likely ta be given hormone treatment such as smoxifn even ifthe tumours did not show signs of hormone eoneitty, ‘The researchers suggest that this could be because since chemotherapy tends to be not recommended for older women, perhaps clinicians bolieved thal tamoxifen could be an alternative. The researchers admit that one drawback of ther study is that there was litle Information on the other diceases thal older women had, which might ‘explain why they were offered treatment less often than younger pation However, the fact ramains that in Sweden, women older than 70 yoars are offered mammography soreening much lass often than younger women— despite accounting for one-thid of all breast cancer cases in the country and these older than 74 years are not soreened at all Eker and co-workers’ findings indicate that older wemen are urgently in need of beter treatment for breast cancer and guidelines that are more appropriate to thelr age group. Developed counties, faced with an Increasingly aging population, cannot afford to neglec the eldety CSET Q7, The main idea presented in paragraph one is that. «only older women need to be concerned about breast cancer. ». breast canoer trials seldom consider older women «breast cancer is more common than other diseases in older woman. 4. older woman do not take part in breast cancer trials. =; ee ee 5922792799997 7PPAAAADAAAANAAM AAA BROKE OE EES A 28. Regarding cancer treatment, Itcan be concluded that a, doctors know cancer treatment wil increase the risk of disease in elderly patent. ». cancer treatments may be a risk forall elderly people « itis unknown whether or not cancer treatments will affect the treatment ‘of other diseases in elderty peoate. 4.older woman are lees likely to have other diseases G9, 1992 Guidelines issued to the Uppsala/Orebro region in Sweden stated that 4. Sweden has a population of 1.9 milion ’b. women with breast cancer need to register their condition to ensure they receive equal treament ¢. identical breast cancer treatment should be available to women of all ages. 4.2 women with breast cancor should have access fo equivalent breast cancer treatment. 10. Which ofthe folowing was net part of Sonja Eaker and her colleagues. research? 1. Comparing ability of breast cancer cells to increase in number. . Grouping woman according to their survival rat. Identiying diferences in treatment methods. 4, Splting the grotips based on age.11. Findings by the researchers indicate that 2. older women ate less likely to have chemotherapy recommended. ». older women prefer hormone treatment to braast-conversing surgery. «older women have fewer ymph nodes 4.clder women respond better lo chemotherapy than to hormone tteatment 212. The word vague is paragraph § mears.. uncertain b.unclear unknown, <4. doubtful 113. One limitation ofthe study i that «older women are treated les often than younger women. ». older women have a lower incidence of breast cancer. «younger women are treated more often than older women, 4. there isa lack of information on other diseases which older women have. 14, Which ofthe following statements best represents the view expressed by the wter at the end ofthe article? 4, Due to ageing population in developed countries, the needs of the elderly must not be ignored. , Older women need more appropriate treatment to sult their age. «Developed countries have neglected the eldery for too long. 4. Itis too expensive treat the elderly 17> 2?2?7P7PFPAPI®FAAAAFANAAAAAAAAAA HOOK HORACE SSeS EESEUELUUUUECCEL EEE o ° Parents, Kids & Vegles ‘Most parents have waged epic bales with their kids over eating vegies. But ifthey don't clean ther plate of the last brussels sprout does it really matter? Vegetables are behind some of the greatest batios botwoen parents and children. Most parents have dinnertime horror ‘tories involving small its of vegetable and lets of screaming, and while these stories can be entertaining, the research showing how few vegies ‘ourkids are eating s nat. ‘The 2009 Australian Instituto of Health and Welfare national report card found that a whopping 78 por cent of 4-8 year old, 86 per cont of 9-13, Yyear- olds and 95 per cont of 14-16 year-olds are not eating the recommended daily servings of vegetables. Take out potatoes, which ‘most kids eat as chips, and the percentage of kids not getting the rutrtion they noed jumps to 97, 98 and 100 percent respectively. Other research has made similar findings. But Australian chidren are hardly going to starve i they don't eat vegetables and its not easy for parents to keep cooking meals that are left on the plate or wrse, tipped on the floor. Does i really matter if cur kids don't eat their greens? Professor Louise Baur, paedattcian and director of weight management services at The Children's Hospital at Westmead, says we all need to eat a wide variety of foods - including vegetables - and chiiren are no diferent. Research shows vegetable ‘consumption can help prevent chronic diseases such as heat disease, type 2 diabetes and a range of cancers. ‘Acconting to Australia’s dietary guidelines, children aged between four ‘and seven should be eating two to four serves of vegetables cally. Eight 10-11 year olds should be eating an extra serve; teenagers shouls have between four to six serves every day. One serve of vegetables is one up of raw salad vegetabes, one medium potato or half @ cup of cooked vegetables or legumes.In the short-term, children who don't eat vegetables can end up with dontal issues, constipation (especially if they skip on fruit as well) and ‘on rare occasions nutional deficiencies, Baur says, But perhaps more importantly, we tend to develop our eating habits in childhood, 20 if youre not cating vegetables and other healthy feode as a child then you are less likely o:do so as an adult Excess weights also a problem: between 6-8 por cont of school age children in Australia are obese and at least another 17 per cent are ‘overweight. You won't automaticaly put on weight if you don't eat ‘vegetables, Baur says, but children who don't eat vegetables are often ‘eating foods that are high in saturated fats, sugar and eat. Children who are overweight are more ikely fo become overweight or obese adults, ‘who are then at greater isk of chronic diseases. ‘And while the most haidened young vagie hater might enjoy an apple, banana or piece of watermelon, Baur says fit dossn't contain the on ‘and other minerals found in vegetables, and it also contains more Sugars, Whi fruitis_an important part of a heathy det, the dietary uidolines suggest kids under 12 only need one to two serves a day. So ‘we know that kids need their vegies, but geting them to eat a mouthful, let alone several cups can be a challenge. Nutonist Or Rosemary Stanton suggests nuition should be 2 whole family affair you can boost your child's vegetable intake by eating your ‘evening meal together atthe dinner table, prferably with te television of. "Vegetables have traditionally been eaten mainly at dimer and with many familes no longer having a family meal, many kide get themselves something o eat - often instant roads, pizza or somo kind of pasta sh (rarely with vegies), Stanton says, Children are also more likely to eat and enjoy vegetables, and other heaithy foods, i they find them interesting, says Stanton. "Several studies show that when kids grow vegies or attend a school with a kitchen garden, they and to eat more vegies... For those in las, there are community garcens in some areas, orf they have a beleon lettuces, herbs, cherry tomatoes etc ..can all be grown in pots." pogo ongnes aa a a ° CFSE UUUUECCCCCCEE beEEULE é 22272777777 PADRAAANMADADA PP eee eee Pee eee oe Ves ‘You can algo pique your childs interest in vegetables by including ther in a rango of tasks, such as grocery shopping, going to markets or by {getting them to help prepare meals. Smal children can toss a salad {you ean rewash any salad leaves that end up on the floor, and older children can take on mare dificult asks, for example peeling and cutting vegetables. But perhaps the most important thing parents can do is ‘model healthy eating. Research has shown children's eating patterns are affected by the famiy's eating behaviour. Lisa Renn, spokasperson for the Dietitians Association Australia, enoourages parents to be persistent. ‘She says there are many easy and craly ways to get vegies off your chiléen's pates and into their mouths: + grate extra vegetables and add them to a favourite pasta sauce + make green mash, add spinach or rocket when mashing potato + serve vegie sticks with clips (think avocado, pumpkin or sweet potato) ‘and other snacks + dd extra vegetables or lagumes to your next soup or stew ‘make muffins using vegetables - corn, pumpkin and sweet potato al ‘work well She also suggests the scaltergun approach: offering a wide variety of ‘vegetables (ine more different colours the better) in small amounts throughout the day, not just at ainner time, There's no denying these suggestions require time, effort and creative ‘marketing. Utimately, ssays Renn, “you do what you can do, get them in where you can, be as, Inventive as possible and be persistent.