READING SUB-TEST : PART A

 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.
PART A -TEXT BOOKLET - STUDY INTO KID’S INHALER USE
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 1200 youngsters found children with a genetic
variation called Arg16 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.
Text B
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 ORMDL3, 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 the next step will be to
study where in the body it operates and how it works. This could well open up new avenues for
the treatment or even prevention of asthma. But the fact that only 30% of the asthmatic children
were carrying it shows that there’s much more to asthma than just genetics, and that mystery still
needs to be solved.
Text C
Turbuhaler Instructions
Before using your Turbuhaler, please read these instructions and follow them carefully.
Turbuhaler is a breath-activated inhaler. This means that when you inhale from the Turbuhaler
the medication is drawn into your lungs. Unlike aerosol sprays, no propellants are necessary to
deliver your medication. This means that you will probably not feel anything as you inhale the
medication. If you carefully follow the four simple steps you can be confident you have received
the correct dose of medication. If you require, further information about your medication ask
your doctor or see your pharmacist for a Consumer Medicine Information leaflet. You may also
like to contact the Asthma Foundation in your state (Australia) or
region (New Zealand) for further information about asthma.
Text D
How to use your Turbuhaler
1. REMOVE THE CAP: Unscrew and lift off thecap.
2. LOAD THE TURBUHALER: Hold your Turbuhaler upright. Hold it by the white body, with
the coloured base at the bottom. Turn the coloured base in one direction as far as it will go. Then
turn it back in the opposite direction. During this procedure you will hear a click.
3. INHALE THE MEDICATION: Breathe out gently away from the Turbuhaler. Hold the
coloured base and place the tip of the mouthpiece (sloping part) between your lips. Breathe in
forcefully and deeply through your mouth. Do not chew or bile the mouthpiece. Remove your
Turbuhaler from your mouth before breathing
out. If you require a second dose, simply repeat steps 2 and 3.
4. REPLACE THE CAP: Remember to screw the cap back on.
NOTE- If you are using Pulmicort Turbuhaler rinse mouth with water after each use.
PART A -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. who discovered the gene that triggers asthma?
2. what are the user instructions of Turbuhaler?
3. what does SNP stands for?
4. give an example for breath-activated inhaler?
5. how many subjects were there in the British study?
6. what is the most common treatment for asthma?
7. name the genetic variation found in children with asthma?
Questions 8-13
Answer each of the questions, 8-13, with a word or short phrase from one of the texts. Each
answer may include words, number of the both. Your answers should be correctly spelled.
8. What are responsible for medication delivery in aerosol sprays?
9. Which gene is more common in the children with asthma?
10. Who provides consumer medicine information leaflet for Turbuhaler?
11. Which Turbuhaler users are required to rinse mouth with water after each use?
12. How many steps are there to ensure the proper usage of Turbuhaler?
13. How many subjects’ genes were compared with healthy controls by researchers in UK?
Questions 14-20
Complete each of the sentences, 14- 20, with a word or short phrase from one of the texts. Each
answer may include words, number or both. Your answers should be correctly spelled
14. You will probably not feel anything as you inhale the medication from ________
15. During the completion of loading procedure of Turbuhaler, you will hear________
16. Genetic markers help to flag certain ____________
17. While inhaling the Turbuhaler, you have to hold____________
18. Researchers in UK were able to home in on several DNA hotspots on_______
19. After using Turbuhaler, do not forget to _________________ back on
20. ______________ seems to have a fundamental role in the working of the immune system
against asthma
END OF PART A THIS TEXT BOOKLET WILL BE COLLECTED
READING SUB-TEST : PART B
In this part of the test, there are six short extracts relating to the work of health
professionals . For questions 1-6, choose the answer (A, B or C) which you think fits best
according to the text. Write your answers on the separate Answer Sheet
Questions 1-6
1. What does this manual tell us about local anaesthetic agents?
A. for both epithermal and central nerve blocks
B. work by dispersing across the myelin sheath or neuron membrane
C. are used by anaesthetists and other experienced medical practitioners
Local anaesthetic agents
Local anaesthetic agents are used by anaesthetists and other experienced practitioners for both
peripheral and central nerve blocks, examples being femoral nerve block and spinal
(subarachnoid) block, respectively. Less commonly now, regional intravenous blockade (Biers’
block) of limbs may be performed. Local anaesthetics work by diffusing across the myelin
sheath or neuron
membrane in their non-ionised form. More lipid-soluble agents are more potent because more of
the drug can cross into the neurone.

