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READING TEST 89
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.

PART A -TEXT BOOKLET - STUDY INTO KID’S INHALER USE

Text A
Inhalers may do nothing to help more than one in 10 children with asthma
who have been found to carry a mutated gene. A British study of nearly
1200 youngsters found children with a genetic variation called Arg16 are
twice as likely as other asthmatics not to respond to Ventolin inhalers, the
most common treatment for asthma. But experts, including Dr Noela
Whitby, of the National Asthma Council of Australia, have said children
need to continue using inhalers.

Text B
BREATHTAKING NEW DISCOVERY OF ASTHMA GENE
Researchers in the UK have uncovered a gene that triggers asthma. Bill
Cookson and colleagues’, from London’s Imperial College, compared the
genes of 1000 children with asthma and 1000 healthy ‘controls’ to track
down genes that were more common in the asthmatics and might
therefore provoke the condition. To do this the team used a system of
genetic markers called SNPs or single nucleotide polymorphisms. These
flag certain genetic sequences. By analysing large numbers of people
with a disease, and comparing them with people who don’t have the
condition, you can see SNPs, and hence DNA hotspots, that crop up
more often in the diseased individuals than in the healthy ones.
Using this technique, the team were able to home in on several DNA
hotspots on chromosome 17, and also identify a new gene, called
ORMDL3, which was much more common in the children with asthma
than the healthy controls. ‘This gene occurs in about 30% of children with
asthma,’ says Cookson. ‘It seems to have a fundamental role in the
working of the immune system, but we don’t know what it does yet.’ So
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the next step will be to study where in the body it operates and how it
works. This could well open up new avenues for the treatment or even
prevention of asthma. But the fact that only 30% of the asthmatic children
were carrying it shows that there’s much more to asthma than just
genetics, and that mystery still needs to be solved.

Text C
Turbuhaler Instructions
Before using your Turbuhaler, please read these instructions and follow
them carefully. Turbuhaler is a breath-activated inhaler. This means that
when you inhale from the Turbuhaler the medication is drawn into your
lungs. Unlike aerosol sprays, no propellants are necessary to deliver your
medication. This means that you will probably not feel anything as you
inhale the medication. If you carefully follow the four simple steps you can
be confident you have received the correct dose of medication. If you
require, further information about your medication ask your doctor or see
your pharmacist for a Consumer Medicine Information leaflet. You may
also like to contact the Asthma Foundation in your state (Australia) or
region (New Zealand) for further information about asthma.

Text D
How to use your Turbuhaler
1. REMOVE THE CAP
Unscrew and lift off the
cap.
2. LOAD THE TURBUHALER
Hold your Turbuhaler upright. Hold it by the white body, with the coloured
base at the bottom. Turn the coloured base in one direction as far as it will
go. Then turn it back in the opposite direction. During this procedure you
will hear a click.
3. INHALE THE MEDICATION
Breathe out gently away from the Turbuhaler. Hold the coloured base and
place the tip of the mouthpiece (sloping part) between your lips. Breathe in
forcefully and deeply through your mouth. Do not chew or bile the
mouthpiece. Remove your Turbuhaler from your mouth before breathing
out. If you require a second dose, simply repeat steps 2 and 3.

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4. REPLACE THE CAP

Remember to screw the cap back on.
NOTE- If you are using Pulmicort Turbuhaler rinse mouth with water after
each use.

PART A -QUESTIONS

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. who discovered the gene that triggers asthma?

2. what are the user instructions of Turbuhaler?

3. what does SNP stands for?

4. give an example for breath-activated inhaler?

5. how many subjects were there in the British study?

6. what is the most common treatment for asthma?

7. name the genetic variation found in children with asthma?

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, number of the both. Your answers should be correctly
spelled.

8. What are responsible for medication delivery in aerosol sprays?

9. Which gene is more common in the children with asthma?

10. Who provides consumer medicine information leaflet for Turbuhaler?

11. Which Turbuhaler users are required to rinse mouth with water after
each use?
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12. How many steps are there to ensure the proper usage of Turbuhaler?

13. How many subjects’ genes were compared with healthy controls by
researchers in UK?

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, number or both. Your answers should be
correctly spelled

14. You will probably not feel anything as you inhale the medication from
________
15. During the completion of loading procedure of Turbuhaler, you will
hear________
16. Genetic markers help to flag certain ____________
17. While inhaling the Turbuhaler, you have to hold____________
18. Researchers in UK were able to home in on several DNA hotspots
on_______
19. After using Turbuhaler, do not forget to _________________ back on
20. ______________ seems to have a fundamental role in the working of
the immune system against asthma

END OF PART A THIS TEXT BOOKLET 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 the answer (A, B or C) which you think fits best
according to the text. Write your answers on the separate Answer Sheet

Questions 1-6

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1. What does this manual tell us about local anaesthetic agents?

