Writing Test 1

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Writing Test 1 - Medicine

Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Patient History:

Name: Mr Antonite Scott

Date of Birth: 18th March 1950

Height: 160cm

Weight: 74kg

Allergies: Shellfish

Substance Intake: Nil

Dentures: Nil

Social History:

Patient lives with his wife. All their children are away. They both
live alone. He is a smoker and an alcoholic. He works as a Bar
Tender.

Depression: controlled by medication

Family History:

Mother: History of Pneumonia

Father: Died of CVA (Cerebro Vascular Accident) recently.

Maternal Grand Mother: Died of COPD

Maternal Grand Father: Unknown

Paternal Grand Mother: Hypertensive

Paternal Grand Father: Known patient of Depression

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Writing Test 1 - Medicine

Past Medical History:

1990: Typhoid and followed with Jaundice attack

1996: HBsAg Positive

2006: Diagnosed Depression and kept on medicine

Present Symptoms:

Diabetic (Increased Blood Sugar continuously)

UTI (Burning Micturation and incontinence)
Cellulitis (Swollen legs and pain)

Provisional Diagnosis: Type II Diabetes Mellitus

Plan: Refer to Diabetologist/Podiatrist for further treatment.

Writing task:

Using the information in the case notes, write a letter of referral

for further treatment to the Diabetologist/Podiatrist Dr Britto at
City hospital.

In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST

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Writing Test 1

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Writing Test 2 - Medicine

Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Patient History:

Name: Mrs Suzanne Mario

Date of Birth: 5th January, 1978.

Height: 158cm

Weight: 60kg

Allergies: Dust, Vinegar

Substance Intake: Sleeping Pills

Dentures: Upper

Social History:

Patient lives single, not married. She lives alone. She is a smoker and
drinks occasionally too. She works as an Assistant Manager for a non-
profit organization.

Peptic ulcer: controlled by medication.

Family History:

Mother: history of Cancer Cervix

Father: died in an accident two years ago. Maternal

Grand Mother: history of Cancer Maternal Grand
Father: had LRTI twice
Paternal Grand Mother: Unknown

Paternal Grand Father: died at the age of 92

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Writing Test 2 - Medicine

Past Medical History:

2000: Irregular Menstruation

2008: Removal of cyst from Right Breast

Present Symptoms:

Pain in the sides of the both Breast

Can feel lumps

Provisional Diagnosis: Cancer Breast

Plan: Refer to Oncologist for further treatment.

Writing task:

Using the information in the case notes, write a letter of referral for
further treatment to the Oncologist Dr Ansari at Lake hospital, 14 Lake
view street, Card Well city.

In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST

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Writing Test 1

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Writing Test 3 - Medicine

Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Patient History:

Name: Mr Roberto Carlos

Date of Birth: 19th April 1948

Height: 164cm

Weight: 94kg

Allergies: Iodine

Substance Intake: Pain Killers and Sleeping Pills

Dentures: Upper and lower

Social History:

Patient is married and has two children. Children are settled away from parents.
They live alone. He is a chain smoker and chronic alcoholic. He worked as a
professor.

Tonsillitis: had tonsillectomy.

Family History:

Mother: was healthy, no medical problems.

Father: heart attack (died at the age of 88).
Maternal Grand Mother: Unknown.
Maternal Grand Father: Unknown.
Paternal Grand Mother: was a hypertensive patient.
Paternal Grand Father: had a history of varicose veins.

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Writing Test 3 - Medicine

Past Medical History:

1990: Protrusion of veins and leg cramps

Diagnosed as DVT and kept on treatment.
Started weight reduction treatment

Present Symptoms:

Intolerance of Leg Cramps

Provisional Diagnosis: DVT

Plan: Refer to General Surgeon for further treatment.

Writing task:

Using the information in the case notes, write a letter of referral for further
treatment to the General Surgeon Dr Christo at Wood Park hospital,
18 Park street, Richmond city.

In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST

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Writing Test 3 - Medicine

Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Patient History:

Name: Mr Roberto Carlos

Date of Birth: 19th April 1948

Height: 164cm

Weight: 94kg

Allergies: Iodine

Substance Intake: Pain Killers and Sleeping Pills

Dentures: Upper and lower

Social History:

Patient is married and has two children. Children are settled away from parents.
They live alone. He is a chain smoker and chronic alcoholic. He worked as a
professor.

Tonsillitis: had tonsillectomy.

Family History:

Mother: was healthy, no medical problems.

Father: heart attack (died at the age of 88).
Maternal Grand Mother: Unknown.
Maternal Grand Father: Unknown.
Paternal Grand Mother: was a hypertensive patient.
Paternal Grand Father: had a history of varicose veins.

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Writing Test 3 - Medicine

Past Medical History:

1990: Protrusion of veins and leg cramps

Diagnosed as DVT and kept on treatment.
Started weight reduction treatment

Present Symptoms:

Intolerance of Leg Cramps

Provisional Diagnosis: DVT

Plan: Refer to General Surgeon for further treatment.

Writing task:

Using the information in the case notes, write a letter of referral for further
treatment to the General Surgeon Dr Christo at Wood Park hospital,
18 Park street, Richmond city.

In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST

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Writing Test 1

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Writing Test 4 - Medicine

Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Patient History:

Name: Mrs Agnes Rosario

Date of Birth: 5th September 1972

Height:152cm

Weight: 56kg

Allergies: Nil

Substance Intake: Pain Killers

Dentures: Nil

Social History:

Patient is married and has no children. She is an English Teacher for an

International School.

Family History:

Mother: History of PCOD

Father: History of asthmatic attack.
Maternal Grand Mother: PCOD
Maternal Grand Father: Unknown.
Paternal Grand Mother: was diabetic
Paternal Grand Father: had a history of URTI

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Writing Test 4 - Medicine

Past Medical History:

1998: Irregular Menstruation, Acne. Had treatment for two months.

1999: Menorrhagia for about 25 days

Present Symptoms:

Menorrhagia and severe back lower abdominal pain

Provisional Diagnosis: PCOD

Plan: Refer to Gynecologist and obstetrician for further treatment.

Writing task:

Using the information in the case notes, write a letter of referral for further
treatment to the Gynecologist and obstetrician Dr Amanda at Whitus hospital,
112 Bill street, Emerald city.

In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST

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Writing Test 5 - Medicine

Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Patient History:

Name: Mr Stephen Brook

Date of Birth: 9th December 1987

Height: 168cm

Weight: 66kg

Allergies: Barley

Dentures: Nil

Social History:

Patient is not married. He is a Gym instructor for an International GYM School.

Family History:

Mother: History of Jaundice.

Father: History of Peptic ulcer
Maternal Grand Mother: was a healthy woman
Maternal Grand Father: CA Prostate
Paternal Grand Mother: had chickenpox at her childhood
Paternal Grand Father: had a history of UTI

Past Medical History:

2010: Food Poison, Vomiting and had treatment.

2011: Burning Sensation and pain at xiphoid process and radiating to back,
regurgitation, vomiting. Had treatment but discontinued after six months.

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Writing Test 5 - Medicine

Present Symptoms:

Burning Sensation and pain at xiphoid process and radiating to back during
mid night, vomiting.

Provisional Diagnosis: Pancreatitis

Plan: Refer to General Physician for further treatment.

Writing task:

Using the information in the case notes, write a letter of referral for further
treatment to the General Physician, Dr Mario, at City hospital, 15 River street,
Herberton city.

In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST

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Writing Test 1

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Writing Answers - Medicine

Sample Letter 1
Dr Britto
City Hospital
(Near to 154 Newcastle St)
Perth WA
Australia

(Today’s date)

Dear Dr Britto

Re: Mr Antonite Scott, DOB 18th March 1950

Mr Antonite Scott is being discharged from our hospital into your care today. He has been a
regular patient at our hospital. He has been diagnosed as a diabetic patient. (There was an
increase in his blood pressure when the patient was admitted into our hospital). The patient
also complained of a feeling of burning sensation while passing urine. The problem was
diagnosed by our team of doctors as Urinary Tract Infection (UTI) (with burning micturation
and incontinence). The patient was not able to keep well for days (as the problem of the
increase in sugar was a continuous one).

The patient displayed problem in walking too (his legs are swollen and he feels pain). The
reason can be attributed to the increase in blood sugar.

The patient has no medical history. None of his family members were diabetic. The patient
once suffered from typhoid followed by jaundice (1990) and diagnosed as HBsAg positive
(1996). He is a patient, suffering some kind of depression too (diagnosed in 2006).

The patient was feeling well at the time of discharge but still there is a need to control his
sugar.

Please, contact me with any queries.

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Writing Answers - Medicine

Yours sincerely
Head Doctor

Sample Letter 2
Dr Ansari
Lake Hospital
14 Lake View Street
Card Well City

(Today’s date)

Dear Dr Ansari

Re: Mrs Suzanne Mario, DOB 5th January 1978

Mrs Suzanne Mario is being discharged from our hospital into your care today. She has been a
patient of cancer for years now (detected now). The patient recently complained of intense
pain in her breasts. She could feel lumps (the problem was supposed to be developed after
she had “cyst from her right breast removed” in the year 2008). The reports on provisional
diagnosis showed the possibility of breast cancer.

Her family showed history of cancer too. Her mother was a patient of cancer (with history of
cancer cervix). Her maternal grandmother too had a cancer related problem (not mentioned
by the patient).

The patient has no medical history apart from the problems related to irregular menstruation
(noted in the year 2000). The patient takes sleeping pills. She smokes and drinks too (drinks
occasionally). There is a need to tackle this problem as the patient is suffering from it badly.

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Writing Answers - Medicine

The patient was well at the time of discharge from our hospital.

Please, contact me with any queries.

Yours sincerely
Head doctor

Sample Letter 3
Dr Christo
Wood Park hospital
18 Park Street
Richmond City

(Today’s date)

Dear Dr Christo

Re: Mr Roberto Carlos, DOB 19th April 1948

Mr Roberto Carlos is being discharged from our hospital into your care today. The patient is
suffering from “intolerance of leg cramps.” On complaints of intense pain and cramps, the
patient was admitted into our hospital. Reports on provisional diagnosis showed the possibility
of DVT (Deep Vein Thrombosis).

Years back, patient suffered from the same problem of cramping. Due to protrusion of veins
and leg cramps, the patient was diagnosed to have DVT (1990). The treatment plan was
suggested too (started weight reduction treatment).

Now again, the patient complained of the same problem. Care is needed to be taken.
The patient is a chain smoker and he is alcoholic too. He sometimes uses pain killers and
sleeping pills (names are not mentioned by the patient, nor the purpose) as well.
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Writing Answers - Medicine

The patient was well at the time of discharge from our hospital apart from the problem
related to DVT.

Please, contact me with any queries.

Yours sincerely
Head Doctor

Sample Letter 4
Dr Amanda
Whitus hospital
112 Bill Street
Emerald City

(Today’s Date)

Dear Dr Amanda

Re: Mrs Agnes Rosario, DOB 5th September 1972

Mrs Agnes Rosario is being discharged from our hospital into your care today. The patient is
suffering from severe Menorrhagia and back / abdominal pain. The reports on provisional
diagnosis showed the possibility of polycystic ovary syndrome (PCOS) too.

This is not for the first time that the patient was admitted into our hospital for the reason of
Menorrhagia. She faced the same problem of Menorrhagia (1999) earlier as well (the
treatment of which lasted for about 25 days).

In the past, the patient complained of the irregular menstruation and underwent treatment
for the same which lasted for about two months too.

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Writing Answers - Medicine

Her family history showed the presence of the PCOS. Her mother suffered from PCOS and her
maternal grandmother too showed the history of the same PCOS related problem.

The patient was well at the time of discharge from our hospital apart from the problem
related to Menorrhagia or PCOS.

There is a need to take great care as the problem is severe this time.

Please, contact me with any queries.

Yours sincerely
Head Doctor

Sample Letter 5
Dr Mario
City hospital
15 River Street
Herberton City

(Today’s Date)

Dear Dr Mario

Re: Mr Stephen Brook, DOB 9th December 1987

Mr Stephen Brook is being discharged from our hospital into your care today. He was
admitted into our hospital due to a problem related to pancreas. The reports on provisional
diagnosis showed the presence of pancreatitis. The patient was suffering from intense pain

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Writing Answers - Medicine

and burning sensation at xiphoid process. There was an increase in pain and burning
sensation during night time too. The patient complained of vomiting too.

Mr Stephen Brook suffered from food poisoning which he got treated well (2010). He had
faced a similar kind of problem related to pancreatitis (burning sensation and pain) earlier as
well (2011) for which the treatment was not completed (the treatment was discontinued after
six months / reasons for the discontinuation of the treatment are best known to the patient).
The patient was well at the time of discharge from our hospital apart from the problem
related pancreatitis.

There is a need to take great care as the problem is severe this time.

Please, contact me with any queries.

Yours sincerely
Head Doctor

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Writing Test 6 - Medicine

Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Patient History:

Patient: Mary Reylon

DOB: 4th Sept 1963

Allergies: Dust / Penicillin

Social History: Professor at the university (teaches physics)

Live with her husband (Winston Reylon)
Work for women rights organization

Family History:

 Mother – High BP, Rheumatoid.

 Father – liver failure
 Maternal Grandmother- died of heart attack (75)
 Maternal Grandfather – died of heart attack (81)
 Paternal Grandfather – a patient of high BP
 Paternal Grandmother – died at the age of 65 due to an accident

Past medical history:

 RSV illness (1965)

 Chicken pox (1973)
 Tonsils removed (1981)
 Miscarriage due to an accident (1987)
 Hyperthyroid (1989)

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Writing Test 6 - Medicine

12 June 2009 Injury to the head (fell from the stairs)

Tourniquet applied (to stop the flow of blood)
Dizziness and queasiness
Large bump on the head
Patient complained of pain even after two days
Unable to sleep (since a week)
Took slipping pills thrice (as suggested by the doctor), no effect

Other signs:

 Persistent or worsening headache

 Imbalance
 Vomiting

Inference: Suggestive of intracranial hematoma

Plan: CT scan is the definitive tool for accurate diagnosis of an intracranial

hemorrhage.

Writing Task:

Using the information in the case notes, write a letter of referral for further
investigation and definitive diagnosis to the neurologist, Dr Wilson, at London
Bridge Hospital, 27 Tooley St London, Greater London.

In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST

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Writing Test 7 - Medicine

Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Patient History:

Patient: Nicole Katie

DOB: 12 July, 1971

Social History:

Lives with her husband (Ivan) and a daughter (Lydia Imogen)

House wife (left work after the marriage)

Family history: No family history

But mother died of kidney failure

Past medical history:

Suffered severe attack of TB (1983)

Appendices (1987)
Depression (due to the sudden death of the first baby – 1992)
Allergic reactions (uterine infection - 1997)

15 April 2005

Failure in digestion
Unable to eat properly due to pain in the stomach
Took pain relievers, analgesics (for two continuous days)
Problem worsened
Felt pain, radiating back to the lower abdomen
Change in coloration of urine (yellowish)
Loss of appetite
Weight loss – 2.5 kg (15 days of time)
Vomited twice

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Writing Test 7 - Medicine

18 April, 2005

Other signs:
Severe pain, lasted for several hours
Pain and vomiting or shortness of breath
Blood in bowel motions or urine
High Fever and sweats

Plan: Abdominal CT scan suggested for accurate diagnosis of

abdominal pain.

Writing Task:
Using the information in the case notes, write a letter of referral for further
investigation and definitive diagnosis to Dr Ralph Emerson, at Royal
London Hospital, Whitechapel Rd London, Greater London E1 1BB,
United Kingdom.

In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST

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Writing Test 8 - Medicine

Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Patient History:

Mark Henry is 53-years-old patient in your General Practice. Just recently he

complained of acute onset of double vision and right eyelid droopiness.

Social History:

The patient lives with his wife

Works as a car mechanic
Denies use of illicit drugs or tobacco
Rarely drinks

Family History:

His father had migraines (died at the age of 83 due to heart attack)
His paternal father had a stroke at the age of 67
No other family history of stroke or vascular disease

9/07/2009

Was sitting in her room; felt sensation in her eye lids

Noticed blurred vision
Appearance of double vision (with objects appearing side by side)
Pain in both the eyes
Transferred to the hospital by his son
Intermittent pounding bifrontal headache
Rated the pain as 7 or 8 on a scale of 1 to 10

General physical examination:

The patient is positively gross (fat).

Temperature is 37.6.
Blood pressure is 130/60.
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Writing Test 8 - Medicine

Pulse is 85.
There is no tenderness over the scalp or neck and no bruits over the eyes or
at the neck.
No proptosis, lid swelling, conjunctival injection, or chemosis.
Cardiac exam shows a regular rate and no murmur.

Past Medical History:

1) Migraine headaches, as described in HPI.

2) Depression.
There is no history of diabetes or hypertension.

Allergies: None.

Medications: Zoloft 50 mg daily, ibuprofen 600 mg a few times per week, and
Vicodin a few times per week.

Other necessary information

He denies associated vomiting, nausea, numbness, weakness, photophobia,

loss of vision, seeing flashing lights or zigzag lines etc.
His recent headaches differ from his “typical migraines” (occurred 4 -5 in
all his life time).
He has never taken anything for these headaches (other than ibuprofen
or Vicodin).

Writing Task:

Using the information in the case notes, write a letter of referral for further
investigation and definitive diagnosis to Dr Martin, at National Hospital for
Neurology, 33 Queen Square London WC1N 3BG, United Kingdom.

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Writing Test 8 - Medicine

In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST

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Writing Test 9 - Medicine

Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Patient History:

Joseph Malcolm is a patient in your General Practice. Just recently he complains

of occasional breathlessness or difficulty in breathing

Age: 42

Gender: male

Occupation: office manager

Subjective Patient Complaints:

Adult onset asthma- Dyspnea, cough

Occasional wheezing symptoms upon increased exercise or when in stress.

Prior contributory health history:

1) Seasonal upper respiratory allergies

2) Occasional loose stools when under stress
3) Occasional episodes of mild eczema (dermatitis)
4) Reports a history of being healthy, aside from this recent asthma problem

What provokes the symptoms?

Provoked by exercise, emotional/physical stress

Cigarette smoke
Seasonal respiratory allergies

Site of symptomatology:

Bronchial, Lung, Chest/ Thoracic region

Time of day/ duration of symptoms:
Daily episodes of dyspnea
Symptoms often worse @3-5 AM (coughing increases)

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Writing Test 9 - Medicine

Medications:

Symptoms temporarily eased with prescription (bronchial inhaler medication).

Writing Task:

Using the information in the case notes, write a letter of referral for further
investigation and definitive diagnosis to Dr Robert Frances,
at St. George’s Hospital, Black Shaw Road, London SW17 0QT,
United Kingdom.

In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST

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Writing Test 1

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Writing Test 10 - Medicine

Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Patient History:

Marques is a patient in your general practice who has recently complained of

severe abdominal pain.

Name of the patient: Mr Marques

Age: 65

October 7, 2006

Chief complain: Abdominal pain

 Complained of sharp, epigastric abdominal pain (gradually worsening over

the past 1-2 months).
 Pain is located in the epigastric region and left upper quadrant of the
abdomen.
 Doesn’t radiate.
 The pain is relatively constant throughout the day and night (but does vary
in severity).
 Rated the pain as 6/10 at its worst.
 He has not tried taking any medicines to relieve the pain.
 The pain is not associated with food or eating (but occasional heartburn).
 Denies any abdominal trauma or injury.
 Complained of weight loss (5lb weight loss over the past 1-2 months).
 The patient has experienced some nausea with the abdominal pain but
has not vomited.

Family History:

Father died due to heart attack.

Mother’s medical history is not known.
No known family history of colon cancer.

Social History:

The patient is a retired lecturer.

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Writing Test 10 - Medicine

He lives with his wife and two grand children.

He denies past or present tobacco and illicit drug use.
He denies alcohol use.

Past Medical History: Other active problems

High Blood Pressure, diagnosed “two years ago, (but well-controlled now).
Depression poorly controlled; started Prozac 2 months ago but still feels depressed.

Hospitalizations: MI, 2003.

Surgeries/procedures: Cardiac catheterization, post-MI, 2003.

Medications:

Aspirin 81mg po qd (since his MI 3 years ago)

Metoprolol 100mg po qd “for two years”
Prozac 20mg po qd; Started 2 months ago

Allergies: No known drug allergies.

No food or insect allergies.

Other information
Pulmonary – denies shortness of breath, denies cough.
Cardiovascular – denies chest pain; denies palpitations.
Genitourinary – denies dysuria; denies increased frequency or urgency of
urination.

Writing Task:
Using the information in the case notes, write a letter of referral for further
investigation and definitive diagnosis to Dr Ivan Gonz, at Willington Hospital,
Central Building, 21 Wellington Road, St John's Wood London.

In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST

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Writing Test 1

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Writing Answers - Medicine

Sample Letter 6
Dr Wilson
London Bridge Hospital
27 Tooley St London
Greater London

(Today’s date)

Dear Dr Wilson

Re: Mrs Mary Reylon, DOB 4th Sept 1963

Mrs Mary Reylon is a patient, admitted into our hospital on 12th June 2009.

Mrs Mary Reylon fell from the staircase and got an injury to her head. As she was profusely
bleeding so a tourniquet was also applied round her head (to stop the flow of blood). The
patient began to feel dizziness and queasiness after that. A large bump on her head
developed too. The patient began to complain of pain even though the pain killers were given.

The patient has not been able to sleep for about a week now (The patient even tried sleeping
pills to get herself enough sleep but the sleeping pills were proven to be ineffective for her).
The patient also complained of persistent headache, imbalance and vomiting which are
suggestive of intracranial hematoma.

Here CT Scan can simply be the definitive tool for accurate diagnosis of intracranial
haemorrhage. Hence, it is requested that the scan shall be taken so that proper action can be
taken.

Please, contact me with any queries (Please, do let me know if you would like to know more
about the patient).

Yours sincerely
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Writing Answers - Medicine

Head Doctor

Sample Letter 7
Dr Ralph Emerson
Royal London Hospital
Whitechapel Rd London
Greater London E1 1BB
United Kingdom

(Today’s date)

Dear Dr Ralph Emerson

Re: Mrs Nicole Katie, DOB 12 July 1971

Mrs Nicole Katie is a patient, admitted into our hospital on 15th April 2005.
Nicole Katie was suffering from some kind of digestion problem (the problem was
undetected).

The patient was not able to eat properly and was feeling pain in her stomach. The patient
took some pain relievers (names are mentioned here) which, in fact, worsened the problem.
The patient began to feel pain which radiated back to her abdomen. The patient noted the
change in colour of her urine too. The patient had lost her appetite (the patient has lost
almost 2.5 Kg in course of 15 days) as well.

During her stay from April 15 to April 18, the condition of the patient was deteriorating.
Especially on 18th of April, the patient complained of much more severe pain which lasted for
hours. She felt pain, shortness of breath and vomited. Blood in bowel motion or urine is also
noted. There is high fever and the patient is sweating too.

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Writing Answers - Medicine

Hence, it is requested that the abdominal CT scan shall be taken for accurate diagnosis of the
abdominal pain.

Please, contact me with any queries.

Yours sincerely
Head Doctor

Sample Letter 8
Dr Martin
National Hospital for Neurology
33 Queen Square London WC1N 3BG
United Kingdom

(Today’s date)

Dear Dr Martin

Re: Mr Mark Henry, Acute onset of double vision and right eyelid droopiness.

Mr Mark Henry is a patient, admitted into our hospital on 9 / 7 / 2009 on complains of acute
onset of double vision and right eyelid droopiness.

On 9 / 7 / 2009, the patient was sitting in his room when he felt sensation in his eyelids. He
began to feel pain in his eyes. He also complained of appearance of double vision. There was
intermittent pounding bifrontal headache too.

Reports on general examination were clear. His pulse was 85 and BP 130 / 60. There was no
swelling of the lids or proptosis.

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Writing Answers - Medicine

His medical history showed that he had suffered from migraine (headaches) and depression.
The patient was prescribed Zoloft (50 mg - daily) and ibuprofen (600 mg - a few times per
week).

The patient denied associated vomiting, nausea or numbness or weakness or loss of vision etc
but said that his recent headaches differ from his typical migraines which actually occurred 4-
5 times in all his life time. The patient never took anything for headache except ibuprofen or
vicodin…

As the problem presented by the patient is a complex one so, further investigation and
definitive diagnosis is much more needed here.

Please, contact me with any queries.

Yours sincerely
Head Doctor

Sample Letter 9
Dr Robert Frances
St. George’s Hospital
Black Shaw Road
London SW17 0QT
United Kingdom

(Today’s date)

Dear Dr Robert Frances

Re: Mr Joseph Malcolm, Age 42

Mr Joseph Malcolm is a patient at our hospital who visits regularly. Just recently, he
complained of occasional breathlessness or difficulty in breathing. The patient’s health history

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Writing Answers - Medicine

showed seasonal upper respiratory allergies, occasional episodes of mild eczema etc. The
patient is reported to be healthy, apart from this recent asthma related problem.
The same problem of asthma, in words of the patient, increases with exercise or emotional or
physical stress or cigarette smoking etc.

The patient has been facing problems related to dyspnea for many days (dates are not
mentioned). The symptoms often get worsened in between 3-5 am. The patient coughs a lot
and he is not able to have full control over his daily activities.

Sometimes, the above symptoms temporally go away when the patient uses bronchial inhaler
medication (but when the patient doesn’t pay attention to medication or get involved in any
kind of physical activity then the same problem of difficulty in breathing occurs).

Further investigation or definitive diagnosis is indispensably required here as the patient has
not been keeping well for many now.

Please, contact me with any queries.

Yours sincerely
Head Doctor

Sample Letter 10
Dr Ivan Gonz
Willington Hospital
Central Building
21 Wellington Road
St John's Wood London

(Today’s date)

Dear Dr Ivan Gonz

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Writing Answers - Medicine

Re: Mr Marques, Age 65

Mr Marques has been a patient for months now. Just recently, he complained of severe
abdominal pain (The patient complained of facing sharp, epigastic abdominal pain which had
been reported to get increased over the last two months).

The pain is located in the epigastic region and left upper quadrant of the abdomen. This pain
is relatively constant throughout the day which may sometimes vary in severity. The patient
had rated this pain as 6 on a scale of 10. The patient didn’t take anything to get relief from
the pain and he denied any abdominal trauma or injury.

He has been a BP patient for over two years as well (his BP is well controlled now). He has
been facing depression related problem too (started Prozac two months ago but still he feels
depressed). The patient is reported to have no drug allergies or food or insect allergies.
The patient was once hospitalized for Myocardial Infarction (year: 2003). He has been on
medications regularly since then. Presently, the patient is using Aspirin - 81mg po qd (since
his MI, 3 years ago), Metoprolol 100 mg po qd (for the past two years).

There is a need for further investigation and definitive diagnosis.

Please, contact me with any queries.

Yours sincerely
Head Doctor

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Writing Test 1

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Writing Tests 11-15 (Medicine)

WRITING TEST 11
Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Case Notes:

Patient History:

Name: Jennet Berritto

Date of Birth: 22 April, 1971

Height: 163 cm

Weight: 75kg

Allergies: Nil

Social History:

Lives with her husband

Likes gardening
Doesn’t drink / smoke
Sometimes take betel leaves

Family History: No family history

Medical History

Type 2 Diabetes Mellitus (2/10/2001)

Hypertension (5/4/2006)
Stomach ulcers (12/7/2007)
Ankle injury (22/5/2008)
COPD (27/6/2011)

Present Symptoms:

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Writing Tests 11-15 (Medicine)

Intense coughing
Pain in the chest, shoulder or back
Shortness of breath
Change in voice
Harsh sounds with each breath
Change in color or volume of sputum

Diagnosis

Chest X-ray - Not cleared

CT-Scan - Positive
Stage 2A (Lung Cancer)
The tumour is 5.5 cm
Cancer cells spread across lymph nodes

Plan: Refer to Dr. Bryan Hardy for further treatment

Writing Task:

Using the information in the case notes, write a letter of referral for further treatment
to Pulmonologist, Dr Bryan Hardy, at EMR hospital,25 Rocklands Rd North Sydney
NSW, Australia, outlining the details of the patient.
In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST 11

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Writing Tests 11-15 (Medicine)

WRITING TEST 12
Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Case Notes:

Patient History:

Name: Christian Aula

Date of Birth: 12/9/1975

Height: 159 cm

Weight: 69 kg

Allergies: Nil

Social History:

Lives with her daughter and son-in-law

Enjoys walking
Doesn’t drink / smoke

Family History:

Mother - Died of heart attack (had a TIA Stroke as well)

Father - Died of liver failure

Medical History:

Allergic Rhinitis

History of Advanced, Home oxygen (02) - Dependent COPD and Heart Failure

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Writing Tests 11-15 (Medicine)

Benign Essential Hypertension

Chronic Respiratory Failure

Present Medications

Prednisone 5 mg qd, Montelukast 10 mg every evening, Albuterol-ipratropium MDI 2

puffs q4h prn SOB, Carvedilol 3.125 mg bid, Bumetanide 2 mg bid, Fluticasone-
salmeterol 500-50 mcg/dose disk with device 2 puffs bid, Potassium chloride 20 mEq
tablet ER bid, Tiotropium bromide 18-mcq capsule one inhalation every morning,
Albuterol/ipratropium hand-held nebulizer q4h prn SOB

Present Symptoms:

Weakness, numbness or paralysis in the face (left side)

Slurred or garbled speech / difficulty in understanding others
Double vision
Dizziness
Loss of balance or coordination

Diagnosis

TIA (Transient Ischemic Attack) Confirmed

BP Checked: 150/95 millimeters of mercury (mm Hg)

Plan: Refer to Dr. Anderson Sally for further treatment

Writing Task:

Using the information in the case notes, write a letter of referral for further treatment
to Hypertension Specialist, Dr. Anderson Sally, at Community Hospital, 33 Albany St
Crows Nest NSW, Australia, outlining the details of the patient.

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Writing Tests 11-15 (Medicine)

In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST 12

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Writing Tests 11-15 (Medicine)

WRITING TEST 13
Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Case Notes:

Patient History:

Name: Huang Bowra

Date of Birth: 27/7/1981

Height: 168 cm

Weight: 79 kg

Allergies: Sulfa Drugs / Tetracyclines

Social History:

Lives alone
Drinks a lot
Takes 2ppd of cigarettes daily

Family History:

No family history

Medical History:

Anxiety, Depression (1999 - due to sudden death of his mother)

Obesity (2000)
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Writing Tests 11-15 (Medicine)

Urinary incontinence (2003)

Hypertension (2007)

Insomnia (2009)

Present Medications

Norvasc 5 mg daily for hypertension

Lorazepam 1 mg HS for insomnia

Vistaril 25 mg BID PRN for anxiety (only when required)

Celexa 10 mg daily for depression (only when required)

Present Symptoms:

Indigestion
Dull, burning pain in the stomach
Burning sensation in the chest
Pain elevates on eating, drinking or taking antacids
Weight loss (has lost about 5 kgs in a course of 15-20 days)
Loss of appetite
Not wanting to eat because of pain
Nausea
Vomiting
Burping
Bloating

Diagnosis

Endoscopy confirmed the presence of stomach ulcers

Ulcers - one half inch in diameter

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Writing Tests 11-15 (Medicine)

Plan: Refer to Dr. Mathews Corrado for further treatment.

Writing Task:

Using the information in the case notes, write a letter of referral for further treatment
to Dr. Mathews Corrado, at Flivo Hospital, 9 Mount Street Hunters Hill NSW, Australia,
outlining the details of the patient.

In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST 13

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Writing Tests 11-15 (Medicine)

WRITING TEST 14
Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Case Notes:

Patient History:

Name: Abora Qualin

Date of Birth: 7/8/1979

Height: 179cm

Weight: 81 kg

Allergies: Sulfa Drugs

Social History:

Lives with her son

Drinks a lot
Quit smoking three months ago

Family History:

Data not available

Past Medical History

Hypertension (2001)
Urinary Tract Infection (2003)
Type 2 Diabetes Mellitus (2007)
Dyslipidemia (1 year ago)
Constipation (1 year ago)

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Writing Tests 11-15 (Medicine)

Vital Signs

BP: 124/76, P: 89, RR: 18, T: 37.2°C

List of Medications

Lantus 10 units QHS, Lisinopril 10 mg, Glipizide XL 7.5 mg, ASA 81 mg,
Hydrochlorothiazide 12.5 mg, Simvastatin 80 mg, Docusate 100 mg PRN.

Present Symptoms:

Complain of severe back pain / groin pain

Vomiting
Fever
Chills
Nausea
Painful Urination

Diagnosis

Urine Sample - Positive (presence of white blood cells in abundance)

Ultrasound - obstructions in the urinary tract

Result: UTI confirmed

Plan: Refer to Dr. Katherine for further analysis and treatment

Writing Task:

Using the information in the case notes, write a letter of referral for further treatment
to Dr. Katherine Mathel, at Marino Kidney Center, 3/77 South Terrace Como WA,
Australia, outlining the details of the patient.

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Writing Tests 11-15 (Medicine)

In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST 14

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Writing Tests 11-15 (Medicine)

WRITING TEST 15
Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Case Notes:

Patient History:

Name: Marcello Caprige

Date of Birth: 12/2/1979

Height: 168 cm

Weight: 73 kg

Allergies: Nil

Social History:

Married / Lives with his wife and son

Doesn’t drink
Smokes
Chew tobacco

Family History: No family history

Past Medical History

Hypertension

Type 2 diabetes mellitus

Depression

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Writing Tests 11-15 (Medicine)

Osteoarthritis

Hyperlipoproteinemia

List of Medications

Metformin 1,000 mg PO BID, Atorvastatin 20 mg PO QHS, Lisinopril 20 mg PO QD,

Furosemide 20 mg PO QD, Aspirin 81 mg PO QD, Glimepiride 2 mg PO QAM,
Venlafaxine 75 mg PO TID, Fish oil 1,200 mg PO QD.

Present Medical Condition:

Change in Blood pressure (last recorded 150/100)

Present Symptoms

Shortness of breath
Severe headache
Severe anxiety
Nose bleeding (occurred twice in last three days)

Diagnosis

High blood pressure noted (170/110)

Result: Hypertension (Stage 2)

Plan: Refer to Dr. Avelin Cooper for further analysis and treatment

Writing Task:

Using the information in the case notes, write a letter of referral for further treatment
to Dr. Avelin Cooper, at MKZ Hospital, 697 Beaufort St Mt Lawley WA, Australia,
outlining the details of the patient.

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Writing Tests 11-15 (Medicine)

In your answer:

 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

The body of the letter should be approximately 180-200 words.

END OF WRITING TEST 15

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Writing Test 1

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Writing Tests Answers 11-15 (Medicine)

WRITING TEST 11

Sample Letter

Dr Bryan Hardy
EMR hospital
25 Rocklands Rd
North Sydney NSW
Australia

(Today’s date)

Dear Dr Bryan Hardy

Sub: Jennet Berritto, DoB 22 April 1971

Jennet Berritto is an elderly woman who visited our hospital on complaints of intense
coughing, shortness of breath, change in her voice etc. She was feeling pain in the
chest and pain around her shoulder too. This pain was accompanied by back pain as
well. There was harsh sound with each breath. The patient complained of change in
color or volume of sputum too.

Her medical history reveals that she has been a patient of diabetes for over 14 years
now. She has been a patient of Hypertension (5/4/2006) too. She has problems
related to COPD (27/6/2011) too.

X-rays taken were not clear so CT scan was suggested. The reports on CT were
positive (Reports on diagnosis showed that she has Lung Cancer - Stage 2A). The
tumor is seemed to be growing. It is presently 5.5 cm. Cancer cells are spreading
across the lymph nodes.

The patient doesn’t drink / smoke but is habituated to taking betel leaves.

The condition of the patient at the time of discharge was good.

I would request you to please, look into this case and provide suitable treatment.
Please, do let me know if you would like to know more about the patient.

Yours sincerely
Doctor

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Writing Tests Answers 11-15 (Medicine)

WRITING TEST 12

Sample Letter

Dr Anderson Sally
Hypertension Specialist
Community Hospital
33 Albany St Crows Nest NSW
Australia

(Today’s date)

Dear Dr Anderson Sally

Sub: Christian Aula, DoB 12/9/1975

Christian Aula is an elderly woman who visited our hospital on Weakness, Numbness
or Paralysis in the face (left side). The patient was not able to speak properly (garbled
speech) and was displaying difficulty in understanding people around. She complained
of double vision, dizziness and loss of balance or coordination too.

Diagnosis confirmed the presence of TIA - Transient Ischemic Attack. Her BP checked
at the time of admission was 150/95 millimeters of mercury (mm Hg).

Her medical history reveals that she has allergic rhinitis, has problems related to
COPD and benign essential hypertension. The list of her medications include the
following: Prednisone 5 mg qd, Montelukast 10 mg every evening, Albuterol-
ipratropium MDI 2 puffs q4h prn SOB, Carvedilol 3.125 mg bid, Bumetanide 2 mg bid,
Fluticasone-salmeterol 500-50 mcg/dose disk with device 2 puffs bid, Potassium
chloride 20 mEq tablet ER bid, Tiotropium bromide 18-mcq capsule one inhalation
every morning, Albuterol/ipratropium hand-held nebulizer q4h prn SOB.

The condition of the patient at the time of discharge was good.

I would request you to please, look into this case and provide suitable treatment.
Please, do let me know if you would like to know more about the patient.

Yours sincerely
Doctor

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Writing Tests Answers 11-15 (Medicine)

WRITING TEST 13

Sample Letter

Dr Mathews Corrado
Flivo Hospital
9 Mount Street
Hunters Hill NSW
Australia

(Today’s date)

Dear Dr Mathews Corrado

Sub: Huang Bowra, DOB 27/7/1981

Huang Bowra is an elderly man who visited our hospital on complaints of symptoms
which were related to stomach ulcer. The patient complained of indigestion, dull,
burning pain in the stomach and burning sensation in the chest. The pain was
elevating on eating, drinking or taking antacids. The patient had also lost about 5 Kgs
in a course of 15-20 days. There was loss of appetite too (it was painful for the
patient to eat). He also complained of nausea, vomiting, burping and bloating.

Endoscopy confirmed the presence of stomach ulcers (one half inch in diameter).

His medical history shows he had problems related to obesity and urinary
incontinence. Presently he is taking medicine for hypertension, insomnia, anxiety and
depression. The list of present medications included the following: Norvasc 5 mg
daily for hypertension, Lorazepam 1 mg HS for insomnia, Vistaril 25 mg BID PRN for
anxiety (only when required), Celexa 10 mg daily for depression (only when
required).

The condition of the patient at the time of discharge was good.

I would request you to please, look into this case and provide suitable treatment.
Please, do let me know if you would like to know more about the patient.

Yours sincerely
Doctor

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Writing Tests Answers 11-15 (Medicine)

WRITING TEST 14

Sample Letter

Dr Katherine Mathel
Marino Kidney Center
3/77 South Terrace Como WA
Australia

(Today’s date)

Dear Dr Katherine Mathel

Sub: Abora Qualin, DOB: 7/8/1979

Abora Qualin is an elderly woman who visited our hospital on complaints of symptoms
which were related to UTI. The patient complained of severe back pain / groin pain,
vomiting and nausea. The patient was suffering from fever and was feeling pain while
passing urine.

