OET® About the Reading sub-test The Reading sub-test consists of three parts and a total of 42 question items. All three parts take a total of 60 minutes to complete. The topics are of generic healthcare interest and are therefore accessible to candidates across all professions. The Reading sub-test structure Part A— expeditious reading task (15 minutes) Part A assesses your ability to locate specific information from four short texts in a quick and efficient manner. The four short texts relate to a single healthcare topic, and you must answer 20 questions in the allocated time period. The 20 questions consist of matching, sentence completion and short answer questions. Part B and Part C— careful reading tasks (45 minutes) Part B assesses your ability to identify the detail, gist or main point of six short texts sourced from the healthcare workplace (100-150 words each). The texts might consist of extracts from policy documents, hospital guidelines, manuals or internal communications, such as emails or memos. For each text, there is one three-option multiple-choice question. Part C assesses your ability to identify detailed meaning and opinion in two texts on topics of interest to healthcare professionals (800 words each). For each text, you must answer eight four-optionmultiplechoicequestions. How is reading ability assessed in OET? Reading Part A (the expeditious reading task) tests your ability to skim and scan quickly across different texts on a given topic in order to locate specific information. For that purpose, Part Ais strictly timed and you must complete all 20 question items within the allocated 15 minutes. To complete the task successfully, you will also need to understand the conventions of different medical text types and understand the presentation of numerical and textual information. Reading Part B tests your ability to understand the detail, gist or main point of complex texts commonly found in the healthcare workplace. To complete the task successfully, you will need to identify specific ideas at sentence level. Reading Part C tests your ability to understand the explicit or implied meaning as well as the attitude or opinion presented in a longer text. To complete the task successfully, you will need to identify the relationship between ideas at sentence and paragraph level. Part C also tests your ability to accurately understand lexical references and complex phrases within the text. Assessors who mark the Reading sub-test are qualified and highly trained. Candidate responses are assessed against an established marking guide. During the marking session, problematic or unforeseen answers are referred to a sub-group of senior assessors for guidance. How are marks for the Reading sub-test distributed? There is a total of 42 marks available in the Reading sub-test, Part A accounts for 20 marks, Part B accounts for 6 marks and Part C accounts for 16 marks Where do I write my answers for the Reading sub-test? In Part A you should write your answers clearly in the spaces given in the question booklet. ea OET®OET® In Part B and Part C, you must shade the circle next to the appropriate answer. Answers written elsewhere in your booklet will not be marked. Itis a good idea to use the sample tests to familiarise yourself with the different task formats you might find in the test. Do | have time to check my answers for the Reading sub-test? You will not be given extra time at the end of the sub-test to check your answers, and it is up to you to manage your time. The test is designed so that the time available is enough for you to read, choose your answers, and check your work. Please remember that there is a strict time limit for Part A (the expeditious reading task), and Part A materials will be collected from you after 15 minutes. You will therefore not have any time to check your Part A answers later in the test. Do my answers have to use the same words as given in the texts? Yes, in Part A you must use exactly the same form of the word or short phrase as given in the four t Can | use abbreviations in the Reading sub-test? Abbreviations are not accepted in the Reading sub-test unless they appear in the texts. Do | lose marks for spelling mistakes? Yes, you must use correct spelling in the Reading sub-test to get the marks. Responses that are not spelled correctly will not receive any marks. American and British English spelling variations are accepted, ¢.g., foetus and fetus are both acceptable. Please note that the Reading sub-test is different from the Listening sub-test in the way misspellings are treated. How many questions do | need to get correct for the Reading sub-test? New reading tests are written for each test session incorporating new material and the grade boundaries are adjusted slightly for each test to allow for minor differences in the difficulty of items included in that particular version. The number of marks needed to secure grade B will therefore vary. However, test-takers awarded grade B (a scale score of 350) will typically have a score of at least 30 marks 92 |PageTEXT A Asthma is a chronic reactive airway disease characterized by reversible inflammation and constriction of bronchial smooth muscle, excessive secretion of mucus, and edema. Asthma causes recurring periods of wheezing, chest tightness, shortness of breath, and coughing. There are many factors that airways react to which can precipitate ast hma, including allergens, physical and emotional stress, cold weather, exercise, chemicals, medications, and infections. There is no cure for asthma, but it can be controlled with effective treatment and management. Vitamin E is a non enzymatic antioxidant that protects the body from free radicals and maintains the immune system. Vitamin E is not produced by the body and must be ingested. There are two forms of vitamin E: gamma-tocopherol and alpha-tocopherol. Recent studies have shown that gamma-tocopherol has been linked to diminished lung function. Gamma- tocopherol is found in canola, soybean, and corn oils, which over the years have become the “healthier” replacements for butter and lard, It has been shown that higher concentrations of gamma-tocopherol in the blood plasma indicated a 10% to 17% reduction in lung. function as measured by spirometry. In contrast, alpha-tocophero!—found in olive oil, wheat germ, and almond and sunflower oils—has been found to have beneficial effects on lung function. Adult-onset asthma patients in the study were found to have significantly lower levels of alpha-tocopherol. 93 | PageTEXT D KIT-ON-A-LID-ASSAY (KOALA) A new diagnostic tool has been developed that can diagnose asthma even in patients experiencing no symptoms at the time of examination and testing. The test requires only a single drop of blood. This test takes advantage of a previously unknown correlation between asthmatic patients and neutrophils, the most abundant type of white blood cells in the blood. These white cells are the first cells to migrate toward inflammation. Neutrophils detect chemical signals in response to inflammation and migrate to the site to assist with the healing process. KOALA can track the speed at which the neutrophils migrate (chemotaxis velocity) to differentiate non asthmatic samples from the significantly reduced speed of asthma patients. In the “ai an asthmatic patient, the speed of neutrophils movement is slower as compared to anort : a ~—- Connect * Look at the four texts, A-D, in the separate Text Bor * 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. ‘Questions 1-7 For each question, 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 Incidence of asthma in patients 94|PageOET® Immune system maintenance with the help of dietary management to fight against asthma Adult-onset asthma is most common in females during the childbearing years Reduce indoor humidity and do not use humidifiers There is no cure for asthma, but it can be controlled with effective treatment and management. Avoid strong odors and sprays such as perfume In the case of an asthmatic patient, the speed of neutrophils movement is slower as compared to a normal patient. 