Professional Documents
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Hiv Testing
Hiv Testing
Text A
What is an ELISA?
An ELISA or enzyme-linked immunosorbent assay, is a method used in the laboratory to aid in the diagnosis
of a wide range of diseases. This test is performed on blood or urine and is used for measuring the amount
of a particular protein or substance in these bodily fluids, such as infectious agents, allergens, hormones or
drugs.
This test relies on the interaction between components of the immune system called antigens and antibod-
ies. Antibodies are proteins produced by the body to identify and neutralise any foreign substances that may
be encountered, such as viruses and bacteria. The substances to which antibodies are produced are known
as the antigens as they stimulate an immune response.
ELISAs are used for numerous types of tests in the laboratory which can assist in the diagnosis of many
different conditions.
It is most commonly requested if it is suspected you have been exposed to viruses such as HIV and Hepatitis
B or C, or bacteria and parasitic infections such as Toxoplasmosis, Lyme disease and Helicobacter pylori. It
can also measure levels of antibodies to see if you have been vaccinated against certain diseases such as
mumps and rubella.
• Measuring certain hormone levels such as HCG in the pregnancy test, thyroid hormones
• Measuring antibodies which are produced in auto-immune conditions such as Lupus and rheuma-
toid arthritis.
Some kits are also available for the general public to use for example; the home pregnancy test is based on
the ELISA principle and detects the presence of a hormone known as human chorionic gonadotrophin (hCG)
which is excreted in the urine of a pregnant woman.
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Text B
Modern HIV tests are extremely accurate. There are a variety of different HIV tests and your healthcare worker
should explain which test you will be given and how you will get your result. Normally, testing involves taking a
small sample of blood from either your finger or your arm, or a sample of oral fluid.
How long an HIV test takes to give you an accurate result depends on the type of test you are taking. If you are
taking a rapid test, you will be given your results within 20 minutes. Other types of tests will be sent to a
laboratory and you may have to wait for the result which may take between a few days to a few weeks for you
to receive a final result.
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Text C
Baseline risk-assessment
PrEP is indicated for those at greater risk of HIV acquisition and therefore comprehensive history taking and
risk assessment, including both sexual and drug taking histories, are required to identify those most likely to
benefit.
Clinicians will need to make pragmatic decisions with patients about future HIV risk, their need for PrEP and
individual-level assessment of the benefit versus potential harms of PrEP. At a population level, given limited
resources and a desire to achieve the maximum impact of PrEP, clinicians should use clinical criteria and
recommendations as outlined in these guidelines, along with local and national criteria for NHS or clinical
trial eligibility to provide PrEP to those at highest risk of HIV acquisition.
It is well recognised that there are other risk behaviours and vulnerability factors that increase the risk of HIV
acquisition and these should be taken into consideration on a case-by-case basis by clinicians when
considering eligibility for PrEP and assessing HIV risk. Although this lacks a clear evidence base, the writing
group has considered this in terms of those who are ‘high risk’, and therefore PrEP would be recommended,
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Text D
Recommend PrEP
(i) HIV-negative MSM and trans women who report condomless anal sex in the previous 6 months and on-
going condomless anal sex.
(ii) HIV-negative individuals having condomless sex with partners who are HIV positive, unless the partner
has been on ART for at least 6 months and their plasma viral load is <200 copies/mL.
PrEP may be offered on a case-by-case basis to HIV-negative individuals considered at increased risk of HIV
acquisition through a combination of factors that may include the following:
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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 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.
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. Your answers should be correctly spelled.
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12. What kind of histories are required to identify those who need PrEP ?
13. How long will it take to detect HIV with self-testing kits?
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. Your answers should be correctly spelled.
15. People who engage in sex falls under population level indicators.
16. HIV tests involve taking sample from or the arm for detailed blood study.
17. for PrEP must be considered on the basis of vulnerability factors for HIV.
19. of self testing kits is satisfactory but requires further medical scrutiny.
20. Individuals who have with HIV positive partners must be recommended
PrEP.
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Part B
In this part of the test, there are four 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.
1. The changes in standards as per the revised protocol was necessitated due to
Executive Summary
Intravenous fluids are important components of appropriate care for hospitalised children. Reports in the
medical literature and warnings issued in other countries have highlighted the risks associated with use of
low sodium content fluids. The importance of appropriate glucose content has also been identified, and
emerging evidence suggests risks associated with high chloride. Individual or facility based responses to
the changing literature, along with the interim recommendations of a national expert group convened under
the auspices of Children’s Healthcare Australasia (CHA), have led to variable practices across NSW Health
hospitals with consequent inconsistencies and risks. The NSW Chief Paediatrician was tasked to engage
clinical experts, HealthShare and a range of other partners in the development of statewide standards
across all NSW facilities. The resultant Standards for Paediatric IV Fluids: NSW Health addresses fluid
content, bag size, labelling, administration, procurement and storage. A succinct Statement of the Stan-
dards presents the key messages and related actions on a single page.