Urine test confirmed the presence of UTI - Urinary Tract Infection. Her medical history
shows that she had this urinary tract infection earlier as well. She first faced this
problem in the year 2003. For the last one year, she has been facing the problems
related to Dyslipidemia and Constipation too. She has BP (diagnosed in the year
2001) and Sugar too (diagnosed in the year 2007). The medications which she is
taking presently include the following: Lantus 10 units QHS, Lisinopril 10 mg,
Glipizide XL 7.5 mg, ASA 81 mg, Hydrochlorothiazide 12.5 mg, Simvastatin 80 mg,
Docusate 100 mg PRN.

The patient is reported to be allergic to sulfa drugs.

The condition of the patient at the time of discharge was good.

I would request you to please, look into this case and provide suitable treatment.
Please, do let me know if you would like to know more about the patient.

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Writing Tests Answers 11-15 (Medicine)

Yours sincerely
Doctor

WRITING TEST 15

Sample Letter

Dr Avelin Cooper
MKZ Hospital
697 Beaufort St
Mt Lawley WA
Australia

(Today’s date)

Dear Dr Avelin Cooper

Sub: Marcello Caprige, Change in Blood pressure (last recorded 150/100)

Marcello Caprige is an elderly man who was admitted into our hospital on complaints
of change in his blood pressure. The patient was not able to breath properly
(shortness of breath) and was suffering from severe headache and anxiety. The
patient complained of nose bleeding too which occurred two times in the last three
days.

Diagnosis revealed that the patient was at Stage 2 (Hypertension). Blood pressure
noted at that time was very high (170/110).

His medical history shows that he has diabetes too (Type 2 diabetes mellitus). He has
been suffering from Depression, Osteoarthritis and Hyperlipoproteinemia as well. The
list of the medications which the patient is presently taking include the following:
Metformin 1,000 mg PO BID, Atorvastatin 20 mg PO QHS, Lisinopril 20 mg PO QD,
Furosemide 20 mg PO QD, Aspirin 81 mg PO QD, Glimepiride 2 mg PO QAM,
Venlafaxine 75 mg PO TID, Fish oil 1,200 mg PO QD.

The patient has no habit of drinking or smoking but sometimes chew tobacco.

The condition of the patient at the time of discharge was good.

I would request you to please, look into this case and provide suitable treatment.
Please, do let me know if you would like to know more about the patient.

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Writing Tests Answers 11-15 (Medicine)

Yours sincerely
Doctor

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Speaking Test 1

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Speaking Test 1 – Medicine

Time allowed: 20 minutes

ROLE PLAYER’S CARD NO. 1

SETTING: Suburban General Practice

PATIENT: You are 52 who has recently undergone thyroid gland removal
operation. A doctor comes to you to examine you. You are very anxious and
you are explaining to her about the difficulties you are facing after the operation.

Task:

 Tell her about the difficulty in swallowing or speaking

 Ask the doctor the reason for difficulty in breathing

 Ask about how much time will it take to get recovered. Also ask what
precautions you need to take etc...

CANDIDATE'S CARD – 1

PLACE: Suburban General Practice

DOCTOR : You are a doctor. You are attending on a patient who has undergone
an operation for thyroid gland removal. The patient is unable to speak properly
and she has difficulty in swallowing or even breathing properly.

Task:

 Begin with warm and friendly greetings.

 Answer questions that he / she may ask

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Speaking Test 1 – Medicine

 Assure him / her that problems related to speaking, swallowing, breathing

will go away sooner (usually, go away after 2-3 weeks)

 Advice him / her not to pressurize his / her vocal chords by speaking
continuously. Also let him / her know of the precautions he / she may have
to take to get well sooner.

ROLE PLAYER’S CARD NO. 2

PLACE: Suburban General Practice

PATIENT: You are a patient who has recently been admitted to the hospital
because of problems related to Bronchitis. You are a heavy smoker, live with
your spouse and have two children: Martha and Julie. You have been struggling
to quit smoking but have been very unsuccessful.

Task:

 Answer the questions the doctor may ask about you, your family etc.

 Take advice on how to quit smoking as well.

CANDIDATE'S CARD – 2

PLACE: Suburban General Practice

DOCTOR: You are a doctor. You are talking now with the patient who has been
admitted due to bronchitis.

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Speaking Test 1 – Medicine

Task:

 Try to take as much information as you can about the patient (his or her
medical history / family background / habits etc)

 Respond to the questions asked by the patient on how to stop smoking forever.

 Suggest some remedial measures

END OF SPEAKING TEST

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Speaking Test 1

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Speaking Test 2 – Medicine

Time allowed: 20 minutes

ROLE PLAYER’S CARD NO. 1

SETTING: Suburban General Practice

PATIENT: You are a patient who is recovering from a minor knee fracture.
A doctor visits you in the morning to examine you. You want to know when you
can get discharge from hospital as you are a student who has exams next month.

Task:

 When you can go back to your home

 How you can recover from this knee fracture (time duration)

 Is there anything you can do to bring improvement in your present

condition….

CANDIDATE'S CARD – 1

PLACE: Suburban General Practice

DOCTOR :

You are a doctor talking to the patient who is recovering from minor knee
fracture. The patient asks you of when he / she can be able to go home as
he / she has exams next month.

As a doctor assure him / her that

 He / she will be alright soon

 He / she can take the exam as well

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Speaking Test 2 – Medicine

 Advice him / her of the importance of taking medicine on time.

 Also let him / her know of the precautions he / she has to take to get well
sooner.

 Suggest some easy exercises that will help bring some improvement in
his / her knee too.

ROLE PLAYER’S CARD NO. 2

PLACE: Hospital

Patient: You are a mother who has a three month's old baby. You would like
to know of the best food that you can give to her. You, as a mother, have noticed
that she has lost weight significantly since the time of her birth.

Ask the doctor

 What should be the best food for three month's old baby?

 Can you start solid food for the baby, apart from breastfeeding?

 Why your baby's weight has gone down?

CANDIDATE’S CARD NO. 2

PLACE: Hospital

DOCTOR: You are a doctor in the hospital. A mother of a three month's old
baby comes to you to inquire about whether she can start giving solid food to her
baby. She is also worried over the fact that her baby has lost weight significantly
since the time of her birth.

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Speaking Test 2 – Medicine

You as a doctor

 Assure her that it is often natural for new born babies to lose weight

 inform her about solid food that she can give (Inform her about the box cereals
etc)

 Let her know of what can be better for her baby too etc...

END OF SPEAKING TEST

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Speaking Test 1

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Speaking Test 3 – Medicine

Time allowed: 20 minutes

ROLE PLAYER’S CARD NO. 1

PLACE: Patient's Home

Patient: You are a diabetic patient. Recently, your physician has suggested that
you should take insulin injection. A doctor has come to your house to teach you
how to give yourself these insulin injections. You are not able to understand
why it is required for you to take these injections and even you are worried
over the process.

Task:

 Ask the doctor why it is necessary to have insulin injections.

 Inform the doctor that you have been managing your diabetes with your diet
and tablets well

 Show your anxiousness when the doctor teaches you how to inject yourself.

CANDIDATE'S CARD – 1

PLACE: PATIENT'S HOUSE

Doctor: You are a doctor. Patient's family physician at the hospital had asked
you to go to the patient's house to teach him / her about how to take insulin
injections on own. The patient is worried as he / she doesn't understand why
it is necessary for him / her to take insulin injections, as he / she thinks that
he / she is able to manage his / her diabetes perfectly well with diet and tablets.

 Explain to the patient why insulin injection is important

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Speaking Test 3 – Medicine

 Explain in detail the process of giving oneself an insulin injection

 Reassure the patient that it is an easier process, if you find the patient
anxious.

 Explain about the significance of using clean needles, the process of

administering, general sites for injections and importance of needle
disposal etc.

ROLE PLAYER’S CARD NO. 2

PLACE: Hospital

Patient: You are a patient who is facing gum problems. On advice, you got ready
for gum biopsy. Now, you are at the hospital and talking to the doctor.

Task:

 Begin with warm greetings

 Ask questions related to gum biopsy, showing anxiety

 Know about the risks involved, if there are any

 Know about the precautions that one has to take after biopsy.

CANDIDATE'S CARD – 2

PLACE: Hospital

Doctor: You are a doctor at the hospital. A patient comes to you to know more
about Gum Biopsy. He / She had been to hospital for a number of times because
of gum problems. He / She is anxious to learn from the physician that he / she
will have to face gum biopsy.

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Speaking Test 3 – Medicine

Task:

 Begin with warm greetings.

 Assure him / her that gum biopsy will not be painful (explain here the
importance of numbing injection)

 Tell him / her that there are no risks (related to bleeding from the biopsy
site, infection of the gums, soreness etc) as long as precautions are taken.

 Advice him / her how to be prepared for the test (you may tell her not to eat
for a few hours before the biopsy).

END OF SPEAKING TEST

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Speaking Test 1

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Speaking Test 4 – Medicine

Time allowed: 20 minutes

ROLE PLAYER’S CARD NO. 1

PLACE: Hospital, Richmond.

PATIENT: You recently have given birth to a girl baby. You want to breastfeed
your baby but you have some problem. Your breasts are swollen with unusual
soreness.

Ask about what can be the best treatment for this.

Remember, you, as a patient, are allergic to some antibiotics. Please, try to avoid
if antibiotics are offered to you. You were given a few tips on breastfeeding but
you have forgotten so ask for the same as well.

CANDIDATE’S CARD NO. 1

PLACE: Hospital, Richmond.

DOCTOR: A woman who is a first time mother is worried at soreness and

engorgement. Her breasts show unusual soreness. You, as a doctor, have to
assure her about this temporary engorgement.

 Let her know of the best medicine.

 Give her a few tips on breastfeeding too.

 How well can she cope up with the problems.

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Speaking Test 4 – Medicine

ROLEPLAYER’S CARD NO. 2

PLACE: Hospital

Patient: You are a patient at the hospital who is recovering from an illness you
had for months. A doctor comes to you to examine you but you are unhappy
because you do not like the food at hospital. You would like to complain about
the same.

 Begin with greetings and explain to her

 Why do you not like the food

 How you yearn for home food

 Can you get food from outside etc.

CANDIDATE’S CARD NO. 2

PLACE: Hospital

DOCTOR: You are a doctor, talking to the patient who has no interest in
hospital food. There are more two weeks for the patient to go home but he /she
expresses his / her wishes to eat home food or any outside food. He / she has
not even touched his / her breakfast as it can be seen by you, lying there,
as it was.

 As a doctor explain

 He / she has to take the breakfast to recover sooner

 Tell him / her that menu at hospital can’t be changed

 Why outside food is not preferred by the management etc.

END OF SPEAKING TEST

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Speaking Test 1

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Speaking Test 5 – Medicine

Time allowed: 20 minutes

ROLE PLAYER’S CARD NO.1

PLACE: Hospital

Patient: You are a patient who has faced bunion surgery an hour ago. You are
anxious to know how fast you can recover from this surgery. You want to speed
up the healing process and would like to decrease your chances of experiencing
discomfort, anything from moderate to severe.

Task:

 Ask the doctor what care you should take to be able to get well sooner.

 Ask about the duration of the pain medications

 Ask about specific exercises that can help you get well soon

CANDIDATE'S CARD – 1

PLACE: Hospital

doctor: You are a doctor who is talking to the patient who has undergone a
bunion surgery an hour ago. The patient is anxious and would like to know
about what he / she can do to recover from this surgery and be able to walk
around without any pain.

Task:

 Begin with warm greetings

 Assure him / her that he / she will become alright sooner.

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Speaking Test 5 – Medicine

 Give him / her some precautions or suggestions on how to speed up the

process of recovery (avoiding shower for the first two weeks, necessity of
bed rest, importance of wearing a surgical shoe, importance of taking pain
killers, if required and use of ointment etc).

ROLE PLAYER’S CARD NO. 1

PLACE: Hospital

Patient: You are a patient who is about to face cardiac catheterization. You are
52 years old and have two children. You are a heavy smoker and a drinker.

Task:

 Begins with warm greetings

 Give out your family details as asked

 Looks for suggestions on how to quit smoking and drinking

CANDIDATE'S CARD – 2

PLACE: Hospital

Doctor: The doctor is talking with the patient who is now going to face cardiac
catheterization. He is an alcoholic and a chain smoker.

Task:

 Begins with warm greetings

 Inquire about his past medical history, family background.

 Make him relax

 Inform him of the bad effects of drinking and smoking

END OF SPEAKING TEST

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Speaking Test 1

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Speaking Test Answers – Medicine

Speaking Test 1:
Script – One

This is just a sample script. The real conversation may involve different dialogues
from the role-player and the candidate………

Doctor: Hello, how are you doing?

Patient: I am fine, doctor.
Doctor: Did you sleep well yesterday?
Patient: Well………..yes, doctor, but there was this pain………it is nagging me.
Doctor: Pain??? How……….when did you feel the pain…..?
Patient: Right after 10 in the evening. I was not able to sleep throughout the night.
Doctor: Well, was that on and off…………I mean was the pain continuous?
Patient: Well, yes, doctor…… it was…. For a few minutes, it was very unbearable for
me……….but later it slowed down……….and again after an hour or so……I began to feel the
same……
Doctor: Oh…..I see……….
Patient: I am really worried…….doctor…
Doctor: Don’t be……….there is nothing to be worried about……….
Patient: When this pain will go away… doctor………. Will it or not……….?
Doctor: Well, this pain will certainly go away. You, please, don’t be worried. The operation
was successful. It may happen in a few of the cases. The patient may feel pain………..but
there is surely nothing to be worried about…………
Patient: Doctor, there is another thing……….that I have to tell you………
Doctor: Please, tell me…………
Patient: I feel difficulty in swallowing as well………It is really difficult for me to swallow down
anything. Even I feel pain when I speak. Will these problems be there in future too….? I am
really worried…….my life is really going to get changed a lot if these problems continue to be
there in future too.
Doctor: Well, It is not like that. Only two days have now been passed since we have
performed the operation. In the beginning these problems of difficulty in speaking or

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Speaking Test Answers – Medicine

swallowing are very common. Many of the patients complain of the same. But you do not be
worried……..These problems will soon go away. You may have to wait for a week or two to get
well again or go back to the normal routine.
Patient: Doctor, I feel difficulty in breathing too. Will this problem be with me or will it go
away?
Doctor: Certainly, this problem will go away. You do not have to be worried. You will be
perfectly alright after two or three weeks.
Patient: I hope for the same, doctor.
Doctor: Now, it is time that you shall take some rest. You really need it and I suggest that
you do not speak much or do not take any solid food for a few days more. Taking solid food
may hurt you. You will have to be very careful.
Patient: Well, thanks, doctor. I will take care of that.
Doctor: And again, I say the same thing. Do not get worried. You are certainly going to lead a
normal life.
Patient: Thanks doctor.
Doctor: Finer, thanks, take care……..

End of the script one

Script – TWO

This is just a sample script. The real conversation may involve different dialogues
from the role-player and the candidate………

Doctor: Hello, I am Doctor Henry.

Patient: Hello, doctor.
Doctor: Well, it seems you like you smoke a lot…………..I can see a pack of cigarette sneaking
at me from your breast pocket.
Patient: Oh, doctor……….
Doctor: How many packs of cigarette do you take in a day?
Patient: Well, doctor, to be honest, I smoke two or three packs of cigarette per day…………I
myself do not know why…….? But I do……

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Speaking Test Answers – Medicine

Doctor: Well, if this is the case then you will really have to do something to keep yourself
away from this as this is going to create a big problem for you. You will really have to quit
smoking.
Patient: Well, I am trying to, doctor…………but …
Doctor: Do you live alone………….or do you have a family?
Patient: Well, I have a family. I am here with my wife and I have got two children, Martha
and Julie. They are my angels.
Doctor: That’s nice to hear. It is good. At least, for the sake of your family, you will have to
seriously find a way to quit smoking. I must say, that your problem, related to bronchitis, is
really getting worse and worse. It is really getting much serious. If you do not quit smoking
now then you will have to face serious consequences of the same.
Patient: Doctor, even I want to quit smoking……….but, you know, I can’t help it…………..Every
time, I think of quitting……….I find it difficult to do the same…………..can you suggest
something that which can help me in quitting……………
Doctor: Well, there is nothing that can be suggested. There are no medicines which can help
you or which can be effective. What all you can do is just this: You can make a strong
resolution and you will have to stick to it……………..you will have to follow what you have
decided for yourself…………..
Patient: I will try doctor……………………this, time, I really will make a strong resolution………….
Doctor: Well, not just a resolution…………. Work on it too………………
Patient: I really love my family………….I will quit smoking…………….
Doctor: That’s what I say…………..when you feel the urge to smoke then think of your
family………….you will surely take yourself back from it……………
Patient: I will doctor……………. I will………….
Doctor: And trust me……….this problem of bronchitis can successfully be eliminated………if only
if you keep yourself away from smoking. You can certainly lead a normal, healthy life if you
stop smoking. You can easily fight this…………..
Patient: I will quit smoking doctor…………….I will…………….
Doctor: So, take care……… and do not forget to come back after a week or so…………….as we
will perform certain tests…………..this will help us in assessing your condition well…………….. For
a week or so, just keep yourself away from smoking………………..
Patient: Thanks, doctor, I will……………..

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Speaking Test Answers – Medicine

Speaking Test 2:
Script ONE

This is just a sample script. The real conversation may involve different dialogues
from the role-player and the candidate………

Doctor: Good morning, how are you doing?

Patient: Fine, doctor……………..
Doctor: How is your knee now?
Patient: Oh…………….it is ok………but I feel some kind of pain………..it is less often
but……………..there is this pain………….
Doctor: How do you rate it on a scale of 10?
Patient: Well, 5 on a scale of 10…………
Doctor: Well………….do not worry……….this will go off……………
Patient: And doctor, is there not any process of speedy recovery? I really want to get well
sooner……………
Doctor: Well, I am afraid……………there is no such process of speedy recovery…………. In cases,
like this, you will have to do nothing but wait to get well…………..
Patient: But, doctor, I really want to get well sooner………….
Doctor: You will………….you will get well sooner but… you will have to spend some more
time…..
Patient: You see, doctor, I am really worried. My final exams are fast approaching and I need
to get well sooner so that I can prepare for my exams and get through easily. I have not
done any kind of preparation yet. Still, there are a lot many things to do.
Doctor: When do you have the exams from?
Patient: I have exams from next month.
Doctor: Oh, I see…….
Patient: Doctor, can it really be possible or not to get well before that…………?
Doctor: Well, knee fractures often take time. Seriously, healing will take some time. I must
say that your case is a complex one. Most of the patients who get knee fractures like yours
often take two to three months’ of time to get to the normal routine……………but now, it

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Speaking Test Answers – Medicine

doesn’t mean that you will also take two to three months……….it can be possible for you to
get around without any kind of help if only if you take good care of yourself……………..
Patient: Can it really be possible, doctor? I mean, I really want to……..I have to………. because
I do not want to miss my exams…………….
Doctor: Yes, it can be possible…………the only thing is you will have to take good care of
yourself………….. a physiotherapist will soon be here and he will teach you some exercises and
you will have to perform those exercises…………….you can leave your bed after a week and you
can make some movements or move around without any kind of help as well…………..
Patient: Oh, doctor, I am really glad………I do not have to miss this year………….I was really
worried……that I would miss this year……….
Doctor: You will certainly not miss this year. After a month’s time from now you will be there
sitting in the examination hall, taking your exam……………..you do not be worried. You will
have to just strictly follow what is being suggested to you or advised……………you will surely
see some improvement in yourself………….in course of 20 to 254 days, you will be able to
make some small movements………and it would be your biggest achievement…………..
Patient: I will certainly follow whatever that you say doctor…………….as I do not want to miss
my exams………….
Doctor: Take some necessary precautions…………………..don’t come in contact with the
water……….do not get yourself hurt……….do not make any movements if it hurts you…………and
inform the doctor if there is anything……….follow those exercises which are being suggested to
you……………
Patient: Sure doctor, I will take care of that…………..
Doctor: Then you are really going to get well sooner…………………and you will surely be able to
take your exams………………
Patient: Thanks doctor…………
Doctor: Thanks, take care………..see you sooner……………

End of the Script ONE

Script TWO

This is just a sample script. The real conversation may involve different dialogues
from the role-player and the candidate………

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Speaking Test Answers – Medicine

Doctor: Hello, please, take the chair………….

Patient: Thank you, doctor………..
Doctor: You have got a nice baby….what’s her name?
Patient: Oh, thanks doctor…………..her name is Tina………….
Doctor: Nice name…………..so, what is the problem?
Patient: Doctor, Tina has now got completed her three months…………. I was wondering what
food could be the best for a three months’ old baby………….?
Doctor: Well, there can be many choices for you………… you can go for anything which is good
………..but preferably in liquid form………which can be perfectly fit for three month’s old
babies………….
Patient: Will solid food be good for the baby, doctor?
Doctor: Well, it will be good for the baby…………..but still, you need to avoid it………. If your
baby is three months’ old then it is necessary that you shall start giving her some semi-solid
food…….pureed food like sweet potatoes, apples, squash etc can be the best…………… you can
give semi-liquid iron-fortified cereals……………
Patient: Shall I continue breastfeeding too, doctor?
Doctor: Well, you shall, it is very much necessary……… you shall not stop breastfeeding your
baby………….breastfeeding is really good……………….your baby will continue to get all essential
nutrients………. Nutrients which are very much necessary for a growing baby………….It helps in
protecting the baby from diseases as well…….. You shall not stop breastfeeding your
baby………and you know, most of the mothers stop breastfeeding and start giving solid food to
their babies………. In such cases, the babies do not fully get everything that which is
necessary for good health…………
Patient: Well, I understood doctor……………..and I have another question to ask………….
Doctor: Oh, please……..
Patient: Doctor, my baby is losing weight………..since the time of her birth, I have been
noticing she has not been the same………..there is a great change in her weight………… I have
been noticing she is getting thinner and thinner ………..
Doctor: Well, it can be common in some cases………… Most of the new born babies lose their
weight……….you do not have to be worried………it can be a normal thing………but if your baby
loses weight after some six months’ of time or if it continues then you need to see me

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Speaking Test Answers – Medicine

again…………. We can assess the problem and can find a solution for the same………….now, you
do not have to think too much about it…………
Patient: Well, thank you, doctor………….Yes, I will…………..
Doctor: And one more thing, I really suggest that you do not stop breastfeeding the
baby……your baby will not lose her weight………
Patient: Certainly, doctor…………I will not………I just want my baby to be healthy……………
Doctor: Well, then, let me prescribe something for the baby……….give her the semi-solid food
which I have prescribe here.……………it will be good for her…………and do not forget to come
again after some three months………….
Patient: Thanks, doctor…….. I will………..Thanks a lot………….

End of the Script TWO

Speaking Test 3:

Script ONE

This is just a sample script. The real conversation may involve different dialogues
from the role-player and the candidate………

Doctor: Hello……….
Patient: Hello, Doctor………….
Doctor: So, how are you feeling now………….?
Patient: Much better, doctor…………….
Doctor: OK, nice to hear that……….
Patient: Doctor, I have already been told that I will have to take the insulin injection but
still………….. I do not understand why is it needed……………..?
Doctor: Well, you see………….. Your sugar level is a bit uncontrolled now………..and if you take
the insulin injection for a few days then your sugar level will come down…………
Patient: My sugar level is higher now………….

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Speaking Test Answers – Medicine

Doctor: Not be worried… just a bit…………..but it is necessary that you shall not take any
chances………..
Patient: Oh…………..how this has happened……… I had been managing perfectly well………….. I
go for exercise in the morning……… I do a lot of physical work……….then how come my sugar
level is higher………..
Doctor: Well, it is not that higher…….. You do not have to be worried……. Please, do not think
much about it….. Here, insulin injection is being prescribed just as a precautionary
measure…………. Just to bring the sugar level to the normal position……...
Patient: Oh, I understand, doctor……………but………….
Doctor: Please, do not be sad…… you are perfectly alright………..and this insulin will help you
do much better as well…………..
Patient: OK, doctor, I understand………….
Doctor: See, you will have to just inject it…………but remember you will have to take
precautions as well…………
Patient: Oh………..
Doctor: See, roll the bottle of insulin well between your hands 2-3 times. You shall mix
well………….you shall not shake the bottle as this will form air bubbles and this will affect the
amount of insulin withdrawn………. Draw exactly the same amount of insulin as required into
the syringe. Always, measure from the top of the plunger…... Check the syringe for the air
bubbles. Well, air bubbles in the syringe will not harm you but still this may reduce the
amount of insulin drawn into the syringe………
Patient: Where can I inject myself, doctor?
Doctor: Well, you can inject into the fat layer just beneath the skin. There are certain areas of
the body which include the stomach area (not around belly button), thighs, (top part and
outer parts), upper arms etc. You shall use the same areas but you shall not inject yourself
into the same spot again and again…….. As this can lead to lumps or scars…….
Patient: Ok, doctor…………. I understand……….
Doctor: And do not worry……… you will have to take this injection just for a few days…………
Patient: Well, I understand………… doctor………….
Doctor: OK, so, let me first give you this injection………….you can see for yourself and then
you can do the same on your own…………..
Patient: That would be good, doctor…………
Doctor: I am going to inject on your arm…………..right arm……………

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Speaking Test Answers – Medicine

Patient: OK, doctor………………

Doctor: Here, I go…………… that’s it…………..over……………….I hope you didn’t feel pain…………..
Patient: Well, I didn’t feel much pain……………doctor………..
Doctor: So, now, you can try for yourself later…………….ok………. if there is anything then you
can call me………..
Patient: Surer, doctor……..thanks a lot…………
Doctor: And do not forget…………take injection once in the morning and then in the
evening………….before you take your food………….
Patient: Sure……..doctor……..thanks a lot………..
Doctor: Thanks………. Take care………bye……

End of the Script ONE

Script TWO

This is just a sample script. The real conversation may involve different dialogues
from the role-player and the candidate………

Doctor: Hello, please, take the chair…………

Patient: Hello, doctor……..thanks………
Doctor: So, what is it that you are worried about…………….
Patient: The same gum problem……………..doctor………..
Doctor: Well, have you undergone any kind of examination yet…………..?
Patient: No, doctor…….. Not yet…………..
Doctor: Well, then you will have to wait for the same………..
Patient: Yes, I am being told of the same………. There is some gum biopsy………….
Doctor: Yes, Gum Biopsy……………… you will have to undergo complete examination…………. So
that we can assess your problem and give you a proper solution………….
Patient: Doctor, is it going to be painful………………?
Doctor: Well, not so……. It will not be …………… you will not face any kind of trouble…………..
Patient: But, doctor, is it necessary………………?

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Speaking Test Answers – Medicine

Doctor: Yes, it is pretty much necessary as your gums are going from bad to
worse………..there is a need to do something otherwise you will face a lot of problems in
future…………
Patient: Well, doctor, can you tell me something about the procedure……………
Doctor: Sure………….It is a very simple process…….. You will be told not to eat anything at
least for two hours before the biopsy………..A painkiller will be sprayed into your mouth in the
area near to the abnormal gums……………we can even give you an injection of numbing
medicine………….. A small tissue of your gum will be removed and will be checked in the lab
for problems… Do not worry. There will be no bleeding……….. If there is any bleeding then it
can be stopped with the help of the process called electrocauterization…………. You may feel
soreness for a few days but this will go off…………
Patient: So, can I continue brushing or do I have to avoid that………..?
Doctor: Well, you can brush but you will have to be very careful………. You shall avoid the area
where the biopsy was performed. At least for a week you will have to avoid…….
Patient: Oh…………. Doctor…. This really seems to be very tougher for me……………..
Doctor: Well, no….. It is not so…………….
Patient: Can’t there be any other process, doctor?
Doctor: I am afraid, there is no other process………………
Patient: OK, fine doctor……… I am ready to undergo this test………..
Doctor: OK……….then………
Patient: But, I have taken some food an hour ago…………….so…. shall I have to wait…………
Doctor: Well, in that case, you will have to………..
Patient: OK, doctor, I will wait………
Doctor: And do not worry……… everything is going to be alright…….. We will make sure you do
not feel any pain………….
Patient: Thanks, doctor…..

End of the Script TWO

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Speaking Test Answers – Medicine

Speaking Test 4:
Script ONE

This is just a sample script. The real conversation may involve different dialogues
from the role-player and the candidate………

Doctor: Hello….
Patient: Hello, doctor…………
Doctor: Please, take the chair…………
Patient: Thank you, doctor………
Doctor: Well, what is her name……………….she must be your first child…………….
Patient: Yes, doctor, this is my first baby………… her name is Martha…………
Doctor: Nice name………..
Patient: Doctor, I have some problem in breastfeeding her….. I want to breastfeed her but I
have noted my breasts are unusually sore……………they are swollen…………..
Doctor: Well, this can be normal in the beginning …………….
Patient: No, it has been over two months……. And I have this same problem……………….
Doctor: Oh…………….
Patient: I am unable to understand….why??? I feel difficulty in breastfeeding my baby………….
Doctor: Well, this can be due to engorgement………are they uncomfortably full and
swollen……………?
Patient: Yes, doctor………….my breasts feel hard, throbbing and uncontrollably full and
painful……………
Doctor: Then you are likely engorged……….is the swelling extended to your armpit too………….?
Patient: Yes, doctor…… I feel pain there as well…….. But only sometimes…………..
Doctor: Any fever………..
Patient: Well, no……………doctor…. There is no fever……….
Doctor: Engorged breasts can be due to many reasons…………But the problem can be tackled
as well…… I can prescribe something for the same………..I may give you some antibiotics
which will help you surely…………

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Speaking Test Answers – Medicine

Patient: Please, doctor……….. But doctor, I am allergic to some antibiotics…………..Last time I

used some antibiotics and that created a problem for me………….
Doctor: Oh, in that case, I will have to suggest something different to you………which can help
you………
Patient: Please, doctor………….
Doctor: Ok……….. I have prescribed something here for you……… take as suggested and come
after a week again……………I may have to prescribe something else if this medicine doesn’t
work………
Patient: Surely, doctor, I will come after a week or so again………….. And one more
thing………doctor ….. I was given some tips for breastfeeding but I forgot……..can you suggest
a few tips…………please………..
Doctor: Well, you just need to position the baby correctly……. And you will have to make sure
that the baby latches on correctly. ………… You can support yourself with pillow if needed……..
cradle your baby close to your breast…….you can support the baby’s head with one hand and
the your breast with the other…….you can tickle the lower lip of the baby and can encourage
sucking……let your baby set the pace………..just look and listen for rhythmic sucking and
swallowing pattern…………and when removing the baby, first release the suction by inserting
your finger into the baby’s mouth……………you need to watch for early signs of hunger which
may include restlessness, stirring, sucking motion or lip movement etc…………
Patient: Well, thanks………..doctor……..
Doctor: Well, do not forget to come after a week……….
Patient: Sure, doctor, thanks a lot…………..I will……………..

End of the Script ONE

Script TWO

This is just a sample script. The real conversation may involve different dialogues
from the role-player and the candidate………

Doctor: Hello………..
Patient: Hello……… doctor…………..
Doctor: So, how are you feeling?

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Speaking Test Answers – Medicine

Patient: Much better now………..

Doctor: And what is this…………….. You have not taken your breakfast?
Patient: Well………. I tried to but……. It seems like I have lost appetite………
Doctor: Well, it can happen ……….but you need to take the food………..you can’t avoid………
Patient: Doctor………… I have been taking food here from the hospital for about a week and
now have got so very bore with the same food every day………I want to eat something
different……….
Doctor: Well, for a few days more, you will have to take the food here from the hospital and
after that you can go home and have anything you like for your breakfast, lunch or
dinner………
Patient: I really want to have something from outside now………..something which I can eat
now for the breakfast…………..
Doctor: I am afraid, here at the hospital food from anywhere is not allowed……………here, we
are much concerned about what we give to our patients……
Patient: But doctor……………
Doctor: No……… you can’t have anything from outside now………. You will have to take the
food which is offered here because this is going to help you recover sooner……………and if you
follow what is being suggested then you are certainly going to go home soon……….
Patient: Well, doctor…. I understand that but……………
Doctor: And I must say this that…….. The menu at the hospital can’t be
changed…………..whatever we offer here is always good for the patients…….
Patient: Oh, doctor…………
Doctor: Please, understand………. And you please, finish your breakfast first……….
Patient: Well…….. Ok……doctor………… and doctor… I would like to know when I can go
home………
Doctor: Well, you can go home as soon you get well…………..
Patient: I feel much better now………..
Doctor: But still, you will have to stay here for a couple of days……… there is illness still in
you………..
Patient: OK, doctor………
Doctor: And again, I say the same thing……….. Take your food on times……….Do not miss your
breakfast or lunch or anything……… if you do not like the food then you can take some fruit or
juices.…… Do let the staff know about the same……….

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Speaking Test Answers – Medicine

Patient: OK, sure, doctor……….

Doctor: And trust me, you will go home within this week itself if there is much more
improvement in you………….
Patient: Thank you, doctor…………
Doctor: OK, then finish your breakfast now………and I will see you in the evening again………..
Patient: OK, doctor…….thanks again………

End of the Script TWO

Speaking Test 5 :
Script ONE

This is just a sample script. The real conversation may involve different dialogues
from the role-player and the candidate………

Doctor: Hello………
Patient: Hello, doctor……..
Doctor: How are you now?
Patient: Well…………fine, doctor…….
Doctor: It was successful……. You will be alright soon………
Patient: Thanks, doctor………but doctor……. I really want to recover soon…
Doctor: Well, you will have to wait …………….
Patient: Can I go home now…………?
Doctor: Yes, you can go home………. You can leave after an hour or two……
Patient: Well…………thanks………. But doctor…….will there be pain again ………….?
Doctor: Well……….no…. you do not worry………but you will have to take good care of
yourself………..
Patient: What shall I have to do or what I shall not………….
Doctor: See, taking care after this surgery is very much needed…….. Your recovery will
depend much more on how you take care of yourself……..you need to follow the instructions
given to you. The first week is very important…… You will have to come here on a weekly
basis so that we can assess your improvement……….

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Speaking Test Answers – Medicine

Patient: Sure, doctor, I will……. And when these sutures will be removed doctor?
Doctor: Well, you will have to wait for two weeks for that……..
Patient: And doctor…… any precautions………?
Doctor: Well, there are many………To ensure proper healing, it is very much necessary that
you do not disturb your dressings……… and you need to keep them dry……….interference can
cause reoccurrence of bunion… You need to use a walker or crutches for a few days……you
can put weight on your foot only when your wound heal…. And you need to wear special
surgical shoes as well……….
Patient: Are there any exercises too which can ensure speedy recovery, doctor?
Doctor: Well, there are….. but you will have to start after a few days…….some exercises or
physical therapy will be recommended to you …………
Patient: And how long do I have to use these antibiotics, doctor?
Doctor: Just for a week or so…………. This is just to prevent infection……….
Patient: Are there any complications, Doctor?
Doctor: Ah…. There can be ……….but you do not worry……..you need to contact immediately if
your dressing loosens or if it comes off or gets wet………. If your dressing is moistened with
blood or drainage…………. If you feel any side effects etc… You really need to contact us if you
find any warning signs of infection which may include fever, chills, persistent pain, persistent
redness or warmth around the dressing, swelling in the calf etc……..
Patient: Surer, doctor, I will take care of that……
Doctor: So, see you then soon…….. You need to report here after a week… and if there is
anything then contact us………
Patient: Sure, doctor. Thanks a lot……..
Doctor: Thanks……… you can leave in an hour or so…. Please, wait till then……..
Patient: Thanks, doctor…..

End of the Script ONE

Script TWO

This is just a sample script. The real conversation may involve different dialogues
from the role-player and the candidate………

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Speaking Test Answers – Medicine

Doctor: Hello………
Patient: Hello, doctor………
Doctor: So, are you ready for the test………..?
Patient: Well. I am……….
Doctor: Are you here with someone………….
Patient: Yes, my wife is there outside………..
Doctor: Oh…….. Good…. Any children….???
Patient: Well, I have got two children….. They are in London……….
Doctor: OK………….. Just a few questions before we begin……….
Patient: Please, ask………
Doctor: Do you smoke?
Patient: Yes, doctor………. A pack of cigarette per day……..
Doctor: Do you drink?
Patient: Occasionally……..
Doctor: Any medical history?
Patient: No…….. Doctor…. I had been very healthy…. But my father died of some heart
related problem……….
Doctor: OK………. And you are 52, right?
Patient: Yes, doctor…. I am 52….
Doctor: We need to begin the test………. and let me explain to you something about
this……….We are going to pass a thin flexible tube (we call it catheter) into the right or left
side of your heart from the groin or the arm………We will give you the medicine to help you
relax before this… And I hope you have not eaten anything…………
Patient: No………… doctor…. I have not eaten anything……… Yesterday, the nurse told me not
to eat anything at least for 6-8 hours before the test……
Doctor: Good…. Then we can perform the test………..
Patient: Well, doctor, is it going to hurt………….?
Doctor: No, it will not……….. We will try our best ……. You may feel some discomfort or
pressure when we will place the catheter but after that you may not…….. Some people may
feel discomfort from lying still or from lying flat on their back………… we will change your
position…….
Patient: Oh, doctor. I am really worried……..

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Speaking Test Answers – Medicine

Doctor: Don’t be……… everything will be alright… Please, you wait for a few minutes
more………. We will get everything arranged and then we will call you………….
Patient: OK, doctor……………..I will wait………
Doctor: Please, do not be nervous…. Everything would be alright…….
Patient: Thanks, doctor……….

End of the Script TWO

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Speaking Test 1

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Speaking Test 6 – Medicine

Time allowed: 20 minutes

ROLE PLAYER’S CARD NO.1

Setting: Alpha Hospital, London

Patient: You are 32 and recovering from an injury to your right hand elbow.
You have recently been operated for the same. It has been over a week and
you are not able to make any movements. You are a bit worried as you feel pain
even if you raise your hand a little. You also fear you will not be able to recover
totally.

Task:

 Explain to the doctor the problem you have been facing and the fear you
have etc..
 Ask your doctor how much time it will take for you to recover and what
you can do to recover sooner.
 Ask if there are any types of exercises which can help you in recovering
sooner.
 Ask your doctor if he can arrange for a physiotherapist for you too.

CANDIDATE’S CARD NO. 1

Setting: Alpha Hospital

Doctor: There is a young boy who has recently been operated by you due to
an injury to his right hand. It has been over a week and the patient is still not
able to make any sort of movements. He is a bit worried and wants to know
how much time he will take to recover.

Task:

 Explain to the patient how severe this injury was (Calm him down by
explaining to him about how lucky he is to have avoided much more severe
injury).

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Speaking Test 6 – Medicine

 Explain to the patient why he is not able to make the movements now
(Explain to him that the elbow bone and the bone round the shoulder are a
bit fractured and how this may take time to heal properly etc).

