Practice Test 1

READING SUB-TEST – QUESTION PAPER: PART A

TIME: 15 MINUTES

INSTRUCTIONS TO CANDIDATES:

DO NOT open this Question Paper or the Text Booklet until

you are told 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.
Text A
Aspirin Resistance

Abstract

In the last few years, the concept of aspirin resistance has been
largely emphasised in the medical literature, although its definition,
mechanism, and specific guidelines for its management remain
unclear. Aspirin displays good antithrombotic activity. Various
laboratory parameters assessing the efficacy of aspirin like
bleeding time, platelet reactivity, thromboxane-A2 (TX-A2)
production, and measurement of platelet aggregation, have
confirmed the lack of its uniform effect on the platelets. Few
studies have reported aspirin resistance to the tune of 5 - 45%.
Various extrinsic and intrinsic factors influence the resistance.
Numerous studies reveal that aspirin resistance can be overcome by
combining it with another antithrombotic agent, i.e., clopidogrel.
Further, clopidogrel resistance has also been reported. So, much is
expected in the field of diagnostic tests in order to know the true
picture of aspirin resistance.

Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Text B
Mechanisms of aspirin resistance
The exact mechanisms are not clear:
True aspirin resistance:
The proposed factors for this type of resistance include:
i. Decreased bioavailability of aspirin.
ii. Accelerated platelet turnover introducing newly formed, non-
aspirinated platelets into the blood stream.
iii. Competition of aspirin with other NSAIDs (like ibuprofen)
preventing aspirin access at Serine 530 of Cox-I.
iv. Transcellular formation of TxA2 by aspirinated platelets from
PGH2 released by other blood cells or vascular cells.
v. TxA2 production by aspirin insensitive Cox-2 in newly formed
platelets or other cells.
vi. (Theoretical) presence of variant Cox-I which is less sensitive to
aspirin inhibition.
vii. Poor compliance by the patient.
 Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Text C
Aspirin dosage
According to the Antithrombotic Trialists’ Collaboration, daily
doses of aspirin (75 - 150 mg) are as effective as higher doses for
prevention of thrombotic events and are associated with low risk of
bleeding. Bornstein et al in their study have shown that even 100
mg of aspirin completely inhibits Cox-1 enzyme, thus further
substantiating the fact that patients with resistance established
during low dose aspirin therapy may respond to higher doses. The
results of this study showed that aspirin in doses of 500 mg/day
significantly prolonged the time between first and second stroke (p
= 0.002) compared with lower doses. Helgason et al revealed that
an increase in the dose of aspirin to 625 that suboptimal reduction
of urinary 11-dehydro TxB2 level during aspirin treatment is
associated with increased risk for future MI and cardiovascular
death, thereby suggesting that “true aspirin resistance” may be a
clinically relevant phenomenon. Inadequate inhibition of TxA2
biosynthesis by aspirin can be seen in patients on ibuprofen
therapy, because of competition of these 14 mg/day in five patients
who were aspirin resistant with 325 mg/day showed aspirin
sensitivity. Another study has revealed that these patients remained
resistant with aspirin 1,300 mg. This shows that inadequate dose
cannot explain aspirin resistance in all subjects.

Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”
Text D
Management of aspirin resistance
Currently there are no specific guidelines for the management of
aspirin resistance. The first step is to enquire about the patient’s
compliance. Regarding optimal aspirin dosing, it is controversial.
No convincing data are available showing that the antithrombotic
effect of aspirin is dose related. The meta-analysis by Anti-
Thrombotic Trialist’s Collaboration refuted the claim that high
doses of aspirin (500 - 1,500 mg/day) were effective than low
doses (75 - 150 mg/day). Other method to manage aspirin
resistance is by addition of another antiplatelet agent – clopidogrel,
because CAPRIE trial has shown greater benefit of combination of
aspirin and clopidogrel compared with aspirin alone. The
combination of aspirin with clopidogrel is an ideal one since
clopidogrel inhibits another pathway of platelet activation.
However, till date, it is not clear whether the superiority of a
combination of clopidogrel and aspirin over aspirin is due to
clopidogrel compensation for aspirin non-responders. Resistance to
even clopidogrel has been reported, which is associated with an
increased risk of recurrent thrombotic events in patients with acute
MI.