8-14 each of:the questions, 8-14,with or si ras one textsaFa 0 INTO O e ute ate n il INE Ra nt 9. What instruction to be given to childrs asthma? 11. By which method body should obtain vitamin E: 12. Which machine can be used to remove arachnids from carpets, furniture, etc? 13 . Which component of blood shows immediate reaction to inflamation process? 14, What can track the chemotaxis velocity? Questions 15-20 Complete each of the sentences, 15-20, with a word or short phrase from one of the texts. Each answer may include words, numbers or both 15. There are two forms of vitamin E: - Sarre 16. triggers. 17. Reduce ---- —--- and humidifiers. 95|Page OET ®.---- are healthier replacements for butter and lard. {ops nace detect chemical signals in response to inflammation and migrate to the site to assist with the healing process. 7 beneficial will diminish lung function and ---------. effects on lung function. sh tetas te Faciocardiomelic dysplasia Lethal faciocardiomelic dysplasia is ext Emnely 1 lymal ‘syndrot It was described only once, in 1975, in 3 affe eStin'a sibship of 13, ni isi rents. Patients were all of low birth weight, had microretrognathia, microstomia, and microglossia, hypoplasia of the radius and ulna with radial deviation of the hands, simian creases and hypoplasia of fingers | and V, hypoplasia of the fibula and tibia with talipes and wide space between toes | and Il, and severe malformation of the left heart which may have been responsible for death of all 3 in the first week or so of life. 1. The study suggests that out of 13 subship, three males were affected due to a) Second-Cousin parents. b) Polymalformative disease c) Low birth weight eS ss OET@Menorrhagia Menorrhagia is a common and major health problem for women. The early recognition of an underlying cause would potentially have a major impact in the diagnosis and treatment of menorrhagia. Recent studies report that the incidence of bleeding disorders as a cause of menorrhagia may be as high as 17-20% Inherited factor 2 deficiency (hypoprothrombinemia) is an extremely rare bleeding disorder, with not more than 50 cases of this disorder reported worldwide so far.Menorrhagia may be the first and the only clinical manifestation of an inherited bleeding disorder. The first patient described with von Willebrand's disease died of menorrhagia at the age of 13 years of age.Despite this, coagulopathies are not usually suspected as etiology of menorrhagia and surgical interventions are done, without getting the patient investigated for coagulopathies or any other systemic disorder known to cause abnormal uterine bleeding like hypothyroidism. Careful history taking and clinical suspicion for an underlying bleeding disorder in 2. History taking and clinical suspicion Cc nn E [ J C a) Early diagnosis and treatment. b) Eradication of the bleeding disorders. c) Reduce the occurrence of inherited bleeding disorders. BTS : OET®Tetralogy of Fallot Tetralogy of Fallot is a congenital cardiac malformation that consists of an interventricular communication, also known as a ventricular septal defect, obstruction of the right ventricular outflow tract, override of the ventricular septum by the aortic root, and right ventricular hypertrophy.The aetiology is multifactorial, but reported associations include untreated maternal diabetes, phenylketonuria, and intake of retinoic acid. Associated chromosomal anomalies can include trisomies 21, 18, and 13, but recent experience points to the much more frequent association of microdeletions of chromosome 22. The risk of recurrence in families is 3%. Useful diagnostic tests are the chest radiograph, electrocardiogram, and echocardiogram. The echocardiogram establishes the definitive diagnosis, and usually provides sufficient information for planning of treatment, which is surgical. Approximately half of patients are now diagnosed antenatally.Differential diagnosis includes primary pulmonary causes of cyanosis, along with other cyanotic heart lesions, such as critical pulmonary stenosis and transposed arterial trunks. Neonates who present with ductal-dependent flow to the lungs will” receive “prostaglandin: jintain performed. Initial i nti be pall pulmonary ray unt, bi re it the t neonatal ‘complete repair. Centres thi 4 complete repair at the age of 4 to 6 months. Follow-up in patients born 30 years ago shows a rate of survival greater than 85%. issues tl OW, such,adult: pulmonary regurgitation, recurrence of pulmon; sis, trigu imias the strategies for surgical and medical gress i mortality of those born with tetralogy of Fallot in the current era is expected to be significantly improved 3. What is the most effective test to diagnose of tetra logy of fallot is: a) Chest radiograph b) Echocardiogram ¢) ElectrocardiogramOET® Familial Thoracic Aortic Aneurysms and Dissections The natural history of ascending aortic aneurysms in the absence of surgical intervention is to progressively enlarge over time and ultimately lead to an aortic dissection (Stanford type A) or rupture. Type A aortic dissections are life-threatening events causing sudden death in approximately 40% of affected individuals, and emergency repair of these dissections are associated with a high degree of morbidity and medical expenditure. In contrast, prophylactic repair of an ascending aortic aneurysm is associated with very low morbidity and mortality, leading to the current recommendation to repair an ascending aortic aneurysm before it dissects or ruptures.Although medical treatment can slow the enlargement of ascending aortic aneurysms, the mainstay of treatment to prevent an aortic dissection is surgical repair when the aortic diameter expands to 5.0 — 5.5 cm.Therefore, the optimal aortic diameter when the risk of aortic dissection exceeds that of surgical repair is still debated. WHANJOORAN c) Both Familial Thoracic Aortic Aneurysms and Disséctio! Sudden sensorineural hearing loss (SSHL)), commonly known as sudden deafness , occurs as an unexplained, rapid loss of hearing—usually in one ear-either at once or over several days. It should be considered a medical emergency. Anyone who experiences SSHL should visit a doctor immediately. Sometimes, people with SSHL put off seeing a doctor because they think their hearing loss is due to allergies a sinus infection , earwax plugging the ear canal or other common conditions. However, delaying SHHL diagnosis and treatment may decrease the effectiveness of treatment. Nine out of ten people with SSHL lose hearing in only one ear. SSHL is diagnosed by conducting a hearing test. If the test shows a loss of at least 30 decibels (decibels are a measure of sound) in three connected frequencies (frequency is a measure of pitch—high to low), the hearing loss is diagnosed as SSHL. 99|PageOET® 5. Anyone Experience SSHL immediately: a) Visit Doctor b) Do heavy test in 3 different frequencies c) Frequency and pitch should be measured Eosinophilia Eosinophilia represents an increased number of eosinophils in the tissues and/or blood. Although enumeration of tissue eosinophil numbers would require examination of biopsied tissues, blood eosinophil numbers are more readily and routinely measured. Hence, eosinophilia is often recognized based on an elevation of eosinophils in the blood. Absolute eosinophil counts exceeding 450 to 550 cells/ul, depending on laboratory standards, are reported as elevated. Percentages generally above 5% of the differential are regarded as elevated in most institutions, although the absolute count should be calculated before a ‘ea of eosinophilia is made. This is d the total white cell count they.can) persist for at leat oe weel Tel unctional roles are yr ftrareted a include antigen presentation; the release of lipid d, patti, and cytokine mediators for acute and. chronic inflammation; responses! to he m cleaFanc degranulation; and ongoing homeostatic finmun| cellular milieu in malignant neoplasms a onl ct id disorders, and are also found in less well charactateat ili as described elsewhere in this paper. 