 Ask him to do a bit of movements in lying position in bed (such as lifting

the hand up and down, slowly and cautiously, giving some movements
to the fingers etc).

 Tell him how a physiotherapist can help him in getting well again.

 Advice the patient to take the medicine on time too.

END OF SPEAKING TEST

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Speaking Test 1

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Speaking Test 7 – Medicine

Time allowed: 20 minutes

ROLE PLAYER’S CARD NO.1

Setting: LEO Hospital

Patient: You are 43 and have recently undergone endoscopic sinus surgery –
FESS (Functional Endoscopic Sinus Surgery). After a week’s stay at the hospital,
you are now going to your home. You do not know what precautions you will
have to take to recover fully. You are worried whether you will have to take the
antibiotics for long period of time. You are a smoker and would like to know
whether you can continue smoking or you will have to quit etc.

Task:

 Explain to the doctor what you are very concerned about (try to know
what you shall do if it bleeds in future etc).
 Ask your doctor what you can do to stop development of any kind of
infection in future etc.
 Ask your doctor if you can indulge in any physical activities or not
(like jogging, running etc).
 Ask your doctor how much time it will take for you to recover and
what you can do to recover etc.
 Ask your doctor whether you will have to come for the check up
monthly or quarterly etc.
 Ask your doctor if you can continue smoking or whether you will have
to quit that.

CANDIDATE’S CARD NO. 1

Setting: LEO Hospital

Doctor: There is a patient who has recently undergone FESS (Functional

Endoscopic Sinus Surgery). After a week’s stay at the hospital, the patient
is finally going home but he / she is worried and wants to know what
precautions he / she has to take to stop any kind of infection or recover fully.
The patient is a smoker and wants to know whether he / she can continue
smoking after a week or two or whether he / she has to quit smoking etc.

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Speaking Test 7 – Medicine

Task:

 Try to calm down the patient by saying that there will be no complications
of any kind after the operation and that nosebleed occurs only in 1-2% of
the patients.
 Explain to the patient what precautions he / she will have to take to avoid
any kind of infection or any sort of trouble etc (explain that he may have to
avoid indulging in any physical activities like running etc, blow the nose
gently after nasal irrigation, avoid heavy nasal blowing for 10+ days after
the operation, avoid smoky or dusty atmospheres, avoid hot baths or
showers etc).
 Explain to the patient why he / she will have to quit smoking for at least
a couple of weeks or months (as this may lead to more number of chances
of infection).
 Advice the patient to take the medicine on time too.

END OF SPEAKING TEST

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Speaking Test 1

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Speaking Test 8 – Medicine

Time allowed: 20 minutes

ROLE PLAYER’S CARD NO.1

Setting: London Hospital

Patient: You are 26 and have got your appendix removed at the hospital.
Two days after the operation, you are again at the hospital just because of
the drainage from the incision. You are a bit worried over this and you want to
know if it is going to affect your life in future

Task:

 Explain to the doctor what problem you are facing (explain how it pains,
about fever, or redness or swelling around the incision, warmness around
incision etc).

 Express that you are worried and that you want to resume your normal
activities sooner or ask your doctor how much time it will take for you to
recover and what you can do to recover sooner etc.

 Ask if you have to adopt any special dieting plan.

 Take suggestions from doctor as to what to do if drainage occurs

in future etc.

CANDIDATE’S CARD NO. 1

Setting: London Hospital

Doctor: There is a young boy who has recently got removed his appendix.
He was given discharge from the hospital on the very next day of operation
but after two days of operation, he was taken back to the hospital again
due to drainage form the incision. The patient is worried and wants to know
what he can do to get well sooner.

Task:

 Explain to the patient what might have led to drainage from the incision
(explain to the patient that it is very rare and that it may happen due to
sudden movement or due to any sort of injury etc).

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Speaking Test 8 – Medicine

 Explain to the patient what diet can be better and what he can do to avoid this
in future.

 Explain to the patient about the complications which are there due to this
unexpected drainage from the incision.

 Explain to the patient that it will take a bit of time to heal again.

 Advice the patient to take the medicine on time and the benefits of adopting
right diet plan etc.

END OF SPEAKING TEST

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Speaking Test 1

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Speaking Test 9 – Medicine

Time allowed: 20 minutes

CANDIDATE’S CARD NO. 1

Setting: CWC Hospital

Doctor: A man of about 54 has recently undergone bypass heart surgery.

He is worried over what precaution he might have to take in order to maintain
a healthy life.

Task:

 Explain to the patient about what precautions he might have to take

in order to avoid any sort of complications after the operations (necessity
of keeping the incision area clean and tidy, not to drive for about first
6 weeks after the operation etc).
 Explain to the patient what diet can be the best for him (let the patient
know about commonness of the poor appetite after the operation or
provide special dietary instructions etc).
 Explain to the patient when he may have to contact doctor immediately
( if there is more numbness, itching, tightness etc around incision, pain
in the legs, around the chest etc).
 Advice the patient to take the medications on time or importance of
regular heart check up.

ROLE PLAYER’S CARD NO. 1

Setting: CWC Hospital

Patient: You are 54 and are recovering from bypass heart surgery. You are
worried and want to know what can be the best thing you can do to recover sooner
or what precautions you may have to take to avoid any sort of problems in future.

Task:

 Talk to the doctor about how you can get well sooner or how much time
it will take for you to recover etc.

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Speaking Test 9 – Medicine

 Try to know from the doctor what your diet shall be.

 Try to know whether you can go for a morning walk after a month or not.

 Ask your doctor what precautions you may have to take in order to be healthy.

END OF SPEAKING TEST

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Speaking Test 1

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Speaking Test 10 – Medicine

Time allowed: 20 minutes

CANDIDATE’S CARD NO. 1

Setting: ENT Hospital, London

Doctor: Mark Surry, 23, is a tonsillectomy patient. Tonsil surgery was done
two days ago. After the operation, the patient started complaining of ear pain
and sickness. He wants to know if there are any complications involved in it
or whether this surgery is going to affect his voice. He also wants to know
about what care he has to take to get well soon.

Task:

 Explain to the patient that the surgery was successfully performed and that
he doesn’t have to worry over anything.

 Explain to the patient why there can be ear pain sometimes (a patient may
have sore ears which is normal. It is because throat and ears have the same
nerves. It doesn’t’ suggest that the patient has an ear infection).

 Explain to the patient about possible complications too (the most serious
among them is bleeding which may occur in 1 in 100 patients. If bleeding
occurs then a second operation may be required).

 Explain to the patient about the possibility of feeling sick (which is common
after the operation which may even get settled quickly).

 Assure the patient that he will have no problem at all (Explain to the patient
that there will be no effect on his voice).

 Explain to the patient what diet can be better for him and what he should
avoid etc.

ROLE PLAYER’S CARD NO. 1

Setting: ENT Hospital

Patient: You are Mark Surry and you are 23. You are a tonsillectomy patient. Two
days after the operation, you started feeling pain in the ear. You are worried and want
to know if there can be any complications after this operation.

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Speaking Test 10 – Medicine

Task:

 Explain to the doctor the problem you are facing (explain how ear pain
develops, about sickness, or illness etc).

 Express that you are a little bit worried over the same.

 Try to know everything about the possible complications that which may occur.

 Ask the doctor if there will be any effect on your voice due to the operation or
what you can do to be normal again.

 Ask if you have to take any special diet.

 Try to know how much time it will take for you to recover. Take suggestions
from the doctor as to what you can do to get well soon.

END OF SPEAKING TEST

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Speaking Test 1

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Speaking Test Answers – Medicine

Speaking Test 6:
Script

This is just a sample script. The real conversation may involve different dialogues
from the role-player and the candidate………

Doctor: Hello………how are you doing now………..?

Patient: Hello, doctor……..everything is fine…….but this pain is still here…….
Doctor: Oh, here around the elbow…….
Patient: Yes, doctor………..I do not understand…… it has been over a week and I am not able
to make any movements…….
Doctor: I understand that it has been over a week but you need to understand this too that
your case was very complex. I must say that you had been very lucky not to have got into
anything troublesome… your surgery was on time………..
Patient: Doctor……… I feel so….. But you see…….. I really want to get well sooner………I am not
able to make movements, not even small movements……. I am not able to raise my
hand……….. It pains me when I do so…….
Doctor: It is normal….. You will have to wait to make some movements………..I must say that
your elbow bone and the bone around the shoulder were badly injured…. You are very lucky
that the injury was not that much severe otherwise you would have not been able to make
use of your hand for a long period of time……
Patient: Oh, I am really thankful to God for that……………. but …doctor, what do you think….
how much time will I take now to get well again……….?
Doctor: Well, I can’t say now but perhaps, you will take a month to get well again or go back
to your normal routine.
Patient: One month? It is really a long time… Do I have to wait for a month……….?
Doctor: Well, you will have to…………. But do not worry, you will be able to make movements
after a week or so……..
Patient: Are there any exercises, doctor? I mean any exercise which can help me get well
again………

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Speaking Test Answers – Medicine

Doctor: Well, there are. A physiotherapist will surely help you………. We have told contacted
one of the best physiotherapists………. He may come here anytime and he will let you know of
what shall do……… you can simply exercise while lying or sitting………….
Patient: Oh, thanks a lot, doctor…….. I am really thankful to you for this……..
Doctor: Oh, please… it is our duty to look after the well being of our patients………
Patient: And doctor, will I be able to lead a normal life………… I mean, will I have any trouble
in future…………?
Doctor: No, do not worry………. You will not have any kind of trouble………….
Patient: Because, a friend of mine underwent a surgery - shoulder surgery….. And after that
he began to feel pain and he has been suffering from pain since the time of his surgery…..
Doctor: When did he undergo surgery…………?
Patient: Well, some four months ago………..
Doctor: But, I assure you…. that will not be the case with you….. You will become alright…
Sometimes, when the surgery is not performed well then the pain flares up…… you do not
worry. We have done the best ………..
Patient: Oh, thank you doctor……….
Doctor: You just take the medicine that which has been prescribed to you on time… and
follow the instructions given to you by the physiotherapist………. You will surely get well
sooner……..
Patient: Oh, sure, doctor…. I will………..
Doctor: Ok, then take care.
Patient: Thanks, doctor…..thanks a lot……..

End of the Script

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Speaking Test Answers – Medicine

Speaking Test 7:
Script

This is just a sample script. The real conversation may involve different dialogues
from the role-player and the candidate………

Doctor: Hello………
Patient: Hello, doctor……..
Doctor: So, how are you now? Feeling better?
Patient: Yes, doctor.
Doctor: Well, I think you can go home now…
Patient: Oh, thanks a lot doctor……
Doctor: I hope you have no trouble now….. That surgery was successfully performed……..
Patient: But doctor, I have a few questions. I am a little worried……….
Doctor: Please, ask…
Patient: Just two days, back it was bleeding………. I am really concerned… will it bleed again
and what shall I do if it bleeds again……………?
Doctor: Well, it will not happen……….. You do not be worried……… We are going to prescribe
something for you which can help you in recovering sooner. You will not face any kind of
problem in future………
Patient: Ah……. Doctor, do I have to continue making use of the medicines throughout my
life….?
Doctor: Well, it is not like that. Until the problem ceases, you will have to take……………and
once, if everything is alright then you can quit making use of them……….
Patient: And about infection……. Doctor….. Will there be any infection again?
Doctor: Well, there will be no infection. We are going to prescribe some antibiotics to you………
and I must say infection develops only when you do not take good care of yourself…..
Patient: No, doctor, I am going to take good care of myself…………..and I want to know doctor
if there is any speedy process of recovery……….?.
Doctor: Well, I am afraid…… there is no such process. You will have to wait for a couple of
weeks to recover fully…….And I must say that you may experience some swelling or
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Speaking Test Answers – Medicine

tenderness at the site of surgery but this is normal…. You shall not get worried……… you may
even have the symptoms like severe cold or sinus infection…..(which can be due to swelling
or dry blood……). I am going to recommend nasal irrigation or saline sprays and some
antibiotic lubricants for the same……….
Patient: When will I be able to resume normal activity level, doctor?
Doctor: I have already told you ……. You will have to wait for a couple of weeks..
Patient: And one last question, doctor? I am used to smoking……. So, do you think I can
smoke……?
Doctor: Well, I am sorry……… you shall not….. You will have to avoid smoking. If you smoke
then this may worsen the condition………. If you want to get well sooner then you will have to
quit smoking……
Patient: Then, it means, I can’t……….
Doctor: Yes, you can’t and you shall not……….
Patient: Well, OK, doctor….. I will avoid….
Doctor: Good…. So, see you again after a week…… and do not forget to take the medicine on
time……..
Patient: Sure, doctor. Thanks a lot………

End of the script

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Speaking Test Answers – Medicine

Speaking Test 8:
Script

This is just a sample script. The real conversation may involve different dialogues
from the role-player and the candidate………

Doctor: Hello……… How are you now…….?

Patient: Hello, doctor…….. Oh……. It is very painful………….
Doctor: Let me check……….
Patient: Doctor…….. It pains me….. It is unbearable………..
Doctor: I think you have not taken the precautions suggested to you…………
Patient: No, doctor, I followed…. But it is just from yesterday night that I began to feel
pain…… I was not able to sleep well….
Doctor: Well, how come you feel pain……….now…….
Patient: I do not know…… doctor… all of a sudden, it starts paining me…….even my
temperature was more…… I fond redness and swelling round the incision too……… the area
round the incision was warmth……… I was not able to understand what was happening………..I
spent the whole night… in pain…………
Doctor: You must have made some sudden movements……..or it could have been because of
some injury………
Patient: Well…. There were no such movements or any kind of injury…………doctor…..
Doctor: Oh…… if there is bleeding or if there is this unexpected drainage then we will have to
perform the operation again………… we will have to sort this out sooner…….
Patient: Operation? Again………? Oh…….. Can’t there be any other option, doctor?
Doctor: Well, you see, I am going to prescribe something for you…… but if the condition
continues to be the same then you will have to undergo a small operation again……… it is
necessary to know why there is pain still……
Patient: But, doctor…..
Doctor: You do not be worried… I am sure of one thing that the medications will help you and
there will be no need of the operation……. Operation is always a secondary operation….. In
most of the cases, patients get well with medications …………

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Speaking Test Answers – Medicine

Patient: Well, I am expecting the same thing, doctor………… I really want to get well soon………
Doctor: And I suggest you adopt the right diet plan too………..
Patient: What shall be the diet, doctor?
Doctor: Take light food for a couple of days... Anything which easily gets digested…
Patient: Sure, doctor, I will take care of that.…
Doctor: And I suggest you avoid taking shower for two to three days…….as there is swelling
or warmth around the incision…………….
Patient: OK, doctor…… I will avoid……
Doctor: Take this prescribed medicine for three days and then come back……….
Patient: Fine, doctor…. I will…….. But will the pain go away………..with this medication….?
Doctor: I am sure, it will…… you do not be worried……..
Patient: OK, thank you, doctor……..
Doctor: OK…. See you again after three days……. And please, call me if there is anything ………
Patient: Sure, doctor… thanks a lot……

End of the Script

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Speaking Test Answers – Medicine

Speaking Test 9:
Script

This is just a sample script. The real conversation may involve different dialogues
from the role-player and the candidate………

Doctor: Hello……… How are you now…….?

Patient: Hello, doctor…….. Feeling a bit well…….
Doctor: You will go home today………
Patient: Oh, thanks doctor………
Doctor: But you shall know this that your operation was very complex………you need to be
very careful to avoid any kind of problem in future……….
Patient: What precautions do I need to take, doctor?
Doctor: Well, you will have to be very careful…. Avoid taking shower for about a week……..
Keep the incision area clean and tidy……. And please, strictly “NO” to driving…….. You shall
not drive at least for the first six weeks………….
Patient: Surely, doctor, I will not…………And doctor, will there be any sort of problem….?
Doctor: Like what?
Patient: I mean, if the infection develops……….
Doctor: No, there will be infection…… In fact, recovery depends much more on how you take
care of yourself………
Patient: Oh, I see…….
Doctor: But, you need to get in touch immediately if there are any signs of
infection……..which may include: increased drainage or oozing from the site of
incision……….increased opening of the incision line, increase in body temperature, If there is
any redness or warmth around the incision etc………..
Patient: I will get in touch with you, doctor… I will………..
Doctor: And I must say it can be very common to develop a black and blue area (bruise)
around the groin site…………. This can’t be from bleeding…….but can be because of the blood
that seeped into the area during the procedure………which migrate to the skin and causes

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Speaking Test Answers – Medicine

discoloration of the skin…….This discoloration can be normal……. And you do not have to
worry……. But will fade over a few weeks……..
Patient: And what more precautions shall I have to take, doctor?
Doctor: Please, do not take part in any physical activity. Try to avoid too much walking or
any kind of movement. You shall be on your feet only for three things, to use the bathroom,
to go for dinner or to go to bed……. You will have to avoid activities which will pull or stress
the affected area……….
Patient: Doctor, will I be able to lead a normal life…….. I am really worried……. I do not know
whether I will be able to lead the same old life or not……….
Doctor: Well, most of the patients lead a normal life even after this heart
catheterization…………. You shall not worry about it……..you will get back to your normal life…
you just need to follow what is being suggested to you and if once you follow what is
suggested or advised then you are going to be well again…………
Patient: Surely, I will follow, doctor………
Doctor: That’s what………. So, you get ready to go home…. And be in touch…….. do not forget
to visit the hospital again after 5 days or so………
Patient: Thanks, doctor… I will come……
Doctor: Take care………..
Patient: Thanks, doctor…….

End of the Script

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Speaking Test Answers – Medicine

Speaking Test 10:

Script

This is just a sample script. The real conversation may involve different dialogues
from the role-player and the candidate………

Doctor: Hello………
Patient: Hello, doctor…
Doctor: So, how are you now?
Patient: Fine, doctor, but I feel some pain in my ear drum……and there is some sort of
sickness too……….
Doctor: Well, I must say that the surgery was successful……..there can be no
complications…….and you do not have to worry………this ear pain can be common…………A
patient may sometimes have sore ears which is very much common. The simple reason for
this can be this: “throat and the ears have the same nerves.” Here, pain in the ear or ear
drum doesn’t mean that you have got some infection……… please, do not be worried………..
Patient: Oh, I understand, doctor, thanks…….. I was thinking that there is going to be some
infection due to this operation……… I was really not able to sleep well because of this ear
pain………
Doctor: Do not be worried…….. I am going to prescribe something new for that…… and you
will be alright…….
Patient: And there is sickness too………… Doctor………
Doctor: Well, this can also be very common but it will go away……. You will feel much better
after some three-four days….
Patient: And what about the voice….. Doctor……….. Will this operation have any effect on my
voice……? I am really thinking a lot about it………….
Doctor: Well, you will have no change in voice….. there can be some change in the beginning
as healing will take time………….but once, you get well… you will have no difficulty… now, you
shall avoid speaking for a long time…… you shall give some relaxation to your vocal
chords……… You will be able to have a normal voice later after you recover fully……
Patient: Are there any complications……..Doctor?

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Doctor: Well, there can be nothing…….. You do not think too much about the same…… only
sometimes, it happens that the patient complains of bleeding…. It occurs 1 in 100
patients…..And I must say, if bleeding occurs then a second operation is required…………but
you do not worry, your case was a simple one………. And there will be no bleeding……
Patient: Oh, thanks doctor……..
Doctor: And one more thing, you will have to focus much more on what you eat………….I mean
you will have to have good diet………
Patient: What my diet shall be, doctor?
Doctor: Take anything which requires less chewing……… Take plenty of fluids……Fluid intake is
the single most consideration, following this surgery…….but strictly “NO” to carbonated
beverages……….And you need to avoid citrus drinks or soda because of the acidic
content…….Avoid milk or milk products too for a couple of days……..Custard, pudding or
pudding pops can be taken……continue pushing the fluids to avoid dehydration…….later, after
some two days you can have soft foods such as noodles, scrambled eggs, mashed potatoes,
soggy cereal, cooked cereal, soups etc…….. And one more thing, do not take anything too hot
or too cold………….
Patient: Thank you, doctor, I will certainly, remember all these things……..
Doctor: OK, then, see you after some three days. Come for the check up….. Do not forget…….
Patient: Surely, I will….. Thanks, doctor………..
Doctor: Take care……..
Patient: Thanks, doctor…….

End of the Script

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Speaking Test 1

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Speaking Tests 11-15 (Medicine)

SPEAKING TEST 11

Time Allowed: 20 minutes

ROLEPLAYER’S CARD NO. 1

SETTING: General Hospital, Sydney

PATIENT: You are a mother whose 1-year-old baby has undergone treatment for
Respiratory syncytial virus (RSV). A doctor has come to you to enquire how your baby
is doing now.

Task:

Begin with warm greetings

Explain to the doctor the problem your baby might be facing

Explain to the doctor how your baby denies eating anything etc

Try to get as much information about RSV as possible

Try to know more about the precautionary measures you will have to take

Try to know more about what you can do make your baby normal again.

CANDIDATE'S CARD – 1

PLACE: General Hospital, Sydney

DOCTOR : You are a doctor who is now talking to a woman whose baby has
undergone treatment for the RSV - Respiratory syncytial virus. She is worried and
very much concerned about her baby’s health.

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Speaking Tests 11-15 (Medicine)

Task:

Begin with warm greetings

Try to know if the baby is facing any problems anymore

Answer the questions the mother of the patient might ask you

Try to provide as much information as you can about RSV

Let the mother know about the precautionary measures too

End of the Speaking Test

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Speaking Tests 11-15 (Medicine)

Speaking Test 12

Time Allowed: 20 minutes

ROLEPLAYER’S CARD NO. 1

SETTING: Accu Health Center

PATIENT: You are a patient who has come to the clinic with a problem of stomach
ache. It has been over a week and you are not able to eat anything properly. You
even feel like throwing it up more and more.

Task:

Begin with warm greetings

Explain to the doctor the problem you are facing

Let the doctor know more of the over-the-counter medications you have used to
treat yourself

Ask questions which might help you understand more about how this ache
occurs or why this happens or how it can be avoided etc

Get the most cost-effective solution for the same

CANDIDATE'S CARD – 1

PLACE: Accu Health Center

DOCTOR : You are a doctor who is now talking with a patient who has been facing a
problem of stomach ache for over a week now. The patient also feels like throwing it
up whenever he / she eats anything.

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Speaking Tests 11-15 (Medicine)

Task:

Begin with warm greetings

Try to know more about the problem, the patient is going through

Answer the questions the patient might ask you

Try to provide as much information as you can about stomach ache (possible
reasons, preventive measures, food habits etc)

Let the patient know more about precautionary measures too

End of the Speaking Test

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Speaking Tests 11-15 (Medicine)

Speaking Test 13

Time Allowed: 20 minutes

ROLEPLAYER’S CARD NO. 1

SETTING: Eeon Health Care Hospital

PATIENT: You are a father whose 6 years old daughter is facing whooping cough.You
are now at the hospital, talking to the doctor who has come to you to enquire about
your daughter’s health.

Task:

Begin with warm greetings

Explain to the doctor the problem your daughter might be facing

Try to get as much information as you can about whooping cough (how it
occurs, what causes it or what can be done to prevent the occurrence of the
same etc)

Ask questions which can clear your doubts about whooping cough

Try to get the precautionary measures too

CANDIDATE'S CARD – 1

PLACE: Eeon Health Care Hospital

DOCTOR : You are a doctor who is now talking with the father of a patient who has
been facing a problem of Whooping Cough for over 10 days now. The father is worried
and wants to know how his daughter might get well etc

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Speaking Tests 11-15 (Medicine)

Task:

Begin with warm greetings

Try to know more about the problem, the patient is facing

Answer the questions the father of the patient might put to you

Try to provide as much information as you can about whooping cough (possible
reasons, preventive measures, food habits etc)

Let the patient know more about precautionary measures too

End of the Speaking Test

Speaking Test 14

Time Allowed: 20 minutes

ROLEPLAYER’S CARD NO. 1

SETTING: Community Hospital

PATIENT: Mary D’souza is a patient who has been undergoing treatment for the
cirrhosis for over a month. You, as her brother, are worried and want to know how
and when she can get well etc.

Task:

Begin with warm greetings

Express you are worried and you want your sister to get well sooner etc

Get all the details as much as you can about Cirrhosis

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Speaking Tests 11-15 (Medicine)

Let the doctor know about the bad habit of drinking your sister has

Get as much information as you can about Cirrhosis

Try to get suggestions from the doctor on how you can stop your sister from
drinking etc

CANDIDATE'S CARD – 1

PLACE: Community Hospital

DOCTOR: You are a doctor who is now talking with the brother of the patient who has
been undergoing treatment for a problem of Cirrhosis for over a month now. The
brother of the patient is worried and wants to know how sooner his son might get well
etc.

Task:

Begin with warm greetings

Try to know more about the problem, the patient is facing

Answer the questions the brother of the patient might ask you about Cirrhosis

Try to provide as much information as you can about Cirrhosis (possible

reasons, preventive measures etc)

Provide suggestions on how to quit drinking too

End of the Speaking Test

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Speaking Tests 11-15 (Medicine)

Speaking Test 15

Time allowed: 20 minutes

CANDIDATE'S CARD – 1

PLACE: Community Hospital

DOCTOR : You are a doctor who is now talking to the patient, Mr. Adly Rehab. The
patient has been operated recently for gastrointestinal cancer - colon cancer. The
patient is doing well but he seems to be very worried and dejected.

Task:

Begin with warm greetings

Calm down the patient / Assure the patient that he is well now

Clear the doubts the patient has about colon cancer

Answer the questions the patient might ask you about colon cancer (Try to
provide as much information as you can about the same - possible reasons,
preventive measures etc)

Try to provide information on diet to be maintained as well

ROLEPLAYER’S CARD NO. 1

SETTING: Community Hospital

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Speaking Tests 11-15 (Medicine)

PATIENT: You are Adley Rehab who has recently undergone operation for Colon
Cancer - Gastrointestinal Cancer. You are now worried and you think you may not
have a life, you used to live.

Task:

Begin with warm greetings

Express how sad you are and how worried you are about your future life

Try to know from the doctor how much time it will take for you to recover fully

Get as much information as you can about the diet you have to take

Try to know what precautionary measures you may have to take as well

End of the Speaking Test

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Speaking Test 1

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Speaking Tests Answers 11-15
(Medicine)

SPEAKING TEST 11

Sample Script

This is just a sample script. Actual discussion or talk can be different from this. It can
be smaller or longer than the present talk or discussion. It is just for the purpose of
test preparation.

Doctor : Good Morning…

Mother: Good Morning, Doctor…….

Doctor : So, how is your baby?

Mother: Looks much better now…...

Doctor : She will be alright sooner… we have already done what is required………..

Mother: I am really thankful ……..doctor……….

Doctor : Well, you need to take good care of your baby now………..

Mother: Yes, i will……. i will………...

Doctor : Is she taking the food……….did you breastfeed her?

Mother: Well…. No……….She denies it…….. .

Doctor : But it is necessary that she shall be fed… Mother’s milk is always good.

Mother: But the baby is not taking it…………..

Doctor : She will…………

Mother: How much time will she take now, Doctor, to get well sooner?

Doctor : She will take a few days more………. she is alright now……...but still………….

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Speaking Tests Answers 11-15
(Medicine)
Mother: Oh…….. i am just waiting to see a smile on her face…………...

Doctor : I hope she is not facing any other problems…….

Mother: Yes, she is not……….. but i want you to prescribe something for the sleep……..
as she is not able to sleep properly….. She gets up crying all the time……….

Doctor : I will prescribe………..

Mother: And i do not know how this happened to my baby……… i even take all the
necessary precautions but it happened………. i do not know, how………..

Doctor: I can understand………. But, you shall know that it is common……… It is very
common……… often infants or children are always at the risk of catching this RSV……..

Mother: Oh……… i see……..

Doctor: Just maintain good hygiene………

Mother: I will do that….

Doctor : I have prescribed something for her…………. she will take some more
time………… but she will be alright…….. You do not worry……..

Mother: Thanks a lot. You have been very helpful, Doctor………..

Doctor : Thank you……….Take care……...

End of the Script

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Speaking Tests Answers 11-15
(Medicine)

SPEAKING TEST 12

Sample Script

This is just a sample script. Actual discussion or talk can be different from this. It can
be smaller or longer than the present talk or discussion. It is just for the purpose of
test preparation.

Doctor : Good Morning…

Patient: Good Morning, Doctor…….

Doctor : Please, take the chair………..

Patient: Thank you, Doctor……...

Doctor : So, what is the problem………?

Patient: I have been suffering from stomach ache……….. it is very painful for
me………...

Doctor : OK………….

Patient: I have not been able to eat anything properly for the last few days…………….

Doctor : For how many days have you been facing this problem?

Patient: It has been over a week now……… i guess……...

Doctor : Oh…. you should have come earlier then…………..

Patient: I wanted to………… but ……. i thought it would go away on its own…….. I
thought it was because of something i have eaten………..

Doctor: Oh, i understand…….

Patient: I have even taken some over-the-counter medicine for the same………..

Doctor : What did you take?

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Speaking Tests Answers 11-15
(Medicine)

Patient: Well, i am sorry…… i forgot the name of that……….

Doctor : Did that help you?

Patient: For a day, it helped me………… but from next day the pain seemed to have
increased…….. I stopped continuing that………..

Doctor: Oh……. i understand……..

Patient: I even feel queasy…… i feel like vomiting too……… .

Doctor: It can be a serious thing then … There is a need for a few tests ………..

Patient: What tests, doctor?

Doctor: I would request you to get an X-ray report first……. We need to make sure
that there is no big problem……...

Patient: Oh…….. it is for the first time that i am facing this problem………….

Doctor: What is your diet? Do you maintain any proper diet?

Patient: Well, yes…… i am very particular about that……… But for the last two weeks i
had been taking in breakfast or dinner anything i came across………...

Doctor: You are not married?

Patient: No, i am not…………

Doctor: It can be because of the change in your diet…………..

Patient: oh……..

Doctor: I would suggest you take fluids……….. Do not take anything hard which can’t
be digested………….I hope you are not facing any problems related to digestion…………

Patient: No….. i am not……..

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Speaking Tests Answers 11-15
(Medicine)
Doctor: Then …. do not worry…. just get your reports by tomorrow……. we need to
analyse the problem first…….. Presently, i am prescribing something for you here
which can help you....

Patient: OK, Doctor…… I will………..

Doctor: Thank you, Take care………

Patient: Thank you, Doctor………..

End of the Script

SPEAKING TEST 13

Sample Script

This is just a sample script. Actual discussion or talk can be different from this. It can
be smaller or longer than the present talk or discussion. It is just for the purpose of
test preparation.

Doctor: Good Morning…

Patient: Good Morning, Doctor…….

Doctor: Please, so, how is your daughter now………..

Patient: ah………. the coughing is just the same……...

Doctor: She is 5 years old, right?

Patient: No, she is 6 years old………..

Doctor: OK………….

Patient: She has been facing this problem for over 5 days now………..

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Speaking Tests Answers 11-15
(Medicine)
Doctor: Oh……….. Did she take the syrup which was prescribed………...

Patient: Well, she took that……….

Doctor: Does she eat a lot of chocolates or candies………?

Patient: Yes, she is so fond of chocolates…. She cries for the same all the time… if i do
not bring for her…….

Doctor: Is she still eating chocolates……..?

Patient: No, since the time i noted that she is coughing …… i stopped giving her the
chocolates…..

Doctor: Good………..

Patient: What can be the reason for this whooping cough, Doctor?

Doctor: Well, it is a bacterial infection…… it is common but can be prevented as well…

There is a need to maintain good hygiene.

Patient: Oh….

Doctor: There will be inflammation …….. in some cases……….

Patient: She complains of pain too……….

Doctor: Well, it will go away………..

Patient: And she is not able to sleep well?

Doctor: I would prescribe something for the sleep too……

Patient: What about the new syrup, doctor?

Doctor: Yes, there is a new syrup in your prescription…………. She will get well sooner
with that…..

Patient: Oh, thank you, Doctor……

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Speaking Tests Answers 11-15
(Medicine)

Doctor: Just make sure, she doesn’t eat plenty of chocolate in future too……….

Patient: I will, doctor……….

Doctor: OK……. take care…..

Patient: Thanks a lot, Doctor………

End of the Script

SPEAKING TEST 14

Sample Script

This is just a sample script. Actual discussion or talk can be different from this. It can
be smaller or longer than the present talk or discussion. It is just for the purpose of
test preparation.

Doctor: Good Evening

Brother of the patient: Good Evening, Doctor……….

Doctor: Please, take the chair…….

Brother of the patient: Thank you, doctor……….I am the brother of Mary D’souza……….

Doctor: Yes, please, tell me………..

Brother of the patient: I was not here in the city…. It was last week that i got to know
that she had got admitted into the hospital…….. I just came back……

Doctor: Oh, that is really nice of you….. she needed someone here…...

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Speaking Tests Answers 11-15
(Medicine)
Brother of the patient: What is the problem, doctor? I hope she will get well
sooner…….

Doctor: Well, there is an infection…. liver infection……. we call it cirrhosis….. It is a

slowly progressing disease in which the healthy liver tissue is replaced with the scar
tissue. It disturbs the proper functioning of the liver.

Brother of the patient: Oh………..

Doctor: It has been over a month now……… Your sister is in initial stage of the
infection…….

Brother of the patient: But, i hope she will become alright………….

Doctor: Well, as i have already told you that she is in initial stage… so, it is
possible………. by the way, does your sister have the habit of drinking…………..?

Brother of the patient: Yes, she drinks…… She started drinking after her divorce……….

Doctor: Oh……

Brother of the patient: I told her many times to stop drinking but……. she never
listened to me……

Doctor: Drinking can cause a lot of problem for her…….. She must stop ………. at least
now……...

Brother of the patient: I will talk to her, Doctor…..

Doctor: Now, we have given her some medicine ……….. she just needs to take the
medicine as prescribed……

Brother of the patient: I will make sure, she take the medicine on time…..
Doctor…….. I just want her to get well sooner……

Doctor: You do not worry… If she stops drinking and if she take the medicine on time
then there can be a great amount of change in her…….

Brother of the patient: Oh…Thank God…..

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(Medicine)

Doctor: It is just a first stage….. And i must say……. she is lucky to have got admitted
here…… Her liver is still healthy and not much affected…………

Brother of the patient: How much time will she take, Doctor, to get well sooner or to
lead a normal healthy life?

Doctor: Well, i can’t say anything now…….. It depends more upon how she takes care
of herself… If he continues drinking after leaving here from the hospital then it can
cause a lot of problems for her… Her health is under her control now…

Brother of the patient: Oh……… i understand, doctor……

Doctor: Just, take good care of your sister………

Brother of the patient: I will, doctor………

Doctor: OK……. take care…..

Brother of the patient: Thanks a lot, Doctor………

End of the Script

SPEAKING TEST 15

Sample Script

This is just a sample script. Actual discussion or talk can be different from this. It can
be smaller or longer than the present talk or discussion. It is just for the purpose of
test preparation.

Doctor: Good Afternoon……

Patient: Good Afternoon, Doctor……….

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Speaking Tests Answers 11-15
(Medicine)
Doctor: So, how are you doing now?

Patient: Well, a bit much better, i guess………...

Doctor: You will be able to lead a normal life again ……. just a few days more…… and
you will be out of our hospital………

Patient: Oh…. a few more days……………… Oh…….

Doctor: Mr. Rehab, please, do not be so sad……..

Patient: I have missed my exams too…

Doctor: You can take exams next year as well………. do not be worried…… The good
thing is your problem has got detected at the right time……...

Patient: Yes….

Doctor: You just need to be very careful for a few days more….

Patient: I will be careful, doctor……..

Doctor: By the way, what have you taken in your breakfast?

Patient: Bread and Milk.

Doctor: Well, good…….. Are you taking the medicine on time?

Patient: Yes, i am taking the medicine on time, Doctor?

Doctor: Good……..

Patient: For how many days will i have to stay here at the hospital, Doctor?

Doctor: Well, just a week more…………..And after that, you can go home……

Patient: Oh, thanks a lot, doctor….

Doctor: Even after you go home from here, it is needed that you shall take good care
of yourself and it is necessary that you shall come here for regular check-up………...

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Speaking Tests Answers 11-15
(Medicine)

Patient: Regular check-up?

Doctor: Yes, it is needed…. in some cases, cancer may grow again………

Patient: Oh………….

Doctor: It is very rare……. it is just a precautionary measure…… You do not have to

think over it……….

Patient: Oh……… i understand, doctor……

Doctor: Just, take good care of yourself………… Maintain good and healthy diet….. Take
the diet-chart from our hospital here. I have already asked the nurse to give you that.
Follow what we suggest for you………..

Patient: I will surely follow……….. thanks a lot, Doctor….

Doctor: OK……. take care…..

Patient: Thank you……….

End of the Script

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Speaking Tests Answers 11-15
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SPEAKING TEST 11

Sample Script

This is just a sample script. Actual discussion or talk can be different from this. It can
be smaller or longer than the present talk or discussion. It is just for the purpose of
test preparation.

Doctor : Good Morning…

Mother: Good Morning, Doctor…….

Doctor : So, how is your baby?

Mother: Looks much better now…...

Doctor : She will be alright sooner… we have already done what is required………..

Mother: I am really thankful ……..doctor……….

Doctor : Well, you need to take good care of your baby now………..

Mother: Yes, i will……. i will………...

Doctor : Is she taking the food……….did you breastfeed her?

Mother: Well…. No……….She denies it…….. .

Doctor : But it is necessary that she shall be fed… Mother’s milk is always good.

Mother: But the baby is not taking it…………..

Doctor : She will…………

Mother: How much time will she take now, Doctor, to get well sooner?

Doctor : She will take a few days more………. she is alright now……...but still………….

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Speaking Tests Answers 11-15
(Medicine)
Mother: Oh…….. i am just waiting to see a smile on her face…………...

Doctor : I hope she is not facing any other problems…….

Mother: Yes, she is not……….. but i want you to prescribe something for the sleep……..
as she is not able to sleep properly….. She gets up crying all the time……….

Doctor : I will prescribe………..

Mother: And i do not know how this happened to my baby……… i even take all the
necessary precautions but it happened………. i do not know, how………..

Doctor: I can understand………. But, you shall know that it is common……… It is very
common……… often infants or children are always at the risk of catching this RSV……..

Mother: Oh……… i see……..

Doctor: Just maintain good hygiene………

Mother: I will do that….

Doctor : I have prescribed something for her…………. she will take some more
time………… but she will be alright…….. You do not worry……..

Mother: Thanks a lot. You have been very helpful, Doctor………..

Doctor : Thank you……….Take care……...

End of the Script

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Speaking Tests Answers 11-15
(Medicine)

SPEAKING TEST 12

Sample Script

This is just a sample script. Actual discussion or talk can be different from this. It can
be smaller or longer than the present talk or discussion. It is just for the purpose of
test preparation.

Doctor : Good Morning…

Patient: Good Morning, Doctor…….

Doctor : Please, take the chair………..

Patient: Thank you, Doctor……...

Doctor : So, what is the problem………?

Patient: I have been suffering from stomach ache……….. it is very painful for
me………...