.
Go to “1” “2” “3” “4” “5” “6” “7” “8” “9” “10”
Questions “11” “12” “13” “14” “15” “16” “17” “18” “19” “20”

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

QUESTIONS

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

1. what are the factors of true aspirin resistance? _____
Go to “Text A” “Text B” “Text C” “Text D”
2. how much of aspirin completely inhibits Cox-1 enzyme? _____
Go to “Text A” “Text B” “Text C” “Text D”
3. what will happen if aspirin compete with other NSAIDs? _____
Go to “Text A” “Text B” “Text C” “Text D”
4. how the the true picture of aspirin resistance is revealed? _____
Go to “Text A” “Text B” “Text C” “Text D”
5. what are the parameters for assessing the efficacy of aspirin?
_____
Go to “Text A” “Text B” “Text C” “Text D”
6. list the methods to manage aspirin resistance? _____
Go to “Text A” “Text B” “Text C” “Text D”
7. whether true aspirin resistance is a clinically relevant
phenomenon? _____
Go to “Text A” “Text B” “Text C” “Text D”

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. How much mg of aspirin is minimum required to completely
inhibit Cox-1 enzyme?
Go to “Text A” “Text B” “Text C” “Text D”
9. Which patients show inadequate inhibition of TxA2 biosynthesis by
aspirin?
Go to “Text A” “Text B” “Text C” “Text D”
10. Name the antiplatelet agent used to manage aspirin resistance?
Go to “Text A” “Text B” “Text C” “Text D”
11. What are responsible for transcellular formation of TxA2?
Go to “Text A” “Text B” “Text C” “Text D”
12. What is the daily doses range of aspirin according to the
Antithrombotic Trialists’Collaboration?
Go to “Text A” “Text B” “Text C” “Text D”
13. Which trial has shown greater benefit of combination of aspirin
and clopidogrel?
Go to “Text A” “Text B” “Text C” “Text D”

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
both.
14. Aspirin displays good _____ activity.
Go to “Text A” “Text B” “Text C” “Text D”
15. Few studies have reported aspirin resistance to the tune of
_____.
Go to “Text A” “Text B” “Text C” “Text D”
16. TxA2 may be produced by aspirin insensitive _____ in newly
formed platelets or other cells.
Go to “Text A” “Text B” “Text C” “Text D”
17. Increase in the dose of aspirin to 625 is associated with
increased risk for future MI and _____.
 Go to “Text A” “Text B” “Text C” “Text D”
18. Inadequate inhibition of TxA2 ______ by aspirin can be seen in
patients on ibuprofen therapy.
Go to “Text A” “Text B” “Text C” “Text D”
19. The first step in management of aspirin resistance is to enquire
about the patient’s ______.
Go to “Text A” “Text B” “Text C” “Text D”
20. The combination of _____ with clopidogrel is an ideal one.
Go to “Text A” “Text B” “Text C” “Text D”

Answer Key
“Practice Test 1”
 Practice Test 2
READING SUB-TEST – QUESTION PAPER: PART B & C

TIME: 45 MINUTES

INSTRUCTIONS TO CANDIDATES:

DO NOT open this Question Paper or the Text Booklet until

you are told to do so.
Write your answers on the spaces provided on this Question
Paper.
You must answer Part B & C within the 45-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 45 minutes, hand in this Question Paper and
the Text Booklet.
DO NOT remove OET material from the test room.

Part B

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

Anaesthetic Machines
The anaesthetic machine (or anaesthesia machine in America) is used by
anaesthesiologists and nurse anaesthetists to support the administration of
anaesthesia. The most common type of anaesthetic machine is the
continuous-flow anaesthetic machine, which is designed to provide an
accurate and continuous supply of medical gases (such as oxygen and nitrous
oxide), mixed with an accurate concentration of anaesthetic vapour (such as
halothane or isoflurane), and deliver this to the patient at a safe pressure and
flow. Modern machines incorporate a ventilator, suction unit, and patient
monitoring devices.
1. The manual is giving information about
A. how to use anaesthetic machines
B. types of anaesthetic machines
C. an overview of anaesthetic machines

Autoclaves and Sterilizers

Sterilization is the killing of microorganisms that could harm patients. It can

be done by heat (steam, air, flame or boiling) or by chemical means.
Autoclaves use high pressure steam and sterilizers use boiling water mixed
with chemicals to achieve this. Materials are placed inside the unit for a
carefully specified length of time. Autoclaves achieve better sterilization than
boiling water sterilizers. Heat is delivered to water either by electricity or
flame. This generates high temperature within the chamber. The autoclave
also contains high pressure when in use, hence the need for pressure control
valves and safety valves. Users must be careful to check how long items need
to be kept at the temperature reached.
2. Why autoclaves are better than boiling water sterilizers?
A. Heat is transferred to water by electricity or flame
B. Autoclaves use high pressure steam
C. Autoclaves generates high temperature within the chamber

ECG: How it works

The electrical activity is picked up by means of electrodes placed on the skin.