‘Q15, According tothe passage what s the reason behind the batts between parents & children? a. over eating of vegies not cleaning «. vegetabies .not eating vegies Q16. Who stand first ie avoiding vegies from dally servings? 2.48 years ». Toon yoars ©. 14.16 yoars 4. Kide 17. Why do parents fee! discomfort in cooking vegetables? a. Children won't eat thom ». Vegetables wll be in plates! lors «.Childron wil starve a.bande, {218, Who cannot be eliminated according to Prof. Louise? 2. diabetic patents bichiléren «children prone to cancer @aande 2277277777 FPFPFPFPPPIP®PAAPAAMAAM MMM OHO ES EES v v » » . > 2 2 > > > 3 > s . > > ° ° > . > ° ° . > > 2 * 2 2 . . 2 2 19, Along with a potato how munch vegetables should be taken in a day? a.acup b.a cup of cooked veggies . none of the above d.aandb 20, Which has the less possibilty to occur with eating les veggies? a. Dental issues . Constipation . Defioiency d. None 21. What will automatically happen when you are not eating vegetables? + a. put on weight reduce in weight c. occurrence of obese «4. nothing will happen 22. Who needs 2 serves of vegetables a day according to the passage? a. 4-7 years b. 8-11 years, c. Below 12 years d.Aande DaTESTS: Lookat the four tts, A, nthe separate Text Booklet » peveach queton, 2 look though th texts, 4, to find the relevant information «Wits yourenswerson the spaces provided ths Question Paper. prawn qerine sire 1-cdeu teal + ‘rouranawas ad be crac ot Pee eS Text A Junior Sports Injuries Title: Patterns of injury in US high schoo! sports: A review. OBJECTIVE: To characterize the risk of injury associated with 10 popular high school sports by comparing the relative frequency of injury and selected injury rates among sports, as well as the participation conditions of each sport DESIGN AND SETTING: A cohort observational study of high school athletes using a surveillance protocol whereby certified athletic trainers recorded data during the 2016-2017 academic years. SUBJECTS: Players listed on the school's team rosters for football, wrestling, baseball, field hockey, softball, girls’ volleyball, boys' or girls! basketball, and boys’ or girls’ soccer. MEASUREMENTS: Injuries and opportunities for injury (exposures) were recorded daily. The definition of reportable injury used in the study required that certified athletic trainers evaluate the injured players and subsequently restrict them from participation, AAPAAAPAIAAPAIAAAAAAN AA MAA AAA EEE OES SHS he TOPS SSE SASS EEFEEEUUUUUUUECCCCCEE? RESULTS: Football hed the highest injury rate per 1000 athiete-exposures| ‘at 81, and girs’ voleybal had the lowest rate at 1.7. Only boys (69.3%) {and gifs’ (67.0%) soocer showed a larger proportion of reported injuries for ‘games than practices, while volleyball was the only sport to demonstrate a higher injury rate per 1000 athlete-exposures for practices than for games. More than 73% of the injures restricted players for fewer than & days, The proportion of knee injuries was highest for gts’ soccer (19.4%) and lowest {or baseball (10.5%). Among the studied sports, sprains and strains ‘accounted for more than 50% of the injures. Of the injuries requiring surgery, 60.3% were to the knee, CONCLUSIONS: An inherent risk of injury is associated with participation in high schoo! sports based on the nature of the game and the activities of the players, Therefor, injury prevention programs should be in place for both practices and games. Preventing e-injury through daily injury management is @ citcal component of an injury prevention progrem. ‘Athough sport injuries cannot be ently eliminated, consistant and professional evaluation of yeary injury patterns can provide focus for the ‘development and evaluation of injury prevention strategies, Text 8 Literature review extract: Prevention of sports injuries. -Langran and Selvaraj conducted a study in Scotland to identify risk {actors for snow apors injuries. They found thet persons under 16 years of age most frequently sustained injury, which may be attributed to inexperience, They conclude that protective wrist guards and safety release binding aystems for eki-boards helps prevent injury to young or inexperienced skiers and enowboarders. Ranali and Rye provide an awareness ofthe orl heath care needs of the female athete, They report that a properly fited, custom- fabricated or mouth-formad mouth-guard is ‘essential In preventing intraoral soft tissue lacerations, tooth and jaw fractures and dislocations, and indirect ‘concussions in spots.‘Although custom-fabricated mouth-guards are expensive, they have been ‘shown to be the most effective and most comfortable for athletes to wear. Pettersen conducted a study to determine the atttudes of Canadian rugby players and coaches regarding, the use of protective headgear. Although he found that fow actualy wear headgear, the equipment is known to prevent lacerations and abrasions to the scalp and may minimize the risk of Text Best practice guidelines for junior sports injury management and return to play |When coaches, official, sports frst elders, other safety personnel, perents and partcjpans follow the safety guidelines the rsk of serious inury is minimal. If an injury does occur, the golden rule in managing tis “do no further damage”. tis important thatthe inured participant is assessed and managed by an appropriately qualified person such as a sports fist alder or ‘spots trainer. Immediate management approaches include DRABCD {checking Danger, Response, Ainvay, Breathing, Compression and Defibillaton) and RICER NO HARM (when an injury is sustained apply Rest, Ice, Compression, Elevation, Referral and NO Hest, Alcohol, Running fr Massage). Young participanis returning to activity too early after an injury ‘are more susceptible to further injury Before returning to participation the particisant should be able to answer yes to the following questions: + Is the injured erea pain free? + Can you move the injured part easly through a ful range of| movement? ‘+ Has the injured area fly regained is strength? ‘Whilst serious head injuries are uncommon in children and young peoples! Sport, participants who have lost consciousness or who are suspected of being concussed must be removed from the activity. Prior o returning to sport or physical seivity, any child who has sustained an injury should have medical clearance, TESS SSe ed V dee eUEVOUUUELELULECECC CCE a >A 2P22PPPPAPAPA®A®IANAAAAAAANAA HRA AHAB EEE SEE Text Research briefs on sports injuries in Canada «« Approximately 3 millon children and adolescents aged 14 and under get hurt annualy playing sports or participating in teoreational sctvtes. ‘Although desth from a sports inurys are, the leacing cause of death from a sports-related injury ise bei injury. + Sports and recreational activities contribute to approximately 18 percent of el traumatic brain injuries among Canadien chléren fand adolescents. * The majorty of het acthities occur during cycing, skateboarding, or skating incidents TEES For each of re questions, 1-7, decide which text (A, B, Co: D) the information comes from. You may use any letter more than once In which tex can you find information about {what does 'DRABCD stands for? 2. who conducted the sudy in Seotlend to Kent risk factors for snow ports injure? - $X when does majoity cf haad injuries sustained in sports or recreational ‘activites occur? 4. what does 'RICER NO HARM’ stands for? 5, who conducted the study among Canadian rugby players and coaches? 6. which game hes highest injury rate in US high school sports? "7. whats the leading cause of death trom a sports-related injury? injuries eustained in sports or recreations! rower soch othe cuestons, 8°13, wih a word or shoct phrase rom one of the tent ech anowor may includ words, number ofthe both. Your answers should be conwctyopebed8, What type of injuries are rare in children and young peoples’ sport? 8. Which equipment prevents lacerations and abrasions to the scalp? 40, Which game hae lowes injury rate in US high school sports? LL. rich type of injury required surgery among majorty players in US high schoo! spors? 112, Whats the golden rule in managing en injury? 