Test 7

Appendicitis: Texts

Text A

Appendicitis definition and facts

• The appendix is a small, worm-like, tubular appendage attached to the cecum of the colon.
• Appendicitis occurs when the appendix becomes blocked, and bacteria invade and infect the wall of the
appendix.
• The most common complications of appendicitis are rupture, abscess, and peritonitis.
• Appendicitis usually is suspected on the basis of a patient's history and physical examination; however, a
white blood cell count, urinalysis, abdominal X-ray, barium enema, ultrasonography, computerized tomography
(CT) scan, and laparoscopy also may be helpful in diagnosis.
• Due to the varying size and location of the appendix and the proximity of other organs to the appendix, it may be
difficult to differentiate appendicitis from other abdominal and pelvic diseases or even during the onset of labor
during pregnancy.
• The treatment for appendicitis usually is antibiotics and appendectomy (surgery to remove the appendix).
• Complications of appendectomy include wound infection and abscess.
• Other conditions that can mimic appendicitis include Meckel's diverticulitis, pelvic inflammatory disease (PID),
inflammatory diseases of the right upper abdomen (gallbladder disease, liver disease, or perforated duodenal
ulcer), right-sided diverticulitis, ectopic pregnancy, and kidney diseases.

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 Text B

Approach Considerations
Appendectomy remains the only curative treatment of appendicitis, but management of patients with an
appendiceal mass can usually be divided into the following 3 treatment categories:

• Patients with a phlegmon or a small abscess: After intravenous (IV) antibiotic therapy, an interval
appendectomy can be performed 4-6 weeks later.

• Patients with a larger well-defined abscess: After percutaneous drainage with IV antibiotics is per-
formed, the patient can be discharged with the catheter in place. Interval appendectomy can be
performed after the fistula is closed.

• Patients with a multicompartmental abscess: These patients require early surgical drainage.

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 Text C

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 Text D

Conditions that mimic Appendicitis

• Meckel's diverticulitis. A Meckel's diverticulum is a small outpouching of the small intestine which
usually is located in the right lower abdomen near the appendix. The diverticulum may become
inflamed or even perforate (break open or rupture). If inflamed and/or perforated, it usually is
removed surgically.

• Pelvic inflammatory disease (PID). The right Fallopian tube and ovary lie near the appendix.
Sexually active women may contract infectious diseases that involve the tube and ovary. Usually,
antibiotic therapy is sufficient treatment, and surgical removal of the tube and ovary are not neces-
sary.

• Inflammatory diseases of the right upper abdomen. Fluids from the right upper abdomen may
drain into the lower abdomen where they stimulate inflammation and mimic appendicitis. Such fluids
may come from a perforated duodenal ulcer, gallbladder disease, or inflammatory diseases of the
liver, for example, a liver abscess.

• Right-sided diverticulitis. Although most diverticuli are located on the left side of the colon, they
occasionally occur on the right side. When a right-sided diverticulum ruptures it can provoke
inflammation that mimics appendicitis.

• Kidney diseases. The right kidney is close enough to the appendix that inflammatory problems
in the kidney-for example, an abscess-can mimic appendicitis.

• Ectopic pregnancy: Although it usually is easy to differentiate between a normal intrauterine

pregnancy, if the fetus implants in the fallopian tube or elsewhere instead of the uterus, the symp-
toms may mimic appendicitis.

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 Part A
Time: 15 minutes
Look at the four texts, A-D, in the separate Text Booklet.
For each question, 1-20, look through the texts, A-D, to find the relevant information.
Write your answers on the spaces provided in this Question Paper.
Answer all the questions within the 15-minute time limit. Your answers should be correctly spelt.

Appendicitis: Questions

Questions 1-7

For each of the questions 1-7, decide which text (A,B, C or D) the information comes from. You may use any
letter more than once.

In which text can you find information about

1. Wound infection and abcess are complications ________________________________

2. Abdominal fluids may drain into the lower regions where

they simulate inflammation ________________________________

3. Thromboembolism prophylaxis during post operative period ________________________________

4. Appendicitis may be difficult to differentiate from other

abdominal diseases ________________________________

5. Internal appendectomy can be performed in uncommon cases ________________________________

6. Irrigation and aspiration of the operational field ________________________________

7. The treatment of appendicitis is usually done by ________________________________

Questions 8-14

Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may
include words, numbers or both.

