READING TEST - 5

DIABETES

Text A
Diabetes is the name given to a group of different conditions in which the body cannot
maintain healthy levels of glucose (a type of sugar) in the blood. It is usually a lifelong condition
that causes a person's blood sugar level to become too high. Blood glucose levels that are too
low can lead to a person falling into a diabetic coma and death. High levels, over a long period
of time can lead to blindness, kidney failure and lower limb amputation.

Type 1 diabetes most commonly affects children and adults aged under 30. Less than 10% of
diabetics have Type 1 diabetes. The pancreas cannot produce insulin so the body cannot
process glucose. There is a high hereditary link. Type 1 cannot be prevented or managed with
diet and exercise. It is thought to be caused by the auto immune system attacking the pancreas.
Type 1 diabetes develops quickly and can make a person very ill.

Type 2 mostly affects adults, especially older people. The body does not produce enough insulin
to keep blood glucose levels at a healthy level. Type 2diabetes is strongly linked to being
overweight and having a lifestyle with a poor diet and limited exercise. This means it can be
prevented and also, the effects of it reduced if lifestyle changes are made. Type 2 diabetes
develops slowly, often over many years.

Gestational diabetes develops during pregnancy, usually in the second half. It can cause
problems for baby and mother if it is not well managed. A large birthweight baby is the most
common side effect. It usually disappears after giving birth but there is an increased risk of the
mother developing Type 2 at some point in the future.

Pre-diabetesis when a person has higher than normal blood sugar readings but not high
enough to be diagnosed as being diabetic. If a person changes their diet, they can stop or delay
the development of Type 2 diabetes.

Text B

Clinical assessment
 Obtain patient history including family history of diabetes and possibility of pregnancy
 Ask if they are experiencing any of the following signs and symptoms:
- feeling very thirsty
- passing urine more frequently than usual, particularly at night
- feeling very tired
- weight loss and loss of muscle bulk
- itching around the penis or vagina, or frequent episodes of thrush
 - cuts or wounds that heal slowly
- blurred vision
 Check pulse, blood pressure, urinalysis and do a capillary blood glucose test (cBGT)

Further investigations to confirm diagnosis

 Random blood glucose test, with a result of 11.1 mmol/L or higher

 Fasting blood glucose test with a result of 7 mmol/L or higher on two separate tests
 Oral glucose tolerance test with a result 11.1 mmol/L or higher
Glycosylated haemoglobin (Hb1Ac) test might also be performed. This measures the average
blood glucose level over the past 2–3 months. A result of 6.5% or higher on two separate tests
indicates diabetes.

Text C
Managing diabetes
 Type 2 and gestational diabetics are often managed with oral medication initially.
 Over time they may need to start insulin replacement therapy to keep their blood glucose levels
within the optimum range.
 Type 1 diabetics always need insulin replacement therapy.
- Insulin can only be taken as subcutaneously. Patients or a relative need to be
taught to do this themselves by injection or using a pump.
- Type 1 diabetics have fluctuating blood glucose levels so need to monitor their
own cBGT levels before meals and the amount of insulin they give themselves,
depends on the result.
- Type 2 and gestational diabetics are usually more stable. If they are taking oral
medication, they may only test their cBGT daily or less frequently.
- Once on insulin, Type 2 and gestational patients need to monitor their cBGT
frequently until stable and then once or twice daily is usually enough. Their
insulin dose usually becomes stable, with the same amount been administered
once or twice a day.
 Some diabetic patients, especially Type 1’s, struggle to keep their levels stable. These patients
may have their insulin administered steadily across 24 hours through an insulin pump. These
patients may also have a monitor that checks their blood glucose levels.
 A healthy lifestyle is an important part of diabetes management
- Carbohydrate counting is important for Type 1 diabetics to help control their
blood glucose levels
- Eating healthy foods (low-fat high-fibre foods) and maintaining a healthy
bodyweight.
- Exercising regularly (at least 30 minutes on most days of the week)
 Text D
Monitoring a person

 Regular checks to monitor several risk factors are encouraged to increase the chance of living a
full and long life. These include:
- annual diabetic eye screening is a 30 minute eye examination that can quickly
detect if there is any damage to blood vessels in the eye as a result of poor blood
glucose control
- annual foot check for ulcers and infections or change in feeling in your feet
- annual blood pressure, cholesterol and kidney function checks
- 3 monthly Glycosylated haemoglobin (Hb1Ac) until stable and then 6 monthly. It
is generally recommended that Hb1Ac levels should be maintained below 7%.
 Encourage appointments with their doctor if they
- have cut, blister or graze to a lower limb
- increased blurred vision
- a urinary tract infection
- signs of hyperglycaemia (high blood glucose),
- signs of hypoglycaemia (low blood glucose)

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
1. annual eye screening?