A. for both epithermal and central nerve blocks
B. work by dispersing across the myelin sheath or neuron
membrane
C. are used by anaesthetists and other experienced medical
practitioners

Local anaesthetic agents

Local anaesthetic agents are used by anaesthetists and other experienced
practitioners for both peripheral and central nerve blocks, examples being
femoral nerve block and spinal
(subarachnoid) block, respectively. Less commonly now, regional
intravenous blockade (Biers’ block) of limbs may be performed.
Local anaesthetics work by diffusing across the myelin sheath or neuron
membrane in their non-ionised form. More lipid-soluble agents are more
potent because more of the drug can cross into the neurone.

2. The guidelines require those administrating flumazenil to

A. remember that it has a short-term life
B. should continually monitor patient for occurring sedation
C. should be prepared to give additional doses
Antagonist
Flumazenil is a competitive inhibitor at the benzodiazepine binding site. It
is available in 5-mL ampoules containing 500 microgrammes (µg) of drug.
A dose of 200 µg should be administered over 15 seconds in suspected
benzodiazepine overdose, with supplementary boluses of 100 µg if the
patient fails to respond. It should be remembered that flumazenil has a
short half-life compared with most benzodiazepines; the patient should
be continually monitored for recurring sedation and the practitioner
prepared to give additional doses.

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3. The purpose of these notes about diagnostic pleural is to

A. help maximise its efficiency.
B. give guidance on the procedure.
C. recommend a procedure for anaesthesia.

Diagnostic pleural aspiration (tap)

For a diagnostic pleural tap attach a green needle to the 50-mL
syringe and insert the needle through the area of skin which has been
anaesthetised. Again, the needle should be inserted just above the upper
border of the rib. Aspirate 50 mL of pleural fluid then withdraw the needle
and apply a dressing to the site. Some hospitals have ready-made
pleural aspiration packs.

4. The purpose of this email is to

A. report on a rise in use of rehabilitation aids.
B. explain different types of rehabilitation aids.
C. remind staff about procedures for usage of rehabilitation aids.

Rehabilitation aids
Active rehabilitation most frequently involves activity, which may be
preformed with or without aids to facilitate movement. Today, there are
many types of aids that facilitate patient mobility and make the work of
staff easier.
The following examples of rehabilitation aids are used to facilitate mobility
in the patient:
• Walkers – solid, underarm, two, three and four-wheel
• Crutches, walking sticks
• Wheelchairs – mechanical, electrical
• Verticalization tables
• Suitable for fitness exercises: Exercise bike, rehabilitation pedal
exerciser to strengthen the lower limbs, and similar.

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5. The notice is giving information about

A. ways of checking that breathing exercises has been done
correctly.
B. how breathing exercises are performed and recommended.
C. which staff should perform breathing exercises.

Breathing exercises
Breathing exercises can be performed separately or they can be part of
fitness or specially targeted exercises. Breathing exercises (breathing
gymnastics) have preventative and therapeutic importance. These are
included if it is necessary to increase lung ventilation, improve
expectoration of secretions from the respiratory tract, etc. Exercise
should be according to the current medical condition of the patient; the
usual recommendation is 20 times, at least 4 – 5 times a day.

6. Which healthcare professional should lead fitness exercise

A. either physiotherapist or nurse
B. neither physiotherapist nor nurse
C. both physiotherapist and nurse
Fitness exercise
Fitness exercise is one of the simplest forms of physical activity for
recumbent and walking patients. It is performed in line with the medical
condition of the patient, usually 1 to 2 times a day for 10 to 15 minutes,
individually or in groups. The physiotherapist or nurse leads the exercise
in a group of patients with the same movement limitations, lying down,
sitting up or standing. The exercise is performed in a well-ventilated
room, usually in the patient’s room.

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. Write your answers on the separate Answer Sheet

Part C -Text 1
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Acupuncture
If you’re in pain, the last thing you may want is someone sticking needles
in you. But plenty of people turn to acupuncture for pain relief. So what is
the evidence? If the idea of someone sticking needles into you sounds
painful, imagine having it done when you are already in pain. It may sound
counterintuitive, but many people turn to acupuncture for pain relief.

