Reading test

Tuberculosis: Texts

Text A

Tuberculosis

Tuberculosis is an infectious disease caused in most cases by a micro-organism called Mycobacterium tuber-
culosis. The micro-organisms usually enter the body by inhalation through the lungs. They spread from the
initial location in the lungs to other parts of the body via the blood stream, the lymphatic system, the airways or
by direct extension to other organs.
• Pulmonary tuberculosis is the most frequent form of the disease, usually comprising over 80% of cases. It is
the form of tuberculosis that can be contagious.
• Extra-pulmonary tuberculosis is tuberculosis affecting organs other than the lungs, most frequently pleura,
lymph nodes, spine and other bones and joints, genitourinary tract, nervous system, abdomen or virtually any
organ. Tuberculosis may affect any part of the body, and may even become widely disseminated throughout
the whole body.
Tuberculosis develops in the human body in two stages. The first stage occurs when an individual who is
exposed to micro-organisms from an infectious case of tuberculosis becomes infected and the second is
when the infected individual develops the disease.

50 Study guide for OET © IRS Group 2018

 Text B

Diagnosis of tuberculosis

The most frequent symptoms of pulmonary tuberculosis are:

• persistent cough for 2 weeks or more: every patient presenting with this symptom should be desig-
nated a tuberculosis suspect;
• sputum production, which may be blood-stained (haemoptysis), shortness of breath and chest pain;
• loss of appetite and loss of weight, a general feeling of illness and tiredness, night sweats and fever.
Any patient presenting with any of these symptoms should be suspected of having tuberculosis. If the patient is,
or was, in contact with a patient with infectious tuberculosis, such a person is even more likely to be suffering
from tuberculosis. © IRS Group
Symptoms of extra-pulmonary tuberculosis depend on the organ involved. Chest pain from tuberculosis pleu-
risy, enlarged lymph nodes and sharp angular deformity of the spine are some of the presenting symptoms or
signs of extra-pulmonary tuberculosis.
Symptoms of extra-pulmonary tuberculosis depend on the organ involved. Chest pain from tuberculosis pleu-
risy, enlarged lymph nodes and sharp angular deformity of the spine are some of the presenting symptoms or
signs of extra-pulmonary tuberculosis.

Tuberculosis cases are most likely to be found among:

• patients who present themselves on their own initiative at a health facility with symptoms suggesting
tuberculosis;
• those (especially children and young adults) living in the same household with smear-positive pa-
tients;
• those infected with HIV;
• those found to have an abnormality that has the appearance of tuberculosis when a chest radiograph
has been taken for clinical investigation of a sick patient.

Confirmation of the diagnosis:

There are several tests available to diagnosis TB. some of these are:
• Mantoux Test: This involves injecting a small amount of tuberculin into the skin in the lower part of the
arm. Then the person must return after 48 to 72 hours to have a trained health care worker look at
their arm and examine for hard area or swelling
• TB culture Test : Culture test involve studying bacteria by growing them on different substances. Bacte-
ria are usually contained in a sputum sample taken from suspected person.
• Chest X-ray: If a person has had bacteria which have caused inflammation in the lungs, an abnormal
shadow may be visible on an X-ray.

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 Text C

First line tuberculosis drugs and its dosage in adults

Drugs Daily dose Preparation Side effects

in mg/kg (range)

Isoniazid 4-6 Tablets(50,100,300 mg)

Aqueous IV/IM solution Burning sensation,
(100mg/ml) Vomiting,Jaundice,
Confusion

Rifampicin 8-12 Capsule(150,300mg) Anorexia, Nausea,

Aqueous IV solution Itching, Purpura,
shock

Pyrazinamide 20-23 Tablet(500 mg) Joint pain,

Jaundice,vomiting

Ethambutol 15-25 Tablet(100 and 400 mg) Visual Impairment

Streptomycin 12-18 IM Injection Dizziness

For drug-resistant TB, a combination of antibiotics called fluoroquinolones and injectable medications such as
amikacin, kanamycin or capreomycin are generally used for 20-30 months.