8. Which conditions require an internal appendectomy

________________________________________________________________

9. Which kinds of patients require early surgical drainage?

________________________________________________________________

10. What is the outpouching of small intestine near appendix?

________________________________________________________________

11. Which kidney is close to the appendix to mimic appendicitis on inflammation?

________________________________________________________________

12. Which period does early mobilisation pertain to?

________________________________________________________________

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13. What is done once the patient tolerates a regular diet?
________________________________________________________________

14. What are the complications of appendectomy?

________________________________________________________________

Questions 15-20

Complete each of the sentences, 15-20, with a word or a short phrase from one of the texts. Each answer
may include words, numbers or both.

15. _____________________________ occurs when bacteria infest the wall of the appendix .

16. The primary assessment of appendicitis is done by patient‟s history and _____________________________ .

17. Surgical _____________________________ consultation appointment falls in the discharge plan.

18. The patient can be discharged, after percutaneous drainage with _____________________________ .

19. _____________________________ diseases that involve the tube and ovary may be contracted by sexually
active women.

20. Inflammatory diseases of the abdomen may be stimulated by _____________________________ from liver
abscess.

END OF PART A

THIS QUESTION PAPER WILL BE COLLECTED

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 Part B
In this part of the test, there are four short extracts relating to the work of health professionals. For questions
1-6, choose the answer (A, B or C) which you think fits best according to the text.

1. What is the significance of the instructional pamphlet?

A to ennumerate the dosage ideally recommended

B to outline the most preventable conditions
C to define the procedure for administration

Instructions for the use of hexadog vaccine

The Hexadog vaccine is used as a preventive measure for such dangerous

diseases as pervirosis, carnivore plague, adenovirus , leptospirosis and rabies dogs.
The drug is areactogenous, harmless and has high immunogenicity. With its help,
immunity is formed two to three weeks after vaccination and is valid for at least 12
months.
Instructions for the use of hexadog vaccine
• One dose is 1 ml, regardless of the weight of the animal and its breed.
• Vaccination is subject only to a healthy animal, past degelmentizatsiyu.
• The lyophilized vaccine is mixed with the liquid vaccine immediately before vaccination to
form a
uniform suspension of the Hexadog vaccine, which must be immediately used.
• Enter the vaccine intramuscularly or subcutaneously into the area of the scapula.
At the injection site, a small seal in the form of a nodule can sometimes occur. It takes
place in a few days. In some dogs, vaccination causes a hypersensitivity reaction. It is
not allowed to introduce other types of vaccines simultaneously with Hexadog.

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2. What is the purpose of the executive summary on assistive technology?

A to enumerate the reason why only few people can afford assistive technology
B to explain how assistive technology can reduce the cost of healthcare services
C to highlight the cumulative impact that assistive technology renders in healthcare

Assistive technology
Assistive technology enables people to live healthy, productive, independent, and dignified lives, and to
participate in education, the labour market and civic life. Assistive technology reduces the need for
formal health and support services, long-term care and the work of caregivers. Without assistive
technology, people are often excluded, isolated, and locked into poverty, thereby increasing the impact
of disease and disability on a person, their family, and society. Today, only 1 in 10 people in need have
access to assistive technology due to high costs and a lack of awareness, availability, trained person-
nel, policy, and financing. People who most need assistive technology include people with disabili-
ties, older people, people with noncommunicable diseases such as diabetes and stroke.
People with mental health conditions including dementia and autism and people with gradual functional
decline also would benefit from assistive technology. Assistive technology can have a positive impact
on the health and well-being of a person and their family, as well as broader socioeconomic benefits.
Across the globe, many people who need assistive technology do not have access to it.

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3. What is the critical aspect of this resuscitation handout

A Particular parts involved in the chain of survival

B Care delivered before the course of an arrest
C Links in the events to improve patient outcomes

Strengthening Resuscitation Guidelines

Emerging evidence suggests opportunities where Resuscitation Guidelines could be strengthened by

focusing on specific aspects of the chain of survival. The chain of survival comprises of four links:
early recognition of critical illness and call for help, early CPR, early defibrillation and post-resuscita-
tion care. The chain identifies the critical links in a succession of events that are required to improve
the outcomes from cardiac arrest. Recent revisions to the chain of survival saw the inclusion of cardiac
arrest prevention and post-resuscitation care. This reflects the importance of the care that a patient
receives both before an arrest occurs and following the return of spontaneous circulation in contribut-
ing to the patients' eventual outcome.

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4. According to the update, allergens do not need to be written on packaging if

A the medicine is intended to be taken by mouth.

B medicine administration is unlikely to result in a reaction.
C there is a small amount of the allergen in the medicine.