The signal is amplified, processed if necessary and then ECG tracings
displayed and printed. Some ECG machines also provide preliminary
interpretation of ECG recordings. There are 12 different types of recording
displayed depending upon the points from where the recordings are taken.
Care must be taken to make the electrode sites clean of dirt before applying
electrode jelly. Most problems occur with the patient cables or electrodes.
3. The guidelines establish that the healthcare professional should
A. aim to make patients fully aware of how ECG works .
B. carefully clean the electrode sites.
C. respect the wishes of the patient above all else.

Benefits of electronic health records

EHR systems are complex applications which have demonstrated benefits.

Their complexity makes it imperative to have good application design,
training, and implementation. Studies have evaluated EHR systems and
reported on various benefits and limitations of these systems. Benefits
included increase in immunization rates, improved data collection, increased
staff productivity, increased visitor satisfaction with services, improved
communication, quality of care, access to data, reduced medical errors, and
more efficient use of staff time. Some of the disadvantages noted were: time-
consuming data entry, slow access of data and decreased quality of patient-
doctor interaction.
4. The notice is giving information about
A. pros and cons of electronic health records
B. necessity of electronic health records
C. demonstrated benefits of electronic health records

mHealth

The use of mobile technologies for data collection about individuals and
interactive information services are a part of a growing area of eHealth called
mHealth. The GOe published a volume on this subject in 2011 which
documents the uptake of mHealth worldwide by types of initiatives and main
barriers to scale. Mobile technologies are emerging as a powerful tool for
health information transfer including making patient information portable.
Such technologies can be more fully utilized through electronic patient
information such as EMRs and EHRs. Electronic records will work best,
however, if there are standards in place for their use and interoperability.

5. The note tells us that the mHealth

A. is a published volume on the GOe
B. is a powerful tool for information transfer
C. makes patient information portable

Systematized Nomenclature of Medicine (SNOMED)

SNOMED was designed to provide a comprehensive nomenclature of clinical

medicine for the purpose of describing records of clinical care in human
medicine. It is a multi-axial and hierarchical classification system. It is multi-
axial in that any given clinical condition can be described through multiple
axes such as topography (anatomy), morphology, organisms such as bacteria
and viruses, chemicals such as drugs, function (signs and symptoms),
occupation, diagnosis, procedure, physical agents or activities, social context,
and syntactic linkages and qualifiers. SNOMED is hierarchical in that each of
the axes has a hierarchical tree that proceeds from general terms to more
specific ones. For example topography (anatomic) terms are first divided into
major organs such as lung, heart, and then into the smaller components of
each.

6. What does this extract from a handbook tell us about Systematized

Nomenclature of Medicine?
A. is a multi-axial and hierarchical classification system
B. is a comprehensive nomenclature of trial medicines
C. is used to described any clinical condition through axis

Answer Key
“Practice Test 2”
 Practice Test 3
READING SUB-TEST – QUESTION PAPER: PART B & C

TIME: 45 MINUTES

INSTRUCTIONS TO CANDIDATES:

DO NOT open this Question Paper or the Text Booklet until

you are told to do so.
Write your answers on the spaces provided on this Question
Paper.
You must answer Part B & C within the 45-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 45 minutes, hand in this Question Paper and
the Text Booklet.
DO NOT remove OET material from the test room.
Part C
In this part of the test, there are two texts about different aspects of
healthcare. Choose the answer (A, B, C or D) which you think fits
best according to the text.