Doctor : OK………….

Patient: I have not been able to eat anything properly for the last few days…………….

Doctor : For how many days have you been facing this problem?

Patient: It has been over a week now……… i guess……...

Doctor : Oh…. you should have come earlier then…………..

Patient: I wanted to………… but ……. i thought it would go away on its own…….. I
thought it was because of something i have eaten………..

Doctor: Oh, i understand…….

Patient: I have even taken some over-the-counter medicine for the same………..

Doctor : What did you take?

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Speaking Tests Answers 11-15
(Medicine)

Patient: Well, i am sorry…… i forgot the name of that……….

Doctor : Did that help you?

Patient: For a day, it helped me………… but from next day the pain seemed to have
increased…….. I stopped continuing that………..

Doctor: Oh……. i understand……..

Patient: I even feel queasy…… i feel like vomiting too……… .

Doctor: It can be a serious thing then … There is a need for a few tests ………..

Patient: What tests, doctor?

Doctor: I would request you to get an X-ray report first……. We need to make sure
that there is no big problem……...

Patient: Oh…….. it is for the first time that i am facing this problem………….

Doctor: What is your diet? Do you maintain any proper diet?

Patient: Well, yes…… i am very particular about that……… But for the last two weeks i
had been taking in breakfast or dinner anything i came across………...

Doctor: You are not married?

Patient: No, i am not…………

Doctor: It can be because of the change in your diet…………..

Patient: oh……..

Doctor: I would suggest you take fluids……….. Do not take anything hard which can’t
be digested………….I hope you are not facing any problems related to digestion…………

Patient: No….. i am not……..

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Speaking Tests Answers 11-15
(Medicine)
Doctor: Then …. do not worry…. just get your reports by tomorrow……. we need to
analyse the problem first…….. Presently, i am prescribing something for you here
which can help you....

Patient: OK, Doctor…… I will………..

Doctor: Thank you, Take care………

Patient: Thank you, Doctor………..

End of the Script

SPEAKING TEST 13

Sample Script

This is just a sample script. Actual discussion or talk can be different from this. It can
be smaller or longer than the present talk or discussion. It is just for the purpose of
test preparation.

Doctor: Good Morning…

Patient: Good Morning, Doctor…….

Doctor: Please, so, how is your daughter now………..

Patient: ah………. the coughing is just the same……...

Doctor: She is 5 years old, right?

Patient: No, she is 6 years old………..

Doctor: OK………….

Patient: She has been facing this problem for over 5 days now………..

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Speaking Tests Answers 11-15
(Medicine)
Doctor: Oh……….. Did she take the syrup which was prescribed………...

Patient: Well, she took that……….

Doctor: Does she eat a lot of chocolates or candies………?

Patient: Yes, she is so fond of chocolates…. She cries for the same all the time… if i do
not bring for her…….

Doctor: Is she still eating chocolates……..?

Patient: No, since the time i noted that she is coughing …… i stopped giving her the
chocolates…..

Doctor: Good………..

Patient: What can be the reason for this whooping cough, Doctor?

Doctor: Well, it is a bacterial infection…… it is common but can be prevented as well…

There is a need to maintain good hygiene.

Patient: Oh….

Doctor: There will be inflammation …….. in some cases……….

Patient: She complains of pain too……….

Doctor: Well, it will go away………..

Patient: And she is not able to sleep well?

Doctor: I would prescribe something for the sleep too……

Patient: What about the new syrup, doctor?

Doctor: Yes, there is a new syrup in your prescription…………. She will get well sooner
with that…..

Patient: Oh, thank you, Doctor……

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Speaking Tests Answers 11-15
(Medicine)

Doctor: Just make sure, she doesn’t eat plenty of chocolate in future too……….

Patient: I will, doctor……….

Doctor: OK……. take care…..

Patient: Thanks a lot, Doctor………

End of the Script

SPEAKING TEST 14

Sample Script

This is just a sample script. Actual discussion or talk can be different from this. It can
be smaller or longer than the present talk or discussion. It is just for the purpose of
test preparation.

Doctor: Good Evening

Brother of the patient: Good Evening, Doctor……….

Doctor: Please, take the chair…….

Brother of the patient: Thank you, doctor……….I am the brother of Mary D’souza……….

Doctor: Yes, please, tell me………..

Brother of the patient: I was not here in the city…. It was last week that i got to know
that she had got admitted into the hospital…….. I just came back……

Doctor: Oh, that is really nice of you….. she needed someone here…...

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Speaking Tests Answers 11-15
(Medicine)
Brother of the patient: What is the problem, doctor? I hope she will get well
sooner…….

Doctor: Well, there is an infection…. liver infection……. we call it cirrhosis….. It is a

slowly progressing disease in which the healthy liver tissue is replaced with the scar
tissue. It disturbs the proper functioning of the liver.

Brother of the patient: Oh………..

Doctor: It has been over a month now……… Your sister is in initial stage of the
infection…….

Brother of the patient: But, i hope she will become alright………….

Doctor: Well, as i have already told you that she is in initial stage… so, it is
possible………. by the way, does your sister have the habit of drinking…………..?

Brother of the patient: Yes, she drinks…… She started drinking after her divorce……….

Doctor: Oh……

Brother of the patient: I told her many times to stop drinking but……. she never
listened to me……

Doctor: Drinking can cause a lot of problem for her…….. She must stop ………. at least
now……...

Brother of the patient: I will talk to her, Doctor…..

Doctor: Now, we have given her some medicine ……….. she just needs to take the
medicine as prescribed……

Brother of the patient: I will make sure, she take the medicine on time…..
Doctor…….. I just want her to get well sooner……

Doctor: You do not worry… If she stops drinking and if she take the medicine on time
then there can be a great amount of change in her…….

Brother of the patient: Oh…Thank God…..

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Speaking Tests Answers 11-15
(Medicine)

Doctor: It is just a first stage….. And i must say……. she is lucky to have got admitted
here…… Her liver is still healthy and not much affected…………

Brother of the patient: How much time will she take, Doctor, to get well sooner or to
lead a normal healthy life?

Doctor: Well, i can’t say anything now…….. It depends more upon how she takes care
of herself… If he continues drinking after leaving here from the hospital then it can
cause a lot of problems for her… Her health is under her control now…

Brother of the patient: Oh……… i understand, doctor……

Doctor: Just, take good care of your sister………

Brother of the patient: I will, doctor………

Doctor: OK……. take care…..

Brother of the patient: Thanks a lot, Doctor………

End of the Script

SPEAKING TEST 15

Sample Script

This is just a sample script. Actual discussion or talk can be different from this. It can
be smaller or longer than the present talk or discussion. It is just for the purpose of
test preparation.

Doctor: Good Afternoon……

Patient: Good Afternoon, Doctor……….

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Speaking Tests Answers 11-15
(Medicine)
Doctor: So, how are you doing now?

Patient: Well, a bit much better, i guess………...

Doctor: You will be able to lead a normal life again ……. just a few days more…… and
you will be out of our hospital………

Patient: Oh…. a few more days……………… Oh…….

Doctor: Mr. Rehab, please, do not be so sad……..

Patient: I have missed my exams too…

Doctor: You can take exams next year as well………. do not be worried…… The good
thing is your problem has got detected at the right time……...

Patient: Yes….

Doctor: You just need to be very careful for a few days more….

Patient: I will be careful, doctor……..

Doctor: By the way, what have you taken in your breakfast?

Patient: Bread and Milk.

Doctor: Well, good…….. Are you taking the medicine on time?

Patient: Yes, i am taking the medicine on time, Doctor?

Doctor: Good……..

Patient: For how many days will i have to stay here at the hospital, Doctor?

Doctor: Well, just a week more…………..And after that, you can go home……

Patient: Oh, thanks a lot, doctor….

Doctor: Even after you go home from here, it is needed that you shall take good care
of yourself and it is necessary that you shall come here for regular check-up………...

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Speaking Tests Answers 11-15
(Medicine)

Patient: Regular check-up?

Doctor: Yes, it is needed…. in some cases, cancer may grow again………

Patient: Oh………….

Doctor: It is very rare……. it is just a precautionary measure…… You do not have to

think over it……….

Patient: Oh……… i understand, doctor……

Doctor: Just, take good care of yourself………… Maintain good and healthy diet….. Take
the diet-chart from our hospital here. I have already asked the nurse to give you that.
Follow what we suggest for you………..

Patient: I will surely follow……….. thanks a lot, Doctor….

Doctor: OK……. take care…..

Patient: Thank you……….

End of the Script

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Reading Test 1 – Part ‘A’

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Reading Test 1

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the summary of Part A - Answer booklet using the information in

the four texts (A1-4) below.

 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.

 Gaps may require 1, 2 or 3 words. Answer ALL questions. Marks are NOT
deducted for incorrect answers.

 You should write your answers next to the appropriate number in the right-
hand column.

 Please use correct spelling in your responses. Do not use abbreviations

unless they appear in the texts.

Text 1

An introduction on Chronic Dry Eye

Dry eye affects an estimated 20.7 million people in the United States and is one of
the most common reasons that people visit their eye doctor. Nearly 40 percent of
Americans experience symptoms of dry eye on a regular basis. Dry eye can be a
progressive disease, and if left untreated, chronic dry eye can lead to more serious
problems, including impaired vision and an increased risk of eye infection.
Seventy-six percent of patients report their chronic dry eye worsens over time
One of the largest groups of people affected by chronic dry eye is menopausal
women. Chronic dry eye occurs when eyes do not produce the right quantity or
quality of tears. The main functions of tears are to lubricate the eyes and protect
them from bacteria and environmental irritants such as dust. This requires both the
right amount of tears and a balance of the many components that make up tears.

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Reading Test 1

Symptoms of dry eye can vary greatly from one person to the next, often fluctuating
throughout the day, usually becoming worse later in the day, and may include itching,
irritation, sensitivity to light, blurred vision, dryness and foreign body sensation. Dry
eye can be a progressive disease that, if left untreated, can lead to increased risk of
infection or visual impairment.

Text 2

What causes dry eye?

Chronic dry eye is often caused by hormonal changes due to aging and menopause or
medical conditions and can be exacerbated by environmental conditions. Dry eye can
be aggravated by a number of external factors such as hot, dry or windy
environments, high altitudes, heating, air-conditioning and smoke. Many people also
find that their eyes become irritated when reading or working on a computer. Contact
lens wearers may also suffer from ocular dryness. Certain medications, thyroid
conditions, vitamin A deficiency and diseases such as Parkinson’s disease, rheumatoid
arthritis, lupus, rosacea, sarcoidosis and Sjögren’s syndrome may also cause dry eye.

Text 3

How do I know if I have dry eye?

If your eyes are dry or if you have symptoms such as blurred vision, itchiness and
sensitivity to light, or if you have been using over-the-counter eye drops three or
more times a day with little success, you may have chronic dry eye. Though a large
percentage of Americans suffer from chronic dry eye, it is more common among
certain groups of people.

They include:

Menopausal women
Older people, because tear production decreases with age
People who live at high altitudes or in sunny, dry, windy environments
Computer users because they blink less when concentrating on the monitor
Contact lens wearers because of increased tear evaporation
People taking medications such as antihistamines, antidepressants, diuretics, oral
contraceptives or hormone replacement therapy

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Reading Test 1

Text 4

Treatment

An eye care professional (ophthalmologist or optometrist) can check for the signs and
symptoms of chronic dry eye using several quick and painless tests to measure visual
clarity, tear production, ocular surface dryness and damage to the cornea or
conjunctiva (the membrane that lines the eyelids). Some of the tests an eye care
professional may use to diagnose dry eye will measure the production, evaporation
rate and quality of the tear film. Special diagnostic drops are used to highlight
problems that otherwise would be invisible, which are particularly helpful to diagnose
the presence and extent of the dryness. These tests may help determine the severity
of the condition.

Treatment is based on disease severity and an evaluation of the cause of the disease.
For example, a humidifier could help treat dry eye resulting from dry air, or if dry eye
is a side effect of one or more medications, the feasibility of stopping the medication
or reducing the dosage can be considered. In general, early treatment for a chronic
disease like dry eye is more likely to achieve better patient outcomes.

Summary Task

Dry eye occurs when the eye does not produce 1..............properly, or when the
tears are not of the correct consistency and evaporate too quickly. There are about
2............million people in the US who get affected by this. The largest groups of
people affected by 3.................is menopausal women. In addition, inflammation of
the surface of the eye may also occur along with dry eye. If left untreated, this
condition can lead to pain, ulcers, or scars on the cornea, and some loss of vision.
However, permanent loss of vision from dry eye is uncommon. Dry eye can make it
more difficult to perform some activities, such as using a 4............. at home or office
or reading for an extended period of time, and it can decrease tolerance for dry
environments, such as the air inside an airplane.

Dry eye can be a temporary or 5............condition. Both excessive and insufficient

dosages of vitamins can contribute to dry eye. A large percentage of
6...............suffer from chronic dry eye which includes 7........................., computer
users, contact lens wearers, people with 8............, people who live at
9.................or in 10............environments and people who takes 11.............. such
as antihistamines, 12..............etc. Dry eye can be associated with immune system
disorders such as 13.............., lupus, and rheumatoid 14................. Depending on
the causes of dry eye, your 15................. may use various approaches to relieve

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Reading Test 1

the 16............ Dry eye can be managed as an 17.............condition. The first

priority is to determine if a disease is the underlying cause of the dry eye (such as
18............... syndrome or lacrimal and meibomian gland dysfunction). If it is, then
the underlying disease needs to be treated. An eye 19......................... uses various
techniques to to measure 20................, visual clarity, ocular 21............. etc. The
tests help determine the 22............ of the cases. The treatment is given only after
perfect 23............. of the causes. For instance, if a 24............can help in treating
dry eye, which results from 25.......... then it is just used. If dry eye results from
taking a 26...........your doctor may recommend switching to a medication that does
not 27 .......... the dry eye side effect.

Reading: Part B - Text Booklet

There are TWO reading texts in Part B. After each of the texts you will find a number
of questions or unfinished statements about the text, each with four suggested
answers or ways of finishing.

You must choose the ONE which you think fits best. For each question, 1-20, indicate
on your answer sheet the letter A, B, C or D against the number of the question

Answer ALL questions. Marks are NOT deducted for incorrect answers.

NOTE: You must complete your Answer Sheet for Part B within the 45 minutes
allowed for this part of the sub-test.

NOW TURN TO THE NEXT PAGE FOR TEXTS AND QUESTIONS

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Reading Test 1

READING PASSAGE A

Cancer and what is cervical cancer?

Paragraph 1

What is cancer?

The body is made up of trillions of living cells. Normal body cells grow, divide, and die
in an orderly fashion. During the early years of a person's life, normal cells divide
faster to allow the person to grow. After the person becomes an adult, most cells
divide only to replace worn-out or dying cells or to repair injuries.

Paragraph 2

Cancer begins when cells in a part of the body start to grow out of control. There are
many kinds of cancer, but they all start because of out-of-control growth of abnormal
cells. Cells become cancer cells because of damage to DNA. DNA is in every cell and
directs all its actions. In a normal cell, when DNA gets damaged the cell either repairs
the damage or the cell dies. In cancer cells, the damaged DNA is not repaired, but the
cell doesn’t die like it should. Instead, this cell goes on making new cells that the
body does not need. These new cells will all have the same damaged DNA as the first
cell does.

Paragraph 3

No matter where a cancer may spread, it is always named for the place where it
started. For example, breast cancer that has spread to the liver is still called breast
cancer, not liver cancer. Likewise, prostate cancer that has spread to the bone is
metastatic prostate cancer, not bone cancer.

Paragraph 4

Different types of cancer can behave very differently. For example, lung cancer and
breast cancer are very different diseases. They grow at different rates and respond to

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Reading Test 1

different treatments. That is why people with cancer need treatment that is aimed at
their particular kind of cancer.

Paragraph 5

Not all tumors are cancerous. Tumors that aren’t cancer are called benign. Benign
tumors can cause problems – they can grow very large and press on healthy organs
and tissues. But they cannot grow into (invade) other tissues. Because they can’t
invade, they also can’t spread to other parts of the body (metastasize). These tumors
are almost never life threatening.

Paragraph 6

What is cervical cancer?

The cervix is the lower part of the uterus (womb). It is sometimes called the uterine
cervix. The body of the uterus (the upper part) is where a baby grows. The cervix
connects the body of the uterus to the vagina (birth canal). The part of the cervix
closest to the body of the uterus is called the endocervix. The part next to the vagina
is the exocervix (or ectocervix). The 2 main types of cells covering the cervix are
squamous cells (on the exocervix) and glandular cells (on the endocervix). The place
where these 2 cell types meet is called the transformation zone. Most cervical cancers
start in the transformation zone

Paragraph 7

Most cervical cancers begin in the cells lining the cervix. These cells do not suddenly
change into cancer. Instead, the normal cells of the cervix first gradually develop pre-
cancerous changes that turn into cancer. Doctors use several terms to describe these
pre-cancerous changes, including cervical intraepithelial neoplasia (CIN), squamous
intraepithelial lesion (SIL), and dysplasia. These changes can be detected by the Pap
test and treated to prevent the development of cancer.

Paragraph 8

Cervical cancers and cervical pre-cancers are classified by how they look under a
microscope. There are 2 main types of cervical cancers: squamous cell carcinoma and
adenocarcinoma. About 80% to 90% of cervical cancers are squamous cell
carcinomas. These cancers are from the squamous cells that cover the surface of the
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Reading Test 1

exocervix. Under the microscope, this type of cancer is made up of cells that are like
squamous cells. Squamous cell carcinomas most often begin where the exocervix
joins the endocervix.

Paragraph 9

Most of the other cervical cancers are adenocarcinomas. Cervical adenocarcinomas

seem to have becoming more common in the past 20 to 30 years. Cervical
adenocarcinoma develops from the mucus-producing gland cells of the endocervix.
Less commonly, cervical cancers have features of both squamous cell carcinomas and
adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.

Paragraph 10

Although cervical cancers start from cells with pre-cancerous changes (pre-cancers),
only some of the women with pre-cancers of the cervix will develop cancer. The
change from cervical pre-cancer to cervical cancer usually takes several years, but it
can happen in less than a year. For most women, pre-cancerous cells will go away
without any treatment. Still, in some women pre-cancers turn into true (invasive)
cancers. Treating all pre-cancers can prevent almost all true cancers.

Questions

An introduction on Cancer

1 When the person becomes an adult then the cells divide only to ...........

A replace old cells

B replace dying cells
C repair injuries
D all of the above

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Reading Test 1

2 In cancer cells

A DNA is damaged (but it can be repaired)

B DNA is not totally damaged
C DNA is permanently damaged, but the cell doesn't die
D DNA is damaged but the cell doesn't die, instead, gives new cells, containing
damaged DNA

3 Breast cancer that has spread to the liver is called

A liver cancer
B breast cancer
C prostate cancer
D bone cancer

4 Benign tumors

A can spread to the other parts of the body

B can not spread to the other parts of the body
C are cancerous
D are highly fatal

5 Most cervical cancers start

A in squamous cells
B glandular cells
C in the transformation zone
D all of the above

6 There are ........... main types of cervical cancers

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Reading Test 1

A two
B three
C four
D five

7 About 80% to 90% of cervical cancers are ............

A adenocarcinoma
B adenosquamous carcinomas
C mixed carcinomas
D squamous cell carcinomas

8 The change from cervical pre-cancer to cervical cancer usually takes .......

A two years
B three years
C four years
D several years (can't say)

9 “All tumors are cancerous-” the statement given here is

A exactly true
B exactly false
C sometimes true
D sometimes false

10 Pre-cancerous cells in women can go away

A with growth in more number of new cells

B with medications from doctors
C without treatment
D can't say

READING PASSAGE B
Hepatitis – Viral Liver Infection

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Reading Test 1

Passage 1

Hepatitis (A, B, or C) can be caused by a virus (Viral Hepatitis), drugs, alcohol,

medications, and blood transfusions. Scientists estimate that between 3.5 and 5.3
million people in the USA are living with hepatitis. A blood test is required to diagnose
Hepatitis infection.

Passage 2

Hepatitis A is a viral liver infection. In most cases the body easily defeats the virus
(much like the flu, which is what you may feel like you have). Because of this it does
not lead to long term liver challenges. Hepatitis A is the most common form of
Hepatitis. It is spread through the feces of a contaminated person. This can easily be
prevented by thoroughly washing hands after using the restroom, before eating, and
after changing a diaper.

Passage 3

Eating raw oysters and undercooked clams can increase your chances of contracting
the virus. If you are traveling in a country where Hepatitis is common make sure you
wash your hands often and well, eat cooked oysters and clams, and use an antiviral
essential oil such as Lemon to help protect yourself.

Passage 4

Hepatitis B is a viral liver infection. Again, most adult bodies are able to fight off the
virus. In this case it is referred to as Acute (something that does not last long)
Hepatitis B. Hepatitis B is spread through contact with blood or body fluids of an
infected person. This can include unprotected sexual intercourse, sharing drug
needles, getting a tattoo with instruments that were not properly cleaned, or by
sharing a personal item such as a razor or toothbrush with an infected person.

Passage 5

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A mother who is infected can pass the virus on to her baby during delivery. Again, the
symptoms are flu-like in nature so it often goes undiagnosed. A person who has
Chronic (lasting three months or more) Hepatitis B may show no symptoms until liver
damage has occurred. Hepatitis B can lead to liver damage or cancer; your doctor
may want to do a biopsy to determine the amount of damage your liver has
experienced.

Passage 6

Hepatitis C is also a viral liver infection. A few people will contract Hepatitis C and get
better. This is called Acute Hepatitis C. Most, however, will develop Chronic Hepatitis
C and go one to deal with liver damage, cirrhosis of the liver, liver cancer, and
possibly liver failure. Hepatitis C is the number one reason for liver transplants in the
USA.

Passage 7

Hepatitis C is spread through contact with contaminated blood. This can occur by
sharing a needle, receiving a blood transfusion or organ transplant (blood and organs
have been screened for Hepatitis in the USA since 1992), getting a tattoo with
equipment that has not been properly cleaned, and, in rare cases, a mother can pass
the virus on to her baby during birth. Scientists are not sure, but think there may be
a slim possibility that the virus may be passed through unprotected sexual
intercourse.

Passage 8

Symptoms generally do not occur until the virus is causing damage. Again, the
symptoms are flu-like; you may also experience jaundice (yellowish eyes and skin)
after the flu-like symptoms go away. Most people discover they are infected by having
routine tests done or by donating blood or organs and the standard tests show the
infection. There is also a home test you can purchase and do if you suspect you are
infected.

Passage 9

Home test:

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Reading Test 1

If you are infected with a Hepatitis virus, or if you have been in the past, one of the
most important things that you can do is strengthen your liver. The easiest way to do
this is the Be Young Liver Cleanse. It is simply to take upon rising in the morning 1
drop of Be Young Lemon essential oil, one drop of Be Young Peppermint essential oil,
and 1 teaspoon to 1 tablespoon of fresh lemon juice, followed by a glass of water.

Passage 10

Be Young essential oils are absolutely 100% pure, EOBBD tested and guaranteed to
be free of synthetics and extenders. Do not try this with an essential oil that you are
not certain has been properly cared for and tested as you do not want to increase
your liver challenge. When properly supported the liver has a remarkable capacity for
regeneration.

Questions

Hepatitis – Viral Liver Infection

11 Hepatitis is caused by

A virus
B alcohol consumption
C medications
D all of the above

12 This spreads through feces of contaminated person

A hepatitis A
B hepatitis B
C both
D can't say

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Reading Test 1

13 Most adult bodies are able to fight off this virus

A hepatitis A virus
B hepatitis B virus
C both
D can't say

14 Hepatitis can lead to

A cancer
B more damage to the cells of liver
C cancerous growth in liver
D not given

15 In USA people go for liver transplantation because of

A hepatitis A
B hepatitis B
C hepatitis C
D all of the above

16 Hepatitis C spreads through

A sharing needles
B blood transfusion
C organ transplantation
D all of the above

17 A patient may experience jaundice when

A the flu-like symptoms appears

B the flu-like symptoms disappears
C eyes become yellow
D all of the above
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Reading Test 1

18 Eating raw oysters and undercooked clams can increase your chances of
contracting which virus?

A hepatitis virus A
B hepatitis virus B
C hepatitis virus C
D can't say

19 Cirrhosis occurs due to

A acute hepatitis A
B acute hepatitis B
C chronic hepatitis c
D chronic hepatitis b

20 “Be Young essential oils” are

A free from extenders
B EOBBD
C full of synthetics
D not given

END OF READING TEST

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Reading Test 1 – Part ‘A’

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Reading Test 1

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the summary of Part A - Answer booklet using the information in

the four texts (A1-4) below.

 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.

 Gaps may require 1, 2 or 3 words. Answer ALL questions. Marks are NOT
deducted for incorrect answers.

 You should write your answers next to the appropriate number in the right-
hand column.

 Please use correct spelling in your responses. Do not use abbreviations

unless they appear in the texts.

Text 1

An introduction on Chronic Dry Eye

Dry eye affects an estimated 20.7 million people in the United States and is one of
the most common reasons that people visit their eye doctor. Nearly 40 percent of
Americans experience symptoms of dry eye on a regular basis. Dry eye can be a
progressive disease, and if left untreated, chronic dry eye can lead to more serious
problems, including impaired vision and an increased risk of eye infection.
Seventy-six percent of patients report their chronic dry eye worsens over time
One of the largest groups of people affected by chronic dry eye is menopausal
women. Chronic dry eye occurs when eyes do not produce the right quantity or
quality of tears. The main functions of tears are to lubricate the eyes and protect
them from bacteria and environmental irritants such as dust. This requires both the
right amount of tears and a balance of the many components that make up tears.

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Reading Test 1

Symptoms of dry eye can vary greatly from one person to the next, often fluctuating
throughout the day, usually becoming worse later in the day, and may include itching,
irritation, sensitivity to light, blurred vision, dryness and foreign body sensation. Dry
eye can be a progressive disease that, if left untreated, can lead to increased risk of
infection or visual impairment.

Text 2

What causes dry eye?

Chronic dry eye is often caused by hormonal changes due to aging and menopause or
medical conditions and can be exacerbated by environmental conditions. Dry eye can
be aggravated by a number of external factors such as hot, dry or windy
environments, high altitudes, heating, air-conditioning and smoke. Many people also
find that their eyes become irritated when reading or working on a computer. Contact
lens wearers may also suffer from ocular dryness. Certain medications, thyroid
conditions, vitamin A deficiency and diseases such as Parkinson’s disease, rheumatoid
arthritis, lupus, rosacea, sarcoidosis and Sjögren’s syndrome may also cause dry eye.

Text 3

How do I know if I have dry eye?

If your eyes are dry or if you have symptoms such as blurred vision, itchiness and
sensitivity to light, or if you have been using over-the-counter eye drops three or
more times a day with little success, you may have chronic dry eye. Though a large
percentage of Americans suffer from chronic dry eye, it is more common among
certain groups of people.

They include:

Menopausal women
Older people, because tear production decreases with age
People who live at high altitudes or in sunny, dry, windy environments
Computer users because they blink less when concentrating on the monitor
Contact lens wearers because of increased tear evaporation
People taking medications such as antihistamines, antidepressants, diuretics, oral
contraceptives or hormone replacement therapy

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Text 4

Treatment

An eye care professional (ophthalmologist or optometrist) can check for the signs and
symptoms of chronic dry eye using several quick and painless tests to measure visual
clarity, tear production, ocular surface dryness and damage to the cornea or
conjunctiva (the membrane that lines the eyelids). Some of the tests an eye care
professional may use to diagnose dry eye will measure the production, evaporation
rate and quality of the tear film. Special diagnostic drops are used to highlight
problems that otherwise would be invisible, which are particularly helpful to diagnose
the presence and extent of the dryness. These tests may help determine the severity
of the condition.

Treatment is based on disease severity and an evaluation of the cause of the disease.
For example, a humidifier could help treat dry eye resulting from dry air, or if dry eye
is a side effect of one or more medications, the feasibility of stopping the medication
or reducing the dosage can be considered. In general, early treatment for a chronic
disease like dry eye is more likely to achieve better patient outcomes.

Summary Task

Dry eye occurs when the eye does not produce 1..............properly, or when the
tears are not of the correct consistency and evaporate too quickly. There are about
2............million people in the US who get affected by this. The largest groups of
people affected by 3.................is menopausal women. In addition, inflammation of
the surface of the eye may also occur along with dry eye. If left untreated, this
condition can lead to pain, ulcers, or scars on the cornea, and some loss of vision.
However, permanent loss of vision from dry eye is uncommon. Dry eye can make it
more difficult to perform some activities, such as using a 4............. at home or office
or reading for an extended period of time, and it can decrease tolerance for dry
environments, such as the air inside an airplane.

Dry eye can be a temporary or 5............condition. Both excessive and insufficient

dosages of vitamins can contribute to dry eye. A large percentage of
6...............suffer from chronic dry eye which includes 7........................., computer
users, contact lens wearers, people with 8............, people who live at
9.................or in 10............environments and people who takes 11.............. such
as antihistamines, 12..............etc. Dry eye can be associated with immune system
disorders such as 13.............., lupus, and rheumatoid 14................. Depending on
the causes of dry eye, your 15................. may use various approaches to relieve

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Reading Test 1

the 16............ Dry eye can be managed as an 17.............condition. The first

priority is to determine if a disease is the underlying cause of the dry eye (such as
18............... syndrome or lacrimal and meibomian gland dysfunction). If it is, then
the underlying disease needs to be treated. An eye 19......................... uses various
techniques to to measure 20................, visual clarity, ocular 21............. etc. The
tests help determine the 22............ of the cases. The treatment is given only after
perfect 23............. of the causes. For instance, if a 24............can help in treating
dry eye, which results from 25.......... then it is just used. If dry eye results from
taking a 26...........your doctor may recommend switching to a medication that does
not 27 .......... the dry eye side effect.

Reading: Part B - Text Booklet

There are TWO reading texts in Part B. After each of the texts you will find a number
of questions or unfinished statements about the text, each with four suggested
answers or ways of finishing.

You must choose the ONE which you think fits best. For each question, 1-20, indicate
on your answer sheet the letter A, B, C or D against the number of the question

Answer ALL questions. Marks are NOT deducted for incorrect answers.

NOTE: You must complete your Answer Sheet for Part B within the 45 minutes
allowed for this part of the sub-test.

NOW TURN TO THE NEXT PAGE FOR TEXTS AND QUESTIONS

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Reading Test 1

READING PASSAGE A

Cancer and what is cervical cancer?

Paragraph 1

What is cancer?

The body is made up of trillions of living cells. Normal body cells grow, divide, and die
in an orderly fashion. During the early years of a person's life, normal cells divide
faster to allow the person to grow. After the person becomes an adult, most cells
divide only to replace worn-out or dying cells or to repair injuries.

Paragraph 2

Cancer begins when cells in a part of the body start to grow out of control. There are
many kinds of cancer, but they all start because of out-of-control growth of abnormal
cells. Cells become cancer cells because of damage to DNA. DNA is in every cell and
directs all its actions. In a normal cell, when DNA gets damaged the cell either repairs
the damage or the cell dies. In cancer cells, the damaged DNA is not repaired, but the
cell doesn’t die like it should. Instead, this cell goes on making new cells that the
body does not need. These new cells will all have the same damaged DNA as the first
cell does.

Paragraph 3

No matter where a cancer may spread, it is always named for the place where it
started. For example, breast cancer that has spread to the liver is still called breast
cancer, not liver cancer. Likewise, prostate cancer that has spread to the bone is
metastatic prostate cancer, not bone cancer.

Paragraph 4

Different types of cancer can behave very differently. For example, lung cancer and
breast cancer are very different diseases. They grow at different rates and respond to

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different treatments. That is why people with cancer need treatment that is aimed at
their particular kind of cancer.

Paragraph 5

Not all tumors are cancerous. Tumors that aren’t cancer are called benign. Benign
tumors can cause problems – they can grow very large and press on healthy organs
and tissues. But they cannot grow into (invade) other tissues. Because they can’t
invade, they also can’t spread to other parts of the body (metastasize). These tumors
are almost never life threatening.

Paragraph 6

What is cervical cancer?

The cervix is the lower part of the uterus (womb). It is sometimes called the uterine
cervix. The body of the uterus (the upper part) is where a baby grows. The cervix
connects the body of the uterus to the vagina (birth canal). The part of the cervix
closest to the body of the uterus is called the endocervix. The part next to the vagina
is the exocervix (or ectocervix). The 2 main types of cells covering the cervix are
squamous cells (on the exocervix) and glandular cells (on the endocervix). The place
where these 2 cell types meet is called the transformation zone. Most cervical cancers
start in the transformation zone

Paragraph 7

Most cervical cancers begin in the cells lining the cervix. These cells do not suddenly
change into cancer. Instead, the normal cells of the cervix first gradually develop pre-
cancerous changes that turn into cancer. Doctors use several terms to describe these
pre-cancerous changes, including cervical intraepithelial neoplasia (CIN), squamous
intraepithelial lesion (SIL), and dysplasia. These changes can be detected by the Pap
test and treated to prevent the development of cancer.

Paragraph 8

Cervical cancers and cervical pre-cancers are classified by how they look under a
microscope. There are 2 main types of cervical cancers: squamous cell carcinoma and
adenocarcinoma. About 80% to 90% of cervical cancers are squamous cell
carcinomas. These cancers are from the squamous cells that cover the surface of the
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exocervix. Under the microscope, this type of cancer is made up of cells that are like
squamous cells. Squamous cell carcinomas most often begin where the exocervix
joins the endocervix.

Paragraph 9

Most of the other cervical cancers are adenocarcinomas. Cervical adenocarcinomas

seem to have becoming more common in the past 20 to 30 years. Cervical
adenocarcinoma develops from the mucus-producing gland cells of the endocervix.
Less commonly, cervical cancers have features of both squamous cell carcinomas and
adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.

Paragraph 10

Although cervical cancers start from cells with pre-cancerous changes (pre-cancers),
only some of the women with pre-cancers of the cervix will develop cancer. The
change from cervical pre-cancer to cervical cancer usually takes several years, but it
can happen in less than a year. For most women, pre-cancerous cells will go away
without any treatment. Still, in some women pre-cancers turn into true (invasive)
cancers. Treating all pre-cancers can prevent almost all true cancers.

Questions

An introduction on Cancer

1 When the person becomes an adult then the cells divide only to ...........

A replace old cells

B replace dying cells
C repair injuries
D all of the above

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2 In cancer cells

A DNA is damaged (but it can be repaired)

B DNA is not totally damaged
C DNA is permanently damaged, but the cell doesn't die
D DNA is damaged but the cell doesn't die, instead, gives new cells, containing
damaged DNA

3 Breast cancer that has spread to the liver is called

A liver cancer
B breast cancer
C prostate cancer
D bone cancer

4 Benign tumors

A can spread to the other parts of the body

B can not spread to the other parts of the body
C are cancerous
D are highly fatal

5 Most cervical cancers start

A in squamous cells
B glandular cells
C in the transformation zone
D all of the above

6 There are ........... main types of cervical cancers

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Reading Test 1

A two
B three
C four
D five

7 About 80% to 90% of cervical cancers are ............

A adenocarcinoma
B adenosquamous carcinomas
C mixed carcinomas
D squamous cell carcinomas

8 The change from cervical pre-cancer to cervical cancer usually takes .......

A two years
B three years
C four years
D several years (can't say)

9 “All tumors are cancerous-” the statement given here is

A exactly true
B exactly false
C sometimes true
D sometimes false

10 Pre-cancerous cells in women can go away

A with growth in more number of new cells

B with medications from doctors
C without treatment
D can't say

READING PASSAGE B
Hepatitis – Viral Liver Infection

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Passage 1

Hepatitis (A, B, or C) can be caused by a virus (Viral Hepatitis), drugs, alcohol,

medications, and blood transfusions. Scientists estimate that between 3.5 and 5.3
million people in the USA are living with hepatitis. A blood test is required to diagnose
Hepatitis infection.

Passage 2

Hepatitis A is a viral liver infection. In most cases the body easily defeats the virus
(much like the flu, which is what you may feel like you have). Because of this it does
not lead to long term liver challenges. Hepatitis A is the most common form of
Hepatitis. It is spread through the feces of a contaminated person. This can easily be
prevented by thoroughly washing hands after using the restroom, before eating, and
after changing a diaper.

Passage 3

Eating raw oysters and undercooked clams can increase your chances of contracting
the virus. If you are traveling in a country where Hepatitis is common make sure you
wash your hands often and well, eat cooked oysters and clams, and use an antiviral
essential oil such as Lemon to help protect yourself.

Passage 4

Hepatitis B is a viral liver infection. Again, most adult bodies are able to fight off the
virus. In this case it is referred to as Acute (something that does not last long)
Hepatitis B. Hepatitis B is spread through contact with blood or body fluids of an
infected person. This can include unprotected sexual intercourse, sharing drug
needles, getting a tattoo with instruments that were not properly cleaned, or by
sharing a personal item such as a razor or toothbrush with an infected person.

Passage 5

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A mother who is infected can pass the virus on to her baby during delivery. Again, the
symptoms are flu-like in nature so it often goes undiagnosed. A person who has
Chronic (lasting three months or more) Hepatitis B may show no symptoms until liver
damage has occurred. Hepatitis B can lead to liver damage or cancer; your doctor
may want to do a biopsy to determine the amount of damage your liver has
experienced.

Passage 6

Hepatitis C is also a viral liver infection. A few people will contract Hepatitis C and get
better. This is called Acute Hepatitis C. Most, however, will develop Chronic Hepatitis
C and go one to deal with liver damage, cirrhosis of the liver, liver cancer, and
possibly liver failure. Hepatitis C is the number one reason for liver transplants in the
USA.

Passage 7

Hepatitis C is spread through contact with contaminated blood. This can occur by
sharing a needle, receiving a blood transfusion or organ transplant (blood and organs
have been screened for Hepatitis in the USA since 1992), getting a tattoo with
equipment that has not been properly cleaned, and, in rare cases, a mother can pass
the virus on to her baby during birth. Scientists are not sure, but think there may be
a slim possibility that the virus may be passed through unprotected sexual
intercourse.

Passage 8

Symptoms generally do not occur until the virus is causing damage. Again, the
symptoms are flu-like; you may also experience jaundice (yellowish eyes and skin)
after the flu-like symptoms go away. Most people discover they are infected by having
routine tests done or by donating blood or organs and the standard tests show the
infection. There is also a home test you can purchase and do if you suspect you are
infected.

Passage 9

Home test:

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If you are infected with a Hepatitis virus, or if you have been in the past, one of the
most important things that you can do is strengthen your liver. The easiest way to do
this is the Be Young Liver Cleanse. It is simply to take upon rising in the morning 1
drop of Be Young Lemon essential oil, one drop of Be Young Peppermint essential oil,
and 1 teaspoon to 1 tablespoon of fresh lemon juice, followed by a glass of water.

Passage 10

Be Young essential oils are absolutely 100% pure, EOBBD tested and guaranteed to
be free of synthetics and extenders. Do not try this with an essential oil that you are
not certain has been properly cared for and tested as you do not want to increase
your liver challenge. When properly supported the liver has a remarkable capacity for
regeneration.