2. The guidelines require those administrating flumazenil to

A. remember that it has a short-term life
B. should continually monitor patient for occurring sedation
C. should be prepared to give additional doses
Antagonist
Flumazenil is a competitive inhibitor at the benzodiazepine binding site. It is available in 5-mL
ampoules containing 500 microgrammes (μg) of drug. A dose of 200 μg should be administered
over 15 seconds in suspected benzodiazepine overdose, with supplementary boluses of 100 μg if
the patient fails to respond. It should be remembered that flumazenil has a short half-life
compared with most benzodiazepines; the patient should be continually monitored for recurring
sedation and the practitioner prepared to give additional doses.

3. The purpose of these notes about diagnostic pleural is to

A. help maximise its efficiency.
B. give guidance on the procedure.
C. recommend a procedure for anaesthesia.
Diagnostic pleural aspiration (tap)
For a diagnostic pleural tap attach a green needle to the 50-mL syringe and insert the needle
through the area of skin which has been anaesthetised. Again, the needle should be inserted just
above the upper border of the rib. Aspirate 50 mL of pleural fluid then withdraw the needle and
apply a dressing to the site. Some hospitals have ready-made pleural aspiration packs.
4. The purpose of this email is to
A. report on a rise in use of rehabilitation aids.
B. explain different types of rehabilitation aids.
C. remind staff about procedures for usage of rehabilitation aids.
Rehabilitation aids
Active rehabilitation most frequently involves activity, which may be
preformed with or without aids to facilitate movement. Today, there are
many types of aids that facilitate patient mobility and make the work of
staff easier.
The following examples of rehabilitation aids are used to facilitate mobility
in the patient:
• Walkers – solid, underarm, two, three and four-wheel
• Crutches, walking sticks
• Wheelchairs – mechanical, electrical
• Verticalization tables
• Suitable for fitness exercises: Exercise bike, rehabilitation pedal
exerciser to strengthen the lower limbs, and similar.
5. The notice is giving information about
A. ways of checking that breathing exercises has been done
correctly.
B. how breathing exercises are performed and recommended.
C. which staff should perform breathing exercises.
Breathing exercises
Breathing exercises can be performed separately or they can be part of
fitness or specially targeted exercises. Breathing exercises (breathing
gymnastics) have preventative and therapeutic importance. These are
included if it is necessary to increase lung ventilation, improve
expectoration of secretions from the respiratory tract, etc. Exercise
should be according to the current medical condition of the patient; the
usual recommendation is 20 times, at least 4 – 5 times a day.
6. Which healthcare professional should lead fitness exercise
A. either physiotherapist or nurse
B. neither physiotherapist nor nurse
C. both physiotherapist and nurse
Fitness exercise
Fitness exercise is one of the simplest forms of physical activity for recumbent and walking
patients. It is performed in line with the medical condition of the patient, usually 1 to 2 times a
day for 10 to 15 minutes, individually or in groups. The physiotherapist or nurse leads the
exercise in a group of patients with the same movement limitations, lying down, sitting up or
standing. The exercise is performed in a well-ventilated room, usually in the patient’s room.
READING SUB-TEST : PART C
In this part of the test, there are two texts about different aspects of healthcare.
For questions 7-22, choose the answer (A, B, C or D) which you think fits best
according to the text. Write your answers on the separate Answer Sheet
Part C -Text 1
Acupuncture
If you’re in pain, the last thing you may want is someone sticking needles in you. But plenty of
people turn to acupuncture for pain relief. So what is the evidence? If the idea of someone
sticking needles into you sounds painful, imagine having it done when you are already in pain. It
may sound counterintuitive, but many people turn to acupuncture for pain relief. Acupuncture is
a component of traditional Chinese medicine, and involves inserting of very thin, metal needles
into specific ‘points’ on the body. The theory, says Dr Marc Cohen, a professor of
complementary medicine at RMIT University, is that inserting the needles stimulates these
‘points’ and unblocks the natural flow of light energy (qi or ch’i) through your body. Blocked qi
is thought to cause disease. Unblocking qi allows your body to heal itself, says Cohen.
You can also think of acupuncture as a way of defusing pain trigger points, says Cohen. “If you
can find a trigger point that reproduces the pain you’re experiencing... that’s a point where you