48. what isthe most effective and mast comfortable protective gear for athletes? Complete each ofthe sentences, 14-20, wih a word or short phrase from ‘one ofthe texts. Esch anower may inckide words, number or both. Your ‘angwors should be correctly spalled 114] Majority ofheed injuries sustained in sports or occur during. eyeing, skateboarding, or skating incidents 15] Preventing through dally injury manegement '8 2 aical component of an injury prevention program 161 : ‘and safety release binding systems for sk-boards helps prevent injury @ sere and snowboarders 17 howed a larger proportion of reported injures for games thar practions fa US high school sports 18] Prior toretuming to sport, any child who has sustained sn injury should Have 19] Injured participant should be assessed and managed by 20] Ranall and Rye provide an awareness ofthe oral health care needs of END OF PART A THIS TEXT BOOKLET WILL BE COLLECTED AAMPAHHOHTTLS 5292277222727 PPPPINDIANDDAANA Vssudcccccce uu VED IPF SESSEEFTHTVUUODYG Inthi part ofthe rest, there are sx short extracts relating to the work of heath professionals. Forquestions 1-6, choose the answer {A 8orC} which yu thnk its best accorcing, to the text Write your answers onthe separate Answer Sheet ‘Lihat does this manual tell us about platelet plug? ‘A. obstruct the aperture and contain the blood flow BB, occludes the aperture and continues the blood flow C. open the aperture and stops the blood flow Platelet function analyzer 100 system It creates an artical vessel consisting ofa sample reserwir, a capil), feta Dilogicaly active membrane with e central aperture Coated with Collagen plus ADP, or colagen plus epinephrine. The application of ‘constant negative pressure aspirates the enticoegulated blood of the sample rom the reservokr through the capilary end the aperture. A platelet plug s formed which gradually occludes the aperture and ultimately the Blood flow through the aperture gradually decreases and eveniually stops. “The {ime needed for Blood flow interruption i recorded. 2. The purpose of these notes about an mannequins isto [A iniroducing a form of substitute training BB. give guidance on potentially dangerous procedures. CC. recommend a new procedure ine safe way. Manneqy Mannequins are a great way o familarce yourself with a new procedure ‘and also maintain familiarly with a previously eamt procedure in a safe ‘way. They are especially useful for infrequently performed, potentially Sangeroum procedures such as surgical chest drain insertion, Mannequins Slane ate not an acceptable substtvte for muliple supervised procedures ‘on reat patient, Other forme of substiule training include the use of fnimal models, which carries ethical implications, and Figh-fidelty simulation3, The email is reminding staff that log book should not ‘A. conlain the frequency of procedures performed 1B. have any personal detail of patients CC. have any unique identifers of patients Logbooks and assessment forms {tis essential to keep a logbook ofthe practical procedures you periomm. Many professions have mandatory logbooks forall trainees provided by their governing body. A logbook shows not ony the number ef Procedures performed but also how frequenity and under what ‘circumstances. The logbook should not contain patients’ personal detail, ‘although unique identifiers (e.g. their hospital number) are permited. 4. The guidelines establish thet the healthcare professional should A. storize medical equipment according to manufacturer's Instructions BB. create, document, implement and maintain a cetiied quality assurance system CC. kil all mieroorganieme capable of reproduction, including spores, Sterilization Steriization isthe process that results Inthe kiln of af microorganisms capable of repracuction. including spores. and to the irreversible, \nactvation of viruses and to Kling mecically signieant worms and eggs. Medical equipment and items intended for steiizaion and pre-steliztion Preparation are used in accordance with the manufacturer's instructions. For sterilization of medical equipment, the healtheare provider will resto, document, implement and mairtain a certified qualty assurance system of rilization, including the controlled release ef the medical equipment. 97277727 PFPAPFAAAAANAAAAAANM AMAA EERE OK ERE ae VERO VOF FFE EEEEEHEUE EEE EUUUUUUCCCCEE 5, The guidelines require those undertaking hand washing procedure to ‘A. rinse hands with warm water BB. rinee hands under flowing water CC. wash hands for almost 20 seconds Hand washing prececure + Ringe hande with water. + Apply enough soap to cover the entire surface of the hands, using small amount of water to creato the foam. * Wash hands fer at least 30 s2conds. * Rinse hands under the running water. + Carefully dry the hands with a disposable towel + Avoid using hot weer repeated skin exposure to hot water can Increase the risk of damage tothe skin. 6. This guideline extract says that the nurse in charge ‘A. should inform relatives about patient's discharge I the patient's heath condition requires it BB. should arrange transportation from the hospital f the pation’s heath condition requires it CC. should book an ambulance from the hospital ithe patient's health condtion requires it Patient discharge If tho pationts concition improves so that treatment can be continued through an outpatient taclty ar at home, then the patient fa discharged, ‘The patient may also be discharged at their own request, known as. DAMA, Lo. a declaration that they are leaving on thor own raqueet, The ‘lease is decided by the attending doctor after consultation with the senior consultant. After thatthe patient deals with the necessary matters, ‘such 88 transportation from the hospital and notifies ther roatves. Ifthe patient isnot colecied by relatives, the nurse will back an ambulance # the patient’ health conction requires itME PES lnthis part ofthe tes, there are two texts about diferent aspects of healthcare For questions 7-22, choose the answer (A,B, CoD) which yeu think fits best according to the text. Write your answers onthe separate Answer Sheet ‘Swine Flu Found in Birds Last week the HINT virus was found in turkeys on fans in Chile, The UN. ow says poulty farms elsewhere in the world coud also bacome infected. Scientists are worried thatthe virus could theoretically mix with mere dangerous stains. It has previously spread from humans to pigs. Howover, ‘swine fy remains no more severe than seasonal fu Chilean autores fret reported the notent las wesk, Two pouty fea sess err eat Vartan abr, a ch nary fa fb UN Food an Agrcture Organon (FAO), eid “Once the sachs have resovre, safe proucton are proce can continue: Tey ao not pose teat io the fod chan Cheon auhotin hve established a temporary quarantine and nave decided to alow he infected bcs o recover ator han culing the kis Sought he reel orece's sive om etd fa wor ej. Canada, Argentine ond Ausaa have provously reported ofthe H1N1 swine flu virus from farm workers to pigs. 2 reas ‘The emergence of a more dangerous strain of fu remains a theoretical ak Daterent stan ot vrs can ix a proces caod genie rauserinert ‘or recombination. So far, there have been nocases of HEN1 bicd fu in flocks in Chile. However, Dr Lubroth sai: In Southeast Asia there isa lot ofthe (HEN!) virus circulating in poultry, “The introduction of HIN} in these Populations would be of greater concern.” Cofn Butter from the UX’s Institute of Animal Health agrees. We hope itis rare event and we must montor closely what happens ned.” he told BEC News. "However, iis not ust about the HEN strain. Any futher spread of the H1Nt virus between birds, or rom birds to humans would net be good. “might make the vs harder to contol, because teu be mee ely fo ange.’ | e SFSSSVVSHSSHUEVEEVELUEUUUUEUCOCCE 1922 PPPAPP®P®A®AANANAAAAAA AMMA HPP H EN ENOTES e P Wiliam Karesh, vie president ofthe Wilife Conservation Society, who studies the spread of animal diseases, says he is not surprised by whet has happened. ‘The location ie surprising, but it could bo thet Chile has a potter surveillance system. "However, tho only constant is that tho situation keeps changing.” “The United States hes counted 522 fatalities through Thursday, and nearly 1,800 people had died worldwide through August 13, U.S. and global health ofcials said. In terms of mortality rte, which considers fu deaths interme of @ nation’s population, Brazil ranks seventh, and the United fates Is 13th, the Brazilian Ministry of Heath said ina news release Wednesday. [Argentina, which hes roported 286 doathe atributod to HIN aa of Auguet 41, ranks frst par capt, the Braziian hesith officals said, and Mexico, where the flu oubresk was discovered in Apel, renks 4 Brazi, Argentina, Chile, Mexico and the United States caves globally, according o the World Health Organization “The Braziion Misty of Health said there have been 6,100 cases of fs in the nation, with 5,208 cases (85.3 percent) confirmed as HINT, also known as swine flu. Fe slate of Swo Pauio had 223 deaths through ‘Wednesday, the largest number in the country, In addition, 480 pregnant women have been confirmed with H1N1, of whom 58 died. Swine fu has. been show to hit young people and pregnant women particularly hard Many schools in Sao Paulo have delayed the start ofthe second samoster for a couple of weeks, and students will have to attend classes on ‘weekends fo calch up, Schools also have suspended extracuriculer ‘actives such ae soccer, volleyball and chess to try to curtal spread of the disease Flu traditionally has is peak during the winter months, and South ‘America, where itis winter, has had a large numberof cases recently. ‘The Woild Health Organization said th's week thatthe United States and cther heavily populated Nerthem Hemisphere counties need te brace for ‘2 second wave of HINt a their winter approachesOfficials st the Centros for Disoese Control and Prevention and other US. health agencies have been preparing and said this week that upto half of the nation's population may contract the diseaee and 00,000 could dia from it. Seasonal fa fypically klle about 64,000 Americans each year. ‘A vaccine against H1N1 is being tested but is not expected to be avaiable Until at east mid-October and wil probably requir two shots atleast one Week apart, health officials have sal Since typically takes a couple at Weeks fora person's immunity to buld up after the vaccine, most ‘Americans would not be protected unti sometime in November. The World Health Organization in June deciared a Level 6 worldwide pandemic, the ‘organization's highest classification 7. Scientists are worried thatthe virus could potentaly spread «from pigs to humans '.) te chicken and turkey farms elsewhere 1) to othor typos of animals 4.) to the seaport of Valparaisa .Q8. What does Dr. Lubroth recommend should be done with the sick birds? 1.) They should be processed immediately. b.) They should be killed. ©) They should be allowed to recover, 4.) They should be given Tami, (28. What isthe meaning ofthe ‘spillover effect mentioned in the passage? 1.) The virus has sproad from Chile to Argentina. 'b,) The virus has spread from factory workers to birds. 2) Turkey blood has been spied during the production provess. 4.) Turkeys have become infected by eating piled contaminated pig fod! POPC CVV dss bddSVVVVVVEUUUUUUUCCCCCCE MIPAPAAPPAIAA DDD DADA DANA D AHMAD DOH OO OK {Q10. Which possibiily i Dr, Lubroth most concemed about? 2.) HEN! virus spreading to Chile .) HS91 virus spreading to Australia .¢) H191 virus spreading o Asia 4.) H101 virus epreading to Canada 11. Which statement best describes the opinion ofthe representative from the Institute of Animal Health? 1.) He doesn't want the virus to spread further because it could lead to genetic reassortment ».] He thinks HEN is no longer important but he is woried about HINT. ..) He hopes that BEC News wil pay more attention to closaly montoring the vius. 4.) Bids and humans should be under more control ctherwise the vis may change. 112. Which statement best doserbes the opinion ofthe Vice President of the Wildlife Conservation Society? a.) He is not surprised that not enough people are studying the spread of ‘animal diseases, - »b,) He a not eurprized thet swine flu has besn reported In birds in Chile. 2.) He is surpsged thatthe situation is constantly changing 4.) He Is gurpised that swine fu has been reported in birds in Chile, but ‘suspects other countries may be unaviare of the spread to birds. 13, According o the Brazilian Ministry of Health a.) The United States has counted 522 fatalies b,) more people nave died in Brazil than in the USA. ©.) more people have died in the USA than in Brazil 4.) Brazil is the 13th worst country for swine fu deaths14, Which ofthe folowing statements is FALSE? ‘452 pregnant wemen have died of Swine Flu in Braz .) Argent has reported $86 H581 related deaths, ‘@) Swine flu was fist discovered in Mexico in Api. 4.) The USA is one of the most severely affected counts Alzheimer Disease Physicians now commonly advise older adults to engage in mentally stimulating activity as a way of reducing thei risk of dementia Indeed, the ‘recommendation is often folowed by the acknowledgment thai evidence of benefits stil lacking, but “t can't hurt.” What could possibly be the problem ‘with older acute epencing their time doing crossword puzzlee and anagrams, completing puzzles, or testing their reaction tims on a ‘computor? In certain respects, there ia no problem. Patients will probably improve atthe targeted skis, and may feel good—partcuery ithe activity is both challenging and successfully completed But can it hurt? Possibly. There are two ways that encouraging mental activity programs might do more harm than good. First they can falsely raise expectations. Second, individuals who do davelop dementia might be blamed for their condition. When heavy smokers get king cancer, they are ‘sometimes seen as having contributed to their own fates, People with ‘Alzheimer disease might similarly be viewed as having brought it on themselves through failure to exercise ther brains ‘There is some evidence to support the idea that mental exercise can improve one's chances of escaping Alzheimer disease, Having mace years of education has been shown to be related tos lower prevalence of Alzheimer dsease. Typically, the risk of Alzheimer disease is two to four times higher in those wiv have fewer years of education, es compared to those who have more years of education. Other epidemiological stucies, ‘although with less consistency, have suggested that thase vino engage in ‘more leisure activities have a lower prevalence and incidence of 17 2PPPFPPPP®APAAAANRAAAAAANA MANHOOD OEE - eee ee euucrccedd VEIT IVI oVddIESFHETUHDUEUELS [Alzheimer disease, Additionally, longitudinal studies have found that older ‘edults without dementia who participate in more intellectually challenging ally actives show loee decline overtime on various taste of cognitive performance. However, both education and Isiauro activities are imperfect measures of ‘mental exercise. For instance, leisure actives represent a combination of influences, Not only s there mental activation, but there may elso be broader health effecs, including stress reduction and improved vascular hheelth— both of which may cantabute fo reducing dementia risk. I could ‘also be that third factor, such as inteligence, leads to greater levels of ‘ecication and more engegement!a cogntvaly simulating activities, and independent, to lower risk of dementia. Research in Scolland, for ‘example, showed that IQ test scores at age 11 were predictive of future ‘dementia risk. ‘The concept of cogniive reserve isoflen used to explain why education and mental simulation ere beneficial. The torm cognitive reserve is ‘sometimes taken to refer directly to brain size orto synaptic density inthe ‘cortex. At other times, cognitive reserva is defined as the ability to ‘compenaate for acquired brain pathology. Taken together, the evidence is ‘ory suggestive that having greater cognitive reserve is related to a reduced isk of Alzheimer disease, But the evidence that mental exercise ‘can increase cognitve reserve and keep dementia at bey is weaker. In ‘dation, poeple wth greater cognitive reserve may choose mentally ‘Stimulating leisure activities and jobs, which makes is dicult to precisely ‘determine whether mentally stimulating activities alone can reduce ‘dementia risk.Cognitve training has demonstrable effects on perfermance, on views of self, and on brain function—but the results are very specific to the skils that are trained, andit is as yet entirely unknown whether thare ie any t’ftfect on wien or whether an individual develops Alzheimer disease, Further, the types of skils taught by practicing mental puzzles may be less helpful in everyday le than more straightforward techniquea, euch as Concentrating or taking notes, or purting abject in the same place each time so that they won't be lost. So fa, there is tle evidence that mental practice will halp prevent the ‘development of dementia. There is better evidence that good brain health | determined by mattiple factors, that brah development early in ite ‘matters, and that genetic influences are of great impertance in accounting for individual diferences in cognitive reserve and in