2.2the condition that precedes diabetes?

3. the acceptable readings for a person’s HB1Ac?

4. how insulin replacement is administered?

5. the habits needed for good diabetes management?

6. the most common side effect of gestational diabetes?

7. the indicators that a person might be diabetic?

Questions 8-14
Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each
answer may include words, numbers or both

8. What is the prevalence of diabetics who have Type 1?

9. Which organ is not working correctly leading to diabetes?

10. What is the most usual treatment approach for people with Type 2 diabetes?

11. How often is it appropriate for a woman with gestational diabetes to test her cBGT if she is
taking oral medication?

12. How are the most common effects of having diabetes monitored?

13. If a person cannot keep their blood glucose levels stable, what device might they use to
administer their insulin?

14. Which type of diabetes can be prevented by making changes to diet and taking up an
exercise regime?

Questions 15-20
Complete each of the sentences, 15-20, with a word or short phrase from one of the texts.
Each answer may include words, numbers or both

15. An oral glucose tolerance test with a result of _________________ or higher confirms a
diagnosis of diabetes.

16. A person with diabetes ought to see a doctor if they have a cut to a
_______________________ .

17. A diabetic eye screening is a half hour long eye that can pick up any early signs of damage to
___________________________ in the eye.

18. A routine diabetes check involves pulse and blood pressure checks, urine analysis and
a____________________________ test .

19. Type 1 diabetes is most predominant in children and adults aged _________________

20. Type 1 diabetic patients check their cBGT before _______________________. And
administer an amount of ------------------------------------- based on the cBGT ------------------------------
 PART - B

Testing for Nystagmus

Patients with abnormal hearing on history or physical examination or with tinnitus or vertigo
undergo an audiogram. Patients with nystagmus or altered vestibular function may benefit
from computerized electronystagmography (ENG), which quantifies spontaneous, gaze, or
positional nystagmus that might not be visually detectable. Computerized ENG caloric testing
quantifies the strength of response of the vestibular system to cool and warm irrigations in
each ear, enabling the physician to discriminate unilateral weakness. Different components of
the vestibular system can be tested by varying head and body position or by presenting visual
stimuli. Posturography uses computerized test equipment to quantitatively assess the patient's
control of posture and balance. The patient stands on a platform containing force and motion
transducers that detect the presence and amount of body sway while the patient attempts to
stand upright. The testing can be done under various conditions, including with the platform
stationary or moving, at or tilted, and with the patient's eyes open or closed, which can help
isolate the contribution of the vestibular system to balance.

1. What tests are identified in this article that determine if a person has
nystagmus in one or both eyes?
A. Computerised electronystagmography
B. Checking the effect on the person when they are on a special platform
C. Putting water of variable temperature into the auditory canal
Screening for childhood obesity and vascular conditions

The proposed study includes children aged between 9-10 years from the SCOPE (Screening for
Pregnancy Endpoints) study. The SCOPE study was conducted in Adelaide during 2005-2008 and
1164 nulliparous pregnant women, their partners and babies were recruited. Detailed
information was collected during pregnancy. Of the 1164 women in the study, 861 had
uncomplicated pregnancies, 93 developed preeclampsia, 118 had gestational hypertension, 95
normotensive women delivered SGA babies and 69 delivered preterm.

We will invite all children of women recruited to the SCOPE study to participate at age 9-10
years. Data will be collected on diet, physical activity, height and weight. Haemodynamic
measures will be done noninvasively as follows. @medcity Central blood pressure and
augmentation index (an indicator of arterial stiffness) will be measured using the USCOMBP+.
Cardiac output and systemic vascular resistance will be measured using the USCOM 1A.
Microvascular function will be assessed by Post Occlusive Reactive Hyperaemia methods using
Laser Doppler. The results of children born after complicated pregnancies will be compared
with those of children born after uncomplicated pregnancies.

2. What daily activities of the child subjects in this clinical trial will be observed?
A. If they had preeclampsia.
B. Their eating and exercise habits.
C. If they have sibling
South Australia worst for children’s asthma hospitalizations according to new report

A new report has revealed that more South Australian children are hospitalised because of their
asthma than anywhere else in the country. Between 2011 and 2013, 361 children per 100,000
on average presented to South Australian hospitals, above the rates for NSW and Victoria.
There were only 157 presentations per 100,000 people in Tasmania, which has the highest
prevalence at 12.6 per cent. Asthma Australia chief executive Michele Goldman said the
number of hospital cases in South Australia was unusual and finding out why was the "magic
question". She said the condition was often overlooked in GP appointments, which could make
management of it tricky. @medcity "There's not enough time currently in the system to provide
the education that's required so that people with asthma understand the condition, understand
the role of preventer medication and have the tools they need to self-manage the condition
well," Ms Goldman said.