Acupuncture is a component of traditional Chinese medicine, and

involves inserting of very thin, metal needles into specific ‘points’ on the
body. The theory, says Dr Marc Cohen, a professor of complementary
medicine at RMIT University, is that inserting the needles stimulates
these ‘points’ and unblocks the natural flow of light energy (qi or ch’i)
through your body. Blocked qi is thought to cause disease. Unblocking qi
allows your body to heal itself, says Cohen.

You can also think of acupuncture as a way of defusing pain trigger points,
says Cohen. “If you can find a trigger point that reproduces the pain you’re
experiencing... that’s a point where you put the needle [to relieve it],” he
says. Interestingly, these acupuncture ‘trigger’ points are not always in the
same spot as your pain. For example, says Cohen, people who have eye
pain often find a tender spot between their first and second toes. The
acupuncture point for frozen shoulder, a painful condition that immobilises
the shoulder joint, is on your chin. Scientific evidence

However, although acupuncture has been practiced for several thousand

years, scientists struggle to explain how it works. One theory suggests the
needling encourages the release of endorphins natural painkillers
produced by the brain) and sets off an inflammatory response that allows
the body to heal itself. Another theory is that acupuncture has a powerful
effect on the mind, says Cohen, which may also help to activate the
body’s pain-relieving mechanisms.

Modern science also has surprisingly little to say on whether acupuncture

successfully relieves pain or not. There are some high- quality studies,
mainly focusing on the relief of back pain and headache but they are small
– so what researchers have done is pool the results. A 2009 review of 22
existing studies on the prevention of migraine with acupuncture found that
people receiving acupuncture had fewer headaches after three to four
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months than those who received either no treatment or routine drug

treatment. Those receiving acupuncture also had fewer undesired
consequences, such as drug side-effects. Another review from the same
year found that acupuncture also reduces the intensity and frequency of
tension-type headaches.

For chronic lower back pain, a 2007 German study of 1162 participants
found that the effectiveness of acupuncture after six months was almost
twice that of conventional therapy (drugs, physical therapy and exercise).
A 2009 American study of 638 people found similar results. However, the
most current reviews pooling all available evidence on chronic lower back
pain don’t paint such a conclusive picture: they found that while
acupuncture is a useful addition to conventional therapies, there isn’t
sufficient evidence that it’s any more effective than other treatments.

In addition, a 2009 review of acupuncture for various types of pain found

that while acupuncture has a small analgesic effect, we can’t be sure this
isn’t caused by the psychological impact of the treatment. In spite of the
lack of conclusive evidence, many people turn to acupuncture to treat all
types of pain, including toothache, menstrual cramps and tennis elbow. If
you want to try acupuncture, you can go to a GP who practices
acupuncture (more than 15 per cent of GPs in Australia do) or a traditional
Chinese medicine practitioner

“A GP will have recourse to western medicine and will be covered by

Medicare, whereas a traditional Chinese medicine practitioner will put…
more emphasis on the traditional Chinese medicine diagnosis and
philosophy, including tongue diagnosis and pulse diagnosis,” says Cohen.
Sessions generally go for 15-30 minutes, and an initial course of once a
week for six weeks is normal for chronic pain, says Cohen. You may need
fewer sessions for acute pain. You should feel some immediate benefit for
acute pain, says Cohen. For chronic pain, you should feel some
immediate benefit that might initially wane off between sessions before
getting better.

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But you do need to give acupuncture a chance to work. “Give it at least

three or four treatments, up to six treatments before you say it doesn’t
work,” says Cohen. Acupuncture administered by a qualified person is
extremely safe, says Cohen. “All drugs have side-effects and certainly
pain medications (such as steroids and anti-inflammatory medications)
can have very severe side-effects.” Practitioners use disposable needles,
so there is minimal risk of infection. It’s worth asking practitioners about
their qualifications (they should have completed a four to five year
degree), whether they are registered with their professional association,
and what their experience is with the condition you’re seeing them for,
says Cohen.

If you do decide to try acupuncture for your pain, it is important that you
still initially seek medical treatment so that you do not miss any underlying
conditions. Nevertheless, many pain specialists caution against becoming
overly reliant on acupuncture, or any other treatment, to help you manage
pain. Dr Paul Wrigley, senior staff specialist at the Pain Management
Research Institute in Sydney, suggests that learning ways to self-manage
your pain – for example by pacing yourself and learning to reduce your
anxiety levels – can help reduce the degree to which pain interferes with
your life. Therefore, while acupuncture helps some people manage their
pain, in the end, you need to figure out what works best for you.