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2. The guidelines on CDCT aims to enumerate the
• Benefit: Screening with LDCT has been shown to substantially reduce the risk of dying from lung cancer
• Limitations: LDCT will not detect all lung cancers or all lung cancers early, and not all patients who have
a lung cancer detected by LDCT will avoid death from lung cancer
• Harms: There is a significant chance of a false-positive result, which will require additional periodic
testing and, in some instances, an invasive procedure to determine whether or not an abnormality is lung
cancer or some nonlung-related incidental finding; <1 in 1000 patients with a false-positive result expe-
riences a major complication resulting from a diagnostic workup; death within 60 d of a diagnostic
evaluation has been documented but is rare and most often occurs in patients with lung cancer
• Individuals who value the opportunity to reduce their risk of dying from lung cancer and who are willing
to accept the risks and costs associated with having an LDCT and the relatively high likelihood of the
need for further tests, even tests that have the rare but real risk of complications and death, may opt to
be screened with LDCT every year.
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3. The evaluation and management exercise requires students to
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4. On suspecting a disorder it is important to
• Ask focused questions if psychosis is suspected and do not too readily dismiss symptoms as the results
of depression, anxiety, or substance misuse
• Avoid arguing with the patient—for example, by saying, “Of course there aren't devils under the bed.” It
works better to say, “I understand that this is how it appears to you, but this is how it appears to me”
• Be true to the person as they were when well. Remember hostility can be a symptom of the illness
• Avoid diagnostic labels at too early a stage; instead, focus the discussion around the patient’s symptoms
and experiences
• Avoid using stigmatising language. For example, some patients prefer “a person who experiences schizo-
phrenia” rather than “schizophrenic”
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5. The statutory catalogue informs
1. Under common law, any restricted sharing of information must not identify any individual unless
there is a legal means and purpose to do so. Permissible legal means will include cases when:
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6. The health guide advices individuals to
• Making decisions now about the types of health care you would and would not want to receive if you
become very sick or injured and couldn’t speak for yourself in the future
• Choosing a person you want to make decisions for you if you’re unable to do so for yourself. This person
is called a health care agent
• Talking with your doctors and loved ones about the types of health care you want to receive so they’ll
respect and honor your values and health care goals
• Writing down your health care goals in MyCare, an advance directive. This form guides your health care
providers as to what types of health care you want. It also helps your loved ones understand your wishes
in case they have to make health care decisions for you
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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..
Pancreatic cancer is the 10th most frequently occurring cancer but the fifth most common cause of cancer
death in Australia, as is also seen in other developed regions of the world. A gradual increase in incidence has
been observed since the 1980s in almost all age groups in both sexes. Increases have been attributed only to
trends in smoking, which is considered causal, with local published data suggesting a lag of about 30 years
between smoking trends and incidence. However, being overweight and obesity may also have contributed, in
part, to incidence trends.
In developed countries, only about 50%–70% of cases of pancreatic cancer are histologically confirmed
based on review of the primary tumour, because pancreatic biopsy procedures have been associated with
significant risks and are often avoided. But improvements in imaging modalities, particularly endoscopic
ultrasound and pancreas-specific computed tomography, and magnetic resonance imaging protocols, together
with endoscopically guided biopsy procedures, are likely to have led to some of the increase in incidence
through improved detection.
In 2011, the latest year for which results are available, 5-year survival from pancreatic cancer was 5.2% in
Australia and 7.3% in the United States (among patients on selected Surveillance, Epidemiology and End
Results Program registers) with modest improvements observed over the past several decades. Five-year
survival from pancreatic cancer was about 3% in the mid1980s in both places. Between 1987 and 2007 in
Australia there was only a 6% drop in mortality from pancreatic cancer in both sexes (in those aged less than
75 years), compared with decreases in mortality of 34% from lung cancer, 47% from bowel cancer and 28%
from all cancers overall. Current projections suggest that within 10 years, pancreatic cancer will be the
second-highest cause of cancer death in the US as mortality and survival from the other four leading causes
of cancer death (lung, bowel, prostate, and breast cancers) improves. If these trends are reflected in Australia,
it would be anticipated that pancreatic cancer will become one of the leading causes of cancer mortality there
also.
Complete resection of the primary tumour currently offers the only hope of cure. Beyond the setting of high-
risk families, screening to identify precursor or early invasive lesions is not feasible for two main reasons.
First, endoscopic ultrasound is invasive and can only be used in specialised settings, so does not meet
criteria for a population screening test. Second, the positive predictive value of screening is limited by the low
population prevalence of pancreatic cancer. Attempts to categorise the population using known risk factors,
including several known single nucleotide polymorphisms, have not yet identified population subgroups at
sufficiently high risk to warrant screening.
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An avenue to optimise outcomes for patients is to ensure that all receive high-quality care in the most
appropriate setting. There is evidence from the US that not all patients with potentially resectable tumours are
offered surgery. Detailed data are not currently available for Australia, but it appears that there is similar
underutilisation of surgery there. It is thus important that all patients without metastatic disease are reviewed
by a multidisciplinary team in a major centre to determine the resectability of their pancreatic tumours. In
addition, it is of great consequence that resections be performed in hospitals that carry out a large number of
these procedures annually, as this has been shown to improve survival.