3. What reason is given in this articles that explains why hospitalisation of

children with asthma is worse in South Australia?
A. Lack of time to upskill asthma sufferers
B. Lack of time to upskill GP practice staff about asthma
C. Lack of time to upskill hospital staff about asthma
Risks associated with hepatitis B in pregnancy

Mother-to-child transmission occurs frequently either in the uterus, through placental leakage,
or through exposure to blood or blood-contaminated fluids at or around the time of birth (Lee
et al 2006). Perinatal transmission is believed to account for 35–50% of hepatitis B carriers (Yao
1996). The risk of perinatal transmission is associated with the hepatitis B envelope antigen
(HbeAg) status of the mother. If a woman is both hepatitis surface antigen (HbsAg) and HbeAg
positive, 70–90% of her children will develop hepatitis B (Stevens et al 1975; Akhter et al 1992).
If the mother is HbsAg positive but HbeAg negative, the risk is reduced (Okada et al 1976;
Beasley et al 1977; Beasley et al 1983; Nayak et al 1987; Aggarwal Ranjan 2004). In a cohort
study of HbsAg-positive, hepatitis B DNA-positive women in Sydney (n=313) (Wiseman et al
2009), transmission rates were 3% among hepatitis B DNA-positive women overall, 7% among
HbeAgpositive mothers and 9% among women with very high hepatitis B DNA levels. It has
been estimated that people who are chronic carriers of HbsAg are 22 times more likely to die
from hepatocellular carcinoma or cirrhosis than noncarriers (95%CI 11.5 to 43.2) (Beasley &
Hwang 1984)

4. Most children born will develop hepatitis B if their mother

A. Has hepatitis B envelop antigen
B. Is a chronic carrier of Hepatitis surface antigen
C. Has hepatitis B envelop and surface antigen
Memo: revised guideline for managing urethral catheters in adults

The purpose of this guideline is to provide the best practice principles to be applied when
inserting and managing urethral catheters for adult patients in NSW Public Health

Organisations (PHOs), to reduce unnecessary catheterisation and the risk of the catheter
associated urinary tract infection.

This document is intended to support all trained and credentialed healthcare clinicians who are
competent in urinary catheter practice for acute care settings. It is the responsibility of the PHO
to ensure clinicians whose role involves the insertion, maintenance or removal of urethral
catheters are trained and credentialed.

This guideline addresses the insertion, care and removal of urethral catheters in adults during
acute care. This guideline does not address suprapubic catheterisation, acute paediatric
catheterisation or care and use of chronic or long term catheters for adult patients. This
document provides limited advice for maternity and birth settings however these units should
refer to local procedures for further clarification.

5. Which health care professionals is this guideline NOT targeted at?

A. Medical officers, acute care nurses and gynaecologists
B. Emergency department nurses, theatre staff and surgical ward staff
C. Aged care sector nurses, midwives and paediatrician
Hearing loss

Sensorineural hearing loss is caused by lesions of either the inner ear (sensory) or the auditory
(8th) nerve. This distinction is important because sensory hearing loss is sometimes reversible
and is seldom life threatening. A neural hearing loss is rarely recoverable and may be due to a
potentially life-threatening brain tumor— commonly a cerebellopontine angle tumor. An
additional type of sensorineural loss is termed auditory neuropathy spectrum disorder, when
sound can be detected but the signal is not sent correctly to the brain, and is thought to be due
to an abnormality of the inner hair cells or the neurons that innervate them within the cochlea.

6. Why is it important to diagnose what type of hearing loss they have?

A. Sensory hearing loss may improve.
B. Neural hearing loss does not improve.
C. Sensory hearing loss is caused by brain tumor.
 PART - C

Text 1
Today, neuroscientists can determine one’s intelligence through a brain scan, as sci-fi as that
sounds. Not only that, it’s only a matter of time before they are able to tell each individual’s set
of aptitudes and shortcomings, simply from scanning their brain. Researchers at Yale led the
study. They interpreted intelligence in this case as abstract reasoning, also known as fluid
intelligence. This is the ability to recognize patterns, solve problems, and identify relationships.
Fluid intelligence is known to be a consistent predictor of academic performance. Yet, abstract
reasoning is difficult to teach, and standardized tests often miss it.