6. Eosinophils are: a) Bone marrow derived cells b) Autoimmune conditions c) Connective tissue disorder 100| PagePART C In this part of the test, there is a text 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. Hyperthyroidism ‘The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid’s job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. The thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they coi The term hyperthyr¢ ii there are ti any thyr id horones ro if id Bla cE i e too har therte a ght ing used to,déscribe the problemis 5 thyrotoxicosis, which refers to high thyfoid hor fespedtive of their source. The thyroid hormone plays a significant role in the pace of many processes in the body; these processes are called your metabolism. If there is too much thyroid hormone being produced, every function of the body tends to speed up. It is not surprising then that some of the symptoms of hyperthyroidism are: nervousness, irritability, increased perspiration, heart racing, hand tremors, anxiety, difficulty sleeping, thinning of your skin, fine brittle hair and weakness in your muscles— especially in the upper arms and thighs. Another symptom might be more frequent bowel movements, but diarrhea is uncommon. You may lose weight despite a good appetite and, for women, menstrual flow may lighten and menstrual periods may occur less often. Since hyperthyroidism increases your metabolism, many individuals initially have a lot of energy. However, as the hyperthyroidism continues, the body tends to break down, so feeling tired is very common. Hyperthyroidism usually begins quite slowly but in some young patients these changes can be very abrupt. At first, the symptoms may be mistaken for simple nervousness due to stress. If you have been trying to lose weight by dieting, you may be pleased with your success unt 101|Page OET®OET® the hyperthyroidism, which has quickened the weight loss, causes other problems. The most common cause (in more than 70% of people) is an overproduction of the thyroid hormone by the entire thyroid gland. This condition is also known as Graves’ disease. Graves’ disease is caused by antibodies in the blood that turn on the thyroid and cause it to grow and secrete too much thyroid hormone. This type of hyperthyroidism tends to run in families and it occurs more often in young women. Little is known about why specific individuals get this disease. ‘Another type of hyperthyroidism is characterized by one or more nodules or lumps in the thyroid that may gradually grow and increase their activity; this causes the total output of thyroid hormones into the blood to become greater than normal. This condition is known as toxic nodular or multi nodular goiter. Also, people may temporarily have symptoms of hyperthyroidism if they have a condition called thyroiditis, a condition caused by a problem with the immune system or a viral infection that causes the gland to leak stored thyroid hormone. The same symptoms can also occur by taking too much thyroid hormone in tablet form. These last two forms of excess thyroid hormone are only called thyrotoxicosis, since the thyroid is not overactive. Hf your physician suspects that you have hyperthyroidism, diagnosis is usually a simple matter. Avphysieal examination us detectsjan enlarged thyroid, glandvand a apid pulse. The physician will rE ' oath 3 n and a tremor of your finge Pate are likely to be fast, anid your eyes may have some abnormalities if yo have'Graves’ disease. The diagnosis of hyperthyroidism will be confirmed by laboratory tests that measure the amount of thyroid hormones— thyroxingi(T4), triiodothyronine (T3). and thyroid-stimul hormone (TSH) in your blood. A high leVel of thy i r el of TSH is common with an overactive thyfoi blood tests sh jourithyroldak , your doctor may want to obtain a picture of your thyroid (a thyroid scan). The scan will find out if your entire thyroid gland is overactive or whether you have a toxic nodular goiter or thyroiditis (thyroid inflammation). A test that measures the ability of the gland to collect iodine (a thyroid uptake) may be done at the same time. . No single treatment is best for all patients with hyperthyroidism. The appropriate choice of treatment will be influenced by your age, the type of hyperthyroidism that you have, the severity of your hyperthyroidism, and any other medical conditions that may be affecting your health, as well as your own preference. It may be a good idea to consult with an endocrinologist who is experienced in the treatment of hyperthyroid patients. If you are unconvinced or unclear about any thyroid treatment plan, a second opinion is a good idea. Hyperthyroidism 102| PageOET® Questions 7. The thyroid hormone helps with A. energy consumption 8. utilization of energy €. maintaining body temperature Denhancing the functions of the kidney 8. In thyrotoxicosis A. the thyroid gland is inactive B. the thyroid gland is less active C. the thyroid gland produces a greater amount of hormones then necessary D. none of the above 9. An increase in the amount of thyroid hormones can ther hormonal functions “ TIAN IOORAN : RAN C-inereasé normal physiological functions sae D. increase pulse rate 10. Which one of these is common in tl id dis Nn Nn & f A. loss of appetite B. decreased metabolism C. tiredness D. none of the above 11. Hyperthyroidism can be the cause of A. high BP B. tiredness C. weight loss D. increase in weight, even while dieting 103 | Page OET®OET® 12. According to the information given, “Grave's disease” occurs more commonly in A.men B. women C. children D. adult women 13. In hyperthyroidism, the level of thyroid hormones is A. considerably higher B. very low C. much higher D. normal 14, Eyes show abnormalities in A. hyperthyroidism IJOORAN Idiopathic Pulmonary Fibrosis (IPF) 4 QO nN n e ¢ t Passage 1 Idiopathic pulmonary fibrosis ( a uj ir tissuein ings. This Scar tissue damages the lungs and makes it hard for oxygen to get in. Not getting enough oxygen to the body can cause serious health problems and even death. “Idiopathic” is the term used when no cause for the scarring can be found; in these cases, doctors think the scarring starts by something that injures the lung. Scar tissue builds up as the lungs try to repair the injury and, in time, so much scarring forms that patients have problems breathing. IPF usually worsens over time. However, while some patients get sick quickly, others may not feel sick for years. Unfortunately, there is no cure for IPF, but there are treatments that may be able to slow down the lung scarring. Understanding the condition will go a long way to help you cope with the effects it has on your body. The two major symptoms of IPF are shortness of breath and a persistent cough. Other symptoms may include: e Fatigue and weakness « Chest pain or tightness in the chest # Loss of appetite ¢ Rapid weight loss The causes of IPF are unknown. There are other conditions that cause lung scarring; the lung scarring that is the result of other conditions is often called “pulmonary fibrosis", but should be called by the name of the cause. These other causes ara OETo— ——————————ee—OOOw OET® include the following: ¢ Diseases, like rheumatoid arthritis and sarcoidosis ¢ Medicines, such as those used for