Update: Improved labelling for allergens

Health professionals are advised that new rules are being implemented for medicine labels to include
improved information about potential allergens. While certain allergens, such as peanuts and gluten,
were already required on medicine labels, the new rules include a longer list of substances that must
be declared. The additional substances include crustacea, fish, eggs, soya, milk and tree nuts. In
some circumstances, allergens do not need to be declared on the medicine label. For example, some
substances may only cause a reaction if they are administered orally and therefore don't have to be
declared if the medicine is only for topical use, and some substances are only declared if there is a
certain amount in the product.

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5. What does the handout on epidemic management indicate?

A the virus was transmitted from South East Asia

B animal influenza viruses are borne by humans
C transmission between humans can also occur

Avian and other zoonotic influenza

Animal influenza viruses are distinct from human seasonal influenza viruses and do not easily transmit
between humans. However, zoonotic influenza viruses - animal influenza viruses that may occasionally
infect humans through direct or indirect contact - can cause disease in humans ranging from a mild
illness to death.Birds are the natural hosts for avian influenza viruses. After an outbreak of A(H5N1)
virus in 1997 in poultry in Hong Kong SAR, China, since 2003, this avian and other influenza viruses
have spread from Asia to Europe and Africa. In 2013, human infections with the influenza A(H7N9)
virus were reported in China.Most swine influenza viruses do not cause disease in humans, but some
countries have reported cases of human infection from certain swine influenza viruses. Close proxim-
ity to infected pigs or visiting locations where pigs are exhibited has been reported for most human
cases, but some limited human-to-human transmission has occurred.Just like birds and pigs, other
animals such as horses and dogs, can be infected with their own influenza viruses (canine influenza
viruses, equine influenza viruses, etc.).

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6. The extract conveys that ART acts by

A restricting the potency of the virus

B suppressing the risk of HIV infection
C stopping the advancement of the virus

Antiretroviral therapy

Standard antiretroviral therapy (ART) consists of the combination of antiretroviral (ARV) drugs to
maximally suppress the HIV virus and stop the progression of HIV disease. ART also prevents onward
transmission of HIV. Huge reductions have been seen in rates of death and infections when use is
made of a potent ARV regimen, particularly in early stages of the disease. WHO recommends ART for
all people with HIV as soon as possible after diagnosis without any restrictions of CD4 counts. It also
recommends offer of pre-exposure prophylaxis to people at substantial risk of HIV infection as an
additional prevention choice as part of comprehensive prevention. Countries are now following to adapt
and implement these recommendations within their own epidemiological settings.

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 Part C
In this part of the test, there will be two texts about different aspects of healthcare.

For questions 7-22, choose the answer (A, B, C or D) which you think fits best according to the text.

Text 1: Implications of mapping the human genome

The human Genome Project began in 1990, following initial co-operation between the US Department of
Energy and the Wellcome Trust, a UK medical charity. China, Germany, France and Japan also became full
partners in the project. The objective was to generate a high-quality reference DNA sequence for the human
genome. The genome represents the complete set of DNA in each organism. In humans it is made up of 3.2
billion linked segments of DNA, known as base pairs. As the activity in every cell in every living organism is
governed by the DNA is its nucleus, it is clear that this project aimed to provide knowledge about the most
fundamental aspects of life. By „reading the book of life‟ (Searls, 2001), the project was perhaps one of the
most ambitious in human history.

At that time, the project was also seen as extremely ambitious in technical terms. The laboratory techniques
which were used to map the DNA were complex and time-consuming and depended on highly skilled laboratory
staff. It was clear that without new technologies and techniques it would not be possible to achieve the stated
objective by 2005, so as a first step, major investments were made in computer technology for data processing.
This marked the beginning of a new scientific discipline of bioinformatics, combining computing and
biology. By 1998, a total of 200 million base pairs had been sequenced by the project. With less than half of
the planned project time remaining, just over 6% of the genome had been mapped. Fortunately, computers
were becoming cheaper and more powerful. Also by this time, significant investment had been made in
developing specialized electronic components which could directly analyse the DNA without the need for
human intervention. Consequently, there was an enormous increase in the speed with which the genome
could be mapped.

In June 2000, a rough draft of the human genome sequence was produced. This covered 90% of the
genome. Unlike the data produced by InterPro, a rival private sector research project, the Human Genome
Project data was freely available to the public and could be used without any restrictions. While it was
possible to access the InterPro data without charge, its use for any purpose was subject to license agreements.
This gave rise to the major debates of the ethics of commercializing genome research in this way. Although
IterPro was the main focus of these debates, it was not alone. Research carried out in November 2000
showed that drug and biotech companies, government institutions and universities had filed patents on
127,000 human genes or partial human gene sequences.