Text D

Tuberculosis: Lifestyle Management

• People with active TB disease should stay away from work and school until the doctor says it’s safe to return,
in order to avoid infecting others.
• Cover the mouth with a tissue when coughing and sneezing, then seal the tissue in a bag to throw it away.
• Make sure the patient’s room has adequate ventilation, so that the exhaled bacteria are carried away.
• People with active disease need to tell their doctor or health professionals about anyone they have had close
contact with, such as family, friends. © IRS Group
• Take all the medications on right time. If patient stop taking medications or skip some doses, the risk of
developing drug resistant TB is high.

52 Study guide for OET © IRS Group 2018

 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.

Tuberculosis: Questions

Questions 1-6

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. Measures to prevent the spread of disease ________________________________

in household setting
2. Indicators of the disease ________________________________

3. How tuberculosis advances in individals ________________________________

4. Patients under risk ________________________________

5. Investigations to be done ________________________________

6. Tuberculosis treatment after exposure ________________________________

7. Mode of transmission of tuberculosis ________________________________

Questions 7-14

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 is the drug used for TB skin test?
________________________________________________________________

9. What is the maximum dose of streptomycin per kilo of a patient’s weight?

________________________________________________________________

10. Which bacteria causes tuberculosis?

________________________________________________________________

11. How long does a patient have to take medication for drug-resistant TB?
________________________________________________________________

12. Which type of tuberculosis spreads from infected person to others?

________________________________________________________________

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13. What needs to be ensured to remove breathe out bacteria from a room?
________________________________________________________________

14. What threat follows the stoppage of TB medications?

________________________________________________________________

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. The disease advances beyond the _____________________________ to affect various areas.

16. The signs of extra-pulmonary disease is based on the involved _______________________

17. Mantoux test checks for hard area and .

_____________________________

18. Inflammation of lungs as a result of presence of bacteria may be evident on ___________________________.

19. _____________________________ is suspected on patients who visit the health sector on their own interest.

20. Four-drug regimen falls under _____________________________ tuberculosis drugs.

END OF PART A

THIS QUESTION PAPER WILL BE COLLECTED

54 Study guide for OET © IRS Group 2018

 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. The standard procedure for health surveillance must include

A tests that require biological monitoring

B formulation of tests for close scrutiny
C constant testing to check for irregularities

Health Surveillance
As part of the monitoring system, health surveillance should be undertaken if appropriate. The health of
employees exposed to hazardous substances can be affected through absorption into the body. The
absorption route can be inhalation, by ingestion, through the skin or a combination of these. When inside
the body the substances are metabolised. Metabolites can target various organs of the body which can
thereby be harmed. Health surveillance therefore requires biological monitoring. At its simplest this could
be a skin inspection ensuring no dermatitic changes have occurred as a result of exposure to an irritant,
through to lung function tests and urine, breath or blood analysis. The criteria used to decide which type of
surveillance is appropriate depend on whether a test is available. Tributyl tin oxide was once used as a
timber preservation treatment; however, it was not known how it was metabolized in the body and therefore
no appropriate test existed. The potential for it to cause harm could not be eradicated and, as many
occupational diseases have a long latency period - up to 40 years for asbestosis, for example - tributyl tin
oxide was withdrawn from use.

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2. The manual promotes ‘airborne precautions’ for the

A use of an elaborate plan to prevent any infection

B ease to monitor adherence of preventive methods
C strength of protection against communicable sickness

Airborne Precautions
Airborne precautions prevent transmission of infectious disease that are spread by airborne droplets (= 5
microns) that remain infectious and suspended in air for long periods of time over long distances and can
be widely dispersed by air currents. Airborne precautions include:
Private room with monitored negative pressure ventilation of 6-12 air exchanges per hour; airborne infec-
tion isolation room (AIIR) preferred © IRS Group

Discharge of air to the outside or HEPA-filtered before recirculation

Door and windows much be kept closed at all times
Respiratory protection (usually an N-95 mask) for susceptible persons must be worn prior to entering
room and removed after leaving room
Droplet mask on patient when leaving room if tolerated; follow respiratory hygiene/cough etiquette
Limit transport to essential purposes only
If possible, non-immune healthcare workers should not care for patients with vaccine-preventable air-
borne diseases