put the needle [to relieve it],” he says. Interestingly, these acupuncture ‘trigger’ points are not
always in the same spot as your pain. For example, says Cohen, people who have eye
pain often find a tender spot between their first and second toes. The acupuncture point for
frozen shoulder, a painful condition that immobilizes the shoulder joint, is on your chin.
Scientific evidence
However, although acupuncture has been practiced for several thousand years, scientists struggle
to explain how it works. One theory suggests the needling encourages the release of endorphins
natural painkillers produced by the brain) and sets off an inflammatory response that allows
the body to heal itself. Another theory is that acupuncture has a powerful effect on the mind, says
Cohen, which may also help to activate the body’s pain-relieving mechanisms.
Modern science also has surprisingly little to say on whether acupuncture successfully relieves
pain or not. There are some high- quality studies, mainly focusing on the relief of back pain and
headache but they are small – so what researchers have done is pool the results. A 2009 review
of 22 existing studies on the prevention of migraine with acupuncture found that people
receiving acupuncture had fewer headaches after three to four months than those who received
either no treatment or routine drug treatment. Those receiving acupuncture also had fewer
undesired consequences, such as drug side-effects. Another review from the same
year found that acupuncture also reduces the intensity and frequency of tension-type headaches.
For chronic lower back pain, a 2007 German study of 1162 participants found that the
effectiveness of acupuncture after six months was almost twice that of conventional therapy
(drugs, physical therapy and exercise).
A 2009 American study of 638 people found similar results. However, the most current reviews
pooling all available evidence on chronic lower back pain don’t paint such a conclusive picture:
they found that while acupuncture is a useful addition to conventional therapies, there isn’t
sufficient evidence that it’s any more effective than other treatments. In addition, a 2009 review
of acupuncture for various types of pain found that while acupuncture has a small analgesic
effect, we can’t be sure this isn’t caused by the psychological impact of the treatment. In spite of
the lack of conclusive evidence, many people turn to acupuncture to treat all types of pain,
including toothache, menstrual cramps and tennis elbow. If you want to try acupuncture, you can
go to a GP who practices acupuncture (more than 15 per cent of GPs in Australia do) or a
traditional Chinese medicine practitioner
“A GP will have recourse to western medicine and will be covered by Medicare, whereas a
traditional Chinese medicine practitioner will put… more emphasis on the traditional Chinese
medicine diagnosis and philosophy, including tongue diagnosis and pulse diagnosis,” says
Cohen. Sessions generally go for 15-30 minutes, and an initial course of once a week for six
weeks is normal for chronic pain, says Cohen. You may need fewer sessions for acute pain. You
should feel some immediate benefit for acute pain, says Cohen. For chronic pain, you should feel
some immediate benefit that might initially wane off between sessions before getting better.
But you do need to give acupuncture a chance to work. “Give it at least three or four treatments,
up to six treatments before you say it doesn’t work,” says Cohen. Acupuncture administered by a
qualified person is extremely safe, says Cohen. “All drugs have side-effects and certainly
pain medications (such as steroids and anti-inflammatory medications) can have very severe
side-effects.” Practitioners use disposable needles, so there is minimal risk of infection. It’s
worth asking practitioners about their qualifications (they should have completed a four to five
year degree), whether they are registered with their professional association, and what their
experience is with the condition you’re seeing them for, says Cohen.
If you do decide to try acupuncture for your pain, it is important that you still initially seek
medical treatment so that you do not miss any underlying conditions. Nevertheless, many pain
specialists caution against becoming overly reliant on acupuncture, or any other treatment, to
help you manage pain. Dr Paul Wrigley, senior staff specialist at the Pain Management Research
Institute in Sydney, suggests that learning ways to self-manage your pain – for example by
pacing yourself and learning to reduce your anxiety levels – can help reduce the degree to which
pain interferes with your life. Therefore, while acupuncture helps some people manage their
pain, in the end, you need to figure out what works best for you. Questions 7-14
7. Acupuncture ___________ of the body
a. Needle stimulates
b. Unblocks the energy flow
c. None of the above
d. A and b

