READING TEST 2

READING SUB-TEST : PART A

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

TEXT BOOKLET
PART A -QUESTIONS AND ANSWER SHEET

Questions 1-7
For each of the questions, 1-7, decide which text (A, B, C or D) the information comes from.
You may use any letter more than once.

In which text can you find information about...

1. What GPs should say to patients requesting codeine?
2. basic indications of an opioid problem?
3. different medications used for weaning patients off opioids?
4. decisions to make before beginning treatment of dependence?
5. defining features of a use disorder?
6. the development of a common goal for both prescriber and patient?
7. sources of further information on pain management?

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. Your answers should be correctly spelled.

8. What will reduced doses of opioids lead to a reduction of?

9. What is the most effective medication for tapering opioid dependence?
10. How long should over the counter codeine analgesics be used for?
11. When should doctors consider referring a patient to a pain expert or clinic?
12. What might a patient give permission to before starting treatment?
13. What might be increasingly neglected as a result of opioid use?
14. How many Buprenorphine patches are needed to taper from codeine tablets?
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. Your answers should be correctly spelled.

The use of Buprenorphine-naxolone requires a (15)........ before treatment.

The use of symptomatic medications for the treatment of opioid dependence has been found to
have (16)........ than tramadol.

Different definitions of opioid dependence share the same (17).........

Once it is decided that opioid taper is a suitable treatment the doctor and patient should create a
(18).........

Recent research indicates that (19)........ can work as well as combination analgesics including
codeine and oxycodone.

The ICD-10 defines a patient as dependent if they have (20)........ key symptoms simultaneously.

END OF PART A, THIS QUESTIONS PAPER WILL BE COLLECTED

READING SUB-TEST : PART B

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

1. The purpose of the memo about IV solution bags is to remind health practitioners
A. of the procedures to follow when using them.
B. of the hazards associated with faulty ones.
C. why they shouldn’t be reused.

Memo to staff - Intravenous solution bags

IV fluids are administered via a plastic IV solution bag which collapses on itself as it empties.
When a bag is disconnected by removing the giving set spike, air can enter the bag. If it is then
reconnected to an IV line, air can potentially enter the patient’s vein and cause an air
embolism. For this reason, partially used IV bags must never be re-spiked. All IV bags are
designed for single use only - for use in one patient and on one occasion only.
All registered large volume injections, including IV bags, are required to have this warning (or
words to the same effect) clearly displayed on the labelling. In addition to the potential risk of
introducing an air embolus, re-spiking can also result in contamination of the fluid, which may
lead to infection and bacteraemia.
2. What do we learn about the use of TENS machines?
A. Evidence for their efficacy is unconfirmed.
B. They are recommended in certain circumstances.
C. More research is needed on their possible side effects.

Update on TENS machines

The Association of Chartered Physiotherapists in Women’s Health has an expert panel which
could not find any reports suggesting that negative effects are produced when TENS has
been used during pregnancy. However, in clinical practice, TENS is not the first treatment of
choice for women presenting with musculoskeletal pain during pregnancy. The initial
treatment should be aimed at correcting any joint or muscle dysfunction, and a rehabilitation
programme should be devised. However, if pain remains a significant factor, then TENS is
preferable to the use of strong medication that could cross the placental barrier and affect
the foetus. No negative effects have been reported following the use of this modality during
any of the stages of pregnancy. Therefore, TENS is preferable for the relief of pain.
3. If surgical instruments have been used on a patient suspected of having prion disease, they
A. must be routinely destroyed as they cannot be reused.
B. may be used on other patients provided the condition has been ruled out.
C. should be decontaminated in a particular way before use with other patients.

Guidelines: Invasive clinical procedures in patients with suspected prion disease

It is essential that patients suspected of suffering from prion disease are identified prior to any
surgical procedure. Failure to do so may result in exposure of individuals on whom any surgical
equipment is subsequently used. Prions are inherently resistant to commonly used
disinfectants and methods of sterilisation. This means that there is a possibility of transmission
of prion disease to other patients, even after apparently effective methods of decontamination
or sterilisation have been used. For this reason, it may be necessary to destroy instruments
after use on such a patient, or to quarantine the instrument until the diagnosis is either
confirmed, or an alternative diagnosis is established. In any case, the instruments can be used
for the same patient on another occasion if necessary.
4. The email suggests that POCT devices
A. should only be used in certain locations.
B. must be checked regularly by trained staff.
C. can produce results that may be misinterpreted.