certain heart conditions * Breathing in mineral dusts, such as asbestos or silica # Allergies or overexposure to dusts, animals, or molds (There are many names for this condition, such as “bird breeder’s lung,” “farmer's lung,” or “humidifier lung.” These conditions are all called hypersensitivity pneumonitis). Five million people worldwide have IPF, and it is estimated that up to 200,000 people in the United States have this condition. It usually occurs in adults between 40 and 90 years of age and it is seen more often in men than in women. Although rare, IPF can sometimes run in families. Patients who have any symptoms of IPF ‘Smoking Cessation: Cigarette smoke not only damages the lining of the lungs, it can also make You more likely to get.a lung infection. While some studies suggest that patients with IPF who smoke actually live longer, these studies are not accepted by everyone, and most experts agree that you should stop smoking. supplemental oxygen: As lung scarring gets worse, many patients need extra oxygen to help them go about theingdaily liveswithiout getting’ too,.ou thgyOliget thisloxygéhifromila tankithat you ca d vs ters of! mi e ca B . o 7 . i enis not addictive,s0 you.do,not » wort about using it much, To help maintain your oxygen levels, ask your doctor about a small, easy-to-use device called a pulse oximeter. This devicejhelps you to know just how much oxygen-flowyyou require, especially during activity. breathing muscles strong, it also gives you more energy; this is because healthy muscles need less oxygen to perform. Nutrition Many patients with IPF lose weight because of their disease. If you lose too much weight, your breathing muscles can become weak and you also may not be able to fight off infections very well. A well-balanced diet is important to keep up your strength, but be wary of supplements and other nutrition treatments that claim to improve IPF; it’s best to consult a doctor first. Questions Idiopathic Pulmonary Fibrosis (IPF) 15. In IPF, patients A. will have lung cancer B. B will have difficulty in inhalation or exhalation C. will find it difficult to move D. require less oxygen 105 [Page OET®OET® 16. Scar tissue develops A. when oxygen supplied is stopped B. when the lungs do not function properly CC. when the lungs try to repair the damage done D. when there is more oxygen supply 17, Major symptoms of IPF are A. fatigue and weakness B. chest pain and breathing C, breathing problems and coughing D. breathing problems and weakness 18. The cause of lung scaring is A. still not known completely B. known C. allergies D. Dsome of the common heart diseases 19. One of the FANJOORAN j 8, blood A ps vy a : © Cf scan D. breathing test to identify ho our lunes wo 20. For lung scarring ‘A. no medication is available B. medication is available C. prevention is better D. notgiven 21. Cessation means A. to continue B. tocease C. to adopt D. to gain tei 22. A patient with lung scarring ‘A. requires oxygen supply B, should eat a healthy diet C. should stop smoking D. none of the above 106 | Page OET®OET® 1.8 uC 3.B 4.D 5.A 6.D 7.D 8, Maintain immune system 9. Not near highways 10. At the time of examinations 14. in igpANJOORAN 14. KOALA Be ers a fon nnec t 16. Urine and saliva 17. Indoor humidity 18. Canola, soybean and corn oils 19. Neutrophils 20. Gamma - tocopherol and alpha - tocopherol PARTB LA 2A 3.B 4c S.A 107 [Page7) ANJOORAN 2 ConnectOET® NEONATAL JAUNDICE TEXT A Martin and Kim were both twenty-five when they had Michael, their first child. Kim remained very healthy during her pregnancy and went into labor at 9:00 a.m., just 3 days after her due date. Delivery went quite smoothly, and that evening, mother and child rested comfortably. Two days later, Kim and Michael were released from the hospital. That evening at feeding time, Kim noticed that the whites of Michael's eyes seemed just slightly yellow, a condition that worsened noticeably by the next morning. Kim called the pediatrician and made an appointment for that morning. Upon examining Michael, the pediatrician informed Martin and Kim that the infant had neonatal jaundice, a condition quite common in newborns and one that need not cause them too much concern. The physician explained that neonatal jaundice was the result of the normal destruction of old or worn fetal red blood cells and the inability of the newborn's liver to effectively process bilirubin, a chemical produced when red blood cells are destroyed. The physician told the parents he would like to see Michael every other day in order to monitor blood bilirubin concentration until the bilirubin concentration dropped into the normal range. He recommended that Kim feed Michael frequently arly eye nm and instructedithem to place Michael in sunlight whenever possible. jal i rly 50% least'alsmall degree. The a Bid lation of bilirub) sdos agen fibers, im neonatal jaul cess bil due to an ee by the digestive tract. This inability is corre decrease the likelihood of reabsorbing significant amounts of bilirubin in the small intestine. Neonatal affects ni ft ul tissue and its adhe ell destruction. It is due to the inability of the young liver cells to the conjugation enzymes. If uncorrected, si Radiation from sunlight alters the chemical form of bilirubin, making is easier for the liver to excrete. the ice, r ‘ah yellow colorati e conjugate bilirubin, or make it soluble in bile, it it can be excreted and removed from the body |, usuallywithi thezliver cellsisynthesize cen aa mc brain damage. Frequent feedings of a newborn wi indicgsincrease gastrointestinal:tractimotilityiand 109 | Page OET®OET® TEXT B INCIDENCE/PREVALENCE Jaundice is the most common condition requiring medical attention in newborn infants. About 50 percent of term and 80 percent of preterm infants develop jaundice in the first week of life.Jaundice also is a common cause of readmission to the hospital after early discharge of newborn infants.2 Jaundice usually appears two to four days after birth and disappears one to two weeks later, usually without the need for treatment. ETIOLOGY/RISK FACTORS In most infants with jaundice, there is no underlying disease and the jaundice is termed physiologic. Physiologic jaundice occurs when there is accumulation of unconjugated bilirubin in the skin and mucous membranes. It typically presents on the second or third day of life and results from the increased production of bilirubin (caused by increased circulating red cell mass and a shortened red cell lifespan) and the decreased excretion of bilirubin (caused by low concentrations of the hepatocyte binding protein, low activity of glucuronyl transferase, and increased enterohepatic circulation) that normally occur in newborn infants. In some infants, unconjugated hyperbilirubinemia may be associated with breastfeeding (breast milk jaundice), and this typically occurs after the third day of life. Although the exact cause of breast milk ee is not clear, itis believed'to be caused by,an unidentifi fa tor in.b hysiologi €5 include blood group incompatibility ( ey 8), Ss emol is, z, and metabolic disorders. i eer PROGNOSIS In the newborn infant, unconjugated bilirubi snetrate the blood-brain barrier and is potentially neurotoxic. Unconjugated hyperbilirubinem , infebtod Lae including the development of kernicterus. in damage arising leposition of bilirubin in brain tissue. However, the exa irubin that ts neurotOkie is Unclear, and kernicterus at autopsy has been reported in infants in the absence of markedly elevated levels of bilirubin.3 Recent reports suggest a resurgence of kernicterus in countries in which this complication had virtually disappeared.4 This has been attributed primarily to early discharge of newborns from the hospital. 