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    17 views21 pages

    Obesity

    Uploaded by

    himanshugupta811997
    oet

    Copyright:

    © All Rights Reserved
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    of 21
    Test 02-19-R @ET READING SUB-TEST — TEXT BOOKLET: PART CANDIDATE NUMBER: LAST NAME: FIRST NAME: MIDDLE NAMES: PROFESSION: Passport Photo VENUE: ‘TEST DATE: ‘CANDIDATE DECLARATION 8y sang hi ou go el sil casa way (neta a ee at ay oh pan eon any OET or tel can yo heater asin ary erg ue ary racic teak any fe nls guns, ogee ary avin cr at, ou mayb quai a you ss nytt snd een of BLA CBLA share eae eter Seley aon apy an am my oem pai In fe andsi gece sais enable erenl ae ences meson ray bo pees a pny war ease, CANDIDATE SIGNATURE: DEL RO) ‘You must NOT remove OET material from the test room. Obes Overweight and Obesity For the Identification and classification of overweight and obesity, use clinical judgement to decide when to measure a patients height and weight. Opportunites include registration with a general practice, consultation for related conditions (such as type 2 diabetes and cardiovascular disease) and other routine health checks. Different weight classes are defined based on @ person's body mass index (BMI) as follows: + healthy weight: 18.5-24.9 kgim2 + overweight: 25-29.9 kgim2. + obesity I: 30-34.9 kgim2 + obesity It 35-38.9 kgima + obesity Ili: 40 kgim2 or more. Interpret BMI with caution in highly muscular adults as it may be a less accurate measure of adiposity inthis group, ‘Some other population groups, such as people of Asian family origin and older people, have comorbidity risk factors that are of concer at different BMIs (lower for adults of an Asian family origin and higher for older people). Base assessment ofthe health rsks associated with being overweight or obese in adults on BMI and waist circumference as follows. For men, waist circumference of less than 94 cm is low, 94102 em is high and more than 102 om is very high. For women, waist circunference of less than 80 cm is low, 80-88 cm is high and more than 88 cm is very high. Use BMI (adjusted for age and gender) as a practical estimate of adiposity in children ‘and young people. Interpret BMI with caution because itis not a direct measure of adiposity. Interventions: Tallor diotary changes to food preferences and allow fora flexible and ineividual approach to reducing calorie intake. Do not use unduly restrictive diets, because they are ineffective in the long term and can be harmful. The main requirement of a dietary approach to weightloss is that total energy intake should be less than energy expenditure, Diets that have a 600 kcallday defict (that is, they contain 600 kcal less than the person needs to stay the same weight) or that reduce calories by lowering the fat content (low-fat diets), in combination with expert support and Intensive follow-up, are recommended for sustainable weightloss. Base the level of intervention to discuss with the patient initially as follows: BMI Classification [Low Waist Gircum. [High Waist Crcum. | Very High Waist Circum. | Comorbidites present Overweight 1 2 2 a Obesity 2 2 2 3 ‘Obesity i 3 3 A é Obesity I 4 4 a 4 1, General advice on healthy weight and Iestyle 2. Diet and physical activity 3. Diet and physical activity; consider drugs 4, Diet and physical activity, consider drugs; consider surgery Pharmacological Interventions Consider pharmacological treatment only after dietary, exercise and behavioural approaches have been started and evaluated. Consider treatment for patients who have not reached thelr target weight loss or have reached a plateau on dietary, activity and behavioural changes. Drug treatment is not generally recommended for children younger than 12 years. Ortistat is indicated for weightloss in combination with a low-calorie, lowfat diet. tis available as 120mg capsules under the brand name Xenical and s 60mg capsules under the brand name All. Xenical is only available with a prescription, whereas Allis available without 2 prescription under the supervision of a pharmacist, Orlistat is 2 potent, specific, and long-acting inhibitor of gastrointestinal lipases, which decreases the amount of fat absorbed ‘rom the diet. Only prescribe orlistat as part of an overall plan for managing obesity in adults who meet one ofthe following criteria + a BMI of 28 kgim2 or more with associated risk factors + @ BMI of 30 kgim2 oF more nb. Intiate orlistat treatment only after careful consideration of the possible impact on efficacy of antiretroviral HIV medicines ‘Surgical Options Gastric Band Procedure type: Reversible. Band placed around top of stomach under general anaesthetic No change to anatomy. Minimum BMI: 30, Expected weight loss: 50-60% excess weight loss (avg 31 kilos) Gastric Sleeve Procedure type: Non-reversible. 