Questions

Hepatitis – Viral Liver Infection

11 Hepatitis is caused by

A virus
B alcohol consumption
C medications
D all of the above

12 This spreads through feces of contaminated person

A hepatitis A
B hepatitis B
C both
D can't say

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13 Most adult bodies are able to fight off this virus

A hepatitis A virus
B hepatitis B virus
C both
D can't say

14 Hepatitis can lead to

A cancer
B more damage to the cells of liver
C cancerous growth in liver
D not given

15 In USA people go for liver transplantation because of

A hepatitis A
B hepatitis B
C hepatitis C
D all of the above

16 Hepatitis C spreads through

A sharing needles
B blood transfusion
C organ transplantation
D all of the above

17 A patient may experience jaundice when

A the flu-like symptoms appears

B the flu-like symptoms disappears
C eyes become yellow
D all of the above
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18 Eating raw oysters and undercooked clams can increase your chances of
contracting which virus?

A hepatitis virus A
B hepatitis virus B
C hepatitis virus C
D can't say

19 Cirrhosis occurs due to

A acute hepatitis A
B acute hepatitis B
C chronic hepatitis c
D chronic hepatitis b

20 “Be Young essential oils” are

A free from extenders
B EOBBD
C full of synthetics
D not given

END OF READING TEST

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Reading Test 1 – Part ‘A’

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Reading Test 2

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the following summary using the information in the four texts
provided.

 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.

 Gaps may require 1, 2 or 3 words

 You should write your answers next to the appropriate number in the
right-hand column.

 Please use correct spelling in your responses.

Text 1

Streptococcal sore throat (strep throat), is an infection of the mucous membranes

lining the throat. Sometimes the tonsils are also infected (tonsillitis). Caused by
group A Streptococcus bacteria, untreated strep throat may develop into rheumatic
fever or other serious conditions.

Strep throat accounts for between 5% and 10% of all sore throats. It occurs most
often between November to April, and while anyone can get strep throat, it's most
common among school children. People who smoke or who are tired, run down, or
who live in damp, crowded conditions are more likely to become infected. Children
under age 2 and adults who aren't around children are less likely to get the disease.

The disease passes directly from person to person by coughing or sneezing; rarely
the bacteria is passed through food if a sick food handler accidentally contaminates
food by coughing or sneezing. Statistically, if someone in the home is infected, one
out of every four other household members may get strep throat within two to seven
days.

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Reading Test 2

Text 2

A person with strep throat suddenly develops a painful sore throat one to five days
after being exposed to the streptococcus bacteria. Unfortunately, it's impossible to
tell the difference between a sore throat caused by strep or by other bacteria or
viruses. The infected person usually feels tired and has a fever, sometimes
accompanied by chills, headache, muscle aches, swollen lymph glands, and nausea.
Young children may complain of abdominal pain. The tonsils look swollen and are
bright red, with white or yellow patches of pus on them. Sometimes the roof of the
mouth is red or has small red spots. Often a person with strep throat has bad breath.

Despite these common symptoms, strep throat can be deceptive. It's possible to
have the disease and not show any of these symptoms. Many young children
complain only of a headache and stomach-ache, without the characteristic sore
throat.

Text 3

There are complications. Occasionally, within a few days of developing the sore
throat, a person may develop a fine, rough, sunburn-like rash over the face and
upper body, together with a fever of between 101-104°F. The tongue becomes
bright red, with a flecked, strawberry-like appearance. When a rash develops, this
form of strep throat is called scarlet fever. The rash is a reaction to toxins released
by the streptococcus bacteria. Scarlet fever is no more dangerous than strep throat,
and is treated the same way. The rash disappears in about five days. One to three
weeks later, patches of skin may peel off, especially on the fingers and toes.

Untreated strep throat can cause rheumatic fever. This is a serious illness, although
it occurs rarely. The most recent outbreak appeared in the United States in the mid-
1980s. Rheumatic fever occurs most often in children between the ages of five and
15, and may have a genetic component, since it seems to run in families. Although
the strep throat that causes rheumatic fever is contagious, rheumatic fever itself is
not.

Text 4

Rheumatic fever begins one to six weeks after an untreated streptococcal infection.
The joints, especially the wrists, elbows, knees, and ankles become red, sore, and
swollen. The infected person develops a high fever, and possibly a
rapid heartbeat when lying down, paleness, shortness of breath, and fluid retention.
A red rash over the trunk may come and go for weeks or months. An acute attack
of rheumatic fever lasts about three months. Rheumatic fever can cause permanent
damage to the heart and heart valves. It can be prevented by promptly treating
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Reading Test 2

streptococcal infections with antibiotics. It does not occur if all the streptococcus
bacteria are killed within the first 10-12 days after infection.

Summary Task

Strep throat is bacterial throat infection that can make your 1………… feel sore and
scratchy. Compared with a 2…………. infection, strep throat symptoms are generally
more severe. Only a small portion of sore throats are the result of strep throat. It's
important to identify strep throat for a number of reasons. Children under age
3……….. and 4………. who aren't around children are less likely to get the disease.
The infected person often feels 5………… and suffers from kind of 6………, which is
sometimes accompanied by headache, muscle aches, swollen 7………., chills, and
8……….. Abdominal pain is also reported, particularly in 9…………. The tonsils become
10………… and look bright red, with 11………. or 12………..patches of pus on them.
Compilations may occur within a few days after the arrival of this disease which
include 13……….. like rash over the face and 14………., fever, ranging from 15……..
When rash develops then this form of sore throat is referred to as16………. fever.
The rash which occurs is result of the reaction to 17………… released by the 18………..
Strep infection may also lead to 19………… fever, a serious condition that can affect
the heart, 20…………., nervous system and skin. It's also possible to have the bacteria
that can cause strep in your throat without having a 21……… throat. Some people
are carriers of strep, which means they can pass the bacteria on to others, but the
22……… are not currently making them sick. In general, signs and symptoms of
strep throat include: Throat pain, Difficulty in 23…………, Headache, 24………… and
sometimes vomiting, Fatigue, Rash etc. Call your doctor if you or your child has
any of these signs and symptoms: A sore throat without cold symptoms such as
25…… nose, A sore throat accompanied by tender, swollen 26……. glands (nodes), A
sore throat that lasts longer than 48 hours, A fever — or pain or swelling in the
joints, shortness of breath or a rash — after a strep infection, even as long as
three weeks after infection; these can be indicators of rheumatic fever

Reading Test 1 - Part B

Time allowed: 60 minutes

There are two reading passages in this test. After each passage you will find a
number of questions or unfinished statements about the passage, each with four
suggested answers or ways of finishing.

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Reading Test 2

You must choose the one which you think fits the best, i.e. the best answer. For each
question, 1-20, indicate on your answer sheet the letter A, B, C or D against the
number of the question.

Answer all questions. Marks will not be deducted for incorrect answers.

READING PASSAGE A

Viral Infection – Yellow Fever

Paragraph 1

Yellow fever is a viral infection spread by a particular species of mosquito. It's most
common in areas of Africa and South America, affecting travellers to and residents
of those areas. In mild cases, it causes fever, headache, nausea and vomiting. But it
can become more serious, causing heart, liver and kidney problems along with
bleeding (haemorrhaging). Up to 50 percent of people with the more severe form
of yellow fever die of the disease.

Paragraph 2

There's no specific treatment for yellow fever. But getting a yellow fever vaccine
before travelling to an area in which the virus is known to exist can protect you from
the disease. During the first three to six days after you've contracted yellow fever —
the incubation period — you won't experience any signs or symptoms. After this, the
virus enters an acute phase and then, in some cases, a toxic phase that can be life-
threatening.

Paragraph 3

Once the yellow fever virus enters the acute phase, you may experience signs and
symptoms including: Fever, Headache, Muscle aches, particularly in your back and
knees, Nausea, vomiting or both, Loss of appetite, Dizziness, Red eyes, face or
tongue
These signs and symptoms usually improve and are gone within several days.

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Reading Test 2

Paragraph 4

Although signs and symptoms may disappear for a day or two following the acute
phase, some people with acute yellow fever then enter a toxic phase. During the
toxic phase, acute signs and symptoms return and more-severe and life-threatening
ones also appear. These can include: Yellowing of your skin and the whites of your
eyes (jaundice), Abdominal pain and vomiting, sometimes of blood, Decreased
urination, Bleeding from your nose, mouth and eyes, Heart dysfunction (arrhythmia),
Liver and kidney failure, Brain dysfunction, including delirium, seizures and coma.

The toxic phase of yellow fever can be fatal.

Paragraph 5

Make an appointment to see your doctor four to six weeks before travelling to an
area in which yellow fever is known to occur. If you don't have that much time to
prepare, call your doctor anyway. Your doctor will help you determine whether you
need vaccinations and can provide general guidance on protecting your health while
abroad.

Seek emergency medical care if you've recently travelled to a region where yellow
fever is known to occur and you develop severe signs or symptoms of the disease.
If you develop mild symptoms, call your doctor.

Paragraph 6

Yellow fever is caused by a virus that is spread by the Aedes aegypti mosquito.
These mosquitoes thrive in and near human habitations where they breed in even
the cleanest water. Most cases of yellow fever occur in sub-Saharan Africa and
tropical South America.

Paragraph 7

Humans and monkeys are most commonly infected with the yellow fever virus.
Mosquitoes transmit the virus back and forth between monkeys, humans or both.
When a mosquito bites a human or monkey infected with yellow fever, the virus
enters the mosquito's bloodstream and circulates before settling in the salivary

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Reading Test 2

glands. When the infected mosquito bites another monkey or human, the virus then
enters the host's bloodstream, where it may cause illness.

Paragraph 8

You may be at risk of the disease if you travel to an area where mosquitoes
continue to carry the yellow fever virus. These areas include sub-Saharan Africa
and tropical South America. Even if there aren't current reports of infected humans
in these areas, it doesn't mean you're risk-free. It's possible that local populations
have been vaccinated and are protected from the disease, or that cases of yellow
fever just haven't been detected and officially reported. If you're planning on
travelling to these areas, you can protect yourself by getting a yellow fever vaccine
at least 10 to 14 days before travelling. Anyone can be infected with the yellow fever
virus, but older adults are at greater risk of getting seriously ill.

Paragraph 9

Diagnosing yellow fever based on signs and symptoms can be difficult because early
in its course, the infection can be easily confused with malaria, typhoid, dengue fever
and other viral hemorrhagic fevers.

To diagnose your condition, your doctor will likely:

Ask questions about your medical and travel history

Collect a blood sample for testing

If you have yellow fever, your blood may reveal the virus itself. If not, blood tests
known as enzyme-linked immuno sorbent assay (ELISA) and polymerase chain
reaction (PCR) also can detect antigens and antibodies specific to the virus. Results
of these tests may not be available for several days.

Paragraph 10

No antiviral medications have proved helpful in treating yellow fever. As a result,

treatment consists primarily of supportive care in a hospital. This includes providing
fluids and oxygen, maintaining adequate blood pressure, replacing blood loss,
providing dialysis for kidney failure, and treating any other infections that develop.
Some people receive transfusions of plasma to replace blood proteins that improve

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Reading Test 2

clotting. If you have yellow fever, you may also be kept away from mosquitoes, to
avoid transmitting the disease to others.

Questions

Viral Infection – Yellow Fever

1 Yellow fever is common in

A Africa
B South America
C both
D not given

2 Signs of yellow fever doesn’t include one of this

A back pain
B vomiting
C nausea
D dry tongue

3 Signs in toxic phase

A loss of appetite
B yellowness of eyes
C brain dysfunction
D B and C

4 Seizures may occur during

A acute phase
B toxic phase
C sometimes in both the phases
D not given

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Reading Test 2

5 Yellow fever which is a viral disease, is spread by

A Aedes agypti mosquito

B Aedes aegypti mosquito
C female mosquito
D contamination

6 Mosquito transmits virus from

A human to monkeys
B monkeys to human
C human to human
D none

7 Taking vaccine …………… days before travelling to areas where the disease is
common is recommended

A 10 days
B 12 days
C 14 days
D 10-14 days

8 Typhoid is
A similar to malaria
B just similar to yellow fever
C one of common hemorrhagic fevers
D not given

9 For detection of yellow fever, a doctor may first ask for

A blood test
B urine test
C glucose test
D blood test and urine test

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10 Supportive care in hospitals include

A free medical check up

B free BP check up
C effective dialysis procedures in case of failure of kidney
D B and C

READING PASSAGE B

Aortic Dissection or Dissecting Aneurysm

Passage 1

An aortic dissection is a serious condition in which a tear develops in the inner layer
of the aorta, the large blood vessel branching off the heart. Blood surges through
this tear into the middle layer of the aorta, causing the inner and middle layers to
separate (dissect). If the blood-filled channel ruptures through the outside aortic
wall, aortic dissection is often fatal.

Passage 2

Aortic dissection, also called dissecting aneurysm, is relatively uncommon. Anyone

can develop the condition, but it most frequently occurs in men between 60 and 70
years of age. Symptoms of aortic dissection may mimic those of other diseases,
often leading to delays in diagnosis. However, when an aortic dissection is detected
early and treated promptly, your chance of survival greatly improves.

Passage 3

Aortic dissection symptoms may be similar to those of other heart problems, such as
a heart attack. Typical signs and symptoms include: Sudden severe chest or upper
back pain (often described as a tearing, ripping or shearing sensation, that radiates
to the neck or down the back), Loss of consciousness (fainting), Shortness of breath,
Sweating, Weak pulse in one arm compared to the other etc.

Passage 4

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If you have signs or symptoms such as severe chest pain, fainting, sudden onset of
shortness of breath or symptoms of a stroke then taking medical assistance is of
preliminary importance. While experiencing such symptoms doesn't always mean
that you have a serious problem, it's best to get checked out quickly. Early detection
and treatment may help save your life.

Passage 5

An aortic dissection occurs in a weakened area of the aortic wall. Chronic high blood
pressure may stress the aortic tissue, making it more susceptible to tearing. You can
also be born with a condition associated with a weakened and enlarged aorta, such
as Marfan syndrome or bicuspid aortic valve. Rarely, aortic dissections may be
caused by traumatic injury to the chest area, such as during motor vehicle accidents.

Passage 6

Aortic dissections are divided into two groups, depending on which part of the aorta
is affected:

Type A: This is the more common and dangerous type of aortic dissection. It involves
a tear in the part of the aorta just where it exits the heart or a tear extending from
the upper to lower parts of the aorta, which may extend into the abdomen.

Type B: This type involves a tear in the lower aorta only, which may also extend into
the abdomen.

Passage 7

Risk factors for aortic dissection include:

Uncontrolled high blood pressure (hypertension), found in at least two-thirds of all

cases
Hardening of the arteries (atherosclerosis)
Weakened and bulging artery (pre-existing aortic aneurysm)
An aortic valve defect (bicuspid aortic valve)
A narrowing of the aorta you're born with (aortic coarctation)

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Passage 8

People with certain genetic diseases are more likely to have an aortic dissection than
are people in the general population.

These include:

Turner's syndrome. High blood pressure, heart problems and a number of other
health conditions may result from this disorder.

Marfan syndrome. This is a condition in which connective tissue, which supports

various structures in the body, is weak. People with this disorder often have a family
history of aneurysms of the aorta and other blood vessels. These weak blood vessels
are prone to tears (dissection) and rupture easily.

Ehlers-Danlos syndrome. This group of connective tissue disorders is characterized by

skin that bruises or tears easily, loose joints and fragile blood vessels.

Loeys-Dietz syndrome. This is a connective tissue disorder marked by twisted

arteries, especially in the neck. People who have Loeys-Dietz syndrome are thought
to be at risk for developing aortic dissections and aneurysms.

Passage 9

An aortic dissection can lead to death, due to severe internal bleeding, including into
the lining around the heart (pericardial sac), Organ damage, such as kidney failure or
life-threatening damage to the intestines, Stroke, possibly including paralysis, Aortic
valve damage, such as causing the aortic valve to leak (aortic regurgitation)

Passage 10

Detecting an aortic dissection can be tricky because the symptoms are similar to
those of a variety of health problems. Doctors often suspect an aortic dissection if the
following signs and symptoms are present: Sudden tearing or ripping chest pain,
Widening of the aorta on chest X-ray, Blood pressure difference between right and
left arms.
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Reading Test 2

Questions

Aortic Dissection or Dissecting Aneurysm

11 In aortic dissection a tear develops in

A outer layer of aorta
B inner layer of aorta
C middle aorta
D a blood vessel branching off the heart

12 Dissecting aneurysm is common among

A men
B women
C both
D children

13 Symptoms of aortic dissection include

A chest pain and swelling
B weak pulse in both arms
C loss of consciousness
D all of the above

14 Aortic dissection can also be caused due to

A high BP
B weak aortic wall
C inborn symptoms
D traumatic injury to chest during accidents

15 The most dangerous type of aortic dissection is

A Type A
B Type B
C aortic aneurism
D aortic coarctation

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16 A condition in which connective tissue is weak

A Turner’s syndrome
B Loeys-Dietz syndrome
C Ehlers-Danlos syndrome
D Marfan’s syndrome

17 People with Loeys-Dietz syndrome are likely to develop

A aneurysms
B ruptured blood vessels
C twisted arteries in the neck
D aortic complications

18 Aortic dissection is

A extremely fatal all the times

B sometimes fatal
C not very severe
D sometimes severe

19 Aortic dissection can lead to death because of

A bleeding in pericardial sac

B kidney failure
C aortic valve damage
D All of the above

20 Detecting aortic dissection is

A easy
B difficult
C impossible
D sometimes possible

END OF READING TEST

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Reading Test 1 – Part ‘A’

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Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the following summary using the information in the four texts
provided.

 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.

 Gaps may require 1, 2 or 3 words

 You should write your answers next to the appropriate number in the
right-hand column.

 Please use correct spelling in your responses.

Text 1

Streptococcal sore throat (strep throat), is an infection of the mucous membranes

lining the throat. Sometimes the tonsils are also infected (tonsillitis). Caused by
group A Streptococcus bacteria, untreated strep throat may develop into rheumatic
fever or other serious conditions.

Strep throat accounts for between 5% and 10% of all sore throats. It occurs most
often between November to April, and while anyone can get strep throat, it's most
common among school children. People who smoke or who are tired, run down, or
who live in damp, crowded conditions are more likely to become infected. Children
under age 2 and adults who aren't around children are less likely to get the disease.

The disease passes directly from person to person by coughing or sneezing; rarely
the bacteria is passed through food if a sick food handler accidentally contaminates
food by coughing or sneezing. Statistically, if someone in the home is infected, one
out of every four other household members may get strep throat within two to seven
days.

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Text 2

A person with strep throat suddenly develops a painful sore throat one to five days
after being exposed to the streptococcus bacteria. Unfortunately, it's impossible to
tell the difference between a sore throat caused by strep or by other bacteria or
viruses. The infected person usually feels tired and has a fever, sometimes
accompanied by chills, headache, muscle aches, swollen lymph glands, and nausea.
Young children may complain of abdominal pain. The tonsils look swollen and are
bright red, with white or yellow patches of pus on them. Sometimes the roof of the
mouth is red or has small red spots. Often a person with strep throat has bad breath.

Despite these common symptoms, strep throat can be deceptive. It's possible to
have the disease and not show any of these symptoms. Many young children
complain only of a headache and stomach-ache, without the characteristic sore
throat.

Text 3

There are complications. Occasionally, within a few days of developing the sore
throat, a person may develop a fine, rough, sunburn-like rash over the face and
upper body, together with a fever of between 101-104°F. The tongue becomes
bright red, with a flecked, strawberry-like appearance. When a rash develops, this
form of strep throat is called scarlet fever. The rash is a reaction to toxins released
by the streptococcus bacteria. Scarlet fever is no more dangerous than strep throat,
and is treated the same way. The rash disappears in about five days. One to three
weeks later, patches of skin may peel off, especially on the fingers and toes.

Untreated strep throat can cause rheumatic fever. This is a serious illness, although
it occurs rarely. The most recent outbreak appeared in the United States in the mid-
1980s. Rheumatic fever occurs most often in children between the ages of five and
15, and may have a genetic component, since it seems to run in families. Although
the strep throat that causes rheumatic fever is contagious, rheumatic fever itself is
not.

Text 4

Rheumatic fever begins one to six weeks after an untreated streptococcal infection.
The joints, especially the wrists, elbows, knees, and ankles become red, sore, and
swollen. The infected person develops a high fever, and possibly a
rapid heartbeat when lying down, paleness, shortness of breath, and fluid retention.
A red rash over the trunk may come and go for weeks or months. An acute attack
of rheumatic fever lasts about three months. Rheumatic fever can cause permanent
damage to the heart and heart valves. It can be prevented by promptly treating
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streptococcal infections with antibiotics. It does not occur if all the streptococcus
bacteria are killed within the first 10-12 days after infection.

Summary Task

Strep throat is bacterial throat infection that can make your 1………… feel sore and
scratchy. Compared with a 2…………. infection, strep throat symptoms are generally
more severe. Only a small portion of sore throats are the result of strep throat. It's
important to identify strep throat for a number of reasons. Children under age
3……….. and 4………. who aren't around children are less likely to get the disease.
The infected person often feels 5………… and suffers from kind of 6………, which is
sometimes accompanied by headache, muscle aches, swollen 7………., chills, and
8……….. Abdominal pain is also reported, particularly in 9…………. The tonsils become
10………… and look bright red, with 11………. or 12………..patches of pus on them.
Compilations may occur within a few days after the arrival of this disease which
include 13……….. like rash over the face and 14………., fever, ranging from 15……..
When rash develops then this form of sore throat is referred to as16………. fever.
The rash which occurs is result of the reaction to 17………… released by the 18………..
Strep infection may also lead to 19………… fever, a serious condition that can affect
the heart, 20…………., nervous system and skin. It's also possible to have the bacteria
that can cause strep in your throat without having a 21……… throat. Some people
are carriers of strep, which means they can pass the bacteria on to others, but the
22……… are not currently making them sick. In general, signs and symptoms of
strep throat include: Throat pain, Difficulty in 23…………, Headache, 24………… and
sometimes vomiting, Fatigue, Rash etc. Call your doctor if you or your child has
any of these signs and symptoms: A sore throat without cold symptoms such as
25…… nose, A sore throat accompanied by tender, swollen 26……. glands (nodes), A
sore throat that lasts longer than 48 hours, A fever — or pain or swelling in the
joints, shortness of breath or a rash — after a strep infection, even as long as
three weeks after infection; these can be indicators of rheumatic fever

Reading Test 1 - Part B

Time allowed: 60 minutes

There are two reading passages in this test. After each passage you will find a
number of questions or unfinished statements about the passage, each with four
suggested answers or ways of finishing.

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Reading Test 2

You must choose the one which you think fits the best, i.e. the best answer. For each
question, 1-20, indicate on your answer sheet the letter A, B, C or D against the
number of the question.

Answer all questions. Marks will not be deducted for incorrect answers.

READING PASSAGE A

Viral Infection – Yellow Fever

Paragraph 1

Yellow fever is a viral infection spread by a particular species of mosquito. It's most
common in areas of Africa and South America, affecting travellers to and residents
of those areas. In mild cases, it causes fever, headache, nausea and vomiting. But it
can become more serious, causing heart, liver and kidney problems along with
bleeding (haemorrhaging). Up to 50 percent of people with the more severe form
of yellow fever die of the disease.

Paragraph 2

There's no specific treatment for yellow fever. But getting a yellow fever vaccine
before travelling to an area in which the virus is known to exist can protect you from
the disease. During the first three to six days after you've contracted yellow fever —
the incubation period — you won't experience any signs or symptoms. After this, the
virus enters an acute phase and then, in some cases, a toxic phase that can be life-
threatening.

Paragraph 3

Once the yellow fever virus enters the acute phase, you may experience signs and
symptoms including: Fever, Headache, Muscle aches, particularly in your back and
knees, Nausea, vomiting or both, Loss of appetite, Dizziness, Red eyes, face or
tongue
These signs and symptoms usually improve and are gone within several days.

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Paragraph 4

Although signs and symptoms may disappear for a day or two following the acute
phase, some people with acute yellow fever then enter a toxic phase. During the
toxic phase, acute signs and symptoms return and more-severe and life-threatening
ones also appear. These can include: Yellowing of your skin and the whites of your
eyes (jaundice), Abdominal pain and vomiting, sometimes of blood, Decreased
urination, Bleeding from your nose, mouth and eyes, Heart dysfunction (arrhythmia),
Liver and kidney failure, Brain dysfunction, including delirium, seizures and coma.

The toxic phase of yellow fever can be fatal.

Paragraph 5

Make an appointment to see your doctor four to six weeks before travelling to an
area in which yellow fever is known to occur. If you don't have that much time to
prepare, call your doctor anyway. Your doctor will help you determine whether you
need vaccinations and can provide general guidance on protecting your health while
abroad.

Seek emergency medical care if you've recently travelled to a region where yellow
fever is known to occur and you develop severe signs or symptoms of the disease.
If you develop mild symptoms, call your doctor.

Paragraph 6

Yellow fever is caused by a virus that is spread by the Aedes aegypti mosquito.
These mosquitoes thrive in and near human habitations where they breed in even
the cleanest water. Most cases of yellow fever occur in sub-Saharan Africa and
tropical South America.

Paragraph 7

Humans and monkeys are most commonly infected with the yellow fever virus.
Mosquitoes transmit the virus back and forth between monkeys, humans or both.
When a mosquito bites a human or monkey infected with yellow fever, the virus
enters the mosquito's bloodstream and circulates before settling in the salivary

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glands. When the infected mosquito bites another monkey or human, the virus then
enters the host's bloodstream, where it may cause illness.

Paragraph 8

You may be at risk of the disease if you travel to an area where mosquitoes
continue to carry the yellow fever virus. These areas include sub-Saharan Africa
and tropical South America. Even if there aren't current reports of infected humans
in these areas, it doesn't mean you're risk-free. It's possible that local populations
have been vaccinated and are protected from the disease, or that cases of yellow
fever just haven't been detected and officially reported. If you're planning on
travelling to these areas, you can protect yourself by getting a yellow fever vaccine
at least 10 to 14 days before travelling. Anyone can be infected with the yellow fever
virus, but older adults are at greater risk of getting seriously ill.

Paragraph 9

Diagnosing yellow fever based on signs and symptoms can be difficult because early
in its course, the infection can be easily confused with malaria, typhoid, dengue fever
and other viral hemorrhagic fevers.

To diagnose your condition, your doctor will likely:

Ask questions about your medical and travel history

Collect a blood sample for testing

If you have yellow fever, your blood may reveal the virus itself. If not, blood tests
known as enzyme-linked immuno sorbent assay (ELISA) and polymerase chain
reaction (PCR) also can detect antigens and antibodies specific to the virus. Results
of these tests may not be available for several days.

Paragraph 10

No antiviral medications have proved helpful in treating yellow fever. As a result,

treatment consists primarily of supportive care in a hospital. This includes providing
fluids and oxygen, maintaining adequate blood pressure, replacing blood loss,
providing dialysis for kidney failure, and treating any other infections that develop.
Some people receive transfusions of plasma to replace blood proteins that improve

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clotting. If you have yellow fever, you may also be kept away from mosquitoes, to
avoid transmitting the disease to others.

Questions

Viral Infection – Yellow Fever

1 Yellow fever is common in

A Africa
B South America
C both
D not given

2 Signs of yellow fever doesn’t include one of this

A back pain
B vomiting
C nausea
D dry tongue

3 Signs in toxic phase

A loss of appetite
B yellowness of eyes
C brain dysfunction
D B and C

4 Seizures may occur during

A acute phase
B toxic phase
C sometimes in both the phases
D not given

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5 Yellow fever which is a viral disease, is spread by

A Aedes agypti mosquito

B Aedes aegypti mosquito
C female mosquito
D contamination

6 Mosquito transmits virus from

A human to monkeys
B monkeys to human
C human to human
D none

7 Taking vaccine …………… days before travelling to areas where the disease is
common is recommended

A 10 days
B 12 days
C 14 days
D 10-14 days

8 Typhoid is
A similar to malaria
B just similar to yellow fever
C one of common hemorrhagic fevers
D not given

9 For detection of yellow fever, a doctor may first ask for

A blood test
B urine test
C glucose test
D blood test and urine test

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10 Supportive care in hospitals include

A free medical check up

B free BP check up
C effective dialysis procedures in case of failure of kidney
D B and C

READING PASSAGE B

Aortic Dissection or Dissecting Aneurysm

Passage 1

An aortic dissection is a serious condition in which a tear develops in the inner layer
of the aorta, the large blood vessel branching off the heart. Blood surges through
this tear into the middle layer of the aorta, causing the inner and middle layers to
separate (dissect). If the blood-filled channel ruptures through the outside aortic
wall, aortic dissection is often fatal.

Passage 2

Aortic dissection, also called dissecting aneurysm, is relatively uncommon. Anyone

can develop the condition, but it most frequently occurs in men between 60 and 70
years of age. Symptoms of aortic dissection may mimic those of other diseases,
often leading to delays in diagnosis. However, when an aortic dissection is detected
early and treated promptly, your chance of survival greatly improves.

Passage 3

Aortic dissection symptoms may be similar to those of other heart problems, such as
a heart attack. Typical signs and symptoms include: Sudden severe chest or upper
back pain (often described as a tearing, ripping or shearing sensation, that radiates
to the neck or down the back), Loss of consciousness (fainting), Shortness of breath,
Sweating, Weak pulse in one arm compared to the other etc.

Passage 4

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If you have signs or symptoms such as severe chest pain, fainting, sudden onset of
shortness of breath or symptoms of a stroke then taking medical assistance is of
preliminary importance. While experiencing such symptoms doesn't always mean
that you have a serious problem, it's best to get checked out quickly. Early detection
and treatment may help save your life.

Passage 5

An aortic dissection occurs in a weakened area of the aortic wall. Chronic high blood
pressure may stress the aortic tissue, making it more susceptible to tearing. You can
also be born with a condition associated with a weakened and enlarged aorta, such
as Marfan syndrome or bicuspid aortic valve. Rarely, aortic dissections may be
caused by traumatic injury to the chest area, such as during motor vehicle accidents.

Passage 6

Aortic dissections are divided into two groups, depending on which part of the aorta
is affected:

Type A: This is the more common and dangerous type of aortic dissection. It involves
a tear in the part of the aorta just where it exits the heart or a tear extending from
the upper to lower parts of the aorta, which may extend into the abdomen.

Type B: This type involves a tear in the lower aorta only, which may also extend into
the abdomen.

Passage 7

Risk factors for aortic dissection include:

Uncontrolled high blood pressure (hypertension), found in at least two-thirds of all

cases
Hardening of the arteries (atherosclerosis)
Weakened and bulging artery (pre-existing aortic aneurysm)
An aortic valve defect (bicuspid aortic valve)
A narrowing of the aorta you're born with (aortic coarctation)

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Passage 8

People with certain genetic diseases are more likely to have an aortic dissection than
are people in the general population.

These include:

Turner's syndrome. High blood pressure, heart problems and a number of other
health conditions may result from this disorder.

Marfan syndrome. This is a condition in which connective tissue, which supports

various structures in the body, is weak. People with this disorder often have a family
history of aneurysms of the aorta and other blood vessels. These weak blood vessels
are prone to tears (dissection) and rupture easily.

Ehlers-Danlos syndrome. This group of connective tissue disorders is characterized by

skin that bruises or tears easily, loose joints and fragile blood vessels.

Loeys-Dietz syndrome. This is a connective tissue disorder marked by twisted

arteries, especially in the neck. People who have Loeys-Dietz syndrome are thought
to be at risk for developing aortic dissections and aneurysms.

Passage 9

An aortic dissection can lead to death, due to severe internal bleeding, including into
the lining around the heart (pericardial sac), Organ damage, such as kidney failure or
life-threatening damage to the intestines, Stroke, possibly including paralysis, Aortic
valve damage, such as causing the aortic valve to leak (aortic regurgitation)

Passage 10

Detecting an aortic dissection can be tricky because the symptoms are similar to
those of a variety of health problems. Doctors often suspect an aortic dissection if the
following signs and symptoms are present: Sudden tearing or ripping chest pain,
Widening of the aorta on chest X-ray, Blood pressure difference between right and
left arms.
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Reading Test 2

Questions

Aortic Dissection or Dissecting Aneurysm

11 In aortic dissection a tear develops in

A outer layer of aorta
B inner layer of aorta
C middle aorta
D a blood vessel branching off the heart

12 Dissecting aneurysm is common among

A men
B women
C both
D children

13 Symptoms of aortic dissection include

A chest pain and swelling
B weak pulse in both arms
C loss of consciousness
D all of the above

14 Aortic dissection can also be caused due to

A high BP
B weak aortic wall
C inborn symptoms
D traumatic injury to chest during accidents

15 The most dangerous type of aortic dissection is

A Type A
B Type B
C aortic aneurism
D aortic coarctation

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16 A condition in which connective tissue is weak

A Turner’s syndrome
B Loeys-Dietz syndrome
C Ehlers-Danlos syndrome
D Marfan’s syndrome

17 People with Loeys-Dietz syndrome are likely to develop

A aneurysms
B ruptured blood vessels
C twisted arteries in the neck
D aortic complications

18 Aortic dissection is

A extremely fatal all the times

B sometimes fatal
C not very severe
D sometimes severe

19 Aortic dissection can lead to death because of

A bleeding in pericardial sac

B kidney failure
C aortic valve damage
D All of the above

20 Detecting aortic dissection is

A easy
B difficult
C impossible
D sometimes possible

END OF READING TEST

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Reading Test 1 – Part ‘A’

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Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the summary of Part A - Answer booklet using the information in the
four texts (A1-4) below.

 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.

 Gaps may require 1, 2 or 3 words. Answer ALL questions. Marks are NOT
deducted for incorrect answers.

 You should write your answers next to the appropriate number in the
right-hand column.

 Please use correct spelling in your responses. Do not use abbreviations unless
they appear in the texts.

Text 1

Diabetes is a defect in the body’s ability to convert glucose (sugar) to energy.

Glucose is the main source of fuel for our body. When food is digested it is changed
into fats, protein, or carbohydrates. Foods that affect blood sugars are called
carbohydrates. Carbohydrates, when digested, change to glucose (Examples of
some carbohydrates are: bread, rice, pasta, potatoes, corn, fruit, and milk
products). Individuals with diabetes should eat carbohydrates but must do so in
moderation. Glucose is then transferred to the blood and is used by the cells for
energy. In order for glucose to be transferred from the blood into the cells, the
hormone - insulin is needed. Insulin is produced by the beta cells in the pancreas
(the organ that produces insulin). In individuals with diabetes, this process is
impaired. Diabetes develops when the pancreas fails to produce sufficient
quantities of insulin (Type 1 diabetes) or the insulin produced is defective and can’t
move glucose into the cells (Type 2 diabetes).

Text 2

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Reading Test 3

There are two main types of diabetes. In type 1 diabetes, the cells in the
pancreas that make insulin are destroyed. If you have type 1 diabetes, you need to
get insulin from shots or a pump everyday. Most teens can learn to adjust the
amount of insulin they take according to their physical activity and eating patterns.
This makes it easier to manage your diabetes when you have a busy schedule. In
type 2 diabetes, the pancreas still makes some insulin but cells can’t use it very
well. If you have type 2 diabetes, you may need to take insulin or pills to help your
body’s supply of insulin work better. Type 2 used to be called “adult onset
diabetes.” Now more teens are getting type 2, especially if they are overweight.

Text 3

If you have more than one of these symptoms you may want to ask your doctor to
test your blood sugar.

Blurred vision
Unusual thirst
Frequent urination
Slow-healing cuts
Unexplained tiredness
Rapid weight loss (Type 1 diabetes)
Erectile dysfunction
Numbness or tingling in hands or feet
Symptoms may occur rapidly with Type 1 diabetes; however, with Type 2 diabetes
the onset is more insidious and may not be noticed.

Text 4

The diagnosis of diabetes is made by a simple blood test measuring your blood
glucose level. Usually these tests are repeated on a subsequent day to confirm the
diagnosis. A diagnosis of diabetes is a frightening and bewildering experience
because there is so much information to take in and the diagnosis may come as a
shock. People with Type 2 diabetes may hear their condition described as “mild,” but
Type 2 diabetes is not a “mild” medical condition. Both forms and all stages of
diabetes are serious, with many possible complications, including eye, heart, kidney,
and nerve damage.

Summary Task

Diabetes means that your blood 1…………. also called blood sugar, is too high.
Glucose comes from the 2…………. you eat and is needed to fuel our bodies.

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Reading Test 3

Your blood always has some glucose in it because your body needs glucose for
3……….. But having too much glucose in your blood is not healthy. An organ called
the 4…………….makes insulin which helps 5……… get from your blood into your cells.
Cells take the glucose and turn it into energy. If you have 6………., the pancreas
makes little or no insulin or your cells cannot use 7……… very well. Glucose builds up
in your blood and cannot get into your cells. If your blood glucose stays too 8…….,
it can damage many parts of the body such as the 9……., eyes, 10…………, and
nerves.

There are two main types of diabetes. Type 11………. occurs most frequently in
children and 12…………, although it can occur at any age. 13…….. is much more
14…….. and accounts for 90-95% of all diabetes. Type 2 diabetes primarily affects
adults, however recently Type 2 has begun developing in 15……….. There is a
strong correlation between Type 2 diabetes, physical inactivity and 16………...

There are various systems which can help one identify 17…….. If anyone has more
than one of any of the 18…..listed down then it is advisable that one should get one’s
19……. tested. Symptoms include: 20……… vision, frequent urination, unexplained
21………., erectile dysfunction, numbness or 22………. or feet. The diagnosis is made
by a simple 23………... The glucose level in blood is 24……….. It should be pointed
here that all 25………. of diabetes are 26……… and can not be described as
27……….Stages may lead to many other complications such as eye, heart, kidney,
and nerve damage.

Reading: Part B - Text Booklet

Instructions

TIME LIMIT: 45 MINUTES

 There are TWO reading texts in Part B. After each of the texts you will find a
number of questions or unfinished statements about the text, each with four
suggested answers or ways of finishing.
 You must choose the ONE which you think fits best. For each question, 1-20,
indicate on your answer sheet the letter A, B, C or D against the number of the
question
 Answer ALL questions. Marks are NOT deducted for incorrect answers.

NOTE: You must complete your Answer Sheet for Part B within the 45 minutes
allowed for this part of the sub-test.

NOW TURN TO THE NEXT PAGE FOR TEXTS AND QUESTIONS

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Reading Test 3

READING PASSAGE A

Idiopathic Pulmonary Fibrosis (IPF)

Passage 1

Idiopathic pulmonary fibrosis (IPF) is a build-up of scar tissue in the lungs. This
scar tissue damages the lungs and makes it hard for oxygen to get in. Not getting
enough oxygen to the body can cause serious health problems and even death.
“Idiopathic” is the term used when no cause for the scarring can be found. In these
cases, doctors think the scarring starts by something that injures the lung. Scar
tissue builds up as the lungs try to repair the injury. In time, so much scarring
forms that patients have problems breathing.