expairing who develops Alzheimer disease and who does not. Atleast half ofthe explanation for individual differences in susceptibility to Alzheimer disease is genetic, athough the genes involved have not yet been completaly ‘discovered. The bslance ofthe explanation les in environmental influences and behavioral health practices, alone or in interaction with ‘genetic facta. However, at this stage, there is no canvineing evidence {that memory practice and other cognitively stimulating actives a sufficient to prevent Alzheimer disease; itis not just # case of use tor lose it” PIPPFP®PPPFIFIMIAPAIAA AAPA APAAMANMOND ONES EE VERIO INOS VESEESFHUUEEEUUEUULECCCCCEE 215, According o paragraph 1, which ofthe folowing statements matches the opinion of most doctors? otimulating setivites are of litle use b, The risk of dementia can be reduced by doing mentally ulating activities ¢. The benefits of mentally stimulting activiios are not yet proven 4. Mentally stimulating activites do more harm than good 216. In paragraph 2, the author expresses the opinion that a, Mentally stimulating activities may offer false hope ’. Dementia sufferers often blame themselves for their condition «. Aleheimer's disease may be caused lack of mental exercise 4. Mentally stimulating sctivties do more harm than good 217, In paragraph 3, which ofthe folowing does not match the information on research inio Alzheimer disease? a People with less education have a higher risk of Alzheimer ciseese ’b. Cognitive performance can be enhenced by regularly doing activities which are mentaly challenging « Having more education reduces the risk of Alzheimer dissase 4. Regular involvernent in lieure activities maj Yeduce the risk of Alzheimer disease Q18. According to 1. The impact of education and figure ie cifcult to meas ', Better vazcular haslth and reduced stress can decrease the risk of dement raph 4, which ofthe folowing statements i falco? People with higher 10 scores may be less tkely to suffer trom dementia 4. Cognitvely stimulating activities reduce dementia risk+» Q19. Which of the following is closest in meaning to the expression: keep dementia at bay? a. delay the onset of dementia b. cure dementia . reduce the severity of dementia treat dementia ‘Q20. Which of the following phrases best summarises the main idea presented in paragraph 6? 1 The effect cognitive training has on Alzheimer disease is limited . Doing mental puzzles may not be as beneficial as concentrating everyday life . Cognitive training improves brain performance . The effect cognitive training has on Alzheimer disease is indefinite Q21. According to paragraph 7, which of the following is correct regarding the development of dementia? a. Genetic factors are the most significant , Environmental factors interact with behavioural factors in determining susceptibility to Alzheimer disease : Good brain health can reduce the risk of developing Alzheimer disease d. None of the above 22. Which of the following would be the best altemative title for the essay? 1a, New developments in Alzheimer research , Benefits of education in fighting Alzheimer disease cc. Doubts regarding mental exercise as a preventive measure for Alzheimer disease 4. The importance of cognitive training in preventing early onset of Alzheimer disease SRE E I . . . » » > 2 2 2 > ° > . , > > ° > > > . ° > . ° > > 2 * ° 2 2 = le 2 > we TEST6 (IEE ‘© Look at the four texts, &-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. QU Sa es ea ENERAL PRACTICE Text A ‘OBJECTIVES: To determine the proportion of patients who have diagnosis of migraine in a sample of New Zealand general practice patients, and to review the prophylactic and acute drug treatments used by these patients. DESIGN, SETTING AND PARTICIPANTS: A cohort of general practitioners collected data from about 30 consecutive patients each as part of the BEACH (Bettering the Evaluation and Care of Health) program; this is a continuous national study of general practice activity in New Zealand. The migraine sub study was concucted in June-July 2017 and December 2017- January 2018. MAIN OUTCOME MEASURES: Proponion of patients with a current diagnosis of migraine; frequency of migraine attacks; current and previous drug treatments; and appropriateness of treatment assessed using published guidelines. RESULTS: 191 GPs reported that 649 of 5663 patients (11.5%) had been diagnosed with migraine. Prevalence was 14.9% in females and 6.1% in males. Migraine frequency in these patients was one or fewer attacks per month in 77.1% (476/617), two per month in 10.5% (65/617), and three or more per month in 12.3% (76/617) (missing data excluded). Only 8.3% (54/648) of migraine patients were currently taking prophylactic medication. Patients reporting three or more migraines or two migraines per month Were significantly more likely to be taking prophylactic medication (19.7% and 25.0%, respectively) than those with less frequent migraine attacks (3.8%) (P< 0.0001) Prophyectc medion had bon used pres sod prov by 15.0% (9864) Tho ox cormon pect pers aed carey Froveuly vote pation and propane, she appropiate ante wore revo Prat agora tr inaprepte uso of at mediator accounted of ‘nephac roatent’ Fourin ve nian pari were erent ting ace rscteton as area for mia and 85 ofa nedatenscoteed i rzommorcatns he Nara Pesrieg Hovever nonteconmendedcrge wera use ncng opie (38% of acute medications). ae CONCLUSIONS: Migraine is recognised frequently in New Zealand ‘oneral practice, Uso of acute medication ofan follows published guidelines Prophylactic medication appears to be underutised, especialy in patients With frequent migraine, GPs appear to elect from alimited rango of therapeutic options for migraine prophylaxis, despite the avalabity of Several other well documented efficacious agents, and some use, inappropriate drugs for migraine prevention, ‘Texts Table 1: Economic burden of migraine inthe USA [Costeement]en (055) Women(UiS5) ToulkaSS) Reeieat 93 |ios Fae Missed workdays|iza0 Joona fran Lost produciviy |1400 [anos ‘(5 aae Teta faze >99 08 2222222727 7272 IADAADAAD ADA AA » » » » » » 2 2 2 2 2. > > . > > > > > > > > > > > > > > 2 2 2 2 2 2 Vi Tete Case 1 ‘Jane’ experienced pressure from emplayers due to her migraine absences. She had three days off workin the frst quarter of tho year, and this was deemed unacceptable and unsustainable by her employers therefore, she has just resigned from her job and hopes that her future ‘employers will be more understanding Ces02: “Sallys' employers and colleagues are aware of har migraine symptoms and are alert to any behaviour changes, which might indicate an Impending attack. In ackiton, colleagues have supportors' contact ‘numbers, should! she need to be escorted during a migraine. As hor ‘employers are pan of the government Workstep Programme’, she has ‘accessed a number of allowances and iniatves: her migraines have ‘been classiied as @ long-term health condition rather than sickness ‘absence, which permits her a higher absence threshold. She now works floxibie hours and has received funding for eye examinations, presctiation lasses, and a laptop to enabie her to work from home. TextD Research brief on migraines in the US . «+ Migraine prevalonce is about 7% in men and 20% in women cover the ages 20 0 64. ‘+The average number of migraine attacks per year was 34 for man and 37 for Wornen ‘+ Men wall need neatly four days in bed every year. Women will need six ‘+ The average length of bed rests five to six hours. ‘+ Oni about 1 in sufferers seck help fom a sector.SE Foreach ofthe questions, 1-7, decide which text /A,Cor Othe ifermaton comes rom. Yournay se any etter mere than once In which text can you find information about ‘L what isthe average length of bed rest? 2. Does employee experience pressure from employers due to migraine fauestions 13-20 ‘complete eden ofthe sentences, 14-20, ith a werdor short phrase from one ofthe texts Esch answer mayindude ore, number or both Your nswers should be correctly spetee 414,n the US, only about 1 In § sufferers seek help from a absences? = ‘3. which patients are more lel to take prophylactic medicaton?, woz ‘appears to be underutlised in patients with frequont migraine 4. what dade ‘BEACH’ stands for? 46. In Now Zealand inappropriate use of, accounted for 8% ‘5.how much economic burden does migraine causes in the US? {. which government program gives allowances for migraine patients? 77. what typo of drugs are popular non-recommended drugs for migraine? ‘eset each ofthe questions 8-23, wth a word or short phase omne cf the texts ach answer may iru words, umber oftheboth, Your answers shouldbe correctly of ‘prophylactic treatments! 