80% of stomach removed under general anaesthetic, Lower digestive system unaltered. Minimum BMI: 35, Expected weight loss: 50-70% excess weight loss (avg 4S kilos) Gastric Bypass Procedure type: Non-reversible. Stomach cut to leave pouch. Intestines rerouted All under general anaesthetic Minimum BMI: 40, Expected weight loss: 60-70% excess weightloss (avg 63kilos) Gastric Balloon Procedure type: Temporary (6 or 12 months). Balloon placed endoscopically under light sedation. No change to anatomy. Minimum BMI: 27, Expected weight loss: 12-19 kilos in 6 months END OF PART A. THIS TEXT BOOKLET WILL BE COLLECTED Test 02-19-R @ET READING SUB-TEST — QUESTION PAPER: PART CANDIDATE NUMBER: LAST NAME: FIRST NAME: MIDDLE NAMES: PROFESSION: Passport Photo VENUE: ‘TEST DATE: ‘CANDIDATE DECLARATION 8y sang hi ou go el sil casa way (neta a ee at ay oh pan eon any OET or tel can yo heater asin ary erg ue ary racic teak any fe nls guns, ogee ary avin cr at, ou mayb quai a you ss nytt snd een of BLA CBLA share eae eter Seley aon apy an am my oem pai In fe andsi gece sais enable erenl ae ences meson ray bo pees a pny war ease, CANDIDATE SIGNATURE: TIME: 15 MINUTES DE LO) DO NOT open this Question Paper or he Text Booklet untl you are old to do so. Write your answers on the spaces provided on this Question Paper. You must answer the questions within the 15-minute time limit ‘One mark will be granted for each correct answer. ‘Answer ALL questions. Marks are NOT deducted for incorrect answers. {At the end of the 15 minutes, hand in this Question Paper and the Text Booklet. DO NOT remove OET material from the test room, PartA 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 in the 45-minute time limit + Your answers should be correctly spelt Obesity: Questions Questions 1-7 For each question, 1-7, decide which text (A, B, G oF B) the information comes from. You may use any letter more than Inwhich text can you find information about 4. specific advice to give patients about ther food intake? 2. tools for diagnosing degrees of obesity? 3. diferent types of medication to prescribe for obese patients? 4. the success rate of diferent forms of surgery? 5, how to establish whether adolescents are obese? 6. specific factors relating to certain ethnic groups? 7. factors informing the most appropriate intervention strategies? Questions 8-13 ‘Answer each of the questions, 8-13, with a word or short phrase from one of the texts. Each answer may include words, numbers or both 8. _Inwhich category should a patient with 2 BMI of 28.00kg/m2 be placed? 98. Which group of patients may be mast at risk of comorbidities at high BMI? 10, What daly calorie deficit is generally recommended? ‘1, What sor of diets should patients be advised not to follow? 12. What isthe minimum age for patients receiving pharmacological intervention? 13, Which type of surgery is not permanent f patients undergo a subsequent procedure? Questions 14-20 Complete each of the sentences 14-20 with a word or short phrase from one of the texts. Each answer may include words, numbers or bath 14. Patients diagnosed as Obesity Il might be advised to consider surgery i they have 418. Dietary changes should be recommended to women whose waist ctcumference is over 16. Patients unable to tolerate a general anaesthetic might be advised to have surgery. 17, Before gastric bypass surgery is considered, patients should have a BMI of more than 18, Apatient might expect to lose in weight as a result of gastric band surgery. 19. Orlistat shouldn't be prescrived to patients taking rugs. 20. BMI data may give false indications of obesity in adults whose body type is. END OF PARTA THIS QUESTION PAPER WILL BE COLLECTED Test 02-19-R @ET READING SUB-TEST — QUESTION PAPER: PARTS B & C CANDIDATE NUMBER: LAST NAME: FIRST NAME: MIDDLE NAMES: PROFESSION: VENUE: Passport Photo ‘TEST DATE: Ins andes eco ondansetron ances ie sien ray bees a hry ware essed, CANDIDATE SIGNATURE: TIME: 45 MINUTES DE LO) DO NOT open this Question Paper until you are tld to do so, ‘One mark will be granted for each correct answer. ‘Answer ALL questions. Marks are NOT deducted for incorrect answers. {At the end ofthe test, hand in this Question Paper. PERN Loon Mark your answers on this Question Paper by filing in the circle using a 28 pencil. Example: @) e@ Part B In this part ofthe test, there are six short extracts relating fo the work of health professionals. For questions 1-6, choose the answer (A, B or C) which you think fits best according tothe text 1. The purpose ofthe memos to ® inform stat of new procedures, cutie some changes in procedures © omind stat about exising procedures Memo: Spillages in the Emergency Department Preventing falls in the ED isa top priority, and a big issue we have seen lately concems liqui spilages in the public areas, especially involving hot drinks from the new vending outlets, If there is such aspil, the healtheare assistant on duty should follow the established protocol: wam patients and others inthe Vicinity ofthe immediate falls risk, then place a yellow sign over the affected area, then mop up the spill with tissue paper, then call tho ‘leaner to clean and dry the area. Once this operation has been performed, the sign should be removed. fa Patient is identified as at risk of creating a spil, they should be provided with a closed cup from which to sip, and nursing staff informed. “The secon ofthe guidlines establishes ® row io operate a device what fo doi device cannot be used © who can decide whether itis appropriate to use a device. 245: Doppler Assessments Only appropriately rained and competent nurses should carry out leg ulcer assessments as poor assessment can lead to inappropriate treatment and patient harm. Leg ulcers are classified as venous, mixed or arterial and some patients may have both venous and arterial disease. To determine whether the patient has any significant arterial disease, a full ankle brachial pressure index (ABP!) measurement using a hand-held Doppler device is necessary. Ifthe Doppler assessment indicates no significant arterial d'sease, then the pationt is treated as having venous ulceration. Clinical guidance advocates that compression bandaging isthe best treatment for healing. Under no circumstances should any form of compression be applied to the patient with significant arterial disease and referral to vascular services is required. In some areas of the community, itis possible for tissue viability teams to perform a more in-depth Doppler assessment called a waveform analysis’, Practice and community nurses can discuss this with their local tissue viablity nurse to see ifit's an option for their patients. This assessment is useful when nurses are not able to carry outa traditional Doppler assessment for clinical reasons, for example, if the pationt cannot le lat fr the time required, 3. What do the instructions say about adverse reactions? ® They nave tobe tated ina separate box rom allergies onthe chat “Toy may be wrongly reported as aegis by paints and carers © Tey should be checked agaist the medicine data sheet, Filling in the Medications Chart: Allergies and adverse reactions Ifthe patient or their carer notes you of any allergies, decide if the reaction is a TRUE allergy or more likely to be alisted side effect of a medicine. Anything that has caused a skin rash, urticaria (hives), facial or throat swelling, 6 anaphylaxis should be documented as causing an allergy. Allergies are usually unexpected reactions to a medicine, food (such as seafood, gluten, eggs, peanuts), or substance (e.g. iodine, preservatives, sulphur) which has been administered, taken, or used in the intended way. Adverse reactions are commonly listed in the medicine's data sheet as a known side effect and are more common patient occurrences than allergies (such as diarchoea with penicilin or nausea with morphine). Complete the allergy and adverse reaction box on the chart, so thatthe information is visible for prescribers and when the chart is scanned to pharmacy. Follow local policy to alert clinical stat, e.g. sticker on patient's medical record, allergy bracelet, entry in patient management system, te. A. Accorting to ho guidlines, patents formaly regarded os ating once ® the sat member responsible is sated his ste case both managerial and secur stat have been informe © siatrhave conducted a thorough search ofthe bung Guidelines: Missing Patients If patient is thought to be missing from the wardicepartment, the Shift Leader must be informed immediately. ‘The shift leader will organise a local search of the ward J department and immediate vicinity (within 20 metres of all exits to the area). The nurse checklist to be followed / completed is in Appendix B).The shif leader will laise with persons in charge of other nearby wards / departments to complete a search of their areas. Areas contacted will be noted (Appendix C). ‘The shift leader decides when a patient isto be treated as missing, having previously searched the ward / dopartment and having taken into account the patient's daily routine or usual patton of behaviour. At that point the missing patient checklist must be completed (Appendix D) and circulated to other parties as appropriate, ©.0 Head of Nursing, site co-ordinator, security and portering staf, police, etc. A search of the complete site will hen be conducted. 