To: All Staff

Subject: Management of Point of Care Testing (POCT) Devices

Due to several recent incidents associated with POCT devices, staff are requested to read
the following advice from the manufacturer of the devices.
The risks associated with the use of POCT devices arise from Management of Point of Care
Testing Devices Version 4 January 2014, the inherent characteristics of the devices
themselves and from the interpretation of the results they provide. They can be prone to
user errors arising from unfamiliarity with equipment more usually found in the laboratory.
User training and competence is therefore crucial.
5. It’s permissible to locate a baby’s identification band somewhere other than the ankles when
A. the baby is being moved due to an emergency.
B. the bands may interfere with treatment.
C. the baby is in an incubator.

Identification bands for babies

The identification bands should be located on the baby’s ankles with correct identification
details unless the baby is extremely premature and/or immediate vascular access is required.
If for any reason the bands need to be removed, they should be relocated to the wrists or if this is
not possible, fixed visibly to the inside of the incubator. Any ill-fitting or missing labels should be
replaced at first check. Identity bands must be applied to the baby’s ankles at the earliest
opportunity as condition allows and definitely in the event of fire evacuation or transportation.
6. What is the memo doing?
A. providing an update on the success of new guidelines
B. reminding staff of the need to follow new guidelines
C. announcing the introduction of new guidelines

Memo: Administration of antibiotics

After a thorough analysis and review, our peri-operative services, in conjunction with the
Departments of Surgery and Anaesthesia, decided to change the protocols for the
administration of pre-operative antibiotics and established a series of best practice
guidelines. This has resulted in a significant improvement in the number of patients
receiving antibiotics within the recommended 60 minutes of their incision. A preliminary
review of the total hip and knee replacements performed in May indicates that 88.9% of
patients received their antibiotics on time.
READING SUB-TEST : PART C
In this part of the test, there are two texts about different aspects of healthcare.
For questions 7-22, choose the answer (A, B, C or D) which you think fits best according to the text. W
answers on the separate Answer Sheet.

Text 1: Detecting Carbon Monoxide Poisoning

Carbon Monoxide (CO) poisoning is the single most common source of poisoning injury
treated in US hospital emergency departments. While its presentation is not uncommon, the
diverse symptoms that manifest themselves do not lead most clinicians to consider
carboxyhemoglobinemia when attempting a diagnosis. The symptoms can be mistaken for
those of many other illnesses including food poisoning, influenza, migraine headache, or
substance abuse.

What's more, in an attempt to find the causative agent for the symptoms, many
unnecessary, and sometimes resource-intensive, diagnostics may be ordered, to no avail.
For example, because the symptoms of CO poisoning may mimic an intracranial bleed, the
time needed to obtain a negative result may hold up a proper diagnosis as well as
needlessly increasing healthcare costs. Of even greater concern, however, is that during
such delays patients may find that their symptoms abate and their health improves as the
hidden culprit, CO, is flushed from the blood during the normal ventilation patterns.

Indeed, multiple reports have shown patients being discharged and returned to the very
environment where exposure to CO took place. Take the case of a 67-year-old man who sought
medical help after three days of lightheadedness, vertigo, stabbing chest pain,cough, chills and
headache. He was admitted, evaluated and discharged with a diagnosis of viral syndrome. Ten
days later, he returned to the Emergency Department with vertigo, palpitations and nausea but
was sent home for outpatient follow-up. Four days later, he presented again with diarrhea and
severe chest pain, collapsing to the floor. This time, he was admitted to the Coronary Care Unit
with acute myocardial infarction. Among the results of a routine arterial blood gas analysis there,
it was found that his carboxyhemoglobin (COHb) levels were 15.6%. A COHb level then obtained
on his wife was 18.1%. A rusted furnace was found to be the source.
There are two main types of CO poisoning: acute, which is caused by brief exposure to a
high level of carbon monoxide, and chronic or subacute, which results from long exposure to
a low level of CO. Patients with acute CO poisoning are more likely to present with more
serious symptoms, such as cardiopulmonary problems, confusion, syncope, coma, and
seizure. Chronic poisoning is generally associated with the less severe symptoms. Low-level
exposure can exacerbate angina and chronic obstructive pulmonary disease, and patients
with coronary artery disease are at risk for ischemia and myocardial infarction even at low
levels of CO.