417. The average number of migraine attacks per year was 37 for inthe US 48. The study concluded that migraine Is recognized, innew “Zealand general practice. 1 land, GPs appear to select ftom a imted rango of In Now Ze spate, {for migraine prophylaxis. 8. Which are the most common prophylactic agents used? 9. What io the migraine prevalence among wemen over the ages 20 to 20.Women will need nesrly__days in bad every et intho US? 10 How many migraine patients are currently taking prophylactic medication ln New Zealand? 414. What the migraine prevalence among men in New Zealand? 12. How many GPs reported patients who had been diagnosed with migraine in New Zealand? 18, What is the average length of bed rest for migraine in the US? e ¢ ¢e « e e e e e e e e e e « « « © © « « « « ° I | | | | ! ! ! | | 1 1 I I I 1 1 1 I I 1 1 I 1 1 I 1 1 1 4 I » » » » » 2 2 2 2 > > > > > > > > ° ° > . ° > ° ° > > * 2 2 2 2 2 2 2 > yoar inthe US. END OF PART A THIS TEXT BOOKLET WILL BE COLLECTED MIS In this part ofthe tet there are sx short extracts releting to the work of health professionals For questions 1-6, choose the answer (A, 8 or C) which you thinkfts best, ‘according tothe text, Write your answers on the separate Answer Sheet1. Tho guidelins establish thet the healthcare professional should involve children in A. all discussions even if consent does not lie with the eild BB. most possible discussions aven if consent dows fia withthe child CC. most corwaniant discussions even if consent does note with the child Children and consent ‘The law rogardirg children's concent is complicated and cegulaly Updated. The healthcare professional should involve chidren as much as is precticably possible in discussions about their care; this isthe case ‘oven if the ultmato decision er ‘consent doos nat ie with the child. Inthe UK and most ofthe developed world a young persan is assasced on an Individual basis on their ability to understand and weigh up options, rather than on their ago. This abilly o take decisions is known as ‘Gilick competence ard originated from a court easo regarting tha prescription of orl contraceptives to young paople under the age of 16. 2. The guidelines requite those undertaking a surgical scrub to ‘A. apply a bactericidal, detergent, surgical sorub solution to warm hands 'B. ensure hands are positioned so as to avoid soap and water running onto CC. dry thoroughly by patting with non-sterile paper towels ‘Surgical serub This involves the use of a chemical disinfection end prolonged ‘washing to physically remove and kill surfaco organisme in the ddoeper layers of the epidermis. This should be done before any invasive or surgicel procadure. + Apply a bactericidal, detergent, surgical scub solution to wet hands land massage in using an 8-point technique, extending the wash to Include the forearms, + Engure the hands are positioned ¢o as to prevent soap and water running onto and contaminating the hands from unwashed areas of the 1997272727797 79797PPPDPPAAAPAANA ANH OOOO KEE YUUCCVOI FES FEEEEEEUEUESEUUUUCCCCCCCEE + Rinse in warm water. * Dry thoroughly by pating with sterile paper towels, 3. The email reminding staff thatthe risk of infection does not ‘A. vary depending on the type of bloodbome virus BB. varies depending on the infectivity ofthe source patient C. varies depending on the contaminated instrument Needlestick injury Needlestck or sharps injuries are a dally risk for healthcare workers and can lead to infection with bloodbome viruses (BEV) such as hepatitis of HIV. The tsk of infection folowing a single sharps (percutaneous) injury ‘varies depending on the ype of BBV. The risk is approximately. +1 in 3 ifthe instrument is contaminated with hepatitis 8 +1 in 30 ifthe instrument is contaminated with hepatits C +1 in 300 f the instrument is contaminated with HIV, though this depends on the infectivity ofthe source patient. 4, The email is reminding staff that the A. immotile pationts must be very attentive B. immobile patients must be well akon caro of . immobile pationts must be also taken care of Equipment for patient safety ‘The side ras are the most commonly used equipment in order to reduce the risk of faling. Older types are removable sie rails, although sie rails that are part ofthe bed are more frequently used. Side ralls can be lowered. Procedure for lowering side rails: Fist, press the small tab onthe sido of the rails, then the round button and hold the rails with your other hand while lowering them. Staff must be very attentive with immobile patients — ite, check the pestion of the parts ofthe body (e.g. hands) when lowering the side ralls to avoid injury65, What dovs this extract from a handbook tell us about immobility problems? ‘A.are addressed by rehabilitation by a physiotherapist doctor prescribed Bare seen patients with coma and lower limb frectures Car soon patents wt coma, wer int acts and bronchial asthma Immobility levels: + Complete immobility — e.g. patentin a coma + Partial immabiliy - 0.9. patients with lower limb fractures + Limited activity associated with disease ~ e.g. patients with bronchial asthma [obit and immobilty problems are adcressed by rehabiltation, which ‘extends to physiotherapy knowledge and practical sls, The job of the Physiotherapist and as prescribed by a doctor is to practice movement, ‘deep breathing using breathing techniques etc. withthe patient. The nurse, In colaboration with the patient, continues withthe exercise and inmaintaining mobility throughout the day and checks the functioning of the patient's proper postion, while the posion of immobile patients is adjusted at reguiar intervals. 6. When preparing patients for a procedure, iis necessary to ‘A. clealy expan, desctive and possibly demonstrate on them B Include both verbal and nonverbal communication . inform of the procedure they willbe partaking in Patient preparation tis important thatthe patients informed ofthe procedure they will be partaking in. The procedure should be clearly explained, described, and possibly demonstrated on them. Verbal and nonverbal communication Batween the staf and the patient is vey important. Communication with the patient should be by short and simple sontences according to their ‘mental lov, their aby to rocoive and follow instructions and tho degree of wlingness to ecoperata. Communicating with understanding ‘and open minded people makes it easier to gain ther trust and ‘cooperation. 1999797799999 999977999 99299 zy BeutsecCcccce = eUseUVEVVEVY Usted vdI0b08 (EDIE Inthe part of the teu, thera are two texts about diferent aspects of healtheare Foe quettiors 7-22, choses the answer (A,B, Cor D) which yeu thinkts best fecordingto the text. White your answers onthe separate Answer Shest OBESITY IS THE BIGGEST PUBLIC HEALTH HURDLE OF ‘THE CENTURY Like many nations, Australias in the throes of an unprecedented ‘epidemic of obesty and type 2 diabetes — an epidemic in acceleration mode. Over the last week, more than 2500 scientists have been in Sydney forthe 10th International Congress of Obesity. The theme of the congress was “From Science to Action”. is aim has been to produce ‘workable strategies to counter the obesity pandemic and to deliver to ‘communties and governments,he leadership that only a meeting of this ‘significance and magnitude can offer. ‘Obesity isthe single most important challenge for public health in the Bat contury. More than 1.5 blion adults worldwide and 10 per cont of hilren are row overweight or obese. Yos the word's waste in bulging - some cynics call the phonomenon “Glabesity’. Professor Philp James, chairman ofthe Intornational Obesity Task Fores, warned the congress that itis sweeping the world with teriFying rapid. ‘Obesity isthe crving force behind type 2 diabetes, which causes significant cardiovascular complications, kidney falure, bindness and ‘amputations. This is leading to decreased life expectancy from type 2 tdabetes, cardiovascular disease and some forms of cancer.