8. How does heating occur in Acupuncture?

a. by unblocking
b. by itself
c. both the above
d. none

9. Acupuncture is a pain trigger point method.

a. yes
b. no
c. not given
d. only for few disease

10. Acupuncture point for frozen shoulder is

a. chin
b. a point in toes
c. a point face
d. all the above

11. Endoprins are _____________

a. painkillers
b. part of brain
c. only (a) or only (b)
d. both a and b

12. To treat ___________ acupuncture was used.

a. Migraine
b. Head aches
c. Both the above
d. None of the above

13. For what does acupuncture gives immediate relief?

a. head aches
b. acute pain
c. migrants
d. none of the above

14. Patients who wish to take acupuncture

a. can follow other treatment
b. should take other treatment
c. in starting go for other treatment
d. all the above

Part C -Text 2
SKIN CANCER MEDICINE IN PRIMARY CARE
The recent report of a patient who attended a skin cancer clinic in New South Wales in 2016, and
apparently failed to have a melanoma diagnosed, and then sued his attending practitioner, sends a
chill through every doctor who has ever assessed a pigmented skin lesion. Although settled out
of court, this case highlights the clinical challenges of screening for and diagnosing skin cancer,
and throws into sharp relief the issue of quality and safety in skin cancer clinics in Australia.
In the Newcastle Herald in July 2018, Emeritus Professor Bill McCarthy of the Sydney
Melanoma Unit is quoted as saying “I want to make it clear that I believe some clinics are very
careful and do good work”. However, he also expressed concern that quality across the clinics
was patchy:
Obviously, some people have seen an entrepreneurial opportunity and some clinics have
been put together by non-medical people who have simply advertised for doctors to work for
them. The staffs of some clinics do not have any specialised training: they may have just
qualified or they may be overseas practitioners. Some fancy themselves as surgeons and maybe
some were in other countries but they may not meet Australian standards. There is no quality
control and no accreditation scheme. Some have come to me for advice. They might tell me they
are going to work in a skin cancer clinic in a country town, for example. They sit in on my
clinics for a day and, while that isn’t training, it’s better than nothing.
Skin cancer is by far the most common cancer in Australia. The most common and
important skin cancers are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and
malignant melanoma. In 2015, there were estimated to be 374 000 cases of BCC plus SCC. The
age standardised incidence of BCC alone in men was 1150/100 000; more than 10 times that of
prostate cancer, the next most common cancer. Most BCCs and SCCs occur in older Australians,
causing considerable morbidity, but little mortality. In 2013–2014, they were also the most
expensive cancer to treat, costing $264 million, followed by breast cancer at $241 million.
Melanoma is the most common cancer among those aged 15–44 years, and the second most
common cause of cancer death in that age group, and it accounts for 3% of all cancer deaths in
all ages (1199 deaths in 2014).
Skin cancers are the most common cancers managed by general practitioners, with more
than 800 000 patient encounters each year. While historically GPs have managed most skin
cancers, in recent years, with the rapid growth of “skin cancer clinics”, there has been a dramatic
change. Little is known about these clinics; some include large “corporate” chains and others
comprise smaller independent operators. Anecdotally, most doctors working in these clinics
seem to be GPs, or at least non-specialist doctors, from a variety of backgrounds.
 Some concerns have been raised about the type and quality of work performed within
these clinics from other sectors of the profession. The pros and cons of “the fragmentation of
general practice”, typified by skin cancer clinics, travel medicine clinics, women’s health clinics
and others have been considered previously. Currently, in Australia, there are: no barriers to
working in skin cancer medicine in primary care; limited training opportunities for generalist
doctors wanting to do this work (and no formal award courses); no opportunities for skin cancer
clinics to be accredited against defined standards; and no quality framework to support this work.
In August this year, the Skin Cancer Society of Australia was formed to provide one mechanism
to redress some of these deficiencies. Two of us (AD, PB) have worked in the skin cancer field
for over 20 years, and A D has provided formal training for 15 years. When one of us (DW)
decided to start working in this field at the beginning of 2018, there was no barrier to taking a
position in a skin cancer clinic, and no formal assessment of competency. There was also no
barrier to accessing the Medicare Benefits Schedule (MBS) item numbers that relate specifically
to the management of skin cancer, including some that relate to fairly significant plastic surgical
procedures. There were no easily accessible training opportunities, or postgraduate awards for
general practitioners in skin cancer medicine. Furthermore, as skin cancer clinics are
demonstrably not general practices, they cannot be accredited through the mechanisms that apply
to Australian general practice. It is unclear whether the concerns expressed by other sectors of
the profession lie in the age-old debate “GPs versus specialists”, or whether it is “skin cancer
clinic doctors versus the rest”. Perhaps it is some of both. Certainly, there is real concern among
mainstream general practice that skin cancer clinics are an expression (or the cause of)
fragmentation, and there is real concern from dermatologists and plastic surgeons about
encroachment on their domains of practice.
Without doubt, some dermatologists believe that they are the doctors best placed to diagnose and
manage patients with skin cancer. However, there are hardly enough dermatologists to cope with
current demand for their general services, let alone enough to manage the majority of skin
cancers in Australia. Furthermore, some plastic surgeons believe that patients receiving surgical
treatment for skin cancer should be treated exclusively by them, but the geographic distribution
of dermatologists and plastic surgeons in Australia precludes their managing most patients. The
perception may exist among some GPs that skin cancer doctors are taking a lucrative
(procedural) aspect of their practice away. At least some of this debate seems to be vested in
professional self-interest, rather than a dispassionate consideration of what is best for the patient.
Most patients with skin cancer can be competently diagnosed and treated by appropriately
trained, non-specialist primary care physicians, whether they are working in skin cancer clinics
or in mainstream general practice. We also believe that consultants, such as dermatologists and
plastic surgeons, have a crucial role to play in helping manage the more complex cases, as well
as providing training. However, much more needs to be done if we are to collectively ensure
that patients enjoy maximal health outcomes, and that doctors are well trained and supported.
Part C -Text 2: Questions 15-22
15. There is concern about quality and safety in skin
cancer clinics because:
a) some doctors employed lack the required skills
b) Australian standards are difficult to meet
c) they are in country towns
d) Doctors rarely attend training

