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Part B
In this part of the test, there are six short extracts relating to the work of health professionals.
For questions 1 to 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.

____________________________________________________________________________

1. In which situation is there a chance of harm to the staff handling the incubator?

A) When moving the incubator and patient on the same floor

B) When shifting the incubator and patient to a different floor

C) When adjusting the height of the incubator

Cast and Splint- Take-Home Instructions:

Always use two people when moving the incubator and patient together. When moving the
incubator within the same floor space, check that the patient is secured safely in the unit
and either remove or secure all loose system components to prevent possible patient injury
or equipment damage. If the move involves varying floor heights or a complete floor level
change, remove all items either not being used or not necessary for the move, lower the
VHA, IV poles and shelves to their lowest position, place all drawers in their locked state,
and remove all accessories from the front and rear rail position.

When raising or lowering the incubator, the operator should ensure that both equipment
and appendages are clear of the unit’s travel path. Patient and incubator connections must
also be checked before adjusting the incubator height. Never place any objects on top of
the drawer assembly and always check before lowering the VH that there is sufficient
clearance between the incubator and stand assembly. Do not raise or lower the unit while
installing or removing medical gas tanks from the tank holder assembly. Failure to do so
could result in personal injury of equipment damage.

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 2. An existing DNR Order can be suspended when

A) the patient desires the suspension

B) the patient is shifted to different venue of care

C) the patient is to undergo a surgery requiring local anaesthesia

Do-Not-Resuscitate Orders:

A do-not-resuscitate order (DNR order)-or do-not-attempt-resuscitation order (DNAR order)

or allow natural death order (AND order)-is a physician order to forgo basic cardiac life
support in the outpatient setting and advanced cardiac life support in the inpatient setting. A
DNR order applies only to cardiopulmonary resuscitation. A DNR order must be written in
the medical record along with notes and orders that describe all other changes in the
treatment goals or plans, so that the entire health care team understands the care plan. A
DNR order does not mean that the patient is necessarily ineligible for other life-prolonging
measures, therapeutic and palliative. A DNR order should not be suspended simply
because of a change in the venue of care. When a patient with a preexisting DNR order is
to undergo, for example, an operative procedure requiring general anesthesia, fiberoptic
bronchoscopy, or gastroesophageal endoscopy, the physician should discuss the rationale
for continuing or temporarily suspending the DNR order. A change in DNR status requires
the consent of the patient or appropriate surrogate decision maker.

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 3. Which of the following measures does Not constitute palliative care?

A) Addressing the patient's spiritual needs

B) Understanding the patient's financial problems

C) Extending support to the bereaved family

Palliative Care:

Although palliative care goes beyond end-of-life care, palliative care near the end of life
entails addressing physical, psychosocial, and spiritual needs and understanding that
patients may at times require palliative treatment in an acute care context. To provide
palliative care, the physician must be up to date on the proper use of medications and
treatments, including the legality and ethical basis of using whatever doses of opioids are
necessary to relieve patient suffering. The physician should seek appropriate palliative care
consultation when doing so is in the patient's best interest, know when and how to use
home-based and institution-based hospice care, and be aware of the palliative care
capabilities of nursing homes to which patients are referred.

Clinicians should also assist family members and loved ones experiencing grief after the
patient's death.

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 4. Which of the following statements is true about pulse oximeter?

A) It can be used outside hospital settings

B) It requires drawing blood samples

C) It can measure blood Carbon dioxide levels

Excerpts from Sales Literature: Pulse Oximeter

Pulse oximeter is particularly convenient for noninvasive continuous measurement of