Part C -Text 1: Questions 7-14

7. Acupuncture ___________ of the body

a. Needle stimulates
b. Unblocks the energy flow
c. None of the above
d. A and b

8. How does heating occur in Acupuncture?

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a. by unblocking
b. by itself
c. both the above
d. none

9. Acupuncture is a pain trigger point method.

a. yes
b. no
c. not given
d. only for few disease

10. Acupuncture point for frozen shoulder is

a. chin
b. a point in toes
c. a point face
d. all the above

11. Endoprins are _____________

a. painkillers
b. part of brain
c. only (a) or only (b)
d. both a and b

12. To treat ___________ acupuncture was used.

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a. Migraine
b. Head aches
c. Both the above
d. None of the above

13. For what does acupuncture gives immediate relief?

a. head aches
b. acute pain
c. migrants
d. none of the above

14. Patients who wish to take acupuncture

a. can follow other treatment

b. should take other treatment
c. in starting go for other treatment
d. all the above

Part C -Text 2

SKIN CANCER MEDICINE IN PRIMARY CARE

The recent report of a patient who attended a skin cancer clinic in New
South Wales in 2016, and apparently failed to have a melanoma
diagnosed, and then sued his attending practitioner, sends a chill through
every doctor who has ever assessed a pigmented skin lesion. Although
settled out of court, this case highlights the clinical challenges of screening
for and diagnosing skin cancer, and throws into sharp relief the issue of
quality and safety in skin cancer clinics in Australia.

In the Newcastle Herald in July 2018, Emeritus Professor Bill McCarthy of

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the Sydney Melanoma Unit is quoted as saying “I want to make it clear

that I believe some clinics are very careful and do good work”. However,
he also expressed concern that quality across the clinics was patchy:

Obviously, some people have seen an entrepreneurial opportunity and

some clinics have been put together by non-medical people who have
simply advertised for doctors to work for them. The staffs of some clinics
do not have any specialised training: they may have just qualified or they
may be overseas practitioners. Some fancy themselves as surgeons and
maybe some were in other countries but they may not meet Australian
standards. There is no quality control and no accreditation scheme. Some
have come to me for advice. They might tell me they are going to work in a
skin cancer clinic in a country town, for example. They sit in on my clinics
for a day and, while that isn’t training, it’s better than nothing.

Skin cancer is by far the most common cancer in Australia. The most
common and important skin cancers are basal cell carcinoma (BCC),
squamous cell carcinoma (SCC), and malignant melanoma. In 2015, there
were estimated to be 374 000 cases of BCC plus SCC. The age-
standardised incidence of BCC alone in men was 1150/100 000; more than
10 times that of prostate cancer, the next most common cancer. Most
BCCs and SCCs occur in older Australians, causing considerable
morbidity, but little mortality. In 2013–2014, they were also the most
expensive cancer to treat, costing $264 million, followed by breast cancer
at $241 million. Melanoma is the most common cancer among those aged
15–44 years, and the second most common cause of cancer death in that
age group, and it accounts for 3% of all cancer deaths in all ages (1199
deaths in 2014).

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Skin cancers are the most common cancers managed by general

practitioners, with more than 800 000 patient encounters each year.
While historically GPs have managed most skin cancers, in recent years,
with the rapid growth of “skin cancer clinics”, there has been a dramatic
change. Little is known about these clinics; some include large
“corporate” chains and others comprise smaller independent operators.
Anecdotally, most doctors working in these clinics seem to be GPs, or at
least non-specialist doctors, from a variety of backgrounds.

Some concerns have been raised about the type and quality of work
performed within these clinics from other sectors of the profession.
The pros and cons of “the fragmentation of general practice”, typified by
skin cancer clinics, travel medicine clinics, women’s health clinics and
others have been considered previously.
Currently, in Australia, there are:

no barriers to working in skin cancer medicine in primary care;

limited training opportunities for generalist doctors wanting
to do this work (and no formal award courses);
no opportunities for skin cancer clinics to be accredited
against defined standards; and
no quality framework to support this work.

In August this year, the Skin Cancer Society of Australia was formed to
provide one mechanism to redress some of these deficiencies.

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Two of us (AD, PB) have worked in the skin cancer field for over 20
years, and A D has provided formal training for 15 years. When one of
us (DW) decided to start working in this field at the beginning of 2018,
there was no barrier to taking a position in a skin cancer clinic, and no
formal assessment of competency. There was also no barrier to
accessing the Medicare Benefits Schedule (MBS) item numbers that
relate specifically to the management of skin cancer, including some
that relate to fairly significant plastic surgical procedures. There were
no easily accessible training opportunities, or postgraduate awards for
general practitioners in skin cancer medicine.