56 Study guide for OET © IRS Group 2018

 3. The extract ails to give information about

A work practices that reduce the risk of injuries

B the need to specify and follow regulations at work
C the importance of risk assessment and control measures

The six pack

Six new sets of regulations were produced in response to the European Parilament Framework Directive.
These are
Management of health and safety at work
Manual handling operations © IRS Group
Personal protective equipment at work
Health and safety (display screen equipment)
Provision and use of work equipment
Workplace (Health, safety and welfare)
While each set of regulations focuses on specific aspects of the workplace, they all have a common
theme. They reinforce the need for risk assessment, introducing control meaures and follow-up monitoring
and review systems. However, for the first time the idea of a ‘competent person’ is introduced. The em-
ployer is required to appoint one or more competent persons to assist in undertaking the measures needed
to comply with the relevant statutory provisions. This person must be knowledgeable about the risks to
health and safety within that workplace.

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4. The extract conveys the need to

A develop patient-centred healthcare service skills

B adopt approaches to achieve excellence in practice
C inculcate skills required by practice developers

Characteristics, Qualities and Skills

Whilst the primary role and function of practice development is the promotion and facilitation of patient-
centred health care services within a department and organization, there had been little work undertaken
examining the systems and processes involved in achieving this. The importance of capturing was to be
clearer about the approaches taken to develop excellence in practice at different organizational levela and
in addition, differentiate the skills and activities inherent in those working in practice development that still
are predominantly nurses. Garbett & McCormack’s substantial study analysing the cocept of practice
development formed the basis for further description and postulation of the characteristics, qualities and
skills of practice developers that remains ongoing.

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 5. What does the regulation outline?

A prevention of similar injuries to employees ahead

B reporting of grievous injuries for acknowledgement
C analysis of the incident and its proper redressal

The reporting of injuries

Employers are required to report to the HSE (or local authority for retail premises) certain injuries, diseases
or dangerous occurrences that have stemmed from work activities. The enforcing authority must be notified
immediately.
The aim of the regulations is to provide information to the HSE for epidemiological purposes. Analysis of the
information may suggest a pattern of disease or injury associated with a particular industry. Action can be
taken to establish the cause of the risk and its prevention. The HSE has also published literature that is
available for healthcare professionals on request.

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6. The extract on randomised control trials on HIV infers

A presence of foreskin is a major precipitating factor

B circumcision performed by certain devices are safe
C immune systems are weak in males are uncircumcised

Male circumcision and HIV infection

A randomized controlled trial is the gold standard for scientific studies, and three such trials conclusively
determined that male circumcision reduces female-to-male HIV transmission by about 60% Responding
to this evidence, in March 2007, the World Health Organization and UNAIDS issued recommendations on
male circumcision and HIV prevention. The primary target cells through which HIV enters the body are
immune system target cells with CD4 receptors, including Langerhans cells. These cells are present in
high density in the epithelium of the inner foreskin and are close to the surface . The highly vascularized
foreskin mucosa and the mucosa at the frenulum are prone to tearing and bleeding during intercourse.
These microinjuries allow easy entry of HIV into the bloodstream. Important note about device-based
surgical methods In 2013, the World Health Organization stated that the male circumcision devices it
prequalifies are efficacious, safe and acceptable as additional methods of male circumcision for HIV pre-
vention among healthy men. Providers who perform circumcisions using device-based surgical methods
should be appropriately trained and competent in these of the specific device.

60 Study guide for OET © IRS Group 2018

 Part C
In this part of the test, there are two texts about different aspects of healthcare. For questions 7-22, choose the
answer (A, B, C or D) which you think fits best according to the text..

Text 1: “Miracle” jab makes fat mice thin

After a four-week course of treatment with a protein called ob, the fat simply falls off, leaving vastly overweight
mice slim, active and sensible eaters. If the protein has the same effect on people, it could be the miracle cure
millions have been waiting for. That, at least, is the theory. But sceptics warn that too little is known about the
way the human version of the ob protein works to be sure that extra doses would help people to lose weight.
But when the results of the tests were leaked last week, Amgen, the Californian biotechnology company
which owns the exclusive rights to develop products based on the protein, saw an overnight jump in its share
prices.