blood oxygen saturation. In contrast, blood gas levels must otherwise be determined in
a laboratory on a drawn blood sample. Pulse oximetry is useful in any setting where a
patient's oxygenation is unstable, including intensive care, operating, recovery,
emergency and hospital ward settings, pilots in unpressurized aircraft, for assessment
of any patient's oxygenation, and determining the effectiveness of or need for
supplemental oxygen. Although a pulse oximeter is used to monitor oxygenation, it
cannot determine the metabolism of oxygen, or the amount of oxygen being used by a
patient. For this purpose, it is necessary to also measure carbon dioxide (CO2) levels.
It is possible that it can also be used to detect abnormalities in ventilation. However,
the use of a pulse oximeter to detect hypoventilation is impaired with the use of
supplemental oxygen, as it is only when patients breathe room air that abnormalities in
respiratory function can be detected reliably with its use. Therefore, the routine
administration of supplemental oxygen may be unwarranted if the patient is able to
maintain adequate oxygenation in room air, since it can result in hypoventilation going
undetected.

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5. The aim of the email is to inform

A) how to improve co-operation and communication among patient care team

B) what to do when members of patient care team disagree on something

C) whom to consult when differences of opinion among staff cannot be resolved

Email to All Staff:

Sub: Conflicts Among Members of a Health Care Team

All health professionals share a commitment to work together to serve the

patient's interests. The best patient care is often a team effort, and mutual
respect, cooperation, and communication should govern this effort. Each
member of the patient care team has equal moral status. When a health
professional has important ethical objections to an attending physician's
order, both should discuss the matter openly and thoroughly. Mechanisms
should be available in hospitals and outpatient settings to resolve differences
of opinion among members of the patient care team. Ethics committees or
ethics consultants may also be appropriate resources.

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6. The currently available plasma-expanders differ in

A) a wide variety of factors

B) molecular weight

C) ability to improve oxygen flux

Plasma Expanders:

Plasma expanders are used to restore the circulating volume of a hypovolaemic

patient. Typically, colloids are used to expand the plasma volume, although
combinations of hypertonic crystalloid and colloid have recently been used. The
currently available colloids vary in their physicochemical, pharmacodynamics and
pharmacokinetic properties. In particular, they differ in molecular weight, which
partly determines their duration of action, and in their ability to expand the plasma
volume. Dextran, hydroxyethyl starch and hypertonic colloid solutions improve
oxygen flux within the microcirculation. Despite their benefits, the use of dextran and
high-molecular-weight starches is limited by their negative impact on coagulation. In
addition, these macro-molecules may also induce acute renal failure in susceptible
patients. Current research focuses on the development of artificial oxygen carriers
as plasma expanders. These substances, which include modified stromal-free
haemoglobin and perfluorocarbon emulsions, are undergoing clinical trials.

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 Part C
In this part of the test, there are two texts about different aspects of health care. For questions 1
to 8, 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.

Text 1:

THE CONSCIOUSNESS METER

An unmet clinical need exists for a device that reliably detects the presence or absence of
consciousness in impaired or incapacitated individuals. During surgery, for example, patients
are anesthetized to keep them immobile and their blood pressure stable and to eliminate pain
and traumatic memories. Unfortunately, this goal is not always met: every year hundreds of
patients have some awareness under anesthesia.

Another category of patients, who have severe brain injury because of accidents, infections or
extreme intoxication, may live for years without being able to speak or respond to verbal
requests. Establishing that they experience life is a grave challenge to the clinical arts. Think of
an astronaut adrift in space, listening to mission control's attempts to contact him. His damaged
radio does not relay his voice, and he appears lost to the world. This is the forlorn situation of
patients whose damaged brain will not let them communicate to the world—an extreme form of
solitary confinement.

In the early 2000s Giulio Tononi of the University of Wisconsin–Madison and Marcello
Massimini, now at the University of Milan in Italy, pioneered a technique, called zap and zip, to
probe whether someone is conscious or not. The scientists held a sheathed coil of wire against
the scalp and “zapped” it—sent an intense pulse of magnetic energy into the skull—inducing a
brief electric current in the neurons underneath. The perturbation, in turn, excited and inhibited
the neurons' partner cells in connected regions, in a chain reverberating across the cortex, until
the activity died out. A network of electroencephalogram (EEG) sensors, positioned outside the
skull, recorded these electrical signals. As they unfolded over time, these traces, each
corresponding to a specific location in the brain below the skull, yielded a movie.