5. According to the policy document, patient request for a chaperone shouldbe respected unless ® the examinations not of an intimate nature ‘he member of sa els itis unnecessanz © this would delay very urgent treatment, Chaperone Policy Intimate personal care is defined as the care associated with bodily functions and personal hygiene, which requires director indirect contact with, or exposure of, intimate parts ofthe body. Itis recognised that much medical and nursing day-to-day care is delivered without a chaperone as part of the unique and trusting relationship between patients and practitioners. However, staf must consider the need for a chaperone on a case- by-case basis, and patients should always be offered the opportunity t have a chaperone if they wish. Staff must be aware that patents from different cultures may regard various pars of the body as intimate. Iti acceptable for linicians to perform intimate examinations without a chaperone ifthe situation is an emergency or life threatening and speed is essential, or the patient's condition means they are unable to be consulted for consent. This should be recorded in the patients notes or electronic record 6. Whatis the newsletter entry suggesting about bio-debridement? ® ttshouis ont be used in exceptional circumstances Itmay bea more efectv technique than suger. © itis relatively easy to learn how to perform it Bio-debridement ‘Among the different types of techniques forthe removal of necrotic material from wounds, surgery is the most ‘widely used. However, in some situations other techniques may b e appropriate. One of the oldest but least known is what is known as bio-debridement or maggot therapy, which uses cultured, sterile larvae of the species Luciala Sericata, In their growth process before becoming fies, the larvae are hungry for nutrients and consume large amounts of necrotic tssue. A retrospective study was conducted with twenty-five patients with diabetic foot ulcers and eighteen patients with pressure uleers, Changes in lesions wore observed and bacterial cultures tested. All the ulcers healed completely. ‘The times taken to achieve bacterial negativity, granulation and healing were all significantly shorter withthe ‘maggot therapy group than in the control group. This technique is fully supported by the iterature and has very Precise indications. It must, however, only be used by trained personnel with knowledge ofthe lifecycle of the larva, Part C In this part ofthe 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: The Impact of Hospital Design on Dementia Patients Hospitalisaton is hazardous for fall older people and particularly for those with dementia, and hospital design may influence clinical outcomes of acutely il ail patients. Dementia-fiandly environments have been proposed to promote Patient well-being, mobility, independence, and meaningful interaction with other patients, staff and family members. Hospitalisation is associated with higher adverse outcomes for those with dementia, who are at 22.5 times higher risk of inpatient falls (IF). Another recent study reported a higher incidence of such falls in dementia patients occupying single rooms as compared to those in traditional muli-bed wards (MBWs). Furthermore, for people with dementia, the risk of sustaining a serious injury following fal is three times higher than amongst fallers with no dementia. Most studies of hospital environments have centred on issues such as patient satisfaction, quality of sleep, privacy, and dignity. Few have sought to empirically address the impact of hospital design on patient safety and clinical outcomes. ‘Although some studies have reported a higher incidence of IF and other associated adverse outcomes in single rooms, and nursing staff do express concems over loss of wider patient surveillance, others have found that a majority of patients express a preference for private rooms, Other Iterature has focussed on the effect of single rooms in acute settings, predominantly addressing the impact on younger patients and those without cognitive impairment, There is. very litle terature, however, concentrating specifically onthe impact of ward environments on outcomes for acutely unwell frail, older patients with dementia, many of whom have prolonged hospital stays due to acute illness. The alms of a new study undertaken in South Wales were to broadly deseribe acutely unwell patients with dementia admitted to two different hospitals environments — single rooms and traditional MBWs — and to study the clinical ‘outcomes and predictors of adverse outcomes in these two environments. A total of fty patients were observed at two hospitals. Most of these (73%) were admitted