All life is connected

Cancer in Humans and Wildlife
WILDLIFE—HUMAN LINKS
Paragraph 1
It may be that biologists, rather than physicians, will be the major
contributors to the health of our wildlife caused by the combined action of
pesticides planet and its people. It was Rachel Carson, a biologist, who
researched and wrote of the harm to wildlife caused by the combined action
of pesticides and radiation. In the tradition of the observant biologist is Theo
Colborn, who, with her colleagues, provided a significant breakthrough in
understanding the hormonal effects of environmental contaminants. In July
1991, a gathering of some of the world’s most astute, - scientists were held at
the Wingspread Conference Center in Wisconsin, where they defined the
pattern of diverse endocrine malfunction seen throughout the animal
kingdom. They revealed a gm“: picture of the Brave New World we should
m rigorously seek not to leave as a legacy to our children.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 2
The conferees, studying wildlife over the globe, described ominous findings
of disease an linked to environmental pollution. Exposure to toxic chemicals
that possess unintended h actions has resulted in anatomic, physiologic,
reproductive, carcinogenic, and behavioral abnormalities across all forms of
animal life: in mollusks, fish, birds, seals, and rodents. These creatures are to
we humans as canaries were to the miners. We must understand that the
destruction of eons of evolutionary function and development in wildlife
foreshadows destruction of the entire biosphere, humans included.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 3
These widespread adverse effects were attributed to xenoestrogens. Xeno -
comes from a Greek origin, meaning “foreign.” Foreign itself is not bad: how
else do we share and spread culture and ideas? But xenoestrogens are less
foreigners than invaders, gaining entrance by the Trojan horse of seemingly
harmless routes: milk, meat, cheese, fish, the products we use to nourish
ourselves and families. Like the invaders of Troy, after the xenoestrogens
gain entrance to the bodies of animals and humans alike, they weaken
defenses and wreak their harm of cancer, hormonal disruption,
immunological abnormalities, and birth defects.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 4
Xenoestrogens are an insidious enemy, but they have had help from powerful
allies: the purveyors of products and chemicals, and legislators, regulators,
and scientists reluctant to bite the money- laden hands that feed them.
Wingspread researchers found that birds exposed to xenoestrogens show
reproductive failure, growth retardation, life-threatening deformities, and
alterations in their brains and liver functions.” There is direct experimental
evidence for permanent [organizational] effects of gonadal steroids on the
brain as well as reproductive organs throughout life. This means that
offspring whose brains have been altered are unable to function as had their
parents. They become different in ability or function.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 5
This means that the sea of hormonally active chemicals in which the fetus
develops may change forever the health and function of the adult, and in
some cases, may alter the course of an entire species. Worldwide there are
reports of declining sperm counts and reduced ratio in births of male babies.
Without the capacity to reproduce, a species ceases to exist. Extinction is
forever; a species loss has never been reversed.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 6
The data derived from animal observations are unequivocal: breast and
genital cancers, _ ital abnormalities, interference with sexual development,
and changes in reproductive behavior all expressions of a root cause. A
possible connection between women with breast cancer and those having
children with reversed sexual orientation is a question that bears study. This
is n n. from science fiction, considering what we have learned from observing
wildlife and the effects inappropriate hormonal influence upon the breast,
brain, and reproductive organs. If an unequivocal answer were to emerge
from human observation, it could have a significant impact upon the
prevailing political and economic landscape, and may finally settle the nature
or nu issue of sexual orientation.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 7
SILENT SPRING-SILENT WOMEN
Considering the accumulated knowledge linking chemical and radioactive
contamination environment with increasing breast cancer rates means we
must focus our energies and prevention. Early were the eloquent words and
pleas for prevention from Rachel Carson. Her book, Silent Spring, originally
published in 1962, while she herself was suffering from breast cancer, is still
a best seller. Ms. Carson documented wholesale killing of species; animals,
birds, fish, insects; the destruction of food and shelter for wild creatures;
failure of reproduction; damage to the nervous system; tumors in wild
animals; increasing rates of leukemia in children; and chronicled the
pesticides and chemicals known at that time to cause cancer. This was over
30 years ago!
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 8
Carson’s is a book for every citizen, for without understanding of our
collective actions and permissions, we cannot govern democratically. In
Australia, a citizen is required to vote. In the United States, proclaimed by
some politicians as the “greatest democracy on earth,” often fewer than 50%
bother to vote in a major election. Of those who do take the time to register
and vote, few are sufficiently alert and/or educated to vote with intelligence,
thought, and compassion. Requiring participation in the governance of one’s
own country is not a bad idea. Requiring thoughtful voting may be more
difficult, especially when it comes to such issues as cancer, pesticide use,
consumer products, nuclear radiation, toxic chemicals, and environmental
destruction. Taking this thought one step further; this democracy could do far
worse than to require reading of Silent Spring as a requirement to vote!
Radical? Perhaps. But is the ongoing cancer epidemic any less radical?
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 9
One successor to Ms. Carson has emerged in the person of Sandra
Steingraber, an ecologist, poet, and scientist. In her book, Living
Downstream, she writes eloquently of the connections between
environmental contamination and cancer. Dr. Steingraber was diagnosed with
bladder cancer at age 20, a highly unusual diagnosis in a woman, a young
woman, a nonsmoker and nondrinker. She pursued the question, why? She
realized a connection with our wild relations and she asks: Tell me, does the
St. Lawrence beluga drink too much alcohol and does the St. Lawrence