Last December, a team led by Jeffrey Friedman and his colleagues at the Howard Hughes Medical Institute at
the Rockefeller University, New York discovered a gene which they called ob. In mice, a defect in this gene
makes them grow hugely obese. Humans have an almost identical gene, suggesting that the product of the
gene – the ob protein – plays a part in appetite control. The ob protein is a hormone, which Friedman has
dubbed leptin. In April, Amgen, which is based in Thousand Oaks, California, paid the institute $20 million for
exclusive rights to develop products based on the discovery. Amgen will carry out safety tests on the protein
in animals next year, and hopes to begin clinical trials on people within a year.

The excitement began last week when the journal Science published the findings of three groups which have
been working on the protein. The results in obese mice with a defective gene that prevents them making the
protein were dramatic. Mary Ann Pelleymounter and her colleagues at Amgen gave obese mice shots of the
protein every day for a month. Those on the highest dose lost an average of 22 per cent of their weight. Before
treatment, these mice overate, had lower metabolic rates than normal, lower temperatures, and raised levels
of insulin and glucose in their blood” says Pelleymounter. “The protein brought all these back to normal
levels,” she says.

More significantly, in terms of the potential for a human slimming drug, the treatment also worked on normal
mice, which lost what little spare fat they had. They lost between 3 and 5 per cent of their bodyweight, almost
all of it in the form of fat, according to Pelleymounter. This is important because no one has identified a
mutation in the human ob gene that might lead to obesity, suggesting that whatever the cause of obesity, the
ob protein might still help people lose weight. Friedman and his team carried out similar experiments. In just
one month, their obese mice shed around half their body fat. In the average obese mouse, fat makes up about
60 per cent of body weight. Treated mice lost their appetite. Within a few days they were eating about 40 per
cent as much as untreated animals. Their fat practically melted away, falling to 28 per cent of their body
weight after a month. In normal mice, treatment reduced the amount of fat from an average of 12.22 per cent
of body weight to a spare 0.67 per cent.

Study guide for OET © IRS Group 2018 61

Friedman and Pelleymounter believe that the protein, which is produced by fat cells, regulates appetite. “We
think it’s something like a circulating hormone to tell the brain there are normal amounts of fat, or too much,
in which case the brain turns down your appetite,” says Pelleymounter. The experiments also show that
treated mice have an increased metabolic rate, suggesting that they burn fat more efficiently. Their appetites
decrease – and they are less sluggish, becoming as active as normal mice.

The third group of researchers from the Swiss pharmaceuticals company Hoffmann-La Roche, are more
sceptical about how significant the ob protein might be in treating obesity. From their studies, they conclude
that the protein is just one of many factors that control appetite and weight. “This is a very important signal,
but it’s one of several,” says Arthur Campfield, who led the team. Campfield doubts whether the ob protein
alone will have much effect in overweight humans. His team hopes to unravel the whole signalling system that
regulates weight, and is particularly keen to find the receptor in the brain that responds to the ob hormone.
Hoffman-La Roche, excluded by the Amgen licence deal from developing products based on the ob protein
itself, hopes to develop pills that interfere with the message pathways in appetite control.

Stephen Bloom, professor of endocrinology at London’s Hammersmith Hospital, agrees. “I think the work with
ob is a major advance, but we’ve not got the tablet yet. That will come when people have made a pill that
stimulates the ob receptor in the brain so it switches off appetite.” Even Pelleymounter at Amgen cautions
against overoptimism at this stage. “We don’t know whether it would be true that people would lose weight,
but you can predict from mice that it would have some positive effect,” she says. “However, I don’t think obese
people should hold out for this. They should carry on with their exercises and dieting.”