Patients that present with low COHb levels correlate well with mild symptoms of CO
poisoning, as do cases that register levels of 50-70%, which are generally fatal. However,
intermediate levels show little correlation with symptoms or with prognosis. One thing that is
certain about COHb levels is that smokers present with higher levels than do non-smokers.
The COHb level in non-smokers is approximately one to two percent. In patients who
smoke, a baseline level of nearly five percent is considered normal, although it can be as
high as 13 percent. Although COHb concentrations between 11 percent and 30 percent can
produce symptoms, it is important to consider the patient's smoking status.

Regardless of the method of detection used in emergency department care, several other
variables make assessing the severity of the CO poisoning difficult. The length of time since
CO exposure is one such factor. The half-life of CO is four to six hours when the patient is
breathing room air, and 40-60 minutes when the patient is breathing 100 percent oxygen. If
a patient is given oxygen during their transport to the emergency department, it will be
difficult to know when the COHb level hit its highest point. In addition, COHb levels may not
fully correlate with the clinical condition of CO-poisoned patients because the COHb level in
the blood is not an absolute index of compromised oxygen delivery at the tissue level.
Furthermore, levels may not match up to specific signs and symptoms: patients with
moderate levels will not necessarily appear sicker than patients with lower levels.
In hospitals, the most common means of measuring CO exposure has traditionally been
through the use of a laboratory CO-Oximeter. A blood sample, under a physician order, is
drawn from either venous or arterial vessel and injected into the device. Using a method
called spectrophotometric blood gas analysis, this then measures the invasive blood
sample. Because the CO-Oximeter can only yield a single, discrete reading for each aliquot
of blood sampled, the reported value is a non-continuous snapshot of the patient's condition
at the particular moment that the sample was collected. It does, however, represent a step in
the right direction. One study found that in hospitals lacking such a device, the average time
it took to receive results of a blood sample sent to another facility was over fifteen hours,
compared to a ten-minute turnaround in CO-Oximeter equipped hospitals.
 Part C – Text 1 : Questions 1 to 8

1. In the first paragraph, what reason for the misdiagnosis of CO poisoning is highlighted?
A. the limited experience physicians have of it
B. the wide variety of symptoms associated with it
C. the relative infrequency with which it is presented
D. the way it is concealed by pre-existing conditions

2. In the second paragraph, the writer stresses the danger of delays in diagnosis leading to

A. the inefficient use of scarce resources.

B. certain symptoms being misinterpreted.
C. a deterioration in the patient's condition.
D. the evidence of poisoning disappearing.

3. The 67-year-old man's CO poisoning was only successfully diagnosed as a result of

A. attending an outpatient clinic.

B. his wife being similarly affected.
C. undergoing tests as an inpatient.
D. his suggesting the probable cause.

4. In the fourth paragraph, confusion is given as a symptom of

A. short-term exposure to high levels of CO.
B. repeated exposure to varying levels of CO.
C. a relatively low overall level of exposure to CO.
D. sustained exposure to CO over an extended period.
5. In the fifth paragraph, what point is made about COHb levels?
A. They fail to detect CO poisoning in habitual smokers.
B. They are a generally reliable indicator of CO poisoning.
C. They correlate very well with extreme levels of CO poisoning.
D. They are most useful in determining intermediate levels of CO poisoning.

6. The phrase 'one such factor' in the sixth paragraph refers to

A. a type of care.
B. a cause of difficulty.
C. a method of detection.
D. a way of making an assessment.

7. One result of administering oxygen to CO poisoned patients in transit is that

A. it becomes harder to ascertain when the COHb level peaked.
B. it may lead to changes in the type of symptoms observed.
C. it could artificially inflate the COHb level in the short term.
D. it affects the ability to assess the effects at tissue level.

8. What reservation about the CO-Oximeter does the writer express?

A. It does not always give an immediate result.
B. Its use needs to be approved by a physician.
C. It requires a skilled analyst to interpret the readings.
D. It does not show variations in the patient's condition

END OF READING TEST ,THIS BOOKLET WILL BE COLLECTED