By April 2003, a finished version of the human genome sequence was available, along with much new
knowledge. By coincidence or design, it was exactly 50 years since Watson and Crick published their paper
on the structure of DNA, which identified the „letters‟ of the genomic alphabet. The finished version identified
all of the estimated 25,000 human genes within the genome, less than one-third fewer than expected. Around
half of them were linked to a specific biological function. As a result of the project, we now know that there is
only 0.1% of a difference in DNA between humans. Specific gene sequences have been associated with
different diseases and disorders including breast cancer, muscle disease, deafness and blindness. DNA-
based tests were among the first commercial applications of the research, and several hundred have been
developed to date.

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Many benefits have already emerged from this research and there will be many more over the next decade.
Researchers have already begun to correlate variations in DNA with differences in results from medical
interventions. This should allow us to classify individuals into subgroups, based on their DNA profile, for
whom drugs could be customized. A new discipline, pharmacogenomics, is developing around the study of
these interactions. The knowledge should also help tackle future pandemics and produce new developments
in stem cell technologies. While these benefits are truly worthwhile, there are a number of key societal
issues arising from the knowledge created by the Human Genome Project. Perhaps the most important
relates to the ownership of genetic information, both at a societal and individual level. At a societal level, we
have seen how InterPro sought to license genomic data to make money and while questions have been
raised regarding its right to do so, it is still free to pursue commercial projects using the data. At the
individual level, the issue of access to and control of data about the genetic makeup of individuals is already
extremely important, given the susceptibility to many diseases has been linked to specific genes which can
be identified by testing. However, as more and more aspects of what makes us human are linked to specific
elements of DNA in our genes, the opportunity for misuse of this information becomes even greater. It may
be that thanks to the Human Genome Project we can now read „the book of life‟, but as a society it is not yet
clear what use we will make of the knowledge we find there.

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Text 1: Questions 7 - 14

7. What was the declared aim of the human genome project?

A provide the most fundamental aspects of life

B generate a reference sequence for human DNA
C be known as the most ambitious project in history
D map out the linking segments of DNA in humans

8. In the second paragraph, what does „that‟ refer to

A the initial phase of the genome project

B the laboratory involved in the experiment
C the publishing of the book of life
D the time taken to finalise the project

9. What was the biggest impediment to the research?

A compiling information received through mapping

B the time duration that was available for the research
C investments required for precise, elaborate detailing
D lack of available techniques for processing the data

10. How did the project achieve a reversal in the time taken?

A there was a sizeable investment in electronic components

B computers were becoming more efficient and capable
C availability of technology without consistent human intervention
D analysis of the genome with increased speed and precision

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11. What according to paragraph 3, is a reason for debate?

A the use of human genome data for ethical purpose

B the rise of private sector entities in research process
C restrictions on the use of data produced by private firms
D patents filed by institutions including governmental ones

12. What scientific breakthrough does gene mapping involve?

A Identification of genes linked to various disorders

B the development of hundreds of DNA based tests
C recognising the letters of genome alphabet
D designing the course for rectifying genetic anomalies

13. In the final paragraph, „whom‟ is used to denote

A people identified with genetic mutations and variations

B groups to which certain drugs are known to be effective
C individuals with a greater affinity to certain medications
D unit which shows similar variations in genetic make up

14. Why is the influence on genetic information crucial?

A it can be used for vested interests

B control over such data gives monopoly
C licensing might be offered on preference
D existing knowledge may not be foolproof

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Text 2: The debate on euthanasia

Over the past few decades, there has been increasing attention paid to medical decisions at the end of life, and
euthanasia, or medically-assisted death, has been the subject of much moral, religious, philosophical, legal
and human rights debate all over the world. At the core of this debate is how to reconcile the desire of
individuals to choose to die with dignity when suffering, and the need, particularly of health professionals, to
uphold the inherent right to life of every person. Recent surveys in Australia and elsewhere consistently
show that a considerable proportion of health care professionals support euthanasia under certain conditions. A
minority of health care professionals also admit to having practised euthanasia.

The position of international human rights law with respect to voluntary euthanasia is not explicit or clearly
defined. Article 6(1) of the International Covenant on Civil and Political Rights (ICCPR) provides: „Every
human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily
deprived of his life.‟ The impact of article 6(1) on voluntary euthanasia raises a number of questions including
the scope of the right to life, the interpretation of „arbitrary‟ deprivation of life, and the definition of life and in
particular when life ends. So far these questions remain largely unanswered.