16. Which of the following statements is not true?

a) Prostate cancer is less common than skin cancer
b) People often die from BCCs & SCCs
c) Melanoma is a common cancer for people aged
between 15~44
d) The older the person the greater the risk of BCCs

17. Which of the following is not mentioned as a problem in Australia

a) Lack of education & training
b) Lack of patients
c) Lack of recognised guidelines for the clinics
d) Ease at which doctors can choose to work in this area

18. Dermatologists and plastic surgeons view skin cancer clinics as a threat to their business.
a) True
b) False
c) Not mentioned
d) Author has no opinion

19. In the paragraph beginning with Without doubt the author’s view is
a) Dermatologists can provide better treatment for skin cancer patients
b) Only plastic surgeons should provide surgery
c) GPs earn a lot of money from skin cancer patients
d) That some practitioners are more concerned about their professional reputation instead of
patient benefit.
20. Which is the right heading for the first section of the article?
a) Where does the divide lie?
b) The problem
c) Skin cancer in Australia
d) Skin cancer in general practice: emergence of new models of care

21. Which is the right heading for the last section of the article?
a) Where does the divide lie?
b) The problem
c) Skin cancer in Australia
d) Skin cancer in general practice: emergence of new models of care

22. Which is not one among the most common type of skin cancers in Australia?
a) basal cell carcinoma
b) actinic keratoses
c)squamous cell carcinoma
d) malignant melanoma