Passage 2

IPF usually worsens over time. However, while some patients get sick quickly,
others may not feel sick for years. There is no cure for IPF, but there are treatments
that may be able to slow down the lung scarring. Understanding your condition will
go a long way to help you cope with the effects it has on your body.

Passage 3

The two major symptoms of IPF are shortness of breath and cough. Other symptoms
may include:

Fatigue and weakness

Chest pain or tightness in the chest
Loss of appetite
Rapid weight loss

Passage 4

The causes of IPF are unknown. There are other conditions that cause lung scarring.
Lung scarring that is the result of other conditions is often called “pulmonary fibrosis”
but should be called by the name of the cause.

These other causes include the following:

Diseases, like rheumatoid arthritis and sarcoidosis

Medicines, such as those used for certain heart conditions
Breathing in mineral dusts, such as asbestos or silica

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Reading Test 3

Allergies or overexposure to dusts, animals, or molds (There are many names for
this condition, such as “bird breeder’s lung,” “farmer’s lung,” or “humidifier lung.”
These conditions are called hypersensitivity pneumonitis).

Passage 4

Five million people worldwide have IPF, and it is estimated that up to 200,000 people
in the United States have this condition. It usually occurs in adults between 40 and
90 years of age and is seen more often in men than in women. Although rare, IPF
can run in families.

Passage 5

Patients with any symptoms of IPF should see a pulmonologist to rule out similar
conditions. The doctor will use a number of tests, including:

Breathing tests: to measure how well your lungs are working.

CT scan: to get a detailed image of your lungs, and to see if scarring has started.
Blood tests: to see if you have an infection, problems with your immune system, or
to see how much oxygen is in your blood.

Bronchoscopy: to test a small sample of lung tissue. A tube is inserted through the
nose or mouth into the lung. A light on the end of the tube lets the doctor see where
to go. The doctor then takes a small piece of lung tissue to be tested (this is called
a biopsy). You usually do not need to stay overnight in the hospital to have this
done.

Thoracoscopic biopsy: to obtain larger tissue samples. This is a surgical procedure

in which small incisions are made in between the ribs. It usually requires a hospital
stay and general anesthesia.

Passage 6

Treatment:

Once lung scarring forms, it cannot be removed surgically. Also, at this time, there
are no medications that remove lung scarring. However, there are treatments, such
as the ones that follow, that may be able to help.

Passage 7

Smoking Cessation:

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Reading Test 3

Cigarette smoke not only damages the lining of the lungs, it can also make you more
likely to get a lung infection. While some studies suggest that patients with IPF who
smoke actually live longer, these studies are not accepted by everyone, and most
experts agree that you should stop smoking.

Passage 8

Supplemental oxygen:

As lung scarring gets worse, many patients need extra oxygen to help them go about
their daily lives without getting too out of breath. You get this oxygen from a tank
that you carry around with you. In later stages of IPF, oxygen may be needed even
while sleeping or resting. Oxygen is not addictive, so you do not have to worry about
using it too much. To help maintain your oxygen levels, ask your doctor about a
small, easy-to-use device called a pulse oximeter. This device helps you to know just
how much oxygen-flow; you need, especially during activity

Passage 9

Exercise:

Regular exercise can help patients with IPF. Staying in shape not only keeps your
breathing muscles strong, it also gives you more energy. This is because healthy
muscles need less oxygen to perform work.

Passage 10

Nutrition

Many patients with IPF lose weight because of their disease. If you lose too much
weight, your breathing muscles can become weak. You also may not be able to fight
off infections very well. A well-balanced diet is important to keep up your strength.
Be wary of supplements and other nutrition treatments that claim to improve IPF.

Questions

Idiopathic Pulmonary Fibrosis (IPF)

1 In IPF, patient

A will have lung cancer

B will have difficulty in inhalation or exhalation
C will find difficulty to move
D requires less oxygen

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Reading Test 3

2 Scar tissue develops

A when oxygen supplied is stopped

B when the lungs do not function properly
C when the lungs try to repair the damaged done
D when there is more oxygen supply

3 Major symptoms of IPF are

A fatigue and weakness

B chest pain and breathing
C breathing problem and coughing
D breathing and weakness

4 The cause of lung scaring is

A still not known fully

B known
C allergy
D some of the common heart diseases

5 One of simple IPF tests is

A bronchoscopy
B blood test
C CT scan
D breathing test to identify how well your lungs work

6 For lung scarring

A no medication is available
B medication is available
C only prevention is better
D not given

7 Cessation means

A to continue
B to cease
C to adopt
D to gain

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Reading Test 3

8 Patient with lung scarring

A requires oxygen supply

B should get good food
C should stop smoking
D none of the above

9 Exercises can help fight the IPF

A true
B false
C sometimes true and sometimes false
D can’t say

10 IPF patients

A may gain more weight

B may lose their weight
C may take more supplements
D should not take supplements as this can be harmful

READING PASSAGE B

Hyperthyroidism

Passage 1

The thyroid gland is a butterfly-shaped endocrine gland that is normally located in

the lower front of the neck. The thyroid’s job is to make thyroid hormones, which
are secreted into the blood and then carried to every tissue in the body. Thyroid
hormone helps the body use energy, stay warm and keep the brain, heart, muscles,
and other organs working as they should.

Passage 2

The term hyperthyroidism refers to any condition in which there is too much thyroid
hormone produced in the body. In other words, the thyroid gland is overactive.
Another term that you might hear for this problem is thyrotoxicosis, which refers to
high thyroid hormone levels in the blood stream, irrespective of their source.

Passage 3

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Thyroid hormone plays a significant role in the pace of many processes in the body.
These processes are called your metabolism. If there is too much thyroid hormone,
every function of the body tends to speed up. It is not surprising then that some of
the symptoms of hyperthyroidism are nervousness, irritability, increased perspiration,
heart racing, hand tremors, anxiety, difficulty sleeping, thinning of your skin, fine
brittle hair and weakness in your muscles—especially in the upper arms and thighs.

Passage 4

You may have more frequent bowel movements, but diarrhea is uncommon. You may
lose weight despite a good appetite and, for women, menstrual flow may lighten and
menstrual periods may occur less often. Since hyperthyroidism increases your
metabolism, many individuals initially have a lot of energy. However, as the
hyperthyroidism continues, the body tends to break down, so being tired is very
common.

Passage 5

Hyperthyroidism usually begins slowly but in some young patients these changes can
be very abrupt. At first, the symptoms may be mistaken for simple nervousness due
to stress. If you have been trying to lose weight by dieting, you may be pleased with
your success until the hyperthyroidism, which has quickened the weight loss, causes
other problems.

Passage 6

The most common cause (in more than 70% of people) is overproduction of thyroid
hormone by the entire thyroid gland. This condition is also known as Graves’ disease
Graves’ disease is caused by antibodies in the blood that turn on the thyroid and
cause it to grow and secrete too much thyroid hormone. This type of hyperthyroidism
tends to run in families and it occurs more often in young women. Little is known
about why specific individuals get this disease.

Passage 7

Another type of hyperthyroidism is characterized by one or more nodules or lumps in

the thyroid that may gradually grow and increase their activity so that the total
output of thyroid hormone into the blood is greater than normal. This condition is
known as toxic nodular or multi nodular goiter. Also, people may temporarily have
symptoms of hyperthyroidism if they have a condition called thyroiditis. This condition
is caused by a problem with the immune system or a viral infection that causes the
gland to leak stored thyroid hormone. The same symptoms can also be caused by
taking too much thyroid hormone in tablet form. These last two forms of excess
thyroid hormone are only called thyrotoxicosis, since the thyroid is not overactive.

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Reading Test 3

Passage 8

If your physician suspects that you have hyperthyroidism, diagnosis is usually a

simple matter. A physical examination usually detects an enlarged thyroid gland and
a rapid pulse. The physician will also look for moist, smooth skin and a tremor of
your fingertips. Your reflexes are likely to be fast, and your eyes may have some
abnormalities if you have Graves’ disease.

Passage 9

The diagnosis of hyperthyroidism will be confirmed by laboratory tests that measure

the amount of thyroid hormones— thyroxine (T4) and triiodothyronine (T3)—and
thyroid-stimulating hormone (TSH) in your blood. A high level of thyroid hormone in
the blood plus a low level of TSH is common with an overactive thyroid gland. If
blood tests show that your thyroid is overactive, your doctor may want to obtain a
picture of your thyroid (a thyroid scan). The scan will find out if your entire thyroid
gland is overactive or whether you have a toxic nodular goiter or thyroiditis (thyroid
inflammation). A test that measures the ability of the gland to collect iodine
(a thyroid uptake) may be done at the same time
.
Passage 10

No single treatment is best for all patients with hyperthyroidism. The appropriate
choice of treatment will be influenced by your age, the type of hyperthyroidism that
you have, the severity of your hyperthyroidism, other medical conditions that may be
affecting your health, and your own preference. It may be a good idea to consult with
an endocrinologist who is experienced in the treatment of hyperthyroid patients. If
you are unconvinced or unclear about any thyroid treatment plan, a second opinion
is a good idea.

Questions

Hyperthyroidism

11 Thyroid hormone helps in

A energy consumption
B utilization of energy
C maintaining body temperature
D enhancing the functions of kidney

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Reading Test 3

12 In thyrotoxicosis

A thyroid gland is inactive

B thyroid gland is less active
C thyroid gland produces more amount of hormone then necessary
D none of the above

13 Increase in amount of thyroid hormones can

A boost up other hormonal functions

B improve metabolic functions
C increase normal physiological functions
D increase pulse rate

14 One of these is common in thyroid diseases

A loss of appetite
B decreased metabolism
C tiredness
D none of the above

15 Hyperthyroidism can be the cause of …………

A high BP
B tiredness
C weight loss
D increase in weight even while dieting

16 According to the information given “Grave’s disease” occurs more commonly in

A men
B women
C children
D adult women

17 In hyperthyroidism, the level of thyroid hormone is

A considerably higher
B very low
C very higher
D normal

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Reading Test 3

18 Eyes show abnormalities in

A hyperthyroidism
B grave’s disease
C thyroid inflammation
D all

19 One of the following suggests overactive thyroid gland

A low level of TSH

B high level of thyroid hormone
C high level of TSH and low level of hormone
D high level of hormone and low level of TSH

20 According to the information given, treatment for hyperthyroidism depends more

on

A age
B only on type of hyperthyroidism
C previous medical history of the patient
D age and type of hyperthyroidism

END OF READING TEST

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Reading Test 1 – Part ‘A’

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Reading Test 3

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the summary of Part A - Answer booklet using the information in the
four texts (A1-4) below.

 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.

 Gaps may require 1, 2 or 3 words. Answer ALL questions. Marks are NOT
deducted for incorrect answers.

 You should write your answers next to the appropriate number in the
right-hand column.

 Please use correct spelling in your responses. Do not use abbreviations unless
they appear in the texts.

Text 1

Diabetes is a defect in the body’s ability to convert glucose (sugar) to energy.

Glucose is the main source of fuel for our body. When food is digested it is changed
into fats, protein, or carbohydrates. Foods that affect blood sugars are called
carbohydrates. Carbohydrates, when digested, change to glucose (Examples of
some carbohydrates are: bread, rice, pasta, potatoes, corn, fruit, and milk
products). Individuals with diabetes should eat carbohydrates but must do so in
moderation. Glucose is then transferred to the blood and is used by the cells for
energy. In order for glucose to be transferred from the blood into the cells, the
hormone - insulin is needed. Insulin is produced by the beta cells in the pancreas
(the organ that produces insulin). In individuals with diabetes, this process is
impaired. Diabetes develops when the pancreas fails to produce sufficient
quantities of insulin (Type 1 diabetes) or the insulin produced is defective and can’t
move glucose into the cells (Type 2 diabetes).

Text 2

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Reading Test 3

There are two main types of diabetes. In type 1 diabetes, the cells in the
pancreas that make insulin are destroyed. If you have type 1 diabetes, you need to
get insulin from shots or a pump everyday. Most teens can learn to adjust the
amount of insulin they take according to their physical activity and eating patterns.
This makes it easier to manage your diabetes when you have a busy schedule. In
type 2 diabetes, the pancreas still makes some insulin but cells can’t use it very
well. If you have type 2 diabetes, you may need to take insulin or pills to help your
body’s supply of insulin work better. Type 2 used to be called “adult onset
diabetes.” Now more teens are getting type 2, especially if they are overweight.

Text 3

If you have more than one of these symptoms you may want to ask your doctor to
test your blood sugar.

Blurred vision
Unusual thirst
Frequent urination
Slow-healing cuts
Unexplained tiredness
Rapid weight loss (Type 1 diabetes)
Erectile dysfunction
Numbness or tingling in hands or feet
Symptoms may occur rapidly with Type 1 diabetes; however, with Type 2 diabetes
the onset is more insidious and may not be noticed.

Text 4

The diagnosis of diabetes is made by a simple blood test measuring your blood
glucose level. Usually these tests are repeated on a subsequent day to confirm the
diagnosis. A diagnosis of diabetes is a frightening and bewildering experience
because there is so much information to take in and the diagnosis may come as a
shock. People with Type 2 diabetes may hear their condition described as “mild,” but
Type 2 diabetes is not a “mild” medical condition. Both forms and all stages of
diabetes are serious, with many possible complications, including eye, heart, kidney,
and nerve damage.

Summary Task

Diabetes means that your blood 1…………. also called blood sugar, is too high.
Glucose comes from the 2…………. you eat and is needed to fuel our bodies.

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Reading Test 3

Your blood always has some glucose in it because your body needs glucose for
3……….. But having too much glucose in your blood is not healthy. An organ called
the 4…………….makes insulin which helps 5……… get from your blood into your cells.
Cells take the glucose and turn it into energy. If you have 6………., the pancreas
makes little or no insulin or your cells cannot use 7……… very well. Glucose builds up
in your blood and cannot get into your cells. If your blood glucose stays too 8…….,
it can damage many parts of the body such as the 9……., eyes, 10…………, and
nerves.

There are two main types of diabetes. Type 11………. occurs most frequently in
children and 12…………, although it can occur at any age. 13…….. is much more
14…….. and accounts for 90-95% of all diabetes. Type 2 diabetes primarily affects
adults, however recently Type 2 has begun developing in 15……….. There is a
strong correlation between Type 2 diabetes, physical inactivity and 16………...

There are various systems which can help one identify 17…….. If anyone has more
than one of any of the 18…..listed down then it is advisable that one should get one’s
19……. tested. Symptoms include: 20……… vision, frequent urination, unexplained
21………., erectile dysfunction, numbness or 22………. or feet. The diagnosis is made
by a simple 23………... The glucose level in blood is 24……….. It should be pointed
here that all 25………. of diabetes are 26……… and can not be described as
27……….Stages may lead to many other complications such as eye, heart, kidney,
and nerve damage.

Reading: Part B - Text Booklet

Instructions

TIME LIMIT: 45 MINUTES

 There are TWO reading texts in Part B. After each of the texts you will find a
number of questions or unfinished statements about the text, each with four
suggested answers or ways of finishing.
 You must choose the ONE which you think fits best. For each question, 1-20,
indicate on your answer sheet the letter A, B, C or D against the number of the
question
 Answer ALL questions. Marks are NOT deducted for incorrect answers.

NOTE: You must complete your Answer Sheet for Part B within the 45 minutes
allowed for this part of the sub-test.

NOW TURN TO THE NEXT PAGE FOR TEXTS AND QUESTIONS

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Reading Test 3

READING PASSAGE A

Idiopathic Pulmonary Fibrosis (IPF)

Passage 1

Idiopathic pulmonary fibrosis (IPF) is a build-up of scar tissue in the lungs. This
scar tissue damages the lungs and makes it hard for oxygen to get in. Not getting
enough oxygen to the body can cause serious health problems and even death.
“Idiopathic” is the term used when no cause for the scarring can be found. In these
cases, doctors think the scarring starts by something that injures the lung. Scar
tissue builds up as the lungs try to repair the injury. In time, so much scarring
forms that patients have problems breathing.

Passage 2

IPF usually worsens over time. However, while some patients get sick quickly,
others may not feel sick for years. There is no cure for IPF, but there are treatments
that may be able to slow down the lung scarring. Understanding your condition will
go a long way to help you cope with the effects it has on your body.

Passage 3

The two major symptoms of IPF are shortness of breath and cough. Other symptoms
may include:

Fatigue and weakness

Chest pain or tightness in the chest
Loss of appetite
Rapid weight loss

Passage 4

The causes of IPF are unknown. There are other conditions that cause lung scarring.
Lung scarring that is the result of other conditions is often called “pulmonary fibrosis”
but should be called by the name of the cause.

These other causes include the following:

Diseases, like rheumatoid arthritis and sarcoidosis

Medicines, such as those used for certain heart conditions
Breathing in mineral dusts, such as asbestos or silica

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Reading Test 3

Allergies or overexposure to dusts, animals, or molds (There are many names for
this condition, such as “bird breeder’s lung,” “farmer’s lung,” or “humidifier lung.”
These conditions are called hypersensitivity pneumonitis).

Passage 4

Five million people worldwide have IPF, and it is estimated that up to 200,000 people
in the United States have this condition. It usually occurs in adults between 40 and
90 years of age and is seen more often in men than in women. Although rare, IPF
can run in families.

Passage 5

Patients with any symptoms of IPF should see a pulmonologist to rule out similar
conditions. The doctor will use a number of tests, including:

Breathing tests: to measure how well your lungs are working.

CT scan: to get a detailed image of your lungs, and to see if scarring has started.
Blood tests: to see if you have an infection, problems with your immune system, or
to see how much oxygen is in your blood.

Bronchoscopy: to test a small sample of lung tissue. A tube is inserted through the
nose or mouth into the lung. A light on the end of the tube lets the doctor see where
to go. The doctor then takes a small piece of lung tissue to be tested (this is called
a biopsy). You usually do not need to stay overnight in the hospital to have this
done.

Thoracoscopic biopsy: to obtain larger tissue samples. This is a surgical procedure

in which small incisions are made in between the ribs. It usually requires a hospital
stay and general anesthesia.

Passage 6

Treatment:

Once lung scarring forms, it cannot be removed surgically. Also, at this time, there
are no medications that remove lung scarring. However, there are treatments, such
as the ones that follow, that may be able to help.

Passage 7

Smoking Cessation:

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Reading Test 3

Cigarette smoke not only damages the lining of the lungs, it can also make you more
likely to get a lung infection. While some studies suggest that patients with IPF who
smoke actually live longer, these studies are not accepted by everyone, and most
experts agree that you should stop smoking.

Passage 8

Supplemental oxygen:

As lung scarring gets worse, many patients need extra oxygen to help them go about
their daily lives without getting too out of breath. You get this oxygen from a tank
that you carry around with you. In later stages of IPF, oxygen may be needed even
while sleeping or resting. Oxygen is not addictive, so you do not have to worry about
using it too much. To help maintain your oxygen levels, ask your doctor about a
small, easy-to-use device called a pulse oximeter. This device helps you to know just
how much oxygen-flow; you need, especially during activity

Passage 9

Exercise:

Regular exercise can help patients with IPF. Staying in shape not only keeps your
breathing muscles strong, it also gives you more energy. This is because healthy
muscles need less oxygen to perform work.

Passage 10

Nutrition

Many patients with IPF lose weight because of their disease. If you lose too much
weight, your breathing muscles can become weak. You also may not be able to fight
off infections very well. A well-balanced diet is important to keep up your strength.
Be wary of supplements and other nutrition treatments that claim to improve IPF.

Questions

Idiopathic Pulmonary Fibrosis (IPF)

1 In IPF, patient

A will have lung cancer

B will have difficulty in inhalation or exhalation
C will find difficulty to move
D requires less oxygen

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Reading Test 3

2 Scar tissue develops

A when oxygen supplied is stopped

B when the lungs do not function properly
C when the lungs try to repair the damaged done
D when there is more oxygen supply

3 Major symptoms of IPF are

A fatigue and weakness

B chest pain and breathing
C breathing problem and coughing
D breathing and weakness

4 The cause of lung scaring is

A still not known fully

B known
C allergy
D some of the common heart diseases

5 One of simple IPF tests is

A bronchoscopy
B blood test
C CT scan
D breathing test to identify how well your lungs work

6 For lung scarring

A no medication is available
B medication is available
C only prevention is better
D not given

7 Cessation means

A to continue
B to cease
C to adopt
D to gain

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Reading Test 3

8 Patient with lung scarring

A requires oxygen supply

B should get good food
C should stop smoking
D none of the above

9 Exercises can help fight the IPF

A true
B false
C sometimes true and sometimes false
D can’t say

10 IPF patients

A may gain more weight

B may lose their weight
C may take more supplements
D should not take supplements as this can be harmful

READING PASSAGE B

Hyperthyroidism

Passage 1

The thyroid gland is a butterfly-shaped endocrine gland that is normally located in

the lower front of the neck. The thyroid’s job is to make thyroid hormones, which
are secreted into the blood and then carried to every tissue in the body. Thyroid
hormone helps the body use energy, stay warm and keep the brain, heart, muscles,
and other organs working as they should.

Passage 2

The term hyperthyroidism refers to any condition in which there is too much thyroid
hormone produced in the body. In other words, the thyroid gland is overactive.
Another term that you might hear for this problem is thyrotoxicosis, which refers to
high thyroid hormone levels in the blood stream, irrespective of their source.

Passage 3

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Reading Test 3

Thyroid hormone plays a significant role in the pace of many processes in the body.
These processes are called your metabolism. If there is too much thyroid hormone,
every function of the body tends to speed up. It is not surprising then that some of
the symptoms of hyperthyroidism are nervousness, irritability, increased perspiration,
heart racing, hand tremors, anxiety, difficulty sleeping, thinning of your skin, fine
brittle hair and weakness in your muscles—especially in the upper arms and thighs.

Passage 4

You may have more frequent bowel movements, but diarrhea is uncommon. You may
lose weight despite a good appetite and, for women, menstrual flow may lighten and
menstrual periods may occur less often. Since hyperthyroidism increases your
metabolism, many individuals initially have a lot of energy. However, as the
hyperthyroidism continues, the body tends to break down, so being tired is very
common.

Passage 5

Hyperthyroidism usually begins slowly but in some young patients these changes can
be very abrupt. At first, the symptoms may be mistaken for simple nervousness due
to stress. If you have been trying to lose weight by dieting, you may be pleased with
your success until the hyperthyroidism, which has quickened the weight loss, causes
other problems.

Passage 6

The most common cause (in more than 70% of people) is overproduction of thyroid
hormone by the entire thyroid gland. This condition is also known as Graves’ disease
Graves’ disease is caused by antibodies in the blood that turn on the thyroid and
cause it to grow and secrete too much thyroid hormone. This type of hyperthyroidism
tends to run in families and it occurs more often in young women. Little is known
about why specific individuals get this disease.

Passage 7

Another type of hyperthyroidism is characterized by one or more nodules or lumps in

the thyroid that may gradually grow and increase their activity so that the total
output of thyroid hormone into the blood is greater than normal. This condition is
known as toxic nodular or multi nodular goiter. Also, people may temporarily have
symptoms of hyperthyroidism if they have a condition called thyroiditis. This condition
is caused by a problem with the immune system or a viral infection that causes the
gland to leak stored thyroid hormone. The same symptoms can also be caused by
taking too much thyroid hormone in tablet form. These last two forms of excess
thyroid hormone are only called thyrotoxicosis, since the thyroid is not overactive.

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Reading Test 3

Passage 8

If your physician suspects that you have hyperthyroidism, diagnosis is usually a

simple matter. A physical examination usually detects an enlarged thyroid gland and
a rapid pulse. The physician will also look for moist, smooth skin and a tremor of
your fingertips. Your reflexes are likely to be fast, and your eyes may have some
abnormalities if you have Graves’ disease.

Passage 9

The diagnosis of hyperthyroidism will be confirmed by laboratory tests that measure

the amount of thyroid hormones— thyroxine (T4) and triiodothyronine (T3)—and
thyroid-stimulating hormone (TSH) in your blood. A high level of thyroid hormone in
the blood plus a low level of TSH is common with an overactive thyroid gland. If
blood tests show that your thyroid is overactive, your doctor may want to obtain a
picture of your thyroid (a thyroid scan). The scan will find out if your entire thyroid
gland is overactive or whether you have a toxic nodular goiter or thyroiditis (thyroid
inflammation). A test that measures the ability of the gland to collect iodine
(a thyroid uptake) may be done at the same time
.
Passage 10

No single treatment is best for all patients with hyperthyroidism. The appropriate
choice of treatment will be influenced by your age, the type of hyperthyroidism that
you have, the severity of your hyperthyroidism, other medical conditions that may be
affecting your health, and your own preference. It may be a good idea to consult with
an endocrinologist who is experienced in the treatment of hyperthyroid patients. If
you are unconvinced or unclear about any thyroid treatment plan, a second opinion
is a good idea.

Questions

Hyperthyroidism

11 Thyroid hormone helps in

A energy consumption
B utilization of energy
C maintaining body temperature
D enhancing the functions of kidney

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12 In thyrotoxicosis

A thyroid gland is inactive

B thyroid gland is less active
C thyroid gland produces more amount of hormone then necessary
D none of the above

13 Increase in amount of thyroid hormones can

A boost up other hormonal functions

B improve metabolic functions
C increase normal physiological functions
D increase pulse rate

14 One of these is common in thyroid diseases

A loss of appetite
B decreased metabolism
C tiredness
D none of the above

15 Hyperthyroidism can be the cause of …………

A high BP
B tiredness
C weight loss
D increase in weight even while dieting

16 According to the information given “Grave’s disease” occurs more commonly in

A men
B women
C children
D adult women

17 In hyperthyroidism, the level of thyroid hormone is

A considerably higher
B very low
C very higher
D normal

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18 Eyes show abnormalities in

A hyperthyroidism
B grave’s disease
C thyroid inflammation
D all

19 One of the following suggests overactive thyroid gland

A low level of TSH

B high level of thyroid hormone
C high level of TSH and low level of hormone
D high level of hormone and low level of TSH

20 According to the information given, treatment for hyperthyroidism depends more

on

A age
B only on type of hyperthyroidism
C previous medical history of the patient
D age and type of hyperthyroidism

END OF READING TEST

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Reading Test 1 – Part ‘A’

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Reading Test 4

Reading: Part A

Instructions

TIME LIMIT: 15 MINUTES

 Complete the summary of Part A - Answer booklet using the information

in the four texts (A1-4) below.

 You do not need to read each text from beginning to end to complete the
task. You should scan the texts to find the information you need.

 Gaps may require 1, 2 or 3 words. Answer ALL questions. Marks are NOT
deducted for incorrect answers.

 You should write your answers next to the appropriate number in the right-
hand column.

 Please use correct spelling in your responses. Do not use abbreviations

unless they appear in the texts.

Text 1

Vocal Cord Paralysis

Vocal cord paralysis occurs when the nerve impulses to your voice box (larynx)
are interrupted. This results in paralysis of the muscle of the vocal cords. Vocal
cord paralysis can affect your ability to speak and even breathe. That's because
your vocal cords, sometimes called vocal folds, do more than just produce
sound. They also protect your airway by preventing food, drink and even your
saliva from entering your windpipe (trachea) and causing you to choke.

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Reading Test 4

There are a number of causes of vocal cord paralysis including damage to

nerves during surgery and certain cancers. Vocal cord paralysis can also be
caused by a viral infection or a neurological disorder which occurs both in
males and females.

Treatment for vocal cord paralysis usually includes voice therapy; however,
surgery is also sometimes necessary.

Text 2

Symptoms of vocal cord paralysis

Your vocal cords are two flexible bands of muscle tissue that sit at the entrance
to the windpipe (trachea). When you speak, the bands come together and
vibrate to make sound. The rest of the time, the vocal cords are relaxed in an
open position, so you can breathe.

In most cases of vocal cord paralysis, only one vocal cord is paralyzed.

If both of your vocal cords are affected, you may have vocal difficulties, as well as
significant problems with breathing and swallowing.

Signs and symptoms of vocal cord paralysis may include: A breathy quality
to the voice, Hoarseness, Noisy breathing, Loss of vocal pitch, Choking or
coughing while swallowing food, drink or saliva, The need to take frequent
breaths while speaking, Inability to speak loudly, Loss of your gag reflex,
Ineffective coughing etc.

Text 3

Causes of vocal cord paralysis

In vocal cord paralysis, the nerve impulses to your voice box (larynx) are
interrupted, resulting in paralysis of the muscle. Doctors often don't know
the cause of vocal cord paralysis. Known causes may include:

Injury to the vocal cord during surgery:

Surgery on or near your neck or upper chest can result in damage to the nerves
that serve your voice box. Surgeries that carry a risk of damage include surgeries
to the thyroid or parathyroid glands, esophagus, neck and chest.

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Reading Test 4

Neck or chest injury:

Trauma to your neck or chest may injure the nerves that serve your vocal
cords or the voice box itself.

Stroke:

A stroke interrupts blood flow in your brain and may damage the part of
your brain that sends messages to the voice box.

Tumors:

Tumors, both cancerous and non-cancerous, can grow in or around

the muscles, cartilages or nerves of your voice box and can cause
vocal cord paralysis.

Inflammation:

Arthritis or surgery can cause inflammation and scarring of the vocal cord joints
or the space between the two vocal cord cartilages, and this inflammation may
prevent your vocal cords from opening and closing. The symptoms and signs of
this disorder mimic vocal cord paralysis, even though the vocal cord nerves
remain normal. In addition, some viral infections can cause inflammation and
damage directly to the nerves in the larynx.

Neurological conditions:

If you have certain neurological conditions, such as multiple sclerosis or

Parkinson's disease, you may experience vocal cord paralysis; however,
these conditions are more likely to cause vocal cord weakness than
complete paralysis

Text 4

Treatment of vocal cord paralysis

Treatment of vocal cord paralysis depends on the cause, the severity of symptoms
and the time from the onset of symptoms. Treatment may include voice therapy,
surgery or both. In some instances, you may get better without surgical treatment.
For this reason, your doctor may delay surgery for six months to a year from the
beginning of your vocal cord paralysis. During this waiting period, your ENT doctor
or language therapist may suggest voice therapy to help keep you from using your
voice improperly while the nerves heal.

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Voice / Speech therapy:

Voice therapy sessions involve exercises or other activities to strengthen your

vocal cords, improve breath control during speech, prevent abnormal tensions
in other muscles around the paralyzed vocal cord and protect your airway
during swallowing. VT can be used even before or after the surgery.

Surgery:

If your vocal cord paralysis symptoms don't fully recover on their own,
surgical treatments may be offered to improve your ability to speak and to
swallow. Surgical options include: Bulk injections, vocal cord
repositioning, tracheotomy etc.

Summary:

Vocal cord paralysis result from abnormal nerve input to the voice 1………
(laryngeal muscles). Paralysis is the total 2…………. of nerve impulse resulting
in no movement of the 3……..Vocal fold paralysis can happen at any age –
from birth to advanced age, in 4………… and 5…………. alike, from a variety
of causes. The effect on patients may vary greatly depending on the patient’s
use of his or her voice. In many of the cases, only one vocal cord can be
6…………. If in case, both the 7………. are affected then there will be
difficulties associated with 8……. and 9………. Common signs and symptoms
of 10…… include A breathy quality to the voice, Noisy 11…….., Loss of vocal
pitch, Choking or 12……..while swallowing food, drink or saliva etc.

Vocal cord paralysis may result from: A viral infection, Stroke, 13…… to the
head, Damage between the nerves and 14……. within the larynx (voice box)
following surgery or cancer to the head, 15………., or chest region.
However, sometimes the cause may be unknown. Some paralyzed vocal cords
will 16……. by themselves within several months. However, there is a possibility
that the paralysis may 17……... Treatment choices depend on the nature of the
18…… as well as the 19……. and your voice needs. 20……… and 21……… are the
two common 22 options. Sometimes, speech therapy may be used before or
after 23….. or sometimes as the sole treatment. Your ENT doctor and Speech
and 24…….Therapist will be able to give you advice on the best options for you.
In case, there is no improvement or 25………. do not fully recover by the use
of speech therapy then 26………..treatments may be offered to improve the
patient’s ability to speak and to swallow which include: Bulk injections, vocal
cord 27………, tracheotomy etc.

END OF READING TEST PART A

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Reading Test 4

Reading: Part B - Text Booklet

Instructions

TIME LIMIT: 45 MINUTES

There are TWO reading texts in Part B. After each of the texts you will find a
number of questions or unfinished statements about the text, each with four
suggested answers or ways of finishing.

You must choose the ONE which you think fits best. For each question, 1-20,
indicate on your answer sheet the letter A, B, C or D against the number of the
question

Answer ALL questions. Marks are NOT deducted for incorrect answers.

NOTE: You must complete your Answer Sheet for Part B within the 45 minutes
allowed for this part of the sub-test.

NOW TURN TO THE NEXT PAGE FOR TEXTS AND QUESTIONS

READING PASSAGE A

Ebola Virus and Marburg Virus

Passage 1

Ebola virus and Marburg virus are related viruses that cause hemorrhagic fevers —
illnesses marked by severe bleeding (hemorrhage), organ failure and, in many cases,
death. Both Ebola virus and Marburg virus are native to Africa, where sporadic
outbreaks have occurred for decades.

Passage 2

Ebola virus and Marburg virus live in animal hosts, and humans can contract the
viruses from infected animals. After the initial transmission, the viruses can spread
from person to person through contact with body fluids or contaminated needles.

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Passage 3

No drug has been approved to treat Ebola virus or Marburg virus. People diagnosed
with Ebola or Marburg virus receive supportive care and treatment for complications.
Scientists are coming closer to developing vaccines for these deadly diseases.

Passage 4

In Ebola virus and Marburg virus, signs and symptoms typically begin abruptly
within five to 10 days of infection. Early signs and symptoms include: Fever, Severe
headache, Joint and muscle aches, Chills, Sore throat and Weakness. Over time,
symptoms become increasingly severe and may include: Nausea and vomiting,
Diarrhea (may be bloody), Red eyes, Raised rash, Chest pain and cough, Stomach
pain, Severe weight loss, Bleeding from the nose, mouth, rectum, eyes and ears

Passage 5

Ebola virus has been found in African monkeys, chimps and other nonhuman
primates. A milder strain of Ebola has been discovered in monkeys and pigs in the
Philippines. Marburg virus has been found in monkeys, chimps and fruit bats in
Africa.

Passage 6

The virus can be transmitted to humans by exposure to an infected animal's bodily

fluids. Examples include: Blood. Butchering or eating infected animals can spread
the viruses. Scientists who have operated on infected animals as part of their
research have also contracted the virus.

Passage 7

Infected people typically don't become contagious until they develop symptoms.
Family members are often infected as they care for sick relatives or prepare the
dead for burial.

Medical personnel can be infected if they don't use protective gear such as surgical
masks and latex gloves. Medical centers in Africa are often so poor that they must
reuse needles and syringes. Some of the worst Ebola epidemics have occurred
because contaminated injection equipment wasn't sterilized between uses.

There's no evidence that Ebola virus or Marburg virus can be spread via insect bites.

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Reading Test 4

Passage 8

Ebola and Marburg hemorrhagic fevers are difficult to diagnose because many of the
early signs and symptoms resemble those of other infectious diseases, such as
typhoid and malaria. But if doctors suspect that you have been exposed to Ebola
virus or Marburg virus, they use laboratory tests that can identify the viruses within
a few days.

Passage 9

Most people with Ebola or Marburg hemorrhagic fever have high concentrations of
the virus in their blood. Blood tests known as enzyme-linked immunosorbent assay
(ELISA) and reverse transcriptase polymerase chain reaction (PCR) can detect
specific genes or the virus or antibodies to them.

Passage 10

No antiviral medications have proved effective in treating Ebola virus or Marburg

virus infection. As a result, treatment consists of supportive hospital care. This
includes providing fluids, maintaining adequate blood pressure, replacing blood loss
and treating any other infections that develop.

Passage 11

As with other infectious diseases, one of the most important preventive measures
for Ebola virus and Marburg virus is frequent hand-washing. Use soap and water,
or use alcohol-based hand rubs containing at least 60 percent alcohol when soap
and water aren't available. In developing countries, wild animals, including
nonhuman primates, are sold in local markets. Avoid buying or eating any of these
animals.

Passage 12

In particular, caregivers should avoid contact with the person's body fluids and
tissues, including blood, semen, vaginal secretions and saliva. People with Ebola or
Marburg are most contagious in the later stages of the disease.

Passage 13

If you're a health care worker, wear protective clothing — such as gloves, masks,
gowns and eye shields. Keep infected people isolated from others. Carefully disinfect
and dispose of needles and other instruments. Injection needles and syringes should
not be reused.

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Reading Test 4

Passage 14

Scientists are working on a variety of vaccines that would protect people from Ebola
or Marburg viruses. Some of the results have been promising, but further testing is
needed.

Questions

Ebola Virus and Marburg Virus

1 Ebola and Marburg Virus are native to

A America
B Japan
C Africa
D China

2 According to the passage(s) Ebola and Marburg viruses

A spread from person to person only
B spread from animals to humans
C spread from animals to animals
D spread person to person after initial transmission from the infected animals

3 One of these statements is true according to the information given in the

passage(s)

A scientists have developed vaccines for treatment of disease by Ebola and Marburg
B scientists are closer to develop an effective vaccine for the treatment
C it is not possible to fight the diseases caused by Ebola and Marburg
D scientists have discovered the causes of transmission of the viruses from animal
to human

4 Symptoms typically are seen within

A five days
B ten days
C five to seven days
D five to ten days

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Reading Test 4

5 In Philippines Ebola is discovered in

A chimpanzees
B human primates
C non-human primates
D monkeys

6 Most known Ebola diseases occur due to

A contamination
B body fluids
C contaminated needles and syringes
D none

7 People with hemorrhagic fever show

A high number of viruses in their blood

B low concentrations of virus
C high concentrations of antibodies
D low concentrations of antibodies

8 Pick one of the best preventive measures stated in the passage(s) here

A hand cleaning with medicinal soap

B use of alcohol-based hand rubs, containing at least 60% alcohol, in absence of
water and soap
C only use of soap
D avoiding direct contact with patients is a necessity

9 People with Ebola or Marburg

A are highly contagious, no matter which state they are in

B are less contagious in the beginning stages
C are highly contagious in the later stages
D are less contagious in the later stages

10 As a health care worker, you

A should keep infected people totally isolated from others

B should not reuse needles and syringes for the second time
C should wear attractive clothing such as gowns and eye shields
D none of the above

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Reading Test 4

READING PASSAGE B

A Chronic Disease - Atopic Dermatitis

Passage 1

Atopic dermatitis is a common chronic skin disease. It is also called atopic eczema.
Atopic is a term used to describe allergic conditions such as asthma and hay fever.
Both dermatitis and eczema mean inflammation of the skin. People with atopic
dermatitis tend to have dry, itchy and easily irritated skin. They may have times
when their skin is clear and other times when they have rash.