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 Text 1: Questions 7 - 14

7. The first paragraph puts forward to the reader that

A a protein treatment has caused mice to lose weight dramatically

B a protein treatment for mice cannot be adapted for use in humans
C scientists agree that a new protein treatment makes people lose weight
D a scientific method of making obese people slim has been developed

8. According to Friedman and his colleagues, the ob protein

A may be transformed from mice to humans

B may be a factor in appetite control
C is produced by the ob hormone
D is mainly found in obese mice

9. What according to paragraph two does dubbed refer to

A written
B named
C defined
D proved

10. A study by Mary Ann Pellymounter and her colleagues found that

A the ob protein caused subjects in the study to decrease their metabolic rate
B the ob protein cased people to lose about twenty percent of their weight
C a deficiency in the ob protein had caused obesity in the subjects
D a defective ob gene resulted in the production of the ob protein

Study guide for OET © IRS Group 2018 63

11. According to the Friedman and Pelleymounter studies, treatment with ob protein

A may be useful only for people with a defective ob gene

B may be useful for anyone who wants to lose weight
C is effective only on mice with a defective ob gene.
D will not be effective on people who want to lose weight

12. What does sluggish in paragraph five denote?

A strong
B lazy
C slow
D sick

13. The research from Hoffman-La Roche are less confident of the protein’s importance because

A it has not been trialled yet on human beings

B the trials done on mice were rather inconclusive
C it does not have a significant role in weight loss
D it is not the only factor involved in appetite control

14. In conclusion, the article suggests that

A a treatment for obesity in humans will be developed from the ob protein

B scientists will soon have more knowledge about the ob receptor in the brain
C the results of the study of mice will lead to weight loss pills for humans
D despite the results of the study of mice, the benefits for humans is unknown

64 Study guide for OET © IRS Group 2018

 Text 2: The search for cholesterol-free fats

Butter, as anyone who has not been living in a cave for the past ten years has probably heard, contains a lot
of saturated fat, which increases the levels of cholesterol in the blood. Margarine, on the other hand, is made
from vegetable oils, which contain cholesterol-lowering polyunsaturated fat. So switching to a diet with only
vegetable fats should lower cholesterol levels, right? ‘Wrong,’ says Margaret A Flynn, a nutritionist at the
University of Missouri. When she performed the experiment with a group of 71 faculty members – switching in
both directions – she found that ‘basically it made no difference whether they ate margarine or butter.’ The
reason, according to a growing group of nutritionists, could be partially hydrogenated fats. Recent studies
suggest that such fats might actually alter cholesterol levels in the blood in all the wrong ways, lowering the
‘good’ high-density lipoprotein and increasing the ‘bad’ low-density lipoprotein.

Partially hydrogenated fats are made by reacting polyunsaturated oils with hydrogen. The addition of hydrogen
turns the oils solid, and some of their polyunsaturated fat is turned into trans monounsaturated fats.
Monounsaturated fat is generally perceived as good, but things are not so simple. ‘Trans monounsaturates
act in the body like saturated fats,’ says Fred A Kummerow, a food chemist at the University of Illinois at
Urbana-Champaign. ‘Almost all naturally occurring monounsaturated fat is of the cis variety, which is more
like polyunsaturated fat.’ Flynn’s study is not the first to raise questions about trans fatty acids. Ten years
ago a Canadian government task force noted the apparent cholesterol-raising effects of trans fats and requested
margarine manufacturers to reduce the amounts – which can easily be done by altering the conditions of the
hydrogenation reaction.

Last August two Dutch researchers, Ronald P Mensink and Martijn B Katan, published a study in the New
England Journal of Medicine that showed eating a diet rich in trans fats increased low-density lipoprotein and
decreased levels of high-density lipoprotein. In an editorial accompanying the study, Scott M Grundy, a lipid
researcher at the University of Texas Southwestern Medical Center at Dallas, wrote that the ability of trans
fatty acids to increase low-density lipoprotein ‘in itself justifies their reduction in the diet.’ Grundy called for
changes in labelling regulations so that cholesterol-raising fatty acids, including trans monounsaturates, are
grouped together. James I Cleeman, co-ordinator of the National Cholesterol Education Program, disagrees.
‘To raise a red flag is premature,’ he says. ‘Mensink’s audience is the research community – the public
needs useable simplifications.’ Cleeman points out that the subjects in Mensink and Katan’s study ate
relatively large amounts of trans fats. He believes more typical consumption levels should be investigated
before any change in recommendations is warranted.