These unfolding records neither sketched a stereotypical pattern, nor were they completely
random. Remarkably, the more predictable these waxing and waning rhythms were, the more
likely the brain was unconscious. The researchers quantified this intuition by compressing the
data in the movie with an algorithm commonly used to “zip” computer files. The zipping yielded
an estimate of the complexity of the brain's response. Volunteers who were awake turned out to
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have a “perturbational complexity index” of between 0.31 and 0.70, dropping to below 0.31
when deeply asleep or anesthetized. Massimini and Tononi tested this zap-and-zip measure on
48 patients who were brain-injured but responsive and awake, finding that in every case, the
method confirmed the behavioral evidence for consciousness. The team then applied zap and
zip to 81 patients who were minimally conscious or in a vegetative state. For the former group,
which showed some signs of nonreflexive behavior, the method correctly found 36 out of 38
patients to be conscious. It misdiagnosed two patients as unconscious. Of the 43 vegetative-
state patients in which all bedside attempts to establish communication failed, 34 were labeled
as unconscious, but nine were not. Their brains responded similarly to those of conscious
controls—implying that they were conscious yet unable to communicate with their loved ones.

Ongoing studies seek to standardize and improve zap and zip for neurological patients and to
extend it to psychiatric and pediatric patients. Sooner or later scientists will discover the specific
set of neural mechanisms that give rise to any one experience. Although these findings will have
important clinical implications and may give succor to families and friends, they will not answer
some fundamental questions: Why these neurons and not those? Why this particular frequency
and not that? Indeed, the abiding mystery is how and why any highly organized piece of active
matter gives rise to conscious sensation. After all, the brain is like any other organ, subject to
the same physical laws as the heart or the liver. What makes it different? What is it about the
biophysics of a chunk of highly excitable brain matter that turns gray goo into the glorious
surround sound and Technicolor that is the fabric of everyday experience?

Ultimately what we need is a satisfying scientific theory of consciousness that predicts under
which conditions any particular physical system—whether it is a complex circuit of neurons or
silicon transistors—has experiences. Furthermore, why does the quality of these experiences
differ? Why does a clear blue sky feel so different from the screech of a badly tuned violin? Do
these differences in sensation have a function, and if so, what is it? Such a theory will allow us
to infer which systems will experience anything. Absent a theory with testable predictions, any
speculation about machine consciousness is based solely on our intuition, which the history of
science has shown is not a reliable guide.

Fierce debates have arisen around the two most popular theories of consciousness. One is the
global neuronal workspace (GNW). The theory begins with the observation that when you are
conscious of something, many different parts of your brain have access to that information. If,
on the other hand, you act unconsciously, that information is localized to the specific sensory
motor system involved. For example, when you type fast, you do so automatically. Asked how
you do it, you would not know: you have little conscious access to that information, which also
happens to be localized to the brain circuits linking your eyes to rapid finger movements.

Integrated information theory (IIT) has a very different starting point: experience itself. Each
experience has certain essential properties. It is intrinsic, existing only for the subject as its
“owner”; it is structured (a yellow cab braking while a brown dog crosses the street); and it is
specific—distinct from any other conscious experience, such as a particular frame in a movie.
Furthermore, it is unified and definite. When you sit on a park bench on a warm, sunny day,
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watching children play, the different parts of the experience—the breeze playing in your hair or
the joy of hearing your toddler laugh—cannot be separated into parts without the experience
ceasing to be what it is.