trom their own homes, whilst others were admitted from residential care homes (17%). Significantly more patients in single rooms (88%) were admitted from their own homes compared to those in MBWs (58%) and they also had significantly better levels of independence as measured by pre-admission Bl Besides the source of admission, however, there were no significant diferences in baseline characteristics of acutely unwell pationts with dementia admitted either to single rooms or MBWS. In this study, it was observed that acutely unwell older people with dementia admitted to single rooms and MBWs had a largely similar demographic profile and clinical characteristics. The reasons for acute admission varied widely, though {alls were the most common reason for admission to both sites. Sepsis, urinary tract infections, loss of consciousness, {and confusion were other common presenting complaints. However, acute patients with dementia admitted to single rooms had a significantly longer length of stay (62.23%) than those admitted to traditional MBWs (42.47%). Besides this, no other significant diferences were observed in clinical outcomes between patients in single rooms and those in MBWs. This study bullds upon similar ndings reported ina previous one, which attibuted such discrepancies to a higher incidence of F in patients with dementia in single rooms. Interestingly, no significant difference was found inthe incidence of IF between single rooms and MBWs. This could be due tothe introcuction of quality initiatives to minimise inpatient falls in single rooms. A systematic nurse training programme on the understanding and correct use of existing multifactorial falls risk assessment (FRA) tools in the single-room hospital has demonstrated a significant and sustained reduction in the mean incidence of IF, Similar rates of IF between single rooms and MBWs may therefore be looked upon in an encouraging light. The sludy focused on the impact of hospital environments on quantitative, measurable clinical outcomes. As such, the researchers did not explore the experiences of older people with dementia in single rooms. In ight of the reduced social interaction and relative isolation reported by some older adults in single rooms, itis possible that some older people with dementia may not always feel they benefitted from single-room hospital accommadation, even where this, ‘was their preference. This isa point which could have been investigated further because various personel, cultural, socioeconomic, and medical factors may affect preferences This observational study suggests hospital environments may affect clinical outcomes, witha significantly higher length of stay for acutely unwell patients with dementia admitted to single rooms as compared to those in MBWs. However, no other significant differences were observed in clinical outcomes in terms of inpatient morality, inpatient falls, discharge to-a new care home, or thity-day readmission The study considered potential confounding factors such as age, delim, pain on admission, depression, and severity of dementia, but found no significant association. It dd, however, ‘observe associations between length of stay and advancing age. Further study to explain this is also warranted, fie nance TEXT 1: Questions 7-14 Inthe fist paragraph, what point is made about the falls risk of patients with dementia? ® is eosor to manage in specialist wards, Itcan be higher her is a history of similar event. © temay ve reduced it they ae made more avare a ® trsoreater than hat of the genera hosp poplaton ‘The wit fets that esearch nts hospital design tends to focus on ® patent atiudes towards it the impkcatons for tating levels, © how welt caters for patents of ferent ages © the needs of patents facing longterm hosptaisato. 8. What des the word ‘therein the second paragraph refer to? ® research sues adverse outcomes © the marty of patents © concars expressed by nurses 410. Inthe South Wales su. patents admited frm residential cae homes were ® ramore advanced sage of dementia less key to be accommodated in single roms © mar ineestd in their immediate environment ® notessindopondont according o standard measures n 2 8, 4, The ‘issrapaniea' roerod io inte fouth paragraph involve ® ifort wasons fr acute admission vatiation in how long pation remained in hospital © the righer numberof als amongst certain patients in the study © the propoion of pation in he siferent pes of accommodation hat does the wrt ind encouraging about the Frings of he South Wales study? ® Araininginiatv seoms thave boon etecve Certain wrong assumgtions have now been corrected © Recommendations ofa previous study have been flowed. © Adowrward trond inthe number offal has been