110| PageOET® TEXT C Neonatal jaundice is one of the most common conditions needing medical attention in newborn babies, About 60% of term and 80% of preterm babies develop jaundice in the first week of life, and about 10% of breast fed babies are still jaundiced at age 1 month.1 Neonatal jaundice is generally harmless, but high concentrations of unconjugated bilirubin may occasionally cause kernicterus (permanent brain damage). This is a rare condition (about seven new cases each year in the United Kingdom?) and sequelae include choreoathetoid cerebral palsy, deafness, and upgaze palsy. Jaundice can also be a sign of serious liver disease, such as biliary atresia, the prognosis for which is better is treated before age 6 weeks.3 Early recognition of jaundice is vital for treatment of any underlying condition and for the appropriate use of phototherapy, which can safely control bilirubin concentrations in most cases. Information for parents and carers Offer parents or carers information about neonatal jaundice that is tailored to their needs and expressed concerns, taking care to avoid causing unnecessary anxiety; discuss verbally and back up the discussions with written information. [Based on low quality qualitative studies and on the level requiring treatment) pinion of the Guideline Development Group (GDG)] is ul ie id AN: Ra llirUbin concentration to a How to check the baby for jaundice IN Bie =) ~ erbiirubinaemia\(a riselinthe serum t . What to do if they suspect jaundice + The importance of recognising jaundice j haulrs|and i {medical advice The importance of checking the baby's nappies for dark urine or pale, chalky stools Reassurance that breast feeding can usually continue. 121 | PageOET ® TEXT D Prevalence of neonatal jaundice The prevalence of neonatal jaundice, using the NICE guideline cut-off values, was 55.2% (n = 53). In Figure, the percentage of neonates per management category is depicted, No neonate needed an exchange transfusion. Only nine (17%) of the 53 infants diagnosed with jaundice appeared clinically jaundiced, of whom four were black infants. FIGURE Percentage of neonates per management category (n = 96). 188 104 & wo \ woricCl iz |Page OET®OET® TIME: 15 minutes * Look at the four texts, A-D, in the separate Text Booklet. + For each question, 1-20, look through the texts, AD, 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. NEONATAL JAUNDICE Questions 1-7 {PANIOORAN 1. Jaundice occurs due to the destructio tus RBCs 2. Physiological and now-physiological causes o C t 3. Exchange transfusions is not necessary in all cases of neonatal jaundice. 4. Complications of neonatal jaundice 5. Neonatal jaundice is usually non-dangerous 6. Sclera of the eye turned to be yellow in neonatal jaundice babies 7. Dark urine and chalky stools are also the signs of neonatal jaundice 113 | PageOET® 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. Neonatal Jaundice is more prevalent in which group of babies? 9. What is the main complications of neonatal jaundice? 10. What is the most easy and convenient treatment method of neonatal jaundice? 11. Mention two areas of the body where yellowish discoloration is evident in neonatal jaundice? 12. Which syndromes are the rare causes of neonatal jaundice? 13. What are the two types of neonatal jaundice? 14. What is the terminology of permanent medical damage? 45. Inability of the ‘to conjugate bi results in. ri rn lation of ct Adipose tissue Nec 16. occurs when there is collection of un Nn bilirubin in the slim and mucus membrane 17. of jaundice is vital for managing neonatal jaundice. 18. Metabolic disorders are one of the of neonatal jaundice. 19. Cerebral palsy is the consequence of neonatal jaundice in some cases 20. jaundice usually occurs__ days after birth of term or preterm babies. 114 [Page OET®OET® 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 answer (A, B or C) which you think fits best according to the text. Mediastinoscopy, medical examination of the mediastinum (the region between the lungs and behind the sternum, or breastbone) using a lighted instrument known as a mediastinoscope. Because the region of the mediastinum contains the heart, trachea, esophagus, and thymus gland, as well as a set of lymph nodes, mediastinoscopy can be used to evaluate and diagnose a variety of thoracic diseases, including tuberculosis and sarcoidosis (a disease characterized by the formation of small grainy lumps within tissues). It fulfills an especially important role in the detection and diagnosis of cancers affecting the thoracic cavity, serving as one of the primary methods by which tissue samples are collected from the mediastinal lymph nodes for the staging of lung cancer; staging involves the investigation of cells to assess the degree to which cancer has spread. Mediastinoscopy is also frequently used in conjunction with noninvasive cancer-detection techniques, including computerized axial tomography (CAT) and positron emission tomography(PET). iIANJOORAN c.To i ct carcinoma Percussion Percussion, in medicine, diagnostic procedure that entails striking the body directly or indirectly with short, sharp taps of a finger or, rarely, a hammer. The procedure was first described in 1761 by the Austrian physician Leopold Auenbrugger von Auenbrugg. Although generally ignored by his contemporaries, it is now routinely employed. The sounds produced by the procedure are helpful in determining the size and position of various internal organs, in revealing the presence of fluid or air in the chest, and in aiding in the diagnosis of certain lung disorders. 2.The sounds in percussion are. ‘A. Determine various directions of internal organs B. Rule out water and air in the thorax. C. Help to find out lung problems 115|Page OET®OET® Rubin's test Rubin's test, diagnostic method for determining whether the fallopian tubes in the human female are occluded. (The fallopian tubes are slender hollow structures on each side of the uterus through which the eggs travel from the ovaries to the uterus.) The test is helpful in explaining certain instances of female infertility. It consists of introducing carbon dioxide inte the uterus and through the fallopian tubes. The gas escapes into the abdominal cavity ifthe tubes are not occluded (positive test), causing referred shoulder pain. The abdominal gas may also be demonstrated by X-ray or fluoroscopy. The insufflation is usually carried out at a gas pressure of less than 120 mm of mercury. The manometer reading decreases to 100 or less if the tubes are clear; if between 120 and 130, there is probably partial stricture; if it rises to 200 and above, it is suggestive that the tubes are obstructed. 3.1n Rubins test, the insufflation is carried out at a pressure of A. Lessthan 120 mm of water B, 115 mm of Hg €. 120 mm of He Taner segment tion J a % aw Redliscifts frofff chia tive 8 sep learhting for wd MMe Bin WR images, where it provided more stable results as compared to manually segmenting the brain tumors by physicians, which is p motion and vision errors. A team | Qi Zhang of Shanghai University fout in I" ifferenti between benign and malignant brea sound) shear lastogra (swe), yielding more than 93% accuracy on the elastogram images of more than 2 patients 4. Dr. Qizhany’s team found that ‘A. Deep learning can help elastography B. Deep learning will help to differentiate benign and malignant breast tumors C.93 % accuracy found in elastogram 116 |PageOET® Histopathologic Cancer Diagnosis With the advent of personalized medicine, diagnostic protocols need to focus equally on efficiency and accuracy, thus increasing the workload and complexity of histopathologic (microscopic examination of tissue in order to study the manifestations of disease) in cancer diagnosis. This has led researchers in the Netherlands to use deep learning to improve the efficiency of histopathologic slide analysis, where the workload for pathologists is reduced and the objectivity of diagnoses is increased. The researchers concluded that deep learning could improve the efficacy of prostate cancer diagnosis and breast cancer staging. In another case, ‘Philips and LabPON are planning to create the worlds largest pathology database of annotated tissue images for deep learning. One of the things the database will provide is data for research and discovery to develop new insights in disease assessment, including cancer. In an effort to accelerate’ cancer research, Oak Ridge National Laboratory (ORNL) researchers are applying deep learning toward automating information collected from cancer pathology reports that are documented across @ nationwide network of cancer registry programs. IV DANJOORA 5s wet did the objectivity of diagnosis increases A. Histopathologic slide analysis's efficiefity imp B. The usage of deep learning by philip hal NHLE ac analysis efficiency improved. C. Netherland researcher's deep learning usage effectively improved histopathological analysis’s efficiency. 