In conclusion, while the rise in pancreatic cancer incidence is slow, as the population ages, more people will
be affected with this disease. The burden of pancreatic cancer relative to other cancer types is likely to
increase. A multilevel approach is needed to control pancreatic cancer, including reducing the prevalence of
risk factors such as smoking and obesity, identifying effective biomarker screening tools and populations in
whom screening or early detection might be feasible, discovering new treatment modalities and ensuring that
all patients have access to optimal care.
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Text 1: Questions 7 - 14
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11. The word modest in paragraph 3 could NOT be replaced by ……
A Minor
B Marked
C Meagre
D Moderate
12. The figures for pancreatic cancer from the passage indicate
A Justify
B Classify
C Rectify
D Objectify
A Dismissive
B Biased
C Objective
D Disapproving
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Text 2: Role of oral health on overall well-being
The relationship between oral health and diabetes (Types 1 and 2) is well known and documented. In the last
decade, however, an increasing body of evidence has given support to the existence of an association between
oral health problems, specifically periodontal disease, and other systemic diseases, such as those of the
cardiovascular system. Adding further layers of complexity to the problem is the lack of awareness in much
of the population of periodontal disease, relative to their knowledge of more observable dental problems, as
well as the decreasing accessibility and affordability of dental treatment in Australia. While epidemiological
studies have confirmed links between periodontal disease and systemic diseases, from diabetes to autoimmune
conditions, osteoporosis, heart attacks and stroke, in the case of the last two the findings remain cautious
and qualified regarding the mechanics or biological rationale of the relationship.
Periodontal diseases, the most severe form of which is periodontitis, are inflammatory bacterial infections
that attack and destroy the attachment tissue and supporting bone of the jaw. Periodontitis occurs when
gingivitis is untreated or treatment is delayed. Bacteria in plaque that has spread below the gum line release
toxins which irritate the gums. These toxins stimulate a chronic inflammatory response in which the body, in
essence, turns on itself, and the tissues and bone that support the teeth are broken down and destroyed.
Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected.
As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this
destructive process only has very mild symptoms. Eventually, however, teeth can become loose and may
have to be removed.
The current interest in the relationship between periodontal disease and systemic disease may best be
attributed to a report by Kimmo Mattila and his colleagues. In 1989, in Finland, they conducted a case-control
study on patients who had experienced an acute myocardial infarction and compared them to control subjects
selected from the community. A dental examination was performed on all of the subjects studied, and a dental
index was computed. The dental index used was the sum of scores from the number of carious lesions,
missing teeth, and periapical lesions and probing depth measures to indicate periodontitis and the presence
or absence of pericoronitis (a red swelling of the soft tissues that surround the crown of a tooth which has
partially grown in). The researchers reported a highly significant association between poor dental health, as
measured by the dental index, and acute myocardial infarction. The association was independent of other risk
factors for heart attack, such as age, total cholesterol, high-density lipoprotein triglycerides, C peptide,
hypertension, diabetes, and smoking.
Since then, researchers have sought to understand the association between oral health, specifically periodontal
disease, and cardiovascular disease (CVD) – the missing link explaining the abnormally high blood levels of
some inflammatory markers or endotoxins and the presence of periodontal pathogens in the atherosclerotic
plaques of patients with periodontal disease. Two biological mechanisms have been suggested. One is that
periodontal bacteria may enter the circulatory system and contribute directly to atheromatous and thrombotic
processes. The other is that systemic factors may alter the immunoflammatory process involved in both
periodontal disease and CVD. It has also been suggested that some of these illnesses may in turn increase
the incidence and severity of periodontal disease by modifying the body’s immune response to the bacteria
involved, in a bi-directional relationship.
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However, not only is ‘the jury out’ on the actual mechanism of the relationship, it also remains impossible to
say whether treating gum disease can reduce the risk of cardiovascular disease and improve health outcomes
for those who are already sufferers. Additional research is needed to evaluate disease pathogenesis. Should
the contributing mechanisms be identified, however, it will confirm the role of oral health in overall well-being,
with some implications of this being the desirability of closer ties between the medical and the dental professions,
and improved public health education, not to mention greater access to preventive and curative dental treatment.
In time, periodontal disease may be added to other preventable risk factors for CVD, such as smoking, high
blood cholesterol, obesity and diabetes.
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Text 2: Questions 15 - 22
A causative
B scientific
C plagiarised
D controlled
A prompted further interest in the link between oral health and systemic disease.
B did not take into account a number of important risk factors for heart attacks.
C concluded that people with oral health problems were likely to have heart attacks.
D was not considered significant when it was first reported but is very major now.
18. The relationship between dental hygeine and heart attacks as is expressed in paragraph three is
A inconclusive
B coincidental
C evident
D inconsequential
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19. As per paragraph three, the dental index was primarily used to
21. If the processes by which gum disease affects CVD, there will be ……
22. The expression the jury (is) out in paragraph 5 means that a definitive conclusion is ……
A imminent.
B impossible.
C without any merit
D yet to be attained.
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