Researchers in this study could accurately predict how a participant would do on a certain test
by scanning their brain with an fMRI. @medcity 126 participants, all a part of the Human
Connectome Project, were recruited. The Human Connectome Project is the mapping of all the
connections inside the brain, to get a better understanding of how the wiring works and what it
means for things like intellect, the emotions, and more. For this study, researchers at Yale put
participants through a series of different tests to assess memory, intelligence, motor skills, and
abstract thinking.

They were able to map the connectivity in 268 individual brain regions. Investigators could tell
how strong the connections were, how active, and how activity was coordinated between
regions. Each person’s connectome was as unique as their fingerprint, scientists found. They
could identify one participant from another with 99% accuracy, from their brain scan. Yale
researchers could also tell whether the person was engaged in the assessment they were taking
or if they were aloof about it.

Emily Finn was a grad student and co-author of this study. She said, “The more certain regions
are talking to one another, the better you’re able to process information quickly and make
inferences.”@medcity Mostly, fluid intelligence had to do with the connections between the
frontal and parietal lobes. The stronger and swifter the communication between these two
regions, the better one’s score in the abstract thinking test. These are some of the latest
regions to have evolved in the brain. They house the higher level functions, such as memory
and language, which are essentially what make us human.
Yale researchers believe that by learning more about the human connectome, they might find
novel treatments for psychiatric disorders. Things like schizophrenia vary widely from one
patient to the next. By finding what’s unique to a particular patient, a psychiatrist can tailor
treatment to suit their needs. Understanding one’s connectome could give insight into how the
disease progresses, and if and how the patient might respond to certain therapies or
medications.

But there are other uses which we may or may not feel comfortable with. For instance, your
child could have their brain scanned to track them at school, according to study author Todd
Constable. It might be used to say whether or not a candidate is qualified for a job or should
pursue a certain career. Brain scans could tell who might be prone to addiction, or what sort of
learning environment a student might flourish in. @medcity School curriculum could even be
changed on a day-to-day basis to t student’s needs. And the dreaded SAT might even be
shelved too, in favor of a simple brain scan.

Peter Bandettini is the chief of functional imaging methods at the National Institute of Mental
Health (NIMH). He told PBS that barring ethical issues, brain scans could someday be used by
employers to tell which potential candidate possesses desirable aptitudes or personality traits,
be they diligent, hardworking, or what-have-you. Richard Haier, an intelligence researcher at
UC Irvine, foresees prison officials using such scans on inmates to tell who might be prone to
violence.

We may even someday learn how to augment human intelligence from studies such as this. It’s
important to remember that intelligence research is still in its infancy. Yet, according to Yale
scientists, we are moving in this direction

Questions 7-14
7. Through a brain scan, neuroscientists today can determine an individual’s
Which of the following does the Human Connectome Project involve?
A. abstract reasoning
B. abilities
C. weaknesses
D. academic performance

8. Which of the following does the Human Connectome Project involve?

A. Mapping networks inside the brain
B. Understanding how connections in the brain function
C. Understanding intellect and emotions
D. Assessing researchers
9. In what way is a connectome similar to a fingerprint?
A. In its strength
B. In its activity
C. In its individuality
D. Note given

10. what does intelligence depend on according to the study

A. On the quality of connections between different regions in the brain
B. On the processing of information in different regions in the brain
C. On the way higher levels function in the brain
D. On the talk between certain regions in the brain

11. Why can the human connectome help patients with schizophrenia?
A. Because disorders like schizophrenia require unique treatment
B. Because the disorder is distinctive for every patient, as is the connectome
C. Because by understanding the connectome doctors can understand
schizophrenia
D. Because individual courses of treatments can be designed for every
patient

12. Which of the following won’t be achieved by mapping the human connectome?
A. Tracking children’s success at school
B. Defining someone’s career
C. Determining the right candidate for a job
D. Identifying drug addicts

13. What does the author imply by saying “the dreaded SAT might even be shelved
too”?
A. That the SAT might be successfully passed.
B. That the SAT might be suspended.
C. That the SAT might be carefully organized.
D. That the SAT might be failed.

14. studies such as this

A. Are not ethical
B. Reveal much about criminal minds
C. Are only at the early stage of development
D. Are at the peak of their success
Text 2
The largest studies to date, by arguably the most respected institutions up to this point, show
that psilocybin, a compound within "magic mushrooms", can be effective in treating depression
and anxiety in cancer patients. The studies were carried out on 29 patients by researchers at
New York University (NYU) and on 51 patients at Johns Hopkins University.