Text 1: Questions 7 to 14

7. In the first paragraph, the example the author presents reinforces

A. Why we a certain technology is necessary.

B. how anaesthesia functions for the patients under surgery.

C. that a perfect anaesthesia is not available yet.

D. what kind of device is needed to measure consciousness of a person.

8. In the paragraph 2, the word establishing could best be replaced by

A. proving

B. convincing

C. founding

D. understanding

9. According to the fourth paragraph, among those "zap and zip" was applied, in which
group were all patients conscious?

A. Deeply asleep

B. Brain-injured

C. Minimally-conscious

D. Vegetative

10. In the paragraph 4, which finding was the author surprised at?
A. The EEG records generated a movie on brain

B. The more stereotyped the waxing and waning rhythms were the more likely the

brain was conscious

C. The zap and zip technique uses the same technology as is used in computers
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 D. The predictability of the EEG records indicated lack of consciousness

11. In the paragraph 5, the writer infers that zap and zip method cannot be used currently
for

A. neurological patients

B. psychiatrists

C. young patients

D. patients' families

12. What does the word they refer to in the fifth paragraph?

A. Families and friends

B. Clinical implications

C. Fundamental questions

D. Neural mechanisms

13. According to the sixth paragraph, a satisfactory theory of consciousness might Not
answer

A. under which conditions a circuit of silicon transistors may have experience.

B. why a clear blue sky appears different from a badly played violin.

C. when a complex set of neurons generates an experience.

D. why some experiences feel different from others.

14. In the final paragraph, which property of an experience is exemplified by 'frame in a

movie'?

A. Intrinsic nature

B. Distinctive nature

C. Unified nature

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 D. Definitive nature

Text 2:
Kawasaki disease
Kawasaki disease, also known as mucocutaneous lymph node syndrome, is a disease in which
blood vessels throughout the body become inflamed. The most common symptoms include a
fever that lasts for more than five days not affected by usual medications, large lymph nodes in
the neck, a rash in the genital area, and red eyes, lips, palms or soles of the feet. Other
symptoms include sore throat and diarrhea. Within three weeks of the onset of symptoms, the
skin from the hands and feet may peel. In some children, coronary artery aneurysms may form
in the heart after 1–2 years.

The disease was first reported by Tomisaku Kawasaki in a four-year-old child with a rash and
fever at the Red Cross Hospital in Tokyo in 1961, and he later published a report on 50 similar
cases. In 1974, the first description of this disorder was published in the English-language
literature. In 1976, Melish et al. described the same illness in 16 children in Hawaii. Melish and
Kawasaki had independently developed the same diagnostic criteria for the disorder, which are
still used today to make the diagnosis of classic Kawasaki disease.

A question was raised whether the disease only started during the period between 1960 and
1970, but later a preserved heart of a seven-year-old boy who died in 1870 was examined and
showed three aneurysms of the coronary arteries with clots, as well as pathologic changes
consistent with Kawasaki disease. Kawasaki disease is now recognized worldwide. In the
United States and other developed nations, it appears to have replaced acute rheumatic fever
as the most common cause of acquired heart disease in children.

Kawasaki disease affects boys more than girls, with people of Asian ethnicity, particularly
Japanese and Korean people, most susceptible, as well as people of Afro-Caribbean ethnicity.
The disease was rare in Caucasians until the last few decades, and incidence rates fluctuate
from country to country. Currently, Kawasaki disease is the most commonly diagnosed pediatric
vasculitis in the world. By far, the highest incidence of Kawasaki disease occurs in Japan, with
the most recent study placing the attack rate at 218.6 per 100,000 children <5 years of age
(about one in 450 children). At this present attack rate, more than one in 150 children in Japan
will develop Kawasaki disease during their lifetimes.

However, its incidence in the United States is increasing. Kawasaki disease is predominantly a
disease of young children, with 80% of patients younger than five years of age. About 2,000-
4,000 cases are identified in the U.S. each year (9 to 19 per 100,000 children younger than 5
years of age). In the United Kingdom, estimates of incidence rate vary because of the rarity of

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Kawasaki disease. However, it is believed to affect fewer than one in every 25,000
people.Incidence of the disease doubled from 1991 to 2000, however, with four cases per
100,000 children in 1991 compared with a rise of eight cases per 100,000 in 2000.