117 [Page OET®OET® Tracking Tumor Development Deep learning can be used to measure the size of tumors undergoing treatment and detect new metastases that might be overlooked. This is exactly what researchers from the Fraunhofer Institute for Medical Image Computing in Germany are doing. The more patient CT and MRI scans the deep learning algorithm reads, the more accurate it becomes, which is the core of deep learning technology. Google Research is also hard at work developing deep learning tools that can “naturally complement pathologists’ workflow.” They used images to train their deep learning algorithm Inception (aka GoogLeNet) to identify breast cancer tumors that have spread to adjacent lymph nodes. The algorithm reached a localization score of 89%, exceeding the 73% accuracy rate for pathologists. 6. The researcher's used deep learning algorithm inception for A. To identify the breast cancer tumors that spread to the lymphnodes B. Identify the spread of tumors to adjacent lymphnodes C. The breast cancer tumors have spread to adjacent lymphnodes T For questions 7-22, choose the answer (A, B, C or D) which you think fits best according to the text. Cancer and whatis cervical cancer? Whatis cancer? The body is made up of trillions of living cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries. Cancer begins when cells in a part of the body start to grow out of control, There are many kinds of cancer, but they all start because of out-of-control growth of abnormal cells. Cells become cancer cells because of damage to DNA. DNAis in every cell and directs all its actions. ina normal cell, when DNA gets damaged the cell either repairs the damage or the cell dies. In cancer calls, the damaged DNA is not repaired, but the cell doesn’t die like it should. OET® 118|PageOET ® Instead, this cell goes on making new cells that the body does not need. These new cells will all have the same damaged DNA as the first cell does. No matter where a cancer may spread, it is always named after the place where it started. For example, breast cancer that has spread to the liver is still cal led breast cancer, not liver cancer. Likewise, prostate cancer that has spread to the bone is metastatic prostate cancer, not bone cancer. Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That is why people with cancer need treatment that is aimed at their particular kind of cancer. Not all tumors are cancerous. Tumors that aren’t cancer are called benign. Benign tumors can cause problems ~ they can grow very large and press on healthy organs and tissues. But they cannot grow into (invade) other tissues. Because they can’t invade, they also can’t spread to other parts of the body (metastasize). These tumors are almost never life threatening. What is cervical cancer? The cervix is the lower part of the uterus (womb). It is sometimes called theuterine cervix. ub body of the a (the upper part) is ices a bt, grows. The cervix ‘Connects the st gina (bi 4s t to the bod! ‘of the je endocervix. Th ct x vic he (or ectocervix). 7 exocervix) and glandular Sa fon oF i The place fd ee 2cell types meet is called the transformation zone. Most ce! ancers start in the transformation zone. into cancer. Instead, the normal cells of the cervix first ae dose ete cancerous changes that turn into cancer. Doctors use several terms to describe these pre-cancerous changes, including cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia. These changes can be detected by the Pap test and treated to prevent the development of cancer. Cervical cancers and cervical pre-cancers are classified by how they look under a microscope. There are 2 main types of cervical cancers: squamous cell carcinoma and adenocarcinoma. About 80% to 90% of cervical cancers are squamous cell carcinomas. These cancers are from the squamous cells that cover the surface of the exocervix. Under the microscope, this type of cancer is made up of cells that are like squamous cells. Squamous cell carcinomas most commonly begins where the exocervix joins the endocervix. Most of the other cervical cancers are adenocarcinomas. Cervical adenocarcinomas seem to have become more common in the past 20 to 30 years. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix, Less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas. 119| Page OET ®OET® Although cervical cancers start from cells with pre-cancerous changes (pre-cancers), only some of the women with pre-cancers of the cervix will develop cancer. The change from cervical pre-cancer to cervical cancer usually takes several years, but it can happen in less than a year. For most women, pre-cancerous cells will go away without any treatment. Still, in some women pre-cancers turn into true (invasive) cancers. Treating all pre-cancers can prevent almost all true cancers. Questions An introduction on to Cancer 7. Whena person becomes an adult, the cells divide only to A. replace old cells B. replace dying cells . repair injuries D. allof the above 8. Incancer cells A. DNA is damaged (bu sap repaii ' _ _ w B. DNA\Is no! is ged J p ¥ i % C. DNA js permanently ed, e celldoesn'tdie | wh D. DNAs damaged but the celldoesn'tdie, insteadigives new cells, containing damaged DNA 9, Breast cancer that has spread to the liver is A. liver cancer B. breast cancer C, prostate cancer D. bone cancer 10. Benign tumors ‘A. can spread to the other parts of the body B. cannot spread to the other parts of the body ©. are cancerous D. are highly fatal 11. Most cervical cancers start A. in squamous cells in glandular cells C. in the transformation zone D. all of the above E. 120,| Page OET® 2OET® 12. There are... main types of cervical cancers A. two B. three C. four D. five 13. About 80% to 90% of cervical cancers are A. adenocarcinoma B. adenosquamous carcinomas C. mixed carcinomas D. squamous cell carcinomas 14, The change from cervical pre-cancer to cervical cancer usually takes «....0 A. two years B, three years CG. four years D. several years (can't say) dope ya % ohVie Hepatitis A B, on,C)'C A d Vi RA f : Ecce Ms Selon people in the andi blood transfusions, Scientists estimate mi USA are living with Hepatitis. A blood te: uired to diagnose Hepatitis infection. Hepatitis A is a viral liver infection. In most caseé the Body easily defe (much like the flu, which is what you may feel like y Becauseof this Edoes n liver challenges. Hepatitis A is the most common form of Hepatitis. It is spread through the feces of a contaminated person. This can easily be prevented by thoroughly washing hands after using the restroom, before eating, and after changing a diaper. Eating raw oysters and undercooked clams can increase your chances of contracting the virus. If you are traveling in a country where Hepatitis