Dealing with death and dying (which includes requests for euthanasia) is an integral part of the practice of
medicine, and medical practitioners frequently have to make decisions that affect the timing of a patient‟s
death. Determinants of attitudes and practices relating to such decisions include unbearable pain and
suffering, the patient‟s mental competence, that is, the ability to make decisions for one‟s self or to exercise
one‟s right to give or refuse informed consent, and patient requests for euthanasia. As well as patient
factors, there are a number of other considerations that relate to the medical practitioners themselves such
as sex, age, religious and personal beliefs, as well as the area of medicine in which they specialise.

In one of the most detailed surveys of the practice of euthanasia, researchers in Holland found that in 1.8
per cent of all deaths in that country a lethal drug was administered, at the patient‟s request, to end life. Also,
in 38 per cent of all deaths doctors had taken medical decisions concerning the end of life that may have
shortened the patient‟s life. The researchers concluded that medical decisions concerning the end of life
were common in medical practice and should be the subject of increased research, teaching, and public
debate.

It is still true to say, however, that most doctors are opposed to euthanasia. Several factors may explain this.
First, in general, death is viewed as a failure in modern medicine; hence the reluctance of medical
professionals to reinforce this perception by accepting euthanasia and physician-assisted suicide. Secondly,
various surveys suggest that doctors would prefer to keep the management of death within their professional
practice (and out of the hands of government regulators) to allow them the flexibility to respond to the
complex realities of differing clinical situations. The regulation of death and dying through a formal legal
process could make it difficult for doctors to respond to the individual needs of the patient and could also
subject doctors to unreasonable and extended legal scrutiny.

The opposition of doctors to euthanasia and physician-assisted suicide may also be related to their „self-
image‟ and the fact that the contribution of doctors to carrying out requests for euthanasia may have
profound effects on their image in the broader society. Doctors see themselves as the bringers of life, hope
and healing, not as the bringers of death. More importantly, the legalisation of euthanasia also raises the
prospect of a complex moral dilemma for those doctors who may be opposed to it on religious or ethical
grounds.

The broader community‟s unease about the legalisation of euthanasia is related to the concerns of some
religious and ethnic groups that, besides violating the ultimate human value, the sanctity of life, such legislation
may render the less privileged and the poor in the community more vulnerable to unethical practices.
However, notwithstanding the concerns of the medical profession and some key groups in society, the
debate about the right of an individual to make a decision about his or her own death is not going to
disappear. Society will ultimately have to resolve the issue by balancing two central human values: sanctity
of life and human dignity.
Text 2: Questions 15 - 22

15. Euthanasia is approved of by

A most healthcare professionals around the world

B only a few health professionals in some countries
C mainly Australian healthcare professionals
D many health professionals in particular circumstances

16. Article 6(1) of the ICCPR is

A ambiguous
B arbitrary
C contradictory
D unconditional

17. The word „integral‟ in paragraph 3 means

A accepted
B central
C regular
D general

18. According to paragraph 3, which one of the following statements is TRUE?

A Medical choices affecting when a patient dies are common

B Doctors can often choose if and when a patient should die
C Euthanasia is an everyday occurrence in modern medicine
D Mental deficiencies can lead patients to request euthanasia

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19. Which one of the following statements is NOT supported by information in paragraph 5?

A Deaths are perceived by some as failures in the medical process.

B Physicians are wary of legal involvement in medical decision-making.
C Governments impose restrictive regulations on medical professionals.
D Doctors value the freedom to respond to patients‟ particular needs.

20. What does the word reinforce in paragraph 5 mean?

A strengthen
B enforce
C oppose
D question

21. According to paragraph 6, many doctors

A are only conscious of their own „self-image‟

B fear a negative perception of their profession
C wish to be seen as creators not enders of life
D are pro-euthanasia for complicated reasons

22. According to the final paragraph, concerns about protecting the poor and vulnerable in society

A have made some people unsure about supporting euthanasia laws

B have not been considered by some religious and ethnic groups
C have not been raised so far in the euthanasia debate
D will eventually force society to resolve this issue

END OF READING TEST

THIS BOOKLET WILL BE COLLECTED

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Reading sub-test
Test 7

PART A QUESTIONS 1 - 20

1 A
2 D
3 C
4 A
5 B
6 C
7 A
8 small and larger abcess
9 patients with multicompartmental abcess
10 Mackel’s diverticulum
11 right kidney
12 post operative period
13 discharge
14 wound infection and abcess
15 appendicitis
16 physical examination
17 post operative
18 IV antibiotics
19 infectious
20 fluids
PART B QUESTIONS 1 - 6

1 C
2 C
3 B
4 B
5 C
6 C

PART C QUESTIONS 7 - 14

7 B
8 A
9 D
10 C
11 C
12 A
13 B
14 A

PART C QUESTIONS 15 - 22

15 D
16 A
17 B
18 A
19 C
20 A
21 B
22 A