As the cause(s) of Kawasaki disease remain unknown, the illness is more accurately referred to
as Kawasaki syndrome. Its cause is widely hypothesized to involve the interaction of genetic
and environmental factors, possibly including an infection in combination with genetic
predisposition to an autoimmune mechanism. Evidence increasingly points to an infectious
cause, but debate continues. Researchers at Boston Children's Hospital reported, "some
studies have found associations between the occurrence of Kawasaki disease and recent
exposure to carpet cleaning or residence near a body of stagnant water; however, cause and
effect have not been established." Other data show a clear correlation between Kawasaki
disease and tropospheric wind patterns; winds blowing from central Asia correlate with
Kawasaki disease cases in Japan, Hawaii, and San Diego. This association with tropospheric
winds has been shown to be modulated at seasonal and interannual timescales by the El Niño–
Southern Oscillation phenomenon, further indicating the agent responsible for the disease is a
wind-borne pathogen. Regardless of where they are living, Japanese children are more likely
than other children to manifest the disease, which suggests genetic susceptibility.

Children with Kawasaki disease should be hospitalized and cared for by a physician who has
experience with this disease. When in an academic medical center, care is often shared
between pediatric cardiology, pediatric rheumatology, and pediatric infectious disease
specialists (although no specific infectious agent has yet been identified). To prevent damage to
the coronary arteries, treatment should be started as soon as the diagnosis is made.
Intravenous immunoglobulin (IVIG) is the standard treatment for Kawasaki disease and is most
useful within the first seven days of onset of fever, in terms of preventing coronary artery
aneurysm.
Salicylate therapy, particularly aspirin, remains an important part of the treatment (though
questioned by some) but salicylates alone are not as effective as IVIG. Except for Kawasaki
disease and a few other indications, aspirin is otherwise normally not recommended for children
due to its association with Reye's syndrome.
Corticosteroids have also been used, especially when other treatments fail or symptoms recur,
but in a randomized controlled trial, the addition of corticosteroid to immune globulin and aspirin
did not improve outcome. Additionally, corticosteroid use in the setting of Kawasaki disease is
associated with increased risk of coronary artery aneurysm, so its use is generally
contraindicated in this setting.

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Questions 15-22

15. According to the paragraph 1, the commonest symptoms of Kawasaki disease

include

A. coronary artery aneurysm

B. discomfort in throat

C. reddening of soles

D. yellowing of eyes

16. According to the second paragraph, the bases for diagnosis of Kawasaki disease

A. were developed by two researchers who did not work together.

B. have undergone significant changes since they were developed.

C. were developed by Mellish and Kawasaki in 1976.

D. have helped recognise the disease in 66 cases till now.

17. In the third paragraph, the analysis of the preserved heart indicates that Kawasaki
disease must have started

A. between 1960 and 1970.

B. between 1870 and 1960.

C. in the first half of the twentieth century.

D. in the second half of the nineteenth century.

18. The information in the paragraph 4 suggests that

A. in Japan, most number of children are dying of Kawasaki disease.

B. Kawasaki disease is the most commonly diagnosed disease in the world.

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 C. Kawasaki disease is a serious problem in Japan

D. Kawasaki disease does not affect Caucasians.

19. What point can be made out about Kawasaki disease in the US?

A. 1 in 5 children affected are aged 5 and above

B. its incidence rates have doubled between 1991 and 2000

C. 2 to 4000 cases are being identified every year

D. 9 to 19 out of 100,000 child deaths result from the disease

20. In the sixth paragraph, which of the following is Not suspected to be a cause of
Kawasaki Syndrome?

A. Genetic factors

B. Living near stagnant water

C. Tropospheric winds

D. Microbes

21. According to the final paragraph, treatment should not be delayed in order particularly
to

A. prevent the onset of fever.

B. safe-guard a specific type of blood vessels.

C. avoid the patient's death.

D. to strengthen coronary arteries.

22. What could serve as the best title for the passage?

A. Causes and Effects of a dangerous disease

B. Overview of a mysterious disease

C. Treatment of a common syndrome in children

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 D. Aetiology of a paediatric problem

END OF READING TEST

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