confirmed Inte sith paragraph the witer suggest that the South Wales study should have ® akon more account of he opinions of pation paid mor atonon 1th patents! bekground, © evesgetd how avare patients were ofthe choles © explored whether patents regreted opting fora single room nthe inal paragraph the war is suggesting hat further research shoud ® conser ine reasons why reaissions often occur. look more careful the issue of patent matali © ensure that confounding actors ar uy explored © montor wnat happens to pationts ater discharge TEXT 2: Core Medication Systems Identifying similarities across a national health service provides an important context for those seeking to develop and proritse systems-based interventions to increase medication safely, However, identifying and exploring variations between hospitals enables advantages and disadvantages of the medication systems to be better understood, and therefore inform future developments in their design, application, andior implementation ‘A recent research paper reported forthe fist time on a number af core medication systems in English NHS hospitals This study found that the majority of hospitals used paper-based prescribing (87%), patient bedside medication lockers (22%), ward stock (84%), patients’ own drugs (PODs) (89%), and one-stop dispensing (OSD) (85%) in the majority of inpatient mecical and surgical wards. However, hospitals varied most noticsably in the methods used to order medications during pharmacy opening hours, particularly in relation to whether medicines were ordered via the ward pharmacist or a ward pharmacy technician. ‘There were also some inter- and intra-hospital variations in practices that were standard prior tothe nationwide introduction of PODs and OSD. Although this anticipated the continued use of drug trolleys to store and transport medicines, the survey uncovered other methods being used to transport medicines during drugs rounds, as well as rnon-OSD supplies for inpatient use. Such variations suggest hospitals have implemented such initiatives in citferent ways. For example, exploratory analysis suggests that there were some geographical differences in the use of drug trolleys and non-OSD supplies. In addition, the report documented the existence of a number of polices related to medication administration, guidance and double-checking practices. ‘Tis isthe first national survey of medication systems used in English NHS hospitals. Previous surveys have focussed ‘only on pharmacy services and therefore many aspects ofthe survey findings cannot be compared with existing Iterature. For example, a European survey of hospital medication procurement and distribution suggested that 37.5% ‘of an unreported number of United Kingdom (UK) hospital pharmacies provided a uni-dase service; however, it is unclear what was meant by a 'uni-dose service’ and how this question was framed. Furthermore, the UK response rate was very low 35% of an unreported number of questionnaires were returned and only 9% overall were usable after ‘adjusting for unanswered questions. Comparison of pharmacy-speciic findings with those from a UK-wide clinical pharmacy survey conducted in 1992, ‘suggest that more hospital pharmacies are now providing a weekend service: 74% of UK hospital pharmacies were ‘open on Saturdays in 1892 versus 90% of English hospitals in 2011, 10% of UK hospital pharmacies were open on Sundays in 1992 versus 74% of English hospitals in 2011. However, the percentage of hospitals that provide a resident ‘on-call pharmacy service (9% of UK hospitals in 1992 versus 99 of English hospitals in 2011) and non-resident on-call pharmacy service (88% of UK hospitals in 1982 versus 80% of English hospitals in 2011) are similar. ‘Some of the variations the recent report identied in medication systems were unexpected. The introduction of patient bedside medication lockers around 2001 was not explicitly intended to eliminate the use of drug trolleys; patient bedside medication lockers were advocated to facilitate inpatient self-administration and the use of PODs. Furthermore, bedside medication lockers could not replace the transport function of drug trolleys. However, the survey revealed drug trolley use to be relatively low; drug trolleys have previously been reported as a standard component of medication administration during drug rounds in UK hospital inpatient wards, although with no quantitative substantiation, Data from the survey also suggest that staff in some hospitals are using other devices to transport medications, for ‘example, a tray ora basket, wit or without a dressing trolley, to transport medications to the patient's bedside during

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