is common make sure you wash your hands often and well, eat cooked oysters and clams, and use an antiviral essential oil such as Lemon to help protect yourself. Hepatitis B is a viral liver infection. Again, most adult bodies are able to fight off the virus. In this case, itis referred to as Acute (something that does not last long) Hepatitis B. Hepatitis B is spread through contact with blood or bodily fluids of an infected person. This can include unprotected sexual intercourse, sharing drug needles, getting a tattoo with instruments that were not properly cleaned, or by sharing a personal item such as a razor or toothbrush with an infected person. A mother who is infected can pass the virus on to her baby during delivery. Again, the symptoms are flu-like in nature so it often goes undiagnosed. A person who has Chronic (lasting three months or more) Hepatitis B may show no symptoms until liver damage has iy ia OET®OET® occurred. Hepatitis B can lead to liver damage or cancer; your doctor may want to doa biopsy to determine the amount of damage your liver has experienced. Hepatitis C is also a viral liver infection. A few people will contract Hepatitis C and get better. This is called Acute Hepatitis C. Mast, however, will develop Chronic Hepatitis C and go on to deal with liver damage, cirrhosis of the liver, r cancer, and possibly liver failure. Hepatitis Cis the number one reason for liver transplants in the USA. Hepatitis C is spread through contact with contaminated blood. This can occur by sharing a needle, receiving a blood transfusion or organ transplant (blood and organs have been sereened for Hepatitis in the USA since 1992), getting a tattoo with equipment that has not been properly cleaned, and, in rare cases, a mother can pass the virus on to her baby during birth. Scientists are not sure, but think there may be a slim possibility that the virus may be passed through unprotected sexual intercourse. Symptoms generally do not occur until the virus is causing damage. Again, the symptoms are flu-like; you may also experience jaundice (yellowish eyes and skin) after the flu-like symptoms go away. Most people discover they are infected by having routine tests done or by donating blood or organs and the standard tests show the infection. There is also a home test youcan purchase and do if r ne you ar infected. Hometest:, ) PA ou are infecte pati i vir i 4 e thost important things Prvhel cc stre ngthe lis Is the Be Young Liver Cleanse: in the morning, Co of Be nase Lemon sort Cc 1 G of Be Young Peppermint essential oil, and 1 teas, followed by a glass of water. Be Young essential oils are absolutely 100% pure, EOBBD tested and guaranteed to C free of synthetics and extenders. Do not try this with an essential oil that you are not certain has been properly cared for and tested as you do not want to increase challenges to your liver. When properly supported, the liver has a remarkable capacity for regeneration. Hepatitis — Viral Liver Infection 15. Hepatitis is caused by A. virus. B. alcohol consumption C, medications D. all of the above Pra OET®OET® 16. This spreads through feces of contaminated person ‘A. hepatitis A B. hepatitis B C. both D.can'tsay 17. Most adult bodies are able to fight off this virus A. hepatitis A virus B. hepatitis B virus C.both D. can't say cw, isican lead to WJANJOORAN us growth in liver ae Connect 19. In the USA people go for liver transplantation because of A. hepatitis A B. hepatitis B C. hepatitis C D. all of the above 20. Hepatitis C spreads through A. sharing needles B. blood transfusion C. organ transplantation D. all of the above 123 |Page OET® EO So aresOET® 21. A patient may experience jaundice when ‘A. the flu-like symptoms appear B. the flu-like symptoms disappear C. eyes become yellow D. all of the above 22. Eating raw oysters and undercooked clams can increase your chances of contracting which virus? A. hepatitis virus A B. hepatitis virus B C. hepatitis virus C JJIOORAN Connect ANSWERS Part A. 1A 2B 3D 4c 5c 6A 124| Page OET®pel OET ® 7C 8 Preterm (Babies) 9 Kernicterus 10frequent feedings/radiation from sunlight 11 skin & sclera 12 Gilbert’s & crigler-Najjar 13 Physiologic / Non physiologic 14 kernicterus 15 young liver cells 16 Physiologic jaundice 17 early recognition 180 phy jologigxcaus: 19 Choredath WAN N J O O Bq A Ni | = 4 af ua @ 202 to4 7 Connect 1A 2c 3B 4B 5C 6C PARTC 7.0 8. D 9. B 10.B rie OET®()ANJOORAN ConnectOET® als' TEXTA A patient with Bell's palsy on the right side of his face, with the muscles on this side appearing to be paralyzed. Bell's palsy involves a weakness or paralysis on one side of the face. Symptoms often appear first thing one morning. A person wakes up and finds that one side of their face does not move. The person may find that they suddenly cannot control their facial muscles, usually on one side. The affected side of the face tends to droop. The weakness may also affect saliva and tear production, and the sense of taste. Many people are afraid they are having a stroke, , but if the weakness or paralysis only affects the face, it is more likely to be Bell's palsy. Approximately 1 in 5,000 people develop Bell's palsy each year. It is classed as a relatively rare condition. In very rare cases, Bell's palsy can affect both sides of the face nerve goes through a narrow gap of oe from the brain tothe face. If the facial nerve is inflamed, it will pr inst the chee jor or ie pinch c the narrow gap. This can result in damage fo the pr . ctiy If the protective covering of the nerve becomes cae al fc brain to the muscles in the face may not be tran ro) A fle fo paralyzed facial muscles. This is Bell's palsy. The exact reason why this happens is unclear. It may result when a virus, usually the herpes virus, inflames the nerve. This is the same virus that causes cold sores and genital herpes. Other viruses that have been linked to Bell's palsy include: Chickenpox and shingles virus , coldsores and genital herpes virus, Epstein-Barr virus, or EBV, responsible for mononucleosis, cytomegalovirus, mumps virus Influenza B, hand-foot-and-mouth disease (coxsackievirus) Bell's palsy risk factors Women who are in the last trimester of their pregnancy or who have just given birth may beat risk from Bell's palsy. Some risk factors have been established. Links have been found between migraine and facial and limb weakness. A study carried cout in 2015 found that people with migraine may have a higher risk of bell’s palsy. The condition more commonly affects: people aged 45 to 60 years, those with diabetes or upper respiratory diseases, 127|PageSET ® — women during pregnancy, especially in the third trimester, women who gave birth less than 1 week ago. Bell's palsy affects men and women equally, TEXT C Treatment Most people will recover from Bell's palsy in 1-2 months, especially those who still have some degree of movement in their facial muscles. Treatment with a hormone called prednisolone can speed up recovery. Astudy found that prednisolone, if administered within 72 hours of onset, can significantly reduce symptom severity and incidence after 12 months. Prednisolone This steroid reduces inflammation. This helps accelerate the recovery of the affected nerve. Prednisolone prevents the release of substances in the body that cause inflammation, such as prostaglandins and leukotrienes. Patients take it by mouth, usually two tablets a day for 10 days. Possible side effects include: abd6minialpain, bloating, acne, difficulty sleeping, dry skin, Headache , dizziness (spinning sensation), inereas petite, increa: | indig tion iat *mood changes | ~ nausea + Oral Thrush = slow wound healing + thinning skin + tiredness ‘These side effects normally get better after a couple of days. ‘An allergic reaction to prednisolone, such as difficulty