Furthermore, Cleeman notes that studies like Flynn’s are hard to interpret because subjects were allowed to
eat as they pleased. Flynn’s study, published this month in the Journal of the American College of Nutrition,
found considerable variability among subjects in their blood lipid profiles. ‘The only way to study the question
properly is in a metabolic ward,’ Cleeman says. ‘Trans fats are a wonderful example of an issue that’s not
ready for prime time.’ Edward A Emken, a specialist on trans fats at the Agricultural Research Service in
Peoria, Illinois, also downplays the concern but for different reasons. Although Mary G Enig, a nutritional
researcher at the University of Maryland, has estimated American adults consume 19 grams of trans fat per
day, Emken thinks that figure is too high. According to his calculations, eliminating trans fatty acids from the

Study guide for OET © IRS Group 2018 65

diet will for most people make only a tiny change in lipoprotein levels. ‘If you’re hypercholesterolaemic, it
could be important, but if you’re not, then it is not going to affect risk at all,’ he concludes.

Emken, together with Lisa C Hudgins and Jules Hirsch, has performed a study to be published in the American
Journal of Clinical Nutrition that finds no association between levels of trans fats in fat tissue in humans and
their cholesterol profiles. To Emken, that suggests trans fats are not a major threat for most people.
Nevertheless, trans fats seem destined for more limelight. ‘How can one defend having cholesterol and saturated
and unsaturated fats listed on food labels but not allow public access to trans information when such fats
behave like saturates?’ asks Bruce J Holub, a biochemist at the University of Guelph in Ontario. ‘At the very
least, one has to ask whether cholesterol-free claims should be allowed on high-trans products.’

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 Text 2: Questions 15 - 22

15. What is ‘wrong’ as made out from paragraph one?

A Switching to a diet with traditional vegetable fats

B Commonly held perception of polyunsaturated fat
C The method adopted by the experimental group
D available information regarding hydrogenated fats

16. M A Flynn’s finding is supported by the proposition that

A butter lowers high-density lipoprotein while margarine increases low-density lipoprotein

B butter contains just as much partially hydrogenated fat as margarine does
C trans monounsaturates behave similar to most naturally occurring monounsaturates
D trans monounsaturated fat increases the cholesterol level

17. The passage points out that

A eating butter is not as dangerous for cholesterol levels as was previously thought
B cholesterol levels in humans can be noticeably reduced by cutting out animal fats
C eating margarine is s healthier option than eating butter
D the benefits of using only vegetable fats in the human diet are arguable

18. In paragraph three, what is meant by ‘to raise a red flag’?

A to warn of dire consequences

B to criticize existing methods
C to express unfounded concern
D to ignore prevalent signs

Study guide for OET © IRS Group 2018 67

19. James I Cleeman is stated to

A agree with Grundy’s recommendation for relabelling

B dispute Mensink and Katan’s research into the effects of eating trans fats
C want Mensink and Katan’s work discussed outside the research community
D want to wait any longer before warning the public

20. Cleeman is of the view that

A Flynn’s study is not very valuable because she is hard to understand

B trans fats should now be discussed and debated by interested members of the public
C Flynn’s study was not sufficiently rigorous
D Flynn’s subjects should have had more food of a more vaied nature

21. On American consumption of trans fats, Edward Emken

A believes that a reduction in this figure could be achieved quite easily

B is not very concerned about trans fat intake levels for most people
C does not think that they should consume so much in trans fats
D thinks that people should eliminate trans fats from their diets

22. The passage summarises that,

A Emken, in a study published has challenged other researchers’ claims

B the levels of trans fats tissue in humans and their cholesterol profiles are not connected
C the issue of trans fat is likely to receive more, rather than less, attention in future
D food products should be labelled with their trans information in addition to current information

END OF READING TEST

THIS BOOKLET WILL BE COLLECTED

68 Study guide for OET © IRS Group 2018