beluga smoke too much and does the St. Lawrence beluga have a bad diet. . .
is that why the beluga whales are ill? ...Do you think you are somehow
immune and that it is only the beluga whale that is being affected?
 Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 10
The portion of Dr. Steingraber’s book that struck me most personally was
when she says: First, even if cancer never comes back, one’s life is utterly
changed. Second, in all the years I have been under medical scrutiny, no one
has ever asked me about the environmental conditions where I grew up, even
though bladder cancer in young women is highly unusual. I was once asked if
I had ever worked with dyes or had been employed in the rubber industry.
(No and no.) Other than these questions, no doctor, nurse, or technician has
ever shown interest in probing the possible causes of my disease-even when I
have introduced the topic. From my conversations with other cancers,
patients, I gather that such lack of curiosity in the medical community is
usual.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 11
I take her words as an indictment of the medical and scientific establishment,
whose point of view must be changed. Certainly the lack of curiosity among
physicians, scientists, policymakers, and politicians has contributed to the
epidemic of illness among humans and wildlife alike. An equally talented
woman is Terry Tempest Williams, an ecologist and wildlife researcher
whose book, Refuge: An Unnatural History of Family and Place, tells the
story of her Utah family, whom she “labels “a clan of one—breasted
women.” Ms. Williams contrasts the life-affirming awareness Great Salt Lake
wildlife refuge against the erosion-of-being, as cancer takes away the women
in her family: her mother, her grandmothers, and six aunts. She writes: “I
cannot prove that my mother Diane Dixon Tempest, or my grandmothers,
Lettie Romney Dixon and Kathryn Blackett Tempest along with my aunts,
developed cancer from nuclear fallout in Utah. But I can’t prove that didn’t.”
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 12
Times are changing. It is becoming impossible to ignore the carnage of
endocrine-disruption chemicals, nuclear radiation, and chemical carcinogens,
alone and in combination, invading nearly every family with cancer. Facing
this reality may be too much for some people, afraid to look, or afraid of
being the next victim. The story of cancer is not an easy one, and neither is
cancer. But if we do not exert our efforts to prevent this disease, we doom our
children and grandchildren to repeat our collective errors. What does it take
to change from environmental destruction and random killing to affirmation
of life? Can the protection of life for ourselves and our environment be
accomplished by women with breast cancer; the women at risk for breast
cancer; the families of breast cancer victims? Who should lead? If we citizens
can’t and don’t try, what are our alternatives?
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
QUESTIONS
Q1. The author’s main contention is that
a. wildlife all around the world is being linked to environmental pollution
b. fish, birds, seals and canaries are being exposed to toxic chemicals
c. humans need to understand the link between destroying the planet’s
wildlife, through exposure to toxic chemicals, and the destruction of the
entire biosphere — which includes human life itself.
d. humans need to understand the link between destroying the planet’s
wildlife, through exposure to toxic chemicals, and behavioural abnormalities
across all forms of life.
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q2. The author states that in an environment of “hormonally active
chemicals”
a. males with higher sperm counts may result ‘
b. more male babies are born
c. lower sperm count in males may result in a particular species being wiped
out ‘
d. males with more sperm count may result
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q3. Dr Sandra Steingraber, ecologist, poet and scientist:
a. realised that contracting bladder cancer was not due to her alcohol drinking
b. realised her bladder cancer was not due to her smoking
c. believed her bladder cancer was due to environmental contamination
d. doctors, nurses and technicians were very interested in her unusual cancer
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q4. The wildlife researcher, Terry Tempest Williams, sees the dichotomy
which exists in the Salt Lake wildlife refuge area:
a. many women in her family have died from breast cancer after a nuclear
fallout in Utah
b. many men in her family have died from breast cancer
c. her family have many one-breasted women — unusual for Utah
d. such wide-spread cancer is probably due to environmental, not genetic
causes
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q5. Animal observations show:
a. changes in sexual maturity are not only due to a root cause
b. genital abnormalities may be due to a root cause
c. inappropriate hormones adversely affect the development of breast, brain
and reproductive organs
d. humans are not similarly affected.
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q6. The author puts forward several ideas about governance except for one of
the following:
a. People who participate in elections are not alert and educated enough
b. Unless the wants and needs of the population are known, it is difficult for
politicians to govern democratically
c. People being required to vote, to participate in the decision making
process, is a good idea
d. Reading Carson’s book, Silent Spring, should be made compulsory for all
voters.
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q7. Rachel Carson’s book Silent Spring, written in 1962, revealed:
a. more had to be done to prevent chemical contamination of the environment
b. there was a link between pesticides, chemicals and cancer
c. chemicals were leading to an inability to reproduce leading to the
eradication of entire species of insects, birds, fish and animals
d. all of the above
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q8. Research about xenoestrogens reveals
a. they are everywhere
b. they are harmless
c. they are in our everyday foods
d. they are in our everyday foods and disrupt hormonal function
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q9. Xenoestrogens
a. lead to birth deformities
b. alter genetically inherited abilities
c. continue to be used by profiteering stakeholders
d. all of the above
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”
Q10. The author asserts:
a. people need to be aware of the dangers of chemicals, radiation, carcinogens
b. tackling cancer should be embraced not shunned
c. change should not be left to only those suffering from breast cancer
d. all of the above
Para- “1” “2” “3” “4” “5” “6”
graphs “7” “8” “9” “10” “11” “12”