breathing, should immediately be reported to a healthcare professional. Any allergic reaction to prednisolone should be reported to the doctor immediately. Allergy symptoms may include: : Hives - breathing difficulties + swelling of the face - lips : tongue . throat. if the patient feels dizzy or drowsy they should refrain from driving or operating heavy machinery. As this symptom may not appear straight away, it is advisable to wait a day before driving or operating machinery. Doctors usually reduce the dose gradually towards the end of the course of steroid medication. This helps prevent withdrawal symptoms, such as vomiting or tiredness. Eye lubrication had a faa } 128 | Page OET® SS 2. PSE SESOET® If the patient is not blinking properly the eye will be exposed and tears will evaporate. Some patients will experience a reduction in tear production. Both may increase the risk of damage or infection in the eye. The doctor may prescribe artificial tears in the form of eye drops and also an ointment. The eye drops are usually taken during the waking hours, while the ointment is applied before going to sleep. Patients who cannot close their eye properly during sleep will need to use surgical tape to keep it shut. Patients who experience worsening eye symptoms should seek medical help immediately. If you cannot get hold of your doctor, go the emergency department of your nearest hospital. Antivirals In some cases, an antiviral, such as acyclovir may be taken alongside prednisolone; however, evidence that theye can help is weak. Care at home Facial exercises: As the facial nerve begins to recover, tightening and relaxing facial muscles can help strengthen them. Dental care: If there is little or no feeling in the mouth it is easy for food to build up leading to decay or gum disease. Brushing and flossing can help prevent this. Problems with eating: If there are difficulties with swallowing, the individual should chew nd eat aoe Choosing soft ee such as yogurt can also help. Symptoms The facial nerves control blinking, opening and closing of the eyes, smiling, salivation, lacrimation (production of tears), and frowning. They also connect with the muscles of the stapes, a bone in the ear involved in hearing. When the facial nerve malfunctions, as in Bell's palsy, the following symptoms can occur: ” sudden paralysis/weakness in one side of the face difficulty closing one of the eyelids irritation in the eye because it does not blink and becomes too dry changes in the amount of tears the eye produces dropping in parts of the face, such as one side of the mouth drooling from one side of the mouth difficulty with facial expressions ' sense of taste may become altered an affected ear may cause sensitivity to sound pain in front or behind the ear on the affected side headache 129| PageOET® Bell's palsy Questions 1-7 For each question, 1-7, decide which text (A, B, Cor D) the information comes from. You may use any letter more than once. In which text can you find information about 1. Tightening and facial muscle relaxation is done during recovery period 2. _Excretory functions like salivation & tear production is affected in Bell's palsy 3. Sense of taste may become altered 4. Risk and damage to eye is associated with bell’s palsy 5. Most of the people misunderstand bell's palsy as stroke 6. _sThereal etiology for bell’s palsy is idiopathic z Questions 8-14 Answer each of the questions, 8-14/With a answer may include words, numbers or both; 8, Two over the count medications wwhich can be used at home to relieve pain? 9. At what time eye drops are generally administered? 10, Which causative agent is responsible for mononucleosis? 11, What is the main reason for irritation in the eye? 412, Which part of the nerve is affected in bell's palsy ? 13. Which age group of people are commonly affected? 130|Page OET® ena ES— OET® Questions 15-20 ‘Complete each of the sentences, 15-20, with a word or short phrase from one of the texts. Each answer may include words, numbers or both 14, Taking foods like ——~ can help in making swallowing easier. i.—— .-- can be used if patient cannot close their eye while sleeping. 16. We should be cautious regarding hypersensitivity reaction to ~ ------ of the face. 17. In exceptional cases, bell’s palsy affect —--------- — to sound 18. Bell's palsy can cause -—-- 19. — --.---- speéd up rehabilitation of affected nerve. 20. People with --------—~ are vulnerable to get bell’s palsy. In this paif of the test, there are six short extracts relating to the work of health professionals. For questions 1-6, choose answer (A, B or C) wh yu think fits best according to the text. Afibrinogenemia is a rare bleeding disorder with an estimated prevalence of 1:1,000,000. Itis an autosomal recessive disease resulting from mutations in any of the 3 genes that encode the 3 polypeptide chains of fibrinogen and are located on the long arm of chromosome 4. Spontaneous bleeding, bleeding after minor trauma and excessive bleeding during interventional procedures are the principal manifestations. We review the management of afibrinogenemia. Replacement therapy is the mainstay of treatment of bleeding episodes in these patients and plasma-derived fibrinogen concentrate is the agent of choice. Cryoprecipitate and fresh frozen plasma are alternative treatments that should be used only when fibrinogen concentrate is not available. Secondary prophylactic treatment may be considered after life-threatening bleeding whereas primary prophylactic treatment is not currently recommended. We also discuss alternative treatment options and the management of surgery, pregnancy and thrombosis in these patients. The development of new tests to. identify higher risk patients and of safer replacement therapy will improve the management of afibrinogenemia in the future. 131|Page OET®OET® 1. Fibrogenemia’s treatment is a) Replacement therapy b) Prophylactic treatments ¢) Alternative treatments. Fibrochondrogenesis Fibrochondrogenesis is a severe skeletal dysplasia characterized by a flat midface, short long bones, short ribs with broad metaphyses, and vertebral bodies that show distinctive hypoplastic posterior ends and rounded anterior ends, giving the vertebral bodies a pinched appearance on lateral radiographic views. The chest is small, causing perinatal respiratory problems which usually, but not always, result in lethality. Affected individuals who survive the neonatal period have high myopia, mild to moderate hearing loss, and severe skeletal dysplasia (summary by Tompson et al., 2012). For a discussion of genetic heterogeneity of fibrochondrogenesis 2. Fibrochondryogenesis is characterized by a) Long ribs and broad met i i J a | c) High to moderate hearing loss. b) Perinated respi rol Fibromuscular Dysplasia caused by the atherosclerotic renovascular disease, Fibromuscular dysplasia (FMD) is a rare systemic vascular disease, affecting younger women and accounting for 10% to 20% of the cases of renal artery stenosis. FMD is an idiopathic, non-inflammatory, non-atherosclerotic disease commonly involving renal and carotid arteries; however, it can affect any arterial bed. FMD classically presents as renovascular hypertension but can also manifest as stroke in young adults. Early diagnosis and treatment are important for long-term prognosis. Etiology cof FMD is unclear despite extensive research. Environmental and genetic factors have been ‘associated with FMD. Biggazi et al. reported bilateral FMD in identical twins, raising the possibility of inheritance. In a retrospective analysis of 104 patients with renal FMD, Pannier Moreau et al. reported an 11% prevalence of familial cases where at least one sibling showed angiographic evidence of renal FMD 3, Fibromuscular Dysplasia affect: a) Younger Women b) Older Women c) Young adults 132| Page