Passage 2

In infants and small children, the rash is often present on the skin around the
knees and elbows and the cheeks. In teenagers and adults, the rash is often
present in the creases of the wrists, elbows, knees or ankles, and on the face or
neck.

Passage 3

Atopic dermatitis usually begins and ends during childhood, but some people
continue to have the disease into adulthood. If you ever had atopic dermatitis,
you may have trouble with one or more of these: Dry, sensitive skin, Hand
dermatitis and Skin infections

Passage 4

The exact cause of atopic dermatitis is unknown. Research suggests that atopic
dermatitis and other atopic diseases are genetically determined. This means that
you are more likely to have atopic dermatitis, food allergies, asthma and/or hay
fever if your parents or other family members have ever had atopic dermatitis.
These diseases may develop one after another over a period of years. This is called
the ―atopic march‖.

Passage 5

Recognizing that a person with atopic dermatitis is at a higher risk of developing

one of these diseases is important for parents, patients and health care providers.
Knowing that a child with a slight wheeze has had a history of atopic dermatitis,
for example makes it easier to diagnose the subtle onset of asthma. There are many
things that make the itching and rash of atopic dermatitis worse. When you learn
more about atopic dermatitis and how to avoid things that make it worse, you may
be able to lead a healthier life.

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Passage 6

If you have a reaction to something you touch, breathe or eat, you might have an
allergy. Allergies can trigger or worsen your atopic dermatitis symptoms. Common
causes of allergy are:Dust mites, Furry and feathered animals, Cockroaches, Pollens,
Molds, Foods, Chemicals.

Passage 7

Your health care provider may recommend allergy testing and food challenges to
see if allergies worsen itching or rash. Allergy testing may include skin testing,
blood tests or patch tests. Many measures can be taken to avoid things to which
you are allergic. Although many of the measures can be done for the entire home,
the bedroom is the most important room to make skin friendly. Talk with health
care provider about what measures you can take to avoid your allergens can be
very beneficial. .

Passage 8

Food allergies may be the cause of itching or rash that occurs immediately after
eating, especially in children. Some common food allergens include milk, eggs,
peanuts, wheat, nuts, soy and seafood. Most people are allergic to only one, two or
at the most three foods. Be aware that diet restrictions can lead to poor nutrition
and growth delay in babies and children. Talk with your health care provider about
maintaining a well-balanced diet.

Passage 9

Emotions and stress do not cause atopic dermatitis, but they may bring on itching
and scratching. Anger, frustration and embarrassment can cause flushing and
itching. Day to day stresses as well as major stressful events can lead to or
worsen the itch-scratch cycle.

The medications used in atopic dermatitis include: Topical steroids, Topical

immuno modulators, Tar products, Antiinfectives, Antihistamines

Passage 10

Steroid medicines that are applied to the skin are called topical steroids. Topical
steroids are drugs that fight inflammation. They are very helpful when rash is not
well controlled. Topical steroids are available in many forms such as ointments,
creams, lotions and gels. It is important to know that topical steroids are made in
low to super potent strengths. Steroid pills or liquids, like prednisone, should be
avoided because of side effects and because the rash often comes back after they
are stopped.

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Reading Test 4

Questions

A Chronic Disease - Atopic Dermatitis

11 People with atopic dermatitis show

A hay fever
B asthma
C dry, itchy and irritated skin
D rash

12 In small children rash is seen

A round elbows
B on the face
C on the neck
D round the knees

13 People with atopic dermatitis have

A dry skin
B skin infections
C hand dermatitis
D all of the above

14 The term atopic refers to

A allergic diseases
B asthma and hay fever
C allergic condition like hay fever
D allergic condition like asthma

15 ………….can worsen dermatitis symptoms

A allergy
B pollens
C dust
D molds

16 According to the information given in the passage(s), avoiding allergens is

A easy
B difficult
C sometimes easy and sometimes difficult
D can’t say

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Reading Test 4

17 ―Allergic conditions like asthma in patients who has had a history of atopic
dermatitis can be easily diagnosed by health professionals,‖ this statement is

A out of the paragraphs given

B false
C true
D can be true or can be false

18 According to the information given, common food allergens can be in

A milk, eggs, fish

B fish, nuts, soya been
C nuts, eggs, wheat
D milk, cereals, sea food

19 Medications used for atopic dermatitis given in the passage includes

A only anti-infection drugs

B Topical immuno modulators
C tar, anti-infection drugs
D all of the above

20 Topical steroids are available in forms like

A gel tubes
B ointments
C lotions
D ointments, creams, lotions and gels

END OF READING TEST

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Reading Test 1 – Part ‘A’

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Reading Test 5

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the summary of Part A - Answer booklet using the information in

the four texts (A1-4) below.

 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.

 Gaps may require 1, 2 or 3 words. Answer ALL questions. Marks are NOT
deducted for incorrect answers.

 You should write your answers nextright-hand column.

 Please use correct spelling in your responses. Do not use abbreviations

unless they appear in the texts.

Text 1

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the

small joints in your hands and feet. Unlike the wear-and-tear damage of
osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a
painful swelling that can eventually result in bone erosion and joint deformity.

An autoimmune disorder, rheumatoid arthritis occurs when your immune system

mistakenly attacks your own body's tissues. In addition to causing joint problems,
rheumatoid arthritis can also affect your whole body with fevers and fatigue.

Rheumatoid arthritis is much more common in women than in men and generally
occurs between the ages of 40 and 60. Treatment focuses on controlling symptoms
and preventing joint damage.

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Signs and symptoms of rheumatoid arthritis may include:

Tender, warm, swollen joints

Morning stiffness that may last for hours
Firm bumps of tissue under the skin on your arms (rheumatoid nodules)
Fatigue, fever and weight loss

Early rheumatoid arthritis tends to affect your smaller joints first — particularly the
joints that attach your fingers to your hands and your toes to your feet. As the
disease progresses, symptoms often spread to the knees, ankles, elbows, hips and
shoulders. In most cases, symptoms occur in the same joints on both sides of your
body.

Rheumatoid arthritis signs and symptoms may vary in severity and may even come
and go. Periods of increased disease activity, called flares, alternate with periods of
relative remission — when the swelling and pain fade or disappear. Over time,
rheumatoid arthritis can cause joints to deform and shift out of place.

Text 2

Causes of Rheumatoid Arthritis

Rheumatoid arthritis occurs when your immune system attacks the synovium —
the lining of the membranes that surround your joints. The resulting inflammation
thickens the synovium, which can eventually invade and destroy the cartilage and
bone within the joint. The tendons and ligaments that hold the joint together
weaken and stretch. Gradually, the joint loses its shape and alignment. Doctors don't
know what starts this process, although a genetic component appears likely. While
your genes don't actually cause rheumatoid arthritis, they can make you more
susceptible to environmental factors — such as infection with certain viruses and
bacteria — that may trigger the disease

Text 3

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Reading Test 5

Rheumatoid arthritis is difficult to be diagnosed

Rheumatoid arthritis can be difficult to diagnose in its early stages because the
early signs and symptoms mimic those of many other diseases. There is no single
test or physical finding to confirm the diagnosis. During the physical exam, your
doctor will check your joints for swelling, redness and warmth. He or she will also
check your reflexes and muscle strength.

Blood tests:

People with rheumatoid arthritis tend to have an elevated erythrocyte sedimentation

rate (ESR, or sed rate), which indicates the presence of an inflammatory process in
the body. Other common blood tests look for rheumatoid factor and anti-cyclic
citrullinated peptide (anti-CCP) antibodies.

X-rays:

Your doctor may recommend X-rays to help track the progression of rheumatoid
arthritis in your joints over time.

Text 4

Cure for rheumatoid arthritis

There is no cure for rheumatoid arthritis. Medications can reduce inflammation in

your joints in order to relieve pain and prevent or slow joint damage. Occupational
and physical therapy can teach you how to protect your joints. If your joints are
severely damaged by rheumatoid arthritis, surgery may be necessary.

Medications

Many drugs used to treat rheumatoid arthritis have potentially serious side effects.
Doctors typically prescribe medications with the fewest side effects first. You may
need stronger drugs or a combination of drugs as your disease progresses.

NSAIDs

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Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce

inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others)
and naproxen (Aleve). Stronger NSAIDs are available by prescription. Side effects
may include ringing in your ears, stomach irritation, heart problems and liver and
kidney damage.

Steroids

Corticosteroid medications, such as prednisone, reduce inflammation and pain and

slow joint damage. Side effects may include thinning of bones, cataracts, weight
gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute
symptoms, with the goal of gradually tapering off the medication.

Other drugs

Several other rheumatoid arthritis drugs target a variety of processes involved with
inflammation in your body. These drugs include anakinra (Kineret), abatacept
(Orencia), rituximab (Rituxan) and tocilizumab (Actemra). Side effects vary but
may include itching, severe abdominal pain, headache, runny nose or sore throat.

Summary:

Rheumatoid arthritis is a disease that affects the 1……….. It causes pain, 2………,
and 3………... If one knee or hand has rheumatoid arthritis, usually the other does
too. This disease often occurs in more than 4………one and can affect any joint in the
body. People with this 5……. may feel sick and 6………., and they sometimes get
fevers. Some people have this disease for only a few 7…. or a year or two then it
goes away without causing 8……... Other people have times when the symptoms get
worse (flares), and times when they get better (remissions). Others have a severe
form of the disease that can last for many 9…… or a lifetime. This form of the
disease can cause serious joint damage. Anyone can get this disease, though it
occurs more often in 10……….. Rheumatoid arthritis often starts in 11……..age and
is most common in 12……..people but children and young adults can also get it.

Doctors don’t know the exact 13…….. of rheumatoid arthritis. They know that with
this arthritis, a person’s 14… attacks his or her own body tissues. Researchers are
learning many things about why and how this happens. Things that may cause
rheumatoid arthritis are: 15………. (passed from parent to child), Environment,
Hormones.

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Rheumatoid arthritis can be hard to diagnose because there is no 16………. test for
the disease. The symptoms can be the same as other kinds of 17……. The full
symptoms can take time to 18…... To diagnose rheumatoid arthritis, doctors use
medical history, physical exam, 19……..and 20………..

Doctors have many ways to treat this disease. The goals of treatment are to take
away pain, reduce swelling, slow down or stop 21……… and thus help people stay
active. Remember this too that there is no 22…….. for rheumatoid arthritis and 23……
can help only to a certain extent in reducing 24……. in your joints Anti-inflammatory
drugs like 25………… and Corticosteroid medications such as 26……..can be helpful
in removing 27…… and slow joint damage

Reading: Part B - Text Booklet

Instructions

TIME LIMIT: 45 MINUTES

 There are TWO reading texts in Part B. After each of the texts you will find a
number of questions or unfinished statements about the text, each with four
suggested answers or ways of finishing.
 You must choose the ONE which you think fits best. For each question, 1-20,
indicate on your answer sheet the letter A, B, C or D against the number of the
question
 Answer ALL questions. Marks are NOT deducted for incorrect answers.

NOTE: You must complete your Answer Sheet for Part B within the 45 minutes
allowed for this part of the sub-test.

NOW TURN TO THE NEXT PAGE FOR TEXTS AND QUESTIONS

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Reading Test 5

READING PASSAGE A

A Hormonal Disorder – Adrenal Insufficiency

Passage 1

Adrenal insufficiency is an endocrine or hormonal disorder that occurs when the

adrenal glands do not produce enough of certain hormones. The adrenal glands are
located just above the kidneys. Adrenal insufficiency can be primary or secondary.
Primary adrenal insufficiency, also called Addison’s disease, occurs when the adrenal
glands are damaged and cannot produce enough of the hormone cortisol and often
the hormone aldosterone. Addison’s disease affects one to four of every 100,000
people, in all age groups and both sexes.

Passage 2

Secondary adrenal insufficiency occurs when the pituitary gland,a bean-sized organ
in the brain, fails to produce enough adrenocorticotropin (ACTH), a hormone that
stimulates the adrenal glands to produce cortisol. If ACTH output is too low, cortisol
production drops. Eventually, the adrenal glands can shrink due to lack of ACTH
stimulation. Secondary adrenal insufficiency is much more common than Addison’s
disease.

Passage 3

Addison's disease symptoms usually develop slowly, often over several months,
and may include: Muscle weakness and fatigue, Weight loss and decreased
appetite, darkening of skin (hyperpigmentation), low blood pressure, even fainting,
salt craving, low blood sugar (hypoglycemia), Nausea, diarrhea or vomiting, muscle
or joint pains etc. Sometimes, however, the signs and symptoms of Addison's
disease may appear suddenly. In acute adrenal failure (addisonian crisis), the signs
and symptoms may also include: Pain in your lower back, abdomen or legs, severe
vomiting and diarrhea, leading to dehydration, low blood pressure and loss of
consciousness.

Passage 4

Your adrenal glands are composed of two sections. The interior (medulla) produces
adrenaline-like hormones. The outer layer (cortex) produces a group of hormones
called corticosteroids, which include glucocorticoids, mineralocorticoids and male sex
hormones (androgens).

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Passage 5

Some of the hormones the cortex produces are essential for life (glucocorticoids
and mineralocorticoids).

Glucocorticoids: These hormones, which include cortisol, influence your body's

ability to convert food fuels into energy, play a role in your immune system's
inflammatory response and help your body respond to stress.

Mineralocorticoids: These hormones, which include aldosterone, maintain your body's

balance of sodium and potassium to keep your blood pressure normal.

Passage 6

Androgens, male sex hormones, are produced in small amounts by the adrenal
glands in both men and women. They cause sexual development in men and
influence muscle mass, libido and a sense of well-being in men and women.

Passage 7

Primary adrenal insufficiency

Addison's disease occurs when the cortex is damaged and doesn't produce its
hormones in adequate quantities. Doctors refer to the condition involving damage
to the adrenal glands as primary adrenal insufficiency. The failure of your adrenal
glands to produce adrenocortical hormones is most commonly the result of the body
attacking itself (autoimmune disease). For unknown reasons, your immune system
views the adrenal cortex as foreign, something to attack and destroy.

Other causes of adrenal gland failure may include: Tuberculosis, Other infections of
the adrenal glands, Spread of cancer to the adrenal glands, Bleeding into the
adrenal glands

Passage 8

Secondary adrenal insufficiency

Adrenal insufficiency can also occur if your pituitary gland is diseased. The pituitary
gland makes a hormone called adrenocorticotropic hormone (ACTH), which
stimulates the adrenal cortex to produce its hormones. Inadequate production of
ACTH can lead to insufficient production of hormones normally produced by your
adrenal glands, even though your adrenal glands aren't damaged. Doctors call this
condition secondary adrenal insufficiency.

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Reading Test 5

Passage 9

Another more common cause of secondary adrenal insufficiency occurs when people
who take corticosteroids for treatment of chronic conditions, such as asthma or
arthritis, abruptly stop taking the corticosteroids.

Passage 10

If you have untreated Addison's disease, an addisonian crisis may be provoked by

physical stress, such as an injury, infection or illness. All treatment for Addison's
disease involves hormone replacement therapy to correct the levels of steroid
hormones your body isn't producing. Some options for treatment include: Oral
corticosteroids, Corticosteroid injections, Androgen replacement therapy.

Questions:

A Hormonal Disorder – Adrenal Insufficiency

1 Addison’s disease effects

A four of every 1 lakh people

B one of every 1 lakh people, including all age-groups
C one to four of every 1 lakh people, including all age groups
D one to four of every 100,000 people

2 Secondary adrenal insufficiency occurs due to one of these reasons

A more production of adrenocorticotropin (ACTH)
B more production of cortisol
C low production of aldosterone
D low production of ACTH

3 According to the passage(s) given symptoms of Addison’s disease occurs

A slowly
B suddenly
C after a month
D slowly after many months

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Reading Test 5

4 Cortex produces

A androgens
B glucoscorticods
C mineralocorticods
D all of the above

5 Aldosterone mantains

A body balance
B balance of sodium and potassium
C high BP
D low BP

6 According to the information given in the passage, the statement that “Androgen
influences muscle mass and physical and mental nature of men and women” is

A true
B false
C can’t say
D not given in the passage(s)

7 Doctors refer the damage to the cortex of kidney as

A primary adrenal insufficiency

B secondary adrenal insufficiency
C other fatal infections
D not given

8 In a condition like secondary adrenal insufficiency

A kidney is damaged
B adrenal glands are damaged
C kidney is slightly damaged
D adrenal glands are not damaged

9 Secondary adrenal insufficiency also occurs because of

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Reading Test 5

A asthma
B arthritis
C both asthma and arthritis
D stopping the use of corticosteroids

10 Treatment of Addison’s disease includes

A replacement therapy of hormone

B correcting the level of steroid hormones
C Androgen replacement therapy.
D all

READING PASSAGE B

Carpal Tunnel Syndrome

Passage 1

Carpal tunnel syndrome is a condition that may be caused by repeatedly performing

stressful motions with your hand or holding your hand in the same position for long
periods of time. CTS is classified as a cumulative trauma disorder, an ailment that
attacks the body’s musculoskeletal system. The musculoskeletal system is made up
of muscles that pull on tendons and move the bones at joints. The joints are held
together by ligaments. Carpal tunnel syndrome specifically affects the sensitive
nerves of, and the blood supply that feeds, the hands and wrists.

Passage 2

Carpal tunnel syndrome has been around for a long time. Meat packers began
complaining of pain and loss of hand function in the 1860s. Back then, these
complaints were largely attributed to poor circulation. But the nature of work has
changed over the years. Today, more jobs are highly specialized and require use
of only a small number of muscles repeatedly. With the growing numbers of people
using computers and keyboards, plus the focus on better health care for workers,
carpal tunnel syndrome is of real concern to both employers and the health care
professionals.

Passage 3

Recent studies have shown that carpal tunnel syndrome, like all other cumulative
trauma disorders, is on the rise while other workplace injuries have leveled off. Many
companies are turning to physical therapists for help in designing and implementing
health promotion and injury prevention programs to protect their employees from
CTS.
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Passage 4

People with CTS usually experience feelings of numbness, weakness, tingling, and
burning in their fingers and hands. If not treated, the symptoms may escalate into
acute, persistent pain. CTS can become so crippling that people can no longer do
their work or even perform simple tasks at home. At its most extreme, carpal tunnel
syndrome forces people to undergo surgery and miss many days of work, or prevents
them from working at all because their hand functions are permanently impaired.

Passage 5

Carpal tunnel syndrome strikes men and women of all ages, and is often found in
workers whose tasks require repeating the same motion in the fingers and hand for
long periods of time. CTS has surfaced among meat packers, assembly line workers,
jackhammer operators, and employees who spend hours working at a computer or
typewriter. Carpal tunnel syndrome shows up in athletes as well as homemakers.

Passage 6

The U.S. Department of Labor has cited carpal tunnel syndrome, as well as other
cumulative trauma disorders, as the cause of 48 percent of all industrial workplace
illnesses. The disease affects more than five million Americans.

Passage 7

CTS’s impact on American businesses is devastating. It shows up in the workplace

in the form of fatigue, poor work performance, discomfort and pain, and poor
employer/employee relations. The high cost of treatment for an employee with CTS,
plus the lost productivity when that employee is absent for a long period of time,
strains the company’s ability to operate efficiently and can lead to morale problems
when other employees have to take over the absent workers’ responsibilities.

Passage 8

Physical therapists with specialized training in cumulative trauma disorders have

been working in industrial and corporate settings for many years to meet the health
care needs of America’s workforce. They work closely with employers to educate
employees about CTS—what causes it and how to avoid it through proper use of
the musculoskeletal system.

Passage 9

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Physical therapists can target and correct poor work habits and improper work
designs, such as tools, furniture, equipment, and work space. They also can assess
the risk potential of an individual and determine if that person is physically unsuited
for a particular job. Among their many responsibilities, physical therapists teach
health awareness and job safety.

Passage 10

A typical education program includes exercises employees can do at work and at

home, adjustments to the overall work environment and individual work stations,
plus early detection of symptoms to avoid painful and costly surgery.

Passage 11

Physical therapists also work with employers and their engineering departments to
design and modify the work environment, helping to remove the causal factors of
CTS. If anyone has symptoms of carpal tunnel syndrome then consulting a physical
therapist or other qualified health care practitioner for an evaluation and
individualized treatment is always recommended

Questions

Carpal Tunnel Syndrome

11 According to the passage CTS is

A cumulative trauma disorder

B caused due to weakness in musculoskeletal system
C occurs due to weakness in ligaments between joints
D all of the above

12 According to the information given CTS

A is on the rise
B is on the rise without any other cumulative trauma disorders
C is one of the common cumulative trauma disorders that is on rise
D is on the rise with many other cumulative trauma disorders

13 “In CTS ……. may become permanently impaired.”

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Reading Test 5

A carpels
B hands
C feet
D wrists

14 CTS often occurs in

A men
B women
C men and women of all ages
D only men of all ages

15 …………complained of pain and loss of hand function in the 1860s

A meat packers
B assembly line workers
C jackhammer operators
D employees who spend hours at a computer

16 CTS accounts for ……….of all industrial workplace illnesses

A 50 %
B 48%
C 84%
D 60%

17 Physical therapists teaches employees about

A proper use of the musculoskeletal system
B how to avoid CTS
C how to bring in more efficiency in work
D health care needs

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Reading Test 5

18 One of the impacts of CTS on American businesses

A low productivity because of absence of workers due to CTS

B absence of workers due to CTS condition
C unfair employee treatment
D none

19 CTS educational program includes

A only detection of CTS symptoms in employees

B explanation to employees on how to avoid CTS
C exercises that employees can do to avoid CTS
D discussion of cost involved in surgery

20 Physical therapists specialized in CTS

A work closely with employees in engineering department

B work with employees to modify the work environment
C design new rules for employees to work
D none

END OF READING TEST

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Reading Test 1 – Part ‘A’

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Reading Tests 1- 5 Answers

TEST 1

Part A Part B
1 Tear 1D
2 20.7 2A
3 Chronic Dry Eye 3B
4 Computer 4B
5 Chronic 5C
6 Americans 6A
7 Menopausal women 7D
8 Autoimmune disorders, 8D
9 High Altitudes 9D
10 Windy 10 B
11 Medications 11 D
12 Diuretics etc 12 A
13 Sjogren’s syndrome 13 B
14 Arthritis 14 A
15 Doctor 15 C
16 Symptoms 16 D
17 ongoing 17 B
18 Sjogren’s 18 A
19 Eye care professional 19 C
20 Tear Production 20 A
21 Occular surface dryness
22 Severity
23 Evaluation / determination
24 Humidifier
25 Dry air
26 Medication
27 Cause

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Reading Tests 1- 5 Answers

TEST 2

Part A Part B
1 Throat 1C
2 Viral Throat 2D
3 Two 3 B and C
4 Adults 4B
5 Tired 5B
6 Fever 6A/B
7 Lymph glands 7D
8 Nausea 8D
9 Young children 9A
10 Swollen 10 D
11 White 11 B
12 Yellow 12 A
13 Sun-burn 13 C
14 Upper body 14 D
15 101-104°F 15 A
16 Scarlet 16 D
17 Toxins 17 A
18 streptococcus bacteria 18 A
19 Rheumatic 19 D
20 Joints 20 B
21 Sore
22 Bacteria
23 Swallowing
24 Stomach ache
25 Runny
26 Lymph

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Reading Tests 1- 5 Answers

TEST 3

Part A Part B
1 glucose 1B
2 food 2C
3 energy 3C
4 pancreas 4A
5 glucose 5D
6 diabetes 6A
7 insulin 7B
8 high 8A / C
9 heart / kidney 9A
10 kidney / heart 10 B / D
11 1 diabetes 11 A
12 young adults 12 C
13 type 2 diabetes 13 B
14 common 14 C
15 children 15 C
16 obesity / excessive overweight 16 B
17 diabetes 17 C
18 symptoms 18 B
19 blood 19 D
20 blurred 20 D
21 tiredness
22 tingling in hands
23 blood test
24 identified / examined / tested
25 stages
26 serious
27 mild

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Reading Tests 1- 5 Answers

TEST 4

Part A Part B
1 Voice Box 1C
2 Interruption 2D
3 Muscle 3 B and D
4 Males 4D
5 Females 5D
6 Paralyzed 6C
7 Vocal cords 7A
8 Breathing / Swallowing 8B
9 Swallowing / Breathing 9C
10 Vocal Cord Paralysis 10 B
11 Breathing 11 C
12 Coughing 12 D
13 Trauma 13 D
14 Muscles 14 B
15 Neck 15 A
16 Recover 16 A
17 Permanent 17 C
18Parlaysis 18 C
19 Cause 19 B
20 Speech Therapy 20 D
21 Surgery
22 Treatment
23 Surgery
24 Language
25 Vocal Cord
26 Surgical
27 Repositioning

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Reading Tests 1- 5 Answers

TEST 5

Part A Part B
1 Joints 1C
2 Swelling 2D
3 Stiffness 3D
4 Joint 4A
5 Disease 5B
6 Tired 6B
7 Months 7A
8 Damage 8D
9 Years 9D
10 Women 10 D
11 Middle Age 11 A
12 Older 12 D
13 Cause 13 D
14 Immune System 14 C
15 Genes 15 A
16 Single 16 B
17 Joint Diseases 17 B
18 Develops 18 A
19 X-rays / Lab Tests / blood tests 19 C
20 Lab Tests / X-rays / blood tests 20 C
21 Joint Damage
22 Cure
23 Medications
24 Inflammation
25 Nonsteroidal
26 Prednisone
27 Pain

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Reading Test 1 – Part ‘A’

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Reading Test 6

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the following summary using the information in the four texts
provided.
 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.
 Gaps may require 1, 2 or 3 words.
 You should write your answers next to the appropriate number in the
right-hand column.
 Please use correct spelling in your responses.

Text 1

Acute diarrhea is one of the most commonly reported illnesses in the United States,
second only to respiratory infections. Worldwide, it is the leading cause of mortality
in children younger than four years old (infants and young children are always much
more susceptible) in both developing and underdeveloped countries.

Definition
An abnormal looseness of the stool, changes in stool frequency, consistency,
urgency and continence (An increased number of stools or looser form than is
customary for the patient, lasting less than 2 weeks, and often associated with
abdominal symptoms such as cramping, bloating, and gas). Although often mild,
acute diarrhea can lead to severe dehydration as a result of large fluid and
electrolyte losses.

Text 2

Acute, watery diarrhea is usually caused by a virus, rotavirus (viral gastroenteritis.)

It can also occur due to food poisoning (common agents are Salmonella and
Campylobacter). Medications such as antibiotics and drugs that contain magnesium
products are also common offenders. Recent dietary changes can also lead to acute
diarrhea. These include: intake of coffee, tea, colas, dietetic foods, gums or mints
that contain poorly absorbable sugars. Acute bloody diarrhea suggests a bacterial
cause like Campylobacter, Salmonella or Shigella. Traveling to developing areas of
the world can result in exposure to bacterial pathogens common in certain areas.
Eating contaminated foods such as ground beef or fresh fruit can cause diarrhea

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Reading Test 6

due to E.coli 0157:H7. Most episodes of acute diarrhea resolve quickly and without
antibiotic therapy with simple dietary modifications. See a doctor if your feel ill, have
bloody diarrhea, severe abdominal pain or diarrhea lasting more than 48 hours.

Text 3

In patients with mild acute diarrhea, no laboratory evaluation is needed because

the illness generally resolves quickly (recovers in 10-15 days). Your doctor may
perform stool cultures or parasite exams if your diarrhea is severe or bloody or if
you traveled to an area where infections are common. The doctor will want to talk
to you about your symptoms to try to identify a cause. The doctor will also want to
examine you, including your abdomen and possibly your back passage. The most
important test to perform at this stage is an examination of your stool to determine
whether there are any infective agents present that might be the cause of the
diarrhoea and other symptoms. It may also be necessary to examine the bowel by
endoscopy to determine whether there is inflammation in the rectum or colon
(colitis).

Text 4

It is important (especially related to children) to take plenty of fluid (may include

mineral water / fruit juices) and salt soups (sodium), carbohydrates (pasta, rice,
salty crackers etc), to avoid dehydration. Milk and dairy products should be avoided
for 24 to 48 hours as they can make diarrhea worse. Initial dietary choices when
re-feeding should begin with soups and broth. Anti-diarrheal drug therapy can be
helpful to control severe symptoms, and includes bismuth subsalicylate and
antimotility agents such as loperamide. These, however, should be avoided in
people with high fever or bloody diarrhea and in children because the use of
antidiarrheals can lead to complications of hemolytic uremic syndrome in cases
of Shiga toxin E coli. Your doctor may prescribe antibiotics if you have high fever,
dysentery, or moderate to severe traveler's diarrhea.

Summary task

Diarrhoeal disease is an important cause of 1………….. worldwide and represents a

leading cause of 2………. death in the developing world. The term diarrhoea is used
when 3……… are passed more than three times a day and when the stools become
loose or 4………. In 5…..diarrhoea, symptoms come on suddenly but usually clear up
within 6…….. days. Diarrhoea can also occur when there is excessive secretion of
fluid into the bowel that overwhelms the ability of the gut to reabsorb the secreted
7… and salts. The most common cause of an attack of acute diarrhoea is an 8….
infection. 9…… and 10…….. are particularly susceptible to intestinal infections which
are most commonly caused by 11…….. 12…… is another common form of acute
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Reading Test 6

diarrhoea, most commonly caused by the 13…….. and 14…….. Most episodes of acute
diarrhoea will settle spontaneously without the need for any 15……. However, if the
episode is 16….., it is important to ensure that you take additional fluids and salts to
replace those lost in the 17……. For most 18………… oral rehydration can usually be
achieved simply by increasing 19….. intake in the form of 20……., fruit juices (which
also contain potassium) and salty soups (sodium), together with some form of 21……
(rice, pasta, salty crackers) which is important for promoting fluid and salt absorption.

Reading Test - Part B

Time allowed: 60 minutes

 There are two reading passages in this test. After each passage you will find a
number of questions or unfinished statements about the passage, each with
four suggested answers or ways of finishing.
 You must choose the one which you think fits the best, i.e. the best answer.
For each question, 1-20, indicate on your answer sheet the letter A, B, C or D
against the number of the question.
 Answer all questions. Marks will not be deducted for incorrect answers.

READING PASSAGE A

Occupational Lung Diseases

Paragraph 1
Occupational lung diseases are a group of illnesses that are caused by either
repeated, extended exposure or a single, severe exposure to irritating or toxic
substances that leads to acute or chronic respiratory ailments. The rate of
occupational lung conditions was highest for education and health service workers
in private industry and local government workers at 3 .8 and 5 .9 per 10,000 full
time workers, respectively. There are two broad categories of occupational lung
diseases: (i) Diseases that are not occupation-specific, but are aggravated at work,
such as occupational asthma (ii) Diseases related to a specific occupation, such as
asbestosis, coal worker’s pneumoconiosis (black lung), berylliosis (brown lung), and
farmer’s lung. Common occupational lung diseases include mesothelioma,
occupational asthma, silicosis, asbestosis, and sick building syndrome. Adult-onset
asthma can be triggered by occupational exposures.

Paragraph 2

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Reading Test 6

The estimated yearly cost of occupational injuries and illnesses is between $128
and $150 billion dollars. Although, occupational lung diseases are often incurable,
they are always preventable. Improving ventilation, wearing protective equipment,
changing work procedures, and educating workers are key factors for prevention.

Paragraph 3

Occupational Asthma (OA) is the most common form of occupational lung disease.
Occupational asthma (also known as work-related asthma) is asthma that is caused
or made worse by exposures in the workplace. Estimates suggest that 15 to 23
percent of new asthma cases in adults are work related. Four states (California, New
Jersey, Massachusetts, and Michigan) tracked cases of occupational asthma over a
seven-year period. During this time, the occupations with the highest percentage of
asthma cases were operators, fabricators, and laborers (32.9%); managerial and
professional specialty (20.2%), and technical, sales, and administrative support jobs
(19.2%). The four most common agents associated with occupational asthma were
miscellaneous chemicals (19.7%), cleaning materials (11.6%), mineral and inorganic
dust (11.1%), and indoor air pollutants (9.9%).

Paragraph 4

Malignant mesothelioma is a fatal type of cancer caused by exposure to asbestos.

Millions of construction and general industry workers have been exposed to asbestos
while on the job. Occupations associated with significantly higher mesothelioma
deaths include plumbers, pipefitters, and steamfitters; mechanical engineers;
electricians; and elementary school teachers. In the U.S., asbestos use peaked in
1973 and but had declined by 99.8 percent in 2007. Because mesothelioma usually
does not show up until 20 to 40 years after exposure, most of the deaths from the
disease are the result of exposures that occurred decades ago. This long lag time
means that mesothelioma deaths are expected to peak around 2010, despite the
much lower current use of asbestos. From 1999 to 2005, 18,068 malignant
mesothelioma deaths were reported in the U.S. Men (81%) and Caucasians (95%)
accounted for the majority of these cases.

Paragraph 5

Silicosis is a disabling, dust-related disease and is one of the oldest occupational lung
diseases in the world. Silicosis is caused by exposure to and inhalation of airborne
crystalline silica. Dust particles from silica can penetrate the respiratory system and
land on alveoli (airsacs). This causes scar tissue to develop in the lungs and impair
the exchange of oxygen and carbon dioxide in the blood. Though symptoms of
silicosis rarely develop in less than five years, progression of the disease can lead to
extreme shortness of breath, loss of appetite, chest pains, and respiratory failure,
which can cause death. Silicosis also makes a person more susceptible to infectious
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Reading Test 6

diseases of the lungs, such as tuberculosis. Death rate is generally low, but still too
high considering that every one of these deaths could have been prevented. Because
of the low number of overall deaths due to silicosis, multiple years of data are
combined to provide a more accurate estimate of the burden of this disease.

Questions

1 According to paragraph 1, the rate of OLC is reported to be higher in

A Health care service providers (private sectors)
B Professionals in field of education
C Government officials
D Local government workers and health care professionals in private industries

2 According to paragraph 1, one of these groups of diseases doesn’t come

under OLD
A mesothelioma and occupational asthma,
B occupational asthma and silicosis, asbestosis
C asbestosis and mesotheliomaic
D asbestosis and silicosis

3 According to paragraph 2, OLDs are

A incurable
B Curable
C Preventable but not curable
D curable and preventable

4 According to paragraph 3, “work related asthma” means

A a disease which occurs due to more work
B a disease which occurs due to less work
C a disease which occurs due to exposure to work
D none of the above

5 According to paragraph 3, common agents which are associated with OA

in lowest percentage are
A Air pollutants
B Mineral and inorganic dust
C Cleaning materials
D Miscellaneous chemicals

6 According to paragraph 4, the root cause of malignant mesothelioma is

associated with the
A use of the asbestos in the construction field
B exposure to asbestos on regular basis
C low quality asbestos
D none of the above

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Reading Test 6

7 According to paragraph 4, the use of the asbestos was almost next to

naught in the year
A 1997
B 1973
C 2007
D 2010

8 According to paragraph 5, dust particles from silica can

A damage lung tissues
B impair O2 and CO2 exchange
C develop a scar on the lung
D all of the above

9 According to paragraph 5, silicosis can cause

A tuberculosis
B pneumonia
C chest pain
D none

10 According to paragraph 5, silicosis is

A more dangerous than occupational asthma
B more dangerous than mesothelioma
C not as fatal as occupational asthma and mesothelioma
D not much fatal

Reading Passage - Two

Immune System – Notes

Paragraph 1

Since inflammation in the body can lead to inflammation in the brain we first need
to understand what inflammation is. Inflammation is part of the immune system’s
response to defend you against microbial infections. It is the body’s first line of
defense against invasion by microorganisms such as bacteria and viruses, and it is
activated rapidly after infection. The microbes are detected as foreign to the body
by immune cells such as macrophages (literally “big eater”). When macrophages
encounter and recognize a foreign microorganism they engulf the microorganism
and, in addition, release a variety of cellular products into the space around them
that start and regulate further defenses that include inflammation. Two classes of
these products, known as cytokines and chemokines, lead to inflammation.
Cytokines are chemical messengers that travel away from the cells that release

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Reading Test 6

them so to alter the functioning of other cells. Chemokines also leave the cell and
attract other cells into the region. Together, they alter the blood vessels near the
site of infection, causing increased blood flow to the area and the entry of immune
system cells

Paragraph 2

Inflammation—swelling, redness, and heat—is part of the immune system’s first

response to microbial infections, but this defensive response is not limited to the
bodily site of infection. Soon after infection, a pattern develops that includes what is
called the “acute phase response (APR)” and “sickness behavior.” Fever is the most
prominent feature of the APR and for good reason: many microorganisms reproduce
best at humans’ normal core body temperature, and the many of the immune
system’s agents for killing them are bolstered by elevated temperature.

Paragraph 3

Sickness behaviors are well known to anyone who has had the flu. They include
reductions in activity, food intake, social interaction, mood sags; it is difficult to
form new memories; sleep changes; and sensitivity to pain increases (just think of
how even a light touch hurts when you have the flu). These changes also reduce the
energetic costs of behavior to free available energy stores to fight the infection.
Fever, for example, is quite energy intensive, requiring an extra 10 to 12 percent in
energy for each degree rise. It is obvious how all the sickness behaviors, with the
exception of memory disruption, fit the scheme of keeping us away from our usual
activities. Memory disruption serves a different purpose.

Paragraph 4

We now understand that all of the changes just described are accomplished through
the CNS. Fever, for example occurs because the set point of temperature-sensitive
cells in the hypothalamus is increased. Of course, behavior, mood, and pain are all
products of the CNS. This raises two issues: a) How does the CNS “know” what is
going on in the peripheral immune system, and b) What kinds of changes are
produced in the CNS that mediate fever and sickness behaviors? The same cytokines
that participate in producing the inflammatory response in the body also initiate the
communication process to the CNS. They accumulate in the bloodstream and thereby
travel to the brain, where, although they are large proteins and cannot readily cross
the blood-brain barrier, these chemical signals are carried across the barrier by
active transport. They cross into the brain in regions where the barrier is weak, and
they bind to receptors on the insides of the cerebral vascular blood vessels, thereby
inducing the production of soluble mediators within the epithelial cells that can cross
into the brain.

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Reading Test 6

Paragraph 5

The cytokine interleukin-1 beta is released in response to pathogen recognition, and

a) activates vagal fibers, b) diffuses into the brain where the barrier is weak, and c)
are actively transported across. In the brain they act on microglia, which then
produce and secrete further cytokines that can act on neuronal cells, thereby
producing sickness behaviors.

Paragraph 6

Often, a set of mechanisms that evolved to handle acute emergencies lead to

outcomes that nature did not intend if they are engaged too long. During a normal
infection, neuro- inflammation and the resulting adaptive sickness behaviors persist
only for several days. However, if these responses become exaggerated or prolonged,
the outcomes may well become established, leading to cognitive impairment instead
of brief memory disruption, depression instead of reduced mood, fatigue instead of
inactivity, and chronic pain instead of acute pain. That is, physiology can become
pathology when a set of processes designed to be relatively brief becomes prolonged.