Answer Key
“Practice Test 3”
 Practice Test 4
READING SUB-TEST – QUESTION PAPER: PART B & C

TIME: 45 MINUTES

INSTRUCTIONS TO CANDIDATES:

DO NOT open this Question Paper or the Text Booklet until

you are told to do so.
Write your answers on the spaces provided on this Question
Paper.
You must answer Part B & C within the 45-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 45 minutes, hand in this Question Paper and
the Text Booklet.
DO NOT remove OET material from the test room.
Part C
In this part of the test, there are two texts about different aspects of
healthcare. Choose the answer (A, B, C or D) which you think fits
best according to the text.

Does Tamiflu really work?

Paragraph 1
The British Medical Journal (BMJ) was dominated in 2009 by a cluster of
articles on oseltamivir (Tamiflu). Between them the articles conclude that the
evidence that oseltamivir reduces complications in otherwise healthy people
with pandemic influenza is now uncertain and that we need a radical change
in the rules on access to trial data.
 Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 2
The use of meta-analysis is governed by the Cochrane review protocol.
Cochrane Reviews investigate the effects of interventions for prevention,
treatment and rehabilitation in a healthcare setting. They are designed to
facilitate the choices that doctors, patients, policy makers and others face in
health care. Most Cochrane Reviews are based on randomized controlled
trials, but other types of evidence may also be taken into account, if
appropriate.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 3
If the data collected in a review are of sufficient quality and similar enough,
they are summarised statistically in a meta-analysis, which generally provides
a better overall estimate of a clinical effect than the results from individual
studies. Reviews aim to be relatively easy to understand for non-experts
(although a certain amount of technical detail is always necessary). To
achieve this, Cochrane Review Groups like to work with “consumers”, for
example patients, who also contribute by pointing out issues that are
important for people receiving certain interventions. Additionally, the
Cochrane Library contains glossaries to explain technical terms.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 4
Briefly, in updating their Cochrane review, published in late 2009. Tom
Jefferson and colleagues failed to verify claims, based on an analysis of 10
drug company trials, that oseltamivir reduced the risk of complications in
healthy adults with influenza. These claims have formed a key part of
decisions to stockpile the drug and make it widely available.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 5
Only after questions were put by the BMJ and Channel 4 News has the
manufacturer Roche committed to making “full study reports” available on a
password protected site. Some questions remain about who did what in the
Roche trials, how patients were recruited, and why some neuropsychiatric
adverse events were not reported. A response from Roche was published in
the BMJ letters pages and their full point by point response is published
online.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 6
Should the BMJ be publishing the Cochrane review given that a more
complete analysis of the evidence may be possible in the next few months?
Yes, because Cochrane reviews are by their nature interim rather than
definitive. They exist in the present tense, always to be superseded by the
next update. They are based on the best information available to the
reviewers at the time they complete their review. The Cochrane reviewers
have told the BMJ that they will update their review to incorporate eight
unpublished Roche trials when they are provided with individual patient data.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 7
Where does this leave oseltamivir, on which governments around the world
have spent billions of pounds? The papers in last years journal relate only to
its use in healthy adults with influenza. But they say nothing about its use in
patients judged to be at high risk of complications- pregnant women, children
under 5, and those with underlying medical conditions; and uncertainty over