“The selection of Sychney as the hast ety forthe conference wes made ‘ight years ago, but in the meantime Australia has assumed the not- ‘s0-weleome honour as the nation with one of the fastest-growing rates ‘of obesity In the word, The 2000 AusDiab study, undertaken by the Intemational Diabetes Insttute, showed that more than 69 per cent of ‘cur adult population overweight or obese, slong wilh 20 per cent of ‘our children, It's a pling in numbers over the last 20 years The Pharmaceutical Benefits Scheme subsisised the obesity-related conditions diabotes and hoort disease by more than $2 blion last yeer, ‘and the cosis aro stil rising. Tis replicated in many rations and this *diabesity’ pandemic is now sotto bankrupt health budgets al over the world. Emerging fom the conference was some important new selentiic research In the last decade, fat has moved fiom being viewed as inet “blibber” to probably the most active endocrine (hormonal) organ In he human body, It makes a vast range of chemical substances vil to body function ~ from control of appetite, eneray balance, our immunity and blood clotting, to regulation of insulin and olher hormonal actions. Fat in the abdominal cavily, the ‘Aussie besr gut" makes chemicals that cause type 2 diabetes and heart disease. (On tho public hoalth sida, VicHoalth CEO Robert Moodie, note that thera. was a role for government regulation and, without, wo wil not be able to curb the epicemic. He said thatthe contemperary environment promotes abesiy. The obesity diabetes epidemic will ‘continue unless ne accept that many years of health premotion aimed at individuals seem to have had virtually no effect. ‘Our own stale and local governments may have inadvertently contributed to this epdemic by allowing developers to create urban ‘social problems. New developments lack preper attenten to sidewalks, po PEPIPPIP®P®PIINOAN NAP AAAAANAD . . ” . . > 2 ° 2 ° > > > > 3 > . : 3 >. >. > ° ° 2 ° > 2 2 2 2 2 > > > o bike paths, pubic transport corridors, playing flelds and frienaly exercise areas thet are eesential fo maintain a heathy lifestyle We cen rejoice that obesity has implanted tet fmiy on government radars. Tackling obesity and is consequences has been taken to a new politcal evel, Our federal and state governments have recognised the need for action to tackle obesty and diabetes through the Better Health Initative. Federal Health Minister Tony Abbot and John Howard have been powerlul advocates of action — with certain reservations such as in the area of banning TY advertising ‘We don't have the luxury of time to doa withthe epidemic its as big 1 threat as global warming and bird lu. Solutions are urgently needed, land involve more basic issues than more exerciso and correcting det. ‘The way ahead for us to adress this “globesiy” crisis isnot for obesity researchers, scianlsts, health professionals and poticias fo lve in thei sios with pet belies on iesues of taxing junk foods and banning ‘TV advertising. What's needed is a big-pleture approach, and to ‘acknowledge our lives and the environment have changed inthe last 20 or 30 years. Just trae weeks ago, Professor Philip James and | wrote an extra {or tha Medical Journal of Australia (2006;185:187-8) which oullined ‘some key legislative and regulatory measures that are required to tum the opidemie around, paticulady in relation to chidhood obesity. We ‘nged urban planning to help people exercice more, physical activy reintroduced ito curicula, ution education in schools, production ‘and availabilty of cheap healthy foods, and responsible labeting and advertising, ‘tthe congress, a major topio was the cal by many forbans on ‘marketing and TV advertising to children, While tis seems sensibe, the evkence that it translates ilo reduced obesiy rates is no yet ‘available. Certainly stronger guidelines are needed, and we mey need to implement guidetnes for food labelling. Currently, labels cannot be Understood by consumers ~ ard health claims are cften misteadingLooking atthe ig picture, the prevention of obesity and type 2 dabetes requires co-ordinated policy and legislative changes, with greater attention on our urban environment, transportation infrastructure, and workplace opportunites for education and exercise. Governments — local, state and federal should comrt to optimising opportunities for ‘xorcise ina safe environment. A multidscipliary, poliicaly divan, co Cordinated approach in health nance, education, sports and agriculture can contribute fo reversing the underiyng causes ofthe obesity ‘epidemic, This may well be the single and most important challange for Public heath nthe 21st century. tis a batte than we can and must win. 7. According tothe ati, in Australia 8) There are more overweight chitin than adults ) Australia has the fastest growth rate of obesity In the past 2 decades Australias rate of obesity has increased 3 fol None of the above 8. Which among the fllowing describes the torm inadvertontiy? 2. Without knowledge b. Without advertising Without acting or without participating 4. nithout intending to or without reazing 8. According lo Robert Moodie 2) Government regulation will rt help lessen the epicemic 'b) Modem lifestyle encourages obesity ) Health promotion is a good way to reduce obesity 4) Obesity is a bigger problem than diabetes ees o¢ DPPPPP®PPIPAI®IIADIAAI AA AAA AAA A ANN OS Zee uecccced VER II CFE FFESSEEEEEEEUEEEEGES 410. to curb eomothing’ means 4. To destroy something b, Tocut something . To contol or limit something 4. To siop something 11. Which of the folowing statements are tu0 4) New euburbs do not encourage people te develop a healt routing 'b) Australians have too much time to enjoy luxury foods ‘john Howard and Tony Abbot support prohibiting TV advertisements 4) obesity isa greater dangor than bird flu & global warming 12, Professor Philip James believes 2) Advertisements must be labelled 'b) Make healthy food more affordable «© Physical education reduces academic levels 4) Education is necessary to encourage people to exercise 41. According to the article can be concluded that 4) Lack of exerese is the number one cause of obesity b) Mode testy fs not as hoalthy as a traditional ifestyle «Obesity and type 2 diabetes can only be reduced if governments ‘are involved inthe process: 2) None of the above414, Which among the folowing describes the word ‘eyne’ In the passage? &. Somebody wa is crucial to society 1h Somebody whois ertical and sarcastic & Somebody who is determined 4. Somebody who hates people Medical staff working the night shift: can naps help? Defvering medical care is a 24-hour business that inevitably involves ‘Working the night shit. However, right shit requires the health professional i work when thebody’s clock (circadian system) demands sloop. Added to ths isthe problem of ‘sleep debt, arising from both prolonged orior waksfuness on tho ft night ehif and ‘cumulative sleep debt after several nights! work and repeated unsatisfactory daytime sleeps, ‘A further aggravation, particularly for trainee medical staff in teaching hospitals, hs boon the demand for excessive work hours across the Working week. As has been dramatically shown in recent well controled ‘studies, the net resut of this assauit on the steep of heath professionel ‘can be impaired patent safety, and the heath and safely of heath professionals themselves. “The good news is that health organisations and regulators aro begin {o Weal the matter seriously, In Austialia the Urited States and Europe, work hours of medical staf have recently been shertened by {government regulation, and bodies such as the Australan Medical Association and professional colleges are aching their members on strategies to improve thoir sloep hesith and thue werk safety. a ee « COUK GFF SSESHEEEEEEEDEVUEUUUCCCECCE? 2EPPPPPAPAPAIPIAAI DAD AA ADANAA DD Wu A recent pubeation prepared by the Royal Collage of Physisiens. (London) (ROP), Werking the night shift preparation, survival and repovery. A guide for junior doctors, ie an excallnt example. Ono proposed countermeasure for exceeeive sleepiness Is the uso of Etrategiclly placed naps both before and curing the night shift But does napping ether before cr curing the night hit reduce elecpinese and improve pertormance, and, If 80, how practical is I? There are two important, independent mechanisms of sleep and sleepiness that hold the Key to these questions. Probably the more potent mechaniem impaicing night-shit alertness is the citcadian System. For most indWviduals, even thoee working permanent night shi, the circadian system i in sleep mode during the right. This causes slowed reactions, inoreased fooling of fatigue, impaked concentration, and increased sleep propensity ‘The second important mechanism affecting nighttime alertness is ‘homecstatic sleep drive, This increases initonsity tho longer we aro auvake and, ike appetite which is gated by eating, homeostatic sleep dive is reduced by sleeping. I the frst ight shift starts at midnight following a normal wake time at about 8 am, about 16 hours of wake sleep debt has lready been accrued and the rest of the night shift vl be performed under intense homeostalic, in addiion to circadian, sleep eve. Performance decrements during his night period can be similar to those ‘measured in the daytime with a blood alcohol concentration of 0.05%— 