Questions

1 According to paragraph 1, first line of defence implies

A macrophages
B immune system
C inflammation
D all of the above

2 According to paragraph 1, chemical messengers have

A the ability to change the functioning of other cells
B greater level of mobility
C no capacity to move further away from cells
D none

3 According to paragraph 2, APR develops

A at the time of infection
B after the infection
C after cure of the infection
D before or after infection

4 According to paragraph 2, fever occurs

A due to the increase in the growth of the microbes
B due to powerless immune system
C due to the multiplication of the microbes, supported by temperature of the human
body
D none
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Reading Test 6

5 According to paragraph 3, one of them is not associated to sickness

behaviors
A loss of appetite and reduction in social interaction
B reduction in social interaction and sleeping hours
C change in mood and body language
D body language and sleeping disorder

6 According to paragraph 4, cytokines are described as

A messenger cells
B protein bodies and messenger cells
C immune response bodies
D none

7 According to paragraph 4, cytokines cross the barrier

A through active transport
B by bridging the blood brain barrier
C by penetrating into the blood vessels
D through the blood stream and lymph vessels

8 What “paragraph 5” describes here?

A depiction of how peripheral immune system communicates to the brain
B depiction of how peripheral immune system stops the communication process
C depiction of how immune system weakens
D A and B

9 Paragraph 6 talks about

A what would happen if the processes become prolonged?
B what would happen if the processes terminated?
C what would happen if the processes are interrupted?
D what would happen if the processes are not started?

10 According to paragraph 6, if the responses become exaggerated then

A loss of memory may take place
B reduction in normal mood may get noted
C cognitive impairment occurs
D acute pain may begin

END OF READING TEST

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Reading Test 1 – Part ‘A’

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Reading Test 6

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the following summary using the information in the four texts
provided.
 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.
 Gaps may require 1, 2 or 3 words.
 You should write your answers next to the appropriate number in the
right-hand column.
 Please use correct spelling in your responses.

Text 1

Acute diarrhea is one of the most commonly reported illnesses in the United States,
second only to respiratory infections. Worldwide, it is the leading cause of mortality
in children younger than four years old (infants and young children are always much
more susceptible) in both developing and underdeveloped countries.

Definition
An abnormal looseness of the stool, changes in stool frequency, consistency,
urgency and continence (An increased number of stools or looser form than is
customary for the patient, lasting less than 2 weeks, and often associated with
abdominal symptoms such as cramping, bloating, and gas). Although often mild,
acute diarrhea can lead to severe dehydration as a result of large fluid and
electrolyte losses.

Text 2

Acute, watery diarrhea is usually caused by a virus, rotavirus (viral gastroenteritis.)

It can also occur due to food poisoning (common agents are Salmonella and
Campylobacter). Medications such as antibiotics and drugs that contain magnesium
products are also common offenders. Recent dietary changes can also lead to acute
diarrhea. These include: intake of coffee, tea, colas, dietetic foods, gums or mints
that contain poorly absorbable sugars. Acute bloody diarrhea suggests a bacterial
cause like Campylobacter, Salmonella or Shigella. Traveling to developing areas of
the world can result in exposure to bacterial pathogens common in certain areas.
Eating contaminated foods such as ground beef or fresh fruit can cause diarrhea

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Reading Test 6

due to E.coli 0157:H7. Most episodes of acute diarrhea resolve quickly and without
antibiotic therapy with simple dietary modifications. See a doctor if your feel ill, have
bloody diarrhea, severe abdominal pain or diarrhea lasting more than 48 hours.

Text 3

In patients with mild acute diarrhea, no laboratory evaluation is needed because

the illness generally resolves quickly (recovers in 10-15 days). Your doctor may
perform stool cultures or parasite exams if your diarrhea is severe or bloody or if
you traveled to an area where infections are common. The doctor will want to talk
to you about your symptoms to try to identify a cause. The doctor will also want to
examine you, including your abdomen and possibly your back passage. The most
important test to perform at this stage is an examination of your stool to determine
whether there are any infective agents present that might be the cause of the
diarrhoea and other symptoms. It may also be necessary to examine the bowel by
endoscopy to determine whether there is inflammation in the rectum or colon
(colitis).

Text 4

It is important (especially related to children) to take plenty of fluid (may include

mineral water / fruit juices) and salt soups (sodium), carbohydrates (pasta, rice,
salty crackers etc), to avoid dehydration. Milk and dairy products should be avoided
for 24 to 48 hours as they can make diarrhea worse. Initial dietary choices when
re-feeding should begin with soups and broth. Anti-diarrheal drug therapy can be
helpful to control severe symptoms, and includes bismuth subsalicylate and
antimotility agents such as loperamide. These, however, should be avoided in
people with high fever or bloody diarrhea and in children because the use of
antidiarrheals can lead to complications of hemolytic uremic syndrome in cases
of Shiga toxin E coli. Your doctor may prescribe antibiotics if you have high fever,
dysentery, or moderate to severe traveler's diarrhea.

Summary task

Diarrhoeal disease is an important cause of 1………….. worldwide and represents a

leading cause of 2………. death in the developing world. The term diarrhoea is used
when 3……… are passed more than three times a day and when the stools become
loose or 4………. In 5…..diarrhoea, symptoms come on suddenly but usually clear up
within 6…….. days. Diarrhoea can also occur when there is excessive secretion of
fluid into the bowel that overwhelms the ability of the gut to reabsorb the secreted
7… and salts. The most common cause of an attack of acute diarrhoea is an 8….
infection. 9…… and 10…….. are particularly susceptible to intestinal infections which
are most commonly caused by 11…….. 12…… is another common form of acute
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Reading Test 6

diarrhoea, most commonly caused by the 13…….. and 14…….. Most episodes of acute
diarrhoea will settle spontaneously without the need for any 15……. However, if the
episode is 16….., it is important to ensure that you take additional fluids and salts to
replace those lost in the 17……. For most 18………… oral rehydration can usually be
achieved simply by increasing 19….. intake in the form of 20……., fruit juices (which
also contain potassium) and salty soups (sodium), together with some form of 21……
(rice, pasta, salty crackers) which is important for promoting fluid and salt absorption.

Reading Test - Part B

Time allowed: 60 minutes

 There are two reading passages in this test. After each passage you will find a
number of questions or unfinished statements about the passage, each with
four suggested answers or ways of finishing.
 You must choose the one which you think fits the best, i.e. the best answer.
For each question, 1-20, indicate on your answer sheet the letter A, B, C or D
against the number of the question.
 Answer all questions. Marks will not be deducted for incorrect answers.

READING PASSAGE A

Occupational Lung Diseases

Paragraph 1
Occupational lung diseases are a group of illnesses that are caused by either
repeated, extended exposure or a single, severe exposure to irritating or toxic
substances that leads to acute or chronic respiratory ailments. The rate of
occupational lung conditions was highest for education and health service workers
in private industry and local government workers at 3 .8 and 5 .9 per 10,000 full
time workers, respectively. There are two broad categories of occupational lung
diseases: (i) Diseases that are not occupation-specific, but are aggravated at work,
such as occupational asthma (ii) Diseases related to a specific occupation, such as
asbestosis, coal worker’s pneumoconiosis (black lung), berylliosis (brown lung), and
farmer’s lung. Common occupational lung diseases include mesothelioma,
occupational asthma, silicosis, asbestosis, and sick building syndrome. Adult-onset
asthma can be triggered by occupational exposures.

Paragraph 2

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Reading Test 6

The estimated yearly cost of occupational injuries and illnesses is between $128
and $150 billion dollars. Although, occupational lung diseases are often incurable,
they are always preventable. Improving ventilation, wearing protective equipment,
changing work procedures, and educating workers are key factors for prevention.

Paragraph 3

Occupational Asthma (OA) is the most common form of occupational lung disease.
Occupational asthma (also known as work-related asthma) is asthma that is caused
or made worse by exposures in the workplace. Estimates suggest that 15 to 23
percent of new asthma cases in adults are work related. Four states (California, New
Jersey, Massachusetts, and Michigan) tracked cases of occupational asthma over a
seven-year period. During this time, the occupations with the highest percentage of
asthma cases were operators, fabricators, and laborers (32.9%); managerial and
professional specialty (20.2%), and technical, sales, and administrative support jobs
(19.2%). The four most common agents associated with occupational asthma were
miscellaneous chemicals (19.7%), cleaning materials (11.6%), mineral and inorganic
dust (11.1%), and indoor air pollutants (9.9%).

Paragraph 4

Malignant mesothelioma is a fatal type of cancer caused by exposure to asbestos.

Millions of construction and general industry workers have been exposed to asbestos
while on the job. Occupations associated with significantly higher mesothelioma
deaths include plumbers, pipefitters, and steamfitters; mechanical engineers;
electricians; and elementary school teachers. In the U.S., asbestos use peaked in
1973 and but had declined by 99.8 percent in 2007. Because mesothelioma usually
does not show up until 20 to 40 years after exposure, most of the deaths from the
disease are the result of exposures that occurred decades ago. This long lag time
means that mesothelioma deaths are expected to peak around 2010, despite the
much lower current use of asbestos. From 1999 to 2005, 18,068 malignant
mesothelioma deaths were reported in the U.S. Men (81%) and Caucasians (95%)
accounted for the majority of these cases.

Paragraph 5

Silicosis is a disabling, dust-related disease and is one of the oldest occupational lung
diseases in the world. Silicosis is caused by exposure to and inhalation of airborne
crystalline silica. Dust particles from silica can penetrate the respiratory system and
land on alveoli (airsacs). This causes scar tissue to develop in the lungs and impair
the exchange of oxygen and carbon dioxide in the blood. Though symptoms of
silicosis rarely develop in less than five years, progression of the disease can lead to
extreme shortness of breath, loss of appetite, chest pains, and respiratory failure,
which can cause death. Silicosis also makes a person more susceptible to infectious
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Reading Test 6

diseases of the lungs, such as tuberculosis. Death rate is generally low, but still too
high considering that every one of these deaths could have been prevented. Because
of the low number of overall deaths due to silicosis, multiple years of data are
combined to provide a more accurate estimate of the burden of this disease.

Questions

1 According to paragraph 1, the rate of OLC is reported to be higher in

A Health care service providers (private sectors)
B Professionals in field of education
C Government officials
D Local government workers and health care professionals in private industries

2 According to paragraph 1, one of these groups of diseases doesn’t come

under OLD
A mesothelioma and occupational asthma,
B occupational asthma and silicosis, asbestosis
C asbestosis and mesotheliomaic
D asbestosis and silicosis

3 According to paragraph 2, OLDs are

A incurable
B Curable
C Preventable but not curable
D curable and preventable

4 According to paragraph 3, “work related asthma” means

A a disease which occurs due to more work
B a disease which occurs due to less work
C a disease which occurs due to exposure to work
D none of the above

5 According to paragraph 3, common agents which are associated with OA

in lowest percentage are
A Air pollutants
B Mineral and inorganic dust
C Cleaning materials
D Miscellaneous chemicals

6 According to paragraph 4, the root cause of malignant mesothelioma is

associated with the
A use of the asbestos in the construction field
B exposure to asbestos on regular basis
C low quality asbestos
D none of the above

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Reading Test 6

7 According to paragraph 4, the use of the asbestos was almost next to

naught in the year
A 1997
B 1973
C 2007
D 2010

8 According to paragraph 5, dust particles from silica can

A damage lung tissues
B impair O2 and CO2 exchange
C develop a scar on the lung
D all of the above

9 According to paragraph 5, silicosis can cause

A tuberculosis
B pneumonia
C chest pain
D none

10 According to paragraph 5, silicosis is

A more dangerous than occupational asthma
B more dangerous than mesothelioma
C not as fatal as occupational asthma and mesothelioma
D not much fatal

Reading Passage - Two

Immune System – Notes

Paragraph 1

Since inflammation in the body can lead to inflammation in the brain we first need
to understand what inflammation is. Inflammation is part of the immune system’s
response to defend you against microbial infections. It is the body’s first line of
defense against invasion by microorganisms such as bacteria and viruses, and it is
activated rapidly after infection. The microbes are detected as foreign to the body
by immune cells such as macrophages (literally “big eater”). When macrophages
encounter and recognize a foreign microorganism they engulf the microorganism
and, in addition, release a variety of cellular products into the space around them
that start and regulate further defenses that include inflammation. Two classes of
these products, known as cytokines and chemokines, lead to inflammation.
Cytokines are chemical messengers that travel away from the cells that release

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Reading Test 6

them so to alter the functioning of other cells. Chemokines also leave the cell and
attract other cells into the region. Together, they alter the blood vessels near the
site of infection, causing increased blood flow to the area and the entry of immune
system cells

Paragraph 2

Inflammation—swelling, redness, and heat—is part of the immune system’s first

response to microbial infections, but this defensive response is not limited to the
bodily site of infection. Soon after infection, a pattern develops that includes what is
called the “acute phase response (APR)” and “sickness behavior.” Fever is the most
prominent feature of the APR and for good reason: many microorganisms reproduce
best at humans’ normal core body temperature, and the many of the immune
system’s agents for killing them are bolstered by elevated temperature.

Paragraph 3

Sickness behaviors are well known to anyone who has had the flu. They include
reductions in activity, food intake, social interaction, mood sags; it is difficult to
form new memories; sleep changes; and sensitivity to pain increases (just think of
how even a light touch hurts when you have the flu). These changes also reduce the
energetic costs of behavior to free available energy stores to fight the infection.
Fever, for example, is quite energy intensive, requiring an extra 10 to 12 percent in
energy for each degree rise. It is obvious how all the sickness behaviors, with the
exception of memory disruption, fit the scheme of keeping us away from our usual
activities. Memory disruption serves a different purpose.

Paragraph 4

We now understand that all of the changes just described are accomplished through
the CNS. Fever, for example occurs because the set point of temperature-sensitive
cells in the hypothalamus is increased. Of course, behavior, mood, and pain are all
products of the CNS. This raises two issues: a) How does the CNS “know” what is
going on in the peripheral immune system, and b) What kinds of changes are
produced in the CNS that mediate fever and sickness behaviors? The same cytokines
that participate in producing the inflammatory response in the body also initiate the
communication process to the CNS. They accumulate in the bloodstream and thereby
travel to the brain, where, although they are large proteins and cannot readily cross
the blood-brain barrier, these chemical signals are carried across the barrier by
active transport. They cross into the brain in regions where the barrier is weak, and
they bind to receptors on the insides of the cerebral vascular blood vessels, thereby
inducing the production of soluble mediators within the epithelial cells that can cross
into the brain.

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Reading Test 6

Paragraph 5

The cytokine interleukin-1 beta is released in response to pathogen recognition, and

a) activates vagal fibers, b) diffuses into the brain where the barrier is weak, and c)
are actively transported across. In the brain they act on microglia, which then
produce and secrete further cytokines that can act on neuronal cells, thereby
producing sickness behaviors.

Paragraph 6

Often, a set of mechanisms that evolved to handle acute emergencies lead to

outcomes that nature did not intend if they are engaged too long. During a normal
infection, neuro- inflammation and the resulting adaptive sickness behaviors persist
only for several days. However, if these responses become exaggerated or prolonged,
the outcomes may well become established, leading to cognitive impairment instead
of brief memory disruption, depression instead of reduced mood, fatigue instead of
inactivity, and chronic pain instead of acute pain. That is, physiology can become
pathology when a set of processes designed to be relatively brief becomes prolonged.

Questions

1 According to paragraph 1, first line of defence implies

A macrophages
B immune system
C inflammation
D all of the above

2 According to paragraph 1, chemical messengers have

A the ability to change the functioning of other cells
B greater level of mobility
C no capacity to move further away from cells
D none

3 According to paragraph 2, APR develops

A at the time of infection
B after the infection
C after cure of the infection
D before or after infection

4 According to paragraph 2, fever occurs

A due to the increase in the growth of the microbes
B due to powerless immune system
C due to the multiplication of the microbes, supported by temperature of the human
body
D none
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Reading Test 6

5 According to paragraph 3, one of them is not associated to sickness

behaviors
A loss of appetite and reduction in social interaction
B reduction in social interaction and sleeping hours
C change in mood and body language
D body language and sleeping disorder

6 According to paragraph 4, cytokines are described as

A messenger cells
B protein bodies and messenger cells
C immune response bodies
D none

7 According to paragraph 4, cytokines cross the barrier

A through active transport
B by bridging the blood brain barrier
C by penetrating into the blood vessels
D through the blood stream and lymph vessels

8 What “paragraph 5” describes here?

A depiction of how peripheral immune system communicates to the brain
B depiction of how peripheral immune system stops the communication process
C depiction of how immune system weakens
D A and B

9 Paragraph 6 talks about

A what would happen if the processes become prolonged?
B what would happen if the processes terminated?
C what would happen if the processes are interrupted?
D what would happen if the processes are not started?

10 According to paragraph 6, if the responses become exaggerated then

A loss of memory may take place
B reduction in normal mood may get noted
C cognitive impairment occurs
D acute pain may begin

END OF READING TEST

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Reading Test 1 – Part ‘A’

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Reading Test 7

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the following summary using the information in the four texts
provided.
 You do not need to read each text from beginning to end to complete the
task. You should scan the texts to find the information you need.
 Gaps may require 1, 2 or 3 words.
 You should write your answers next to the appropriate number in the
right-hand column.
 Please use correct spelling in your responses.

Text 1

Irritable Bowel Syndrome (IBS is a functional bowel disorder characterized by

chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the
absence of any detectable organic cause. It is a chronic gastrointestinal disorder of
unknown cause. Common symptoms include abdominal cramping or pain, bloating
and gassiness, and altered bowel habits. Irritable bowel syndrome has been called
spastic colon, functional bowel disease, and mucous colitis. However, IBS is not a
true "colitis." The term colitis refers to a separate condition known as inflammatory
bowel disease (IBD). Irritable bowel syndrome is not contagious, inherited, or
cancerous. However, IBS often disrupts daily living activities. The prevalence is
greater in women (it affects twice as many women as men). Though most of the
patients are older than 60 years, IBS can affect all ages. IBS is not life threatening.

Text 2

What are the causes of Irritable Bowel Syndrome (IBS)?

The cause of irritable bowel syndrome is currently unknown. IBS is thought to

result from interplay of abnormal gastrointestinal (GI) tract movements, increased
awareness of normal bodily functions, and a change in the nervous system
communication between the brain and the GI tract. Abnormal movements of the
colon, whether too fast or too slow, are seen in some, but not all, people who have
IBS. Irritable bowel syndrome has also developed after episodes of gastroenteritis.
It has been suggested that IBS is caused by dietary allergies or food sensitivities,
but this has never been proven.

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Reading Test 7

Symptoms of irritable bowel syndrome may worsen during periods of stress or

menses, but these factors are unlikely to be the cause that leads to development of
IBS.

What are the signs and symptoms of Irritable Bowel Syndrome (IBS)?

The primary symptoms of IBS are

Abdominal pain or discomfort
Frequent diarrhea or constipation (change in bowel habits)
Feeling of incomplete evacuation (tenesmus),
Bloating or abdominal distention
Gassiness (flatulence)
Passing mucus from the rectum Gassiness (flatulence)
Passing mucus from the rectum
Weight loss
Vomiting rarely nausea
Fever

Text 3

How is it diagnosed?

After taking your medical history, your health care provider will examine your
abdomen and may do a rectal exam. There is no specific test for IBS. Depending
on your history and exam, your provider may do the following tests to look for other
possible causes of your symptoms:

blood tests
tests of bowel movement samples to check for blood and infection
x-rays
colonoscopy or sigmoidoscopy (procedures that allow your provider to see the inside
of your colon with a thin, flexible, lighted tube)
barium enema (a procedure in which a special liquid is passed into the colon through
the rectum before x-rays are taken) to check the colon lining.
Your health care provider may ask you to try a milk-free diet to see if lactose
intolerance (trouble digesting milk) may be causing your symptoms.

Text 4

How is it treated?

Doctors have not yet found a cure for IBS. However, controlling the diet and
emotional stress usually relieves the symptoms. Some medicines may also help.

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Reading Test 7

Diet: Increasing the fiber in your diet often helps, although sometimes a decrease
in fiber is needed. Try eating smaller meals more often. Avoid foods that cause gas,
such as cabbage.

Food diary: Your health care provider may ask you to keep a food diary to see if
eating a particular food, for example, milk or sausage, worsens your symptoms.

Stress: Your provider will help you identify things that cause stress in your life and
will suggest ways to help you control them. Relaxation or biofeedback techniques
may help you manage stress.

Medicines: Your provider may prescribe:

bulk-forming agents, such as bran or methyl cellulose

antispasmodic drugs to slow contractions in the bowel and help with diarrhea and
pain antidepressants, which can help control chronic pain
one of two new serotonin-related medicines to help with diarrhea or constipation.

Summary

Irritable bowel syndrome (IBS) is a chronic (long-lasting) disorder of the 1………..

(also called the colon or bowel). IBS is not a disease it's a 2……, which means
that the bowel doesn't work as it should. Although IBS can cause much distress,
it does not damage the 3…. and does not lead to life threatening illness. IBS is the
most common 4…….. and it affects twice as many 5……. as men and usually begins
in early adult life. It is not known to be contagious, 6…….., or 7…………
The cause of IBS is not fully understood. Most symptoms of IBS probably results
from 8……….. of the muscles in the lower part of the 9…….. Sometimes an abnormal
contraction delays bowel movements, causing 10……….. At other times it may lead
to more rapid passage of bowel movements, causing 11……... In either case it
usually causes abdominal cramps. Some foods may trigger attacks. Symptoms
may also be triggered by 12……… or depression because muscles in the bowel
are controlled by the 13……...

The most common symptoms include: (i) cramping and pain in the 14………, which
may be severe (ii) constipation or diarrhea (iii) a lot of gas. Other symptoms
include: (i) bloating (ii) a feeling of fullness in the rectum. Symptoms often occur
after you have eaten a 5…… or when you are under stress. Your symptoms may
be relieved by having a bowel movement.

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Reading Test 7

A combination of history, physical examination, and selected tests are used to

help 16…….irritable bowel syndrome. No single blood test or17…….confirms a
diagnosis of IBS. The symptoms of irritable bowel syndrome (IBS) can often be
18……. by changing your diet and lifestyle, and understanding the nature of the
condition. In some cases, medication or psychological treatments may also be
helpful. Changing your 19……. will play an important part in controlling
your symptoms of IBS. However, there is no "one size fits all" diet for people
with IBS. People with IBS are often advised to modify the amount of 20….. in
their diet. Reducing the amount of 21……… in your life may help lower the frequency
and severity of your IBS symptoms.

Reading Test - Part B

Time allowed: 60 minutes

 There are two reading passages in this test. After each passage you will find
a number of questions or unfinished statements about the passage, each with
four suggested answers or ways of finishing.
 You must choose the one which you think fits the best, i.e. the best answer.
For each question, 1-20, indicate on your answer sheet the letter A, B, C or D
against the number of the question.
 Answer all questions. Marks will not be deducted for incorrect answers.

READING PASSAGE A

Paget's Disease

Paragraph 1

Paget's disease of bone is an unusual, chronic bone condition that occurs in only
about 1% of people in the United States and slightly more often in men than in
women (3 to 2). Individuals with Paget's disease experience rapid bone repair,
which causes a variety of symptoms from softer bones to enlarged bone growth,
typically in the pelvis, low back (spine), hips, thighs, head (skull) and arms.
Medical therapies have proven effective in reducing the frequency of pain,
fractures and arthritis that may be caused by this condition.
Paget's disease typically occurs in an older population and usually in only a few
of their bones.

Bones become large and soft, leading to problems such as bending, breaking,
pinched nerves, arthritis and reduced hearing. Effective and safe treatment
methods can help most people with Paget's disease.

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Reading Test 7

Paragraph 2

What is Paget’s disease?

Normally, as people age, their bones rebuild at a slower rate. For those with
Paget's disease, however, this process of rebuilding bones takes place at a faster
rate. As a result, the rebuilt bone has an abnormal structure. The involved bone can
be soft, leading to weakness and bending of the pelvis, low back (spine), hips,
thighs, head and arms. Or, the rebuilt bone can enlarge, making it more susceptible
to arthritis, hearing loss, fractures and discomfort. Given that this takes place in
those over the age of 40, the symptoms often are mistaken for changes associated
with aging.

Paragraph 3

What causes Paget's?

The cause of Paget's disease is unknown. It does appear to be, at least partially,
due to heredity, perhaps when activated by exposure to a virus.

Who gets Paget's?

Indicative of the heredity consideration: Paget's disease occurs more commonly

in European populations and their descendants. In 30% of cases, disease incidence
often involves more than one member of a family.

How is Paget's diagnosed?

Paget's is rarely discovered in individuals before they reach the age of 40, and
the number of people identified increases in each progressive age group.
Typically, it is the appearance of the bones on an X-ray that signals the physician
to make the diagnosis. Blood tests taken most often will indicate an increase in
serum alkaline phosphatase (SAP), which is reflective of the rapid new bone
turnover. Urine test results also will indicate the speed at which this rebuilding is
taking place. Physicians usually obtain a non-invasive bone scan to determine the
extent of bone involvement. Only if cancer is suspected will it be necessary to
biopsy the bone to examine it under a microscope.

Paragraph 4

How Paget’s disease is treated?

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Treatment approaches can focus on providing physical assistance, including the

addition of wedges in the shoe, canes as walking aids and the administration of
physical therapy (this can be considered to be the best). Medications that help
reduce the pain associated with Paget's include acetaminophen (e.g., Tylenol) and
anti-inflammatory drugs such as ibuprofen and naproxen. In addition, a group of
medications called bisphosphonates reduce the pain and help the body regulate
the bone-building process to stimulate more normal bone growth. Your physician
may prescribe an oral medication:

Alendronate (Fosamax) or etidronate (Didronel) to be taken by mouth every day

for 6 months.
Tiludronate (Skelid) to be taken by mouth every day for 3 months.
Risedronate (Actonel) to be taken by mouth every day for 2 months.
All oral medications should be taken with a large glass of water (6-8 oz) upon
arising in the morning. Patients should remain upright for the next 30 minutes and
not eat until that time has passed. Any of these treatments can be repeated if
necessary. Side effects of these medicines may involve heartburn and sometimes
increasing bone pain for a short period of time.

Paragraph 5

There are also injectable medications. Injectable medications that can be given
for Paget's include:
Pamidronate (Aredia), which is injected in the vein once a month or once every
few months. The injection takes a few hours. Unusually, there can be inflammation
of the eye or loss of bone around the teeth (osteonecrosis).
Zoledronate (Reclast), which is injected in the vein once a year. The injection takes
less than 30 minutes.
Calcitonin, a hormone that is injected under the skin several times a week.

Surgery for arthritis caused from Paget's disease is effective in reducing pain and
improving function. Medical treatment is not expected to correct some of the
changes of the Paget's disease that have already occurred, such as hearing loss,
deformity or osteoarthritis.

Questions

1 According to paragraph 1, Paget’s disease

A Affects more number of women than men
B Affects 3 men in 4
C Affects 3 women in 4
D Affects more number of men than women

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Reading Test 7

2 According to paragraph 1, Paget’s disease can lead to

A Bone disorder
B Softening of bone
C Arthritis in final stage
D None of the above

3 According to paragraph 2, Paget’s disease is a condition in which

A Bones become large and soft
B Rebuilding of bones is stopped
C Pelvis blends at a faster rate
D Rebuilding of bone is accelerated

4 According to paragraph 2, reformation of the bones can lead to

A Low back pain, loss of hearing and discomfort
B Arthritis, loss of hearing and softening of bone tissues
C Fractures and discomfort only
D All of the above

5 According to paragraph 3, which of the following statements is right?

A If one member of the family is affected with Paget’s disease then other members
will also surely get affected
B If one member of the family is known to have Paget’s disease then others can also
get affected
C Paget’s disease is highly heritable
D Paget’s disease in, some cases, is heritable and inheritable

6 What does “paragraph 3” suggest here?

A Those who reach the age of 40 shall undergo blood test and urine test for the
identification of Paget’s disease
B Physicians shall always suggests the patients to go for non-invasive bone scan
C Increase is indicative of the development of the bone at a rapid speed
D It is necessary to biopsy the bone to know the nature of the disease

7 According to paragraph 4, oral medications

A May increase bone pain
B Shall be taken only during morning time
C May disturb physiological function
D All of the above

8 According to paragraph 4, which of the following statements is not true?

A Tylenol can reduce the pain associated with the Paget’s disease
B Actonel shall be taken for 3 months
C Bisphosphonates can effectively stimulate normal bone growth
D Calcitonin shall be injected couple of times in a week.

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9 According to paragraph 5, which one of the following statements is wrong?

A Aredia, Tiludronateand calcitone can be very effective
B Pamidronate, zoledronate are the most effective injections
C Calcitone can’t be as effective as others.
D None of the above

10 According to paragraph 5, which of the following statements is wrong?

A Paget’s disease is a condition which can lead to arthritis
B Surgery can really finish off Paget’s disease
C Surgery of arthritis occurred due to Paget’s disease can only reduce the pain
associated with it
D Medical treatment will not correct loss in hearing or deformity or osteoarthritis
resulted from it

Reading Passage - Two

Pancreatic Cancer

Paragraph 1

Cancer is a class of diseases characterized by out-of-control cell growth, and

pancreatic cancer occurs when this uncontrolled cell growth begins in the pancreas.
Rather than developing into healthy, normal pancreas tissue, these abnormal cells
continue dividing and form lumps or masses of tissue called tumors. Tumors then
interfere with the main functions of the pancreas. If a tumor stays in one spot and
demonstrates limited growth, it is generally considered to be benign. More
dangerous, or malignant, tumors form when the cancer cells migrate to other parts
of the body through the blood or lymph systems. When a tumor successfully spreads
to other parts of the body and grows, invading and destroying other healthy tissues,
it is said to have metastasized. This process itself is called metastasis, and the result
is a more serious condition that is very difficult to treat. In the United States each
year, over 30,000 people are diagnosed with pancreatic cancer. Europe sees more
than 60,000 diagnoses each year. In Asian countries, it can even be more than that.

Paragraph 2

Pancreatic cancer is categorized depending on whether it affects the exocrine or

endocrine functions of the pancreas. There is an important distinction between the
two broad types of pancreatic cancer because they have different risk factors,
causes, symptoms, diagnostic tests, treatments, and prognoses. Tumors that
affect the exocrine functions are the most common type of pancreatic cancer.
Sometimes these tumors or cysts are benign, called cystadenomas. However, it
is more likely to find malignant tumors called adenocarcinomas, which account for
95% of exocrine pancreatic cancers. Adenocarcinomas typically start in gland cells
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Reading Test 7

in the ducts of the pancreas, but they can also arise from pancreatic enzyme cells
(acinar cell carcinoma). Other types of pancreatic cancers that are associated with
exocrine functions include adenosquamous carcinomas, squamous cell carcinomas,
and giant cell carcinomas, named for their appearances underneath a microscope.
There is also a disease called ampullary cancer (carcinoma of the ampulla of Vater)
that starts where the bile duct and pancreatic duct meet the duodenum of the small
intestine.

Paragraph 3

Cancer is ultimately the result of cells that uncontrollably grow and do not die.
Normal cells in the body follow an orderly path of growth, division, and death.
Programmed cell death is called apoptosis, and when this process breaks down,
cancer results. Pancreatic cancer cells do not experience programmatic death, but
instead continue to grow and divide. Although scientists do not know exactly what
causes these cells to behave this way, they have identified several potential risk
factors. Cancer can be the result of a genetic predisposition that is inherited from
family members. It is possible to be born with certain genetic mutations or a fault
in a gene that makes one statistically more likely to develop cancer later in life.
About 10% of pancreatic cancers are thought to be caused by inherited gene
mutations. Genetic syndromes that are associated with pancreatic cancer include
hereditary breast and ovarian cancer syndrome, melanoma, pancreatitis, and non-
polyposis colorectal cancer (Lynch syndrome).

Paragraph 4

Carcinogens are a class of substances that are directly responsible for damaging
DNA, promoting or aiding cancer. Certain pesticides (dyes may also be included in
this list here), and chemicals used in purification of the metal are thought to be
carcinogenic, increasing the risk of developing pancreatic cancer. When our bodies
are exposed to carcinogens, free radicals are formed that try to steal electrons from
other molecules in the body. Theses free radicals damage cells, affecting their ability
to function normally, and the result can be cancerous growths. As we age, there is
an increase in the number of possible cancer-causing mutations in our DNA. This
makes age an important risk factor for pancreatic cancer, especially for those over
the age of 60. There are several other diseases that have been associated with an
increased risk of cancer of the pancreas. These include cirrhosis or scarring of the
liver, helicobacter pylori infection (infection of the stomach with the ulcer-causing
bacteria H. pylori), diabetes mellitus, chronic pancreatitis (inflammation of the
pancreas), and gingivitis or periodontal disease.

Paragraph 5

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In order to find out pancreatic cancer, physicians will request a complete physical
exam as well as personal and family medical histories. The way in which the cancer
presents itself will differ depending on whether the tumor is in the head or the tail of
the pancreas. Tail tumors present with pain and weight loss while head tumors
present with steatorrhea, weight loss, and jaundice. Doctors also look for recent onset
of atypical diabetes mellitus, Trousseau's sign, and recent pancreatitis.
In general, when making a pancreatic cancer diagnosis, physicians pay special
attention to common symptoms such as abdominal or back pain, weight loss, poor
appetite, tiredness, irritability, digestive problems, gallbladder enlargement, blood
clots (deep venous thrombosis (DVT) or pulmonary embolism), fatty tissue
abnormalities, diabetes, swelling of lymph nodes, diarrhea, steatorrhea, and jaundice.

Questions

1 According to paragraph 1, pancreatic tumor can be

A Benign
B Malignant
C Benign and malignant
D None

2 According to paragraph 1, metastasized is a condition

A When pancreatic tumours spread to other parts of the body
B When malignant tumors form in pancreas
C When harmful tumors invade and destroy other healthy tissues of the body
D when tumors are grown automatically in other parts of the body

3 According to paragraph 2, commonest pancreatic cancer is associated with

A Endocrine gland
B Exocrine gland
C Cystadenomas
D Adenocarcinomas

4 According to paragraph 2, ampullary cancer is associated with

A Endocrine gland
B Exocrine gland
C Pancreatic duct
D None

5 According to paragraph 3, failure of apoptosis results in

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Reading Test 7

A Pancreatic cell growth

B Enlargement of the pancreatic duct
C Cancerous tissues in the pancreas
D B and C

6 According to paragraph 3, cancerous growth in pancreas is a result of

A Specific carcinogens
B Family genes
C Genetic mutations
D none

7 According to paragraph 4, the risk of pancreatic cancer is associated with

these carcinogens
A pesticides and dyes
B pesticides, dyes and chemicals used for refining metals
C Only dyes
D None

8 According to paragraph 4, diseases associated with pancreatic cancer

include
A Cirrhosis
B Infection of the stomach
C Diabetes Mellitus
D All

9 Paragraph 5 talks about

A How pancreatic cancer is diagnosed?
B How cancerous growth in pancreas can be stopped?
C How pancreatic disease can be prevented?
D None

10 According to paragraph 5, one of them is not the symptom associated

with PC
A Back pain and problems in digestion
B Digestive problems and blood clotting
C Pulmonary edema and enlargement of the gall bladder
D Jaundice and modification in the lymph

END OF READING TEST

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Reading Test 7

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Reading Test 1 – Part ‘A’

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Reading Test 8

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the following summary using the information in the four texts
provided.
 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.
 Gaps may require 1, 2 or 3 words.
 You should write your answers next to the appropriate number in the
right-hand column.
 Please use correct spelling in your responses.

Text 1

Short Bowel Syndrome (sometimes referred to as SBS) is a disorder that affects

people who have had large portions of their small intestine surgically removed
as a result of a digestive illness, such as Crohn’s disease. Approximately 10,000–
20,000 people in the United States have short bowel syndrome.
Short bowel syndrome in neonates may be present at birth due to a congenital
anomaly or may develop in older infants and children as a result of disease or
trauma, occurring later in life. SBS usually caused by massive intestinal resection,
do not always strictly correlate with the length of the remaining small intestine.
Those who are at risk include: Babies (usually premature) who have had surgery
for NEC and Patients who have had surgery for volvulus (twisting of the intestines),
Patients born with narrowing or obstruction of their intestine, Patients with
intestinal pseudo-obstruction or abnormal motility of the bowel, Patients after
having parts of the intestine removed for other reasons (e.g. tumors, abnormal
blood supply, strictures, etc.), Patients with damage to their intestines from
radiation therapy and Patients born with abnormally short small intestine.

Text 2

The most common symptom of short bowel syndrome is chronic (long-term)

diarrhea. This, in turn, can cause malnutrition, dehydration, and weight loss.
These problems can become life-threatening if not treated properly.

Other symptoms of short bowel syndrome may include:

• Abdominal pain and cramping
• Bloating

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Reading Test 8

• Heartburn
• Flatulence (intestinal gas)
• Steatorrhea (oily and/or foul-smelling stool)
• Fatigue
• Weakness
• Bacterial infections
• Food sensitivities

Text 3

Short bowel syndrome can be accompanied by a number of complications.

These include:
Kidney stones: Decreased absorption of fats, calcium, and bile salts in the bowel
can cause kidney stones, which are known to decrease urine flow from the kidneys
to the bladder, impair kidney function, and cause pain.
Electrolyte abnormalities: Electrolytes —such as potassium, sodium, and
magnesium—are minerals that control important functions in the body. Unbalanced
electrolytes can result in irregular heartbeat, muscle weakness, headache, and
nausea.

Text 4

One of the major complications that take part in SBS is listed down:
Vitamin and mineral deficiencies: Short bowel syndrome can affect the amount
of vitamins that the body absorbs, sometimes with serious consequences. For
instance, a lack of vitamin B12 can result in damage to the brain and nerves in the
spinal cord, while a deficiency in vitamin E can cause swelling and poor muscle
coordination. Too little vitamin C can lead to problems with the gums and skin.
Reduced absorption of vitamin D and calcium can cause osteoporosis and lead to
fractures. In addition, the diarrhea commonly associated with short bowel syndrome
can result in low mineral levels such as zinc and magnesium, sometimes leading
to skin rashes, muscle cramping, and irregular heart rhythms.
In addition to these, bacterial overgrowth or gastric hyper secretions can also be
very complicated.

Summary

Short bowel syndrome (SBS) occurs when a significant portion of the 1……………..
does not function normally. This can occur if a large part of the intestine has
been 2…………..removed or if a 3……….. is born with an abnormally 4………
intestine. Those who are at risk can include: Babies who have had surgery for
NEC, Patients who have had surgery for 5……….(twisting of the intestines),
Patients with intestinal resection for 6………..Patients with 7………… or abnormal

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Reading Test 8

motility of the bowel or Patients born with 8……… small intestine. Symptoms of
SBS may include: Diarrhea, 9………or weight loss, 10……., Poor appetite, increased
gas, foul smelling stools,

11………., pallor, 12………. etc. There are complications too which are closely
associated with 13………. which can well be summarized as: Failure to thrive,
the child does not gain 14……..according to the growth curve, 15…….., Vitamin
16………. as a result of poor absorption in the 17…………, 18……. from excess
stomach acid, 19…….overgrowth in areas of dilated intestine, Kidney 