its role in reducing complications in healthy adults still leaves it as a useful
drug for reducing the duration of symptoms. However, as Peter Doshi points
out on this outcome it has yet to be compared in head to head trials with non-
steroidal inflammatory drugs or paracetamol. And given the drug’s known
side effects, the risk-benefit profile shifts considerably if we are talking only
in terms of symptom relief.
Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
Paragraph 8
We don’t know yet whether this episode will turn out to be a decisive battle
or merely a skirmish in the fight for greater transparency in drug evaluation.
But it is a legitimate scientific concern that data used to support important
health policy strategies are held only by a commercial organisation and have
not been subject to full external scrutiny and review. It can’t be right that the
public should have to rely on detective work by academics and journalists to
patch together the evidence for such a widely prescribed drug. Individual
patient data from all trials of drugs should be readily available for scientific
scrutiny.
 Questions “Q1” “Q2” “Q3” “Q4” “Q5” “Q6” “Q7” “Q8” “Q9” “Q10”
QUESTIONS
Q1. A cluster of articles on oseltamivir in the British Medical Journal
conclude__________
a. complication are reduced in healthy people by oseltamivir
b. the efficacy of Tamiflu in now in doubt
c. complications from pandemic influenza are currently uncertain
d. a series of articles supporting Tamiflu
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q2. Cochrane Reviews are designed to __________
a. set randomized controlled trials to specific values
b. compile literature meta-analysis
c. peer review articles
d. influence doctors choice of prescription
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q3. According to the article, which one of the following statements about
Tamiflu is FALSE?
a. The use of randomized controls is suspect
b. The efficacy of Tamiflu is certain
c. Oseltamivir induces complications in healthy people
d. Cochrane reviews are useful when examining the efficacy of Tamiflu
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q4. According to the article, Cochrane Review Groups __________
a. like to work for “consumers”.
b. are being overhauled.
c. use language suitable for expert to expert communication.
d. evaluate a clinical effect better than individual studies.
 Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q5. Which would make the best heading for paragraph 4?
a. Analysis of 10 drug company trials
b. The stockpiling of Oseltamivir
c. Risk of complications in healthy adults
d. Tamiflu claims fail verification
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q6. According to the article, which one of the following statements about
Roche is TRUE?
a. Full study reports were made freely available on the internet
b. Patients were recruited through a double blind trial
c. The identities and roles of researcher in the Roche trials are not fully
accounted for
d. Not all neuropsychiatric adverse events were reported
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q7. Cochrane reviews should __________
a. use a more complete analysis
b. not be published until final data is available
c. be considered interim rather than definitive advice
d. be superseded by a more reliable method of reporting results
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q8. Which would make the best heading for paragraph 7?
a. Risk-benefit profile of Tamiflu
b. Studies limited to healthy adults
c. High risk of complications
d. Oseltamivir only for high risk patients
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q9. Which one of the following is given as THE LEAST CERTAIN
application of oseltamivir?
a. All of the below
b. Healthy adults with influenza
c. Patients judged to be at high risk of complications
d. In terms of symptom relief
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”
Q10. From the article, it can be inferred that __________
a. Research on Tamiflu needs to be re-evaluated and more transparent
b. There is no need to stockpile Tamiflu
c. The studies by Roche may have been falsified
d. The effectiveness of Tamiflu in healthy adults is validated
Paragraphs “1” “2” “3” “4” “5” “6” “7” “8”

Answer Key
“Practice Test 4”