10.10%. Day sloop in the homne environment is likely to bo shorter and less sffectve than night sleep so, even though second and subsequent right shifts may folow fower wekoful hours (810 hours), homeostatic sleep rive i ikaly to remain elevated during night shits Bocause of incomplete repayment ofthe previous sleep debtincluding the aftemoon sleepy period (1-4 pm). : aed What about napping during a ight shit to prove alertness and eco sors and accents? Be afetocn naps 10-20 minis (o-cabed Power ee) mov sernose ana paremanc, Wo ompaed tornoon napa of'5, 10,20, and 90 minutes of ta sleep The 10 minte Sleep (aout 15 rinulo nap opportunity produeod improvements over tho hour pos nap pols halt sleirese and prtrmance maasures, wiht any of the potrap impairment of oop era at Toowed te 20 and 30 minute naps Whathe these ese would be repletad at, cay, 3am fv ight: shit oncom, wth considerably (fester homoosatic and ceadian sleep dives now beng este ny fw sts have messured he elect of lt hit api pe of ata 2 hou pea avec obo Samay al Spm However, 1-2 hournaps were flowed by sep eri, cry wich alertness wes inpeted fx up oan hor Longer nap, though benef once slep neta ha been siete, maybe Used okay by matical staf ishing to maintain coi of pati ar, Beer naps {8.26 ruts have ao rove peromance hth Therefore, the picture emerging from night jng from night-shit napping studies is similar to that from the afternocn studies. Very bref nape (10-18 minutes of eloop) may improve alerinoss immediately without tho negative effects cf sleop inotia. How long this improvement lasts and » » > 2 2 > 2 > > OPP ee ed hati the optimal nep length on tf night shit remains to be {detormined. In the meantime, as recommended in the recent ROP guido, health professionals who work night chit shoul, forthe eako of their ow health nd safety and that of their patients, consider tho benefits of right shif napping. Optimal benefit and a higher take-up rate se Ikely for sleep lengihs of 10-15 minutes, 415. Which of the folowing is not mentioned a cause of sleep debt? 2) Regier lack cf sleep curing the day 1b) Staying awake fer a long period before the fist night shift ‘© Poor heath among health professionals 4) A build up of sleep debt during the night shift period 48, Which ofthe folowing stalements is notmentioned? 2) Lack of sleep among health professionals can affect the safe treatment of pationts ') Lack of sleep among health professionals can affect the health of health professionals Long hours are very common for trainee medical stat NIPPIPPPPPPA®III DD DRA DAA » » » » » » 2 2 2 > > > > > > . > ° > > ° ° . > > 2 » 2 2 2 2 2 2 2 2 3 22. Which naps are known as power naps? a) Very brief afternoon naps b) Briefer afternoon naps ©) Brief afternoon naps @) Briefer forenoon naps ESTTEST7 > IE * 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 al the questions within the 15-minute time limit. © Your answers should be correctly spelt. MMOS Text A Inhalers may do nothing to help more than one in 10 children with asthma who have been found to carry a mutated gene. A British study of nearly 4200 youngsters found children with a genetic variation called Argié are twice as likely as other asthmatics not to respond to Ventolin inhalers, the most common treatment for asthma. But experts, including Dr Noela ‘Whitby, of the National Asthma Council of Australia, have said children need to continue using inhalers. TextB BREATHTAKING NEW DISCOVERY OF ASTHMA GENE, Researchers in the UK have uncovered a gene that triggers asthma. Bill ‘Cookson and colleagues’, from London's Imperial College, compared the genes of 1000 children with asthma and 1000 healthy ‘controls’ to track. ‘down genes that were more common in the asthmatics and might therefore provoke the condition. To do this the team used a system of genetic markers called SNPs or single nucleotide polymorphisms, These flag certain genetic sequences. By analysing large numbers of people with a disease, and comparing them with people who don't have the condition, you can see SNPs, and hence DNA hotspots, that crop up more often in the diseased individuals than in the healthy ones. Using this technique, the team were able to home in on several DNA hotspots on chromosome 17, and also identify a new gene, called ORMDLS, which was much more common in the children with asthma than the healthy controls. ‘This gene occurs in about 30% of children with asthma,’ says Cookson. ‘it seems to have a fundamental role in the ‘working of the immune system, but we don't know what it does yet.' So e e e e e « e e « « « « e e e e é SSCECEEEEEUUUUUEUEECECE? vd? the nest step wil be to study wherein the bedy it operates end how it ‘works. This could well open up new avenues forthe treatment or even prevention of asthma. But the fact that only 30% of the asthmatic chien were carying t shows that there's much rore to asthma than just netics, and that mystery sil needs to be solved. Text Turbuhaler Instructions Before using your Turbuhaler, please read these instructions and follow them carefuly. Turbuhaler is @ bresth-activated inhaler, This means that when you inhale rom the Turbuhaler the mecication ie érawn into your lungs. Unike aerosel sprays, no propellants are necessary to deliver your ‘medication. This means that you will probebly not feel anything aa you inhale the mecicaton, If you careful follow the four simple steps you can be confident you have received the correct dase of medication, If you requite, further information about your mediation ask your doctor or see your pharmacist fora Consumer Medicine Information leaflet. You may ‘also Ike to contact the Asthma Foundation in your state (Australi) or region (New Zealand) for furthor information ebout asthma, Text How to use your Turbuhaler 1. REMOVE THE CAP Unscrew and lit of the ap, 2. LOAD THE TURBUHALER Hold your Turbuhaler upright. Hold itby the white body, with the coloured base atthe bottom. Turn the coloured base in one direction aa far as it wll 190. Then tum it back in the opposite rection. During ths procedure you will heara click. 3. INHALE THE MEDICATION Breathe cut gently away from the Turbuhaler. Hold the coloured base and Place the tp of the mouthpiece (sloping part) between your lips. Breatbe in forcefully and deeply through your mouth. Do net chew or ile the ‘mouthpiece. Remove your Turbuhaler from your mouth before breathing ‘out. If you require a second dase, simply repeat steps 2 and 3,4, REPLACE THE CAP Remember to screw the cap back on. NOTE- Ifyou are using Pulmicort Turbuhaler rinse mouth with water after each use. EET For eachot the question, 17, decile whieh text (A 8, Cor] the information eres fom. You ay use any letter more than once In which text can you find information about 41. who clacovered the gene that triggers esthma? 2. what are the user instructions of Turbuhaler? 3, what dose SNP stands for? 4. give an example for broat sctvated inhaler? 5, how many eubjects were therein the British study? 6. what isthe most common treatment for asthma? name the genetic variation found in chidren with asthma? ‘Answer eachof the questions 8-13, wits word a short phrase fromone of th tts, Exch answer may include words, number ofthe bth You answers shouldbe correctly speted ‘8, What are responsible for medication delivery In aerosol sprays? 8, Which gene is more common inthe chiren with asthma? 410, Who provides consumer medicine information leefet for Turbubaler? 114, Which Turbuhaler users are required to rinse mouth with water after each use? 1949772797777 PF7F7FFPFPFPPPPP PPP - . © » » » » » buvseesuues COVKCKCKVVVVIFFTTG 412. How many stops are there fo ensure the proper usage of Turbuhaler? 4, How many subjects’ genes were compared with healthy controls by researchers in UK? a complete each ofthe sentences, 4-20, wth a word or short phrase fromone ofthe tents Each answer may ncide words, number or eth. Your answers shoud be correctiy speed 44, You wil probebly net feel anything as you inhele the medication from 15. During the completion of loading procedure of Turbuhsler, you will heer, 46. Genetic markers help to flag certain, 417. While inhaling the Turbuhaler, you heve to hold__ 48, Researchers in UK were able to home in on several DNA hotspots 49, After using Turbuhaler, do not forget back on 20, seems to have a fundamental rle ln the worklng of the immune system against asthma END OF PART A THIS TEXT BOOKLET WILL BE COLLECTED TI In this part ofthe test, there ae sixshort extrets relating to the work of health professionals : For questions 2-6, choose the answer (A, 8.0) which you thine fits best ‘according tothe text Write your answers onthe separate Answer Sheet