Notably, up to 40% of all cancer patients are afflicted by psychological issues related to their
illness. Around 80% of the cancer patients in the studies got noticeably better after just one
dose. And they sustained the psychological gains they made for up to seven months, with few
minor side effects. Patients reported improvements in their quality of life, having more energy,
going out more and having better relationships with family members. Interestingly, those who
had a stronger trip reported the strongest gains in alleviating their depression and anxiety.

A number of authorities in psychiatry and addiction medicine expressed their support for the
work. These include Dr. Jeffrey Lieberman, a former president of the American Psychiatric
Association and Dr. Daniel Shalev from the New York State Psychiatric Institute, who wrote that
the studies are ”a model for revisiting criminalized compounds of interest in a safe, ethical
way.”

The studies were also reviewed by regulators and were described by the New York Times as
"most meticulous" to date. The lead author of the Johns Hopkins study, psychiatrist Dr. Roland
Griffiths, was optimistic on the possibilities of the new treatment, likening it to a
groundbreaking surgery rather than the painstaking work to make feel people better used by
traditional psychiatric approaches. “I really don’t think we have any models in psychiatry that
look like” the effects demonstrated in the two trials, said Griffiths. @medcity “Something
occurs and it’s repaired and it’s better going forward … very plausibly for more than six
months,” he added. “In that sense it’s a new model.”

One of the participants in the study, Sherry Marcy, described the changes in how she felt this
way: "The cloud of doom seemed to just lift… I got back in touch with my family and kids, and
my wonder at life," said Marcy, who has been battling cancer from 2010. @medcity "Before, I
was sitting alone at home, and I couldn't move … This study made a huge difference, and it's
persisted."

The particulars of both studies involved randomly offering patients either psilocybin or a
placebo at the first session, and then giving them the opposite treatment seven weeks later.
This way all participants eventually took psilocybin. In both studies, the success rate of
psilocybin versus the placebo was very clear, with 83% getting better on psilocybin and only
14% on the placebo in the NYU study.
Psilocybin, of course, has been banned in the U.S. for over 40 years. While they were allowed to
use it for their studies, the scientists warn against self-medicating depression by taking "magic
mushrooms". @medcity (7) They caution that professionals are needed to control the dosage
and provide a supportive environment in which to experience the drug's effects. The psilocybin
therapy may also not be appropriate for people with schizophrenia or young adults.

To move forward in this field, Dr. Shalev and Dr. Lieberman (8) see a need to loosen research
restrictions, because "there is much potential for new scientific insights and clinical
applications.” Ideally, the next step would be a trial with a larger sample, perhaps across several
centers with hundreds of subject

Questions 15-22
15. How many patients took part in the experimental studies?
A. Twenty-nine
B. Fifty-one
C. Eighty
D. Eighteen

16. What were the outcomes of psilocybin?

A. It helped all the patients alleviate the pain.
B. It helped cancer patients deal with depression.
C. It had continuous and long-lasting positive effects.
D. Although it relieved pain, it had some side-effects.

17. What do several renowned psychiatrists think of the studies?

A. That they offer a helpful but addictive way of addressing illnesses.
B. That such studies lead to criminalization of illegal compounds.
C. That such studies lead to decriminalization of illegal compounds.
D. That such studies pave the way for safe use of illegal compounds.

18. Psychiatrist Dr. Roland Griffiths

A. Compared the treatment to a revolutionary surgery.
B. Compared the treatment to a painstaking surgery.
C. Couldn’t compare the treatment to anything else done before.
D. Was convinced of the treatment’s effects due to the plausibility of the
results.
19. Which of the following is true about Sherry Marcy’s experience with the
treatment?
A. She felt like being on a cloud.
B. She stopped being depressed.
C. She managed to battle cancer
D. She felt relieved.

20. How were the patients chosen to receive either psilocybin or a placebo?
A. First, 83% of the patients received psilocybin, then a placebo.
B. First, 83% of the patients received a placebo, then psilocybin.
C. The patients weren’t selected according to a plan, but by chance.
D. All the patients were first given psilocybin, and then a placebo.

21. Which of the following is not true about psilocybin?

A. It is not allowed to be used in the USA.
B. It is not suitable for those suffering from schizophrenia.
C. It must be used with caution by the patients.
D. The dose and provision must be provided by a specialist in the area.

22. What does the author imply with the phrase”a need to loosen research
restrictions”?
A. That it is necessary to make the rules surrounding research less strict.
B. That it is necessary to create a better atmosphere for further research.
C. That it is necessary to invite more doctors to take part in the research.
D. That it is necessary to spread the results of the research across several
centres