Furthermore, as skin cancer clinics are demonstrably not general

practices, they cannot be accredited through the mechanisms that apply
to Australian general practice. It is unclear whether the concerns
expressed by other sectors of the profession lie in the age-old debate
“GPs versus specialists”, or whether it is “skin cancer clinic doctors
versus the rest”. Perhaps it is some of both. Certainly, there is real
concern among mainstream general practice that skin cancer clinics are
an expression (or the cause of) fragmentation, and there is real concern
from dermatologists and plastic surgeons about encroachment on their
domains of practice.

Without doubt, some dermatologists believe that they are the doctors
best placed to diagnose and manage patients with skin cancer.
However, there are hardly enough dermatologists to cope with current
demand for their general services, let alone enough to manage the
majority of skin cancers in Australia. Furthermore, some plastic
surgeons believe that patients receiving surgical treatment for skin
cancer should be treated exclusively by them, but the geographic
distribution of dermatologists and plastic surgeons in Australia
precludes their managing most patients. The perception may exist
among some GPs that skin cancer doctors are taking a lucrative
(procedural) aspect of their practice away. At least some of this debate
seems to be vested in professional self-interest, rather than a
dispassionate consideration of what is best for the patient.

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Most patients with skin cancer can be competently diagnosed and

treated by appropriately trained, non-specialist primary care physicians,
whether they are working in skin cancer clinics or in mainstream
general practice. We also believe that consultants, such as
dermatologists and plastic surgeons, have a crucial role to play in
helping manage the more complex cases, as well as providing training.
However, much more needs to be done if we are to collectively ensure
that patients enjoy maximal health outcomes, and that doctors are well
trained and supported.

Part C -Text 2: Questions 15-22

15. There is concern about quality and safety in skin
cancer clinics because:
a) some doctors employed lack the required skills
b) Australian standards are difficult to meet
c) they are in country towns
d) Doctors rarely attend training

16. Which of the following statements is not true?

a) Prostate cancer is less common than skin cancer
b) People often die from BCCs & SCCs
c) Melanoma is a common cancer for people aged
between 15~44
d) The older the person the greater the risk of BCCs

17. Which of the following is not mentioned as a problem in Australia

a) Lack of education & training
b) Lack of patients
c) Lack of recognised guidelines for the clinics
d) Ease at which doctors can choose to work in this area

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18. Dermatologists and plastic surgeons view skin cancer

clinics as a threat to their business.
a) True
b) False
c) Not mentioned
d) Author has no opinion

19. In the paragraph beginning with Without doubt the

author’s view is
a) Dermatologists can provide better treatment for
skin cancer patients
b) Only plastic surgeons should provide surgery
c) GPs earn a lot of money from skin cancer patients
d) That some practitioners are more concerned about
their professional reputation instead of patient benefit.

20. Which is the right heading for the first section of the
article?
a) Where does the divide lie?
b) The problem
c) Skin cancer in Australia
d) Skin cancer in general practice: emergence of new models of
care

21. Which is the right heading for the last section of the
article?
a) Where does the divide lie?
b) The problem
c) Skin cancer in Australia

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d) Skin cancer in general practice: emergence of new

models of care

22. Which is not one among the most common type of skin cancers in
Australia?
a) basal cell carcinoma
b) actinic keratoses
c)squamous cell
carcinoma
d) malignant melanoma

END OF READING TEST, THIS BOOKLET WILL BE COLLECTED

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Reading test 89 : Answer Key

Part A - Answer key 1 – 7

1. B
2. D
3. B
4. C
5. A
6. A
7. A

Part A - Answer key 8 – 14

8. propellants
9. ORMDL3
10. pharmacist
11. Pulmicort
12. four
13. 1000
14. Turbuhaler

Part A - Answer key 15 – 20

15. a click
16. genetic sequences
17. the coloured base
18. chromosome 17
19. screw the cap
20. ORMDL3

Reading test - part B – answer key

1. C
2. C
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3. B
4. B
5. B
6. A

Reading test - part C – answer key

Text 1 - Answer key 7 – 14
7. c
8. c
9. c
10. c
11. a
12. d
13. b
14. c

Text 2 - Answer key 15 – 22

15. a
16. b
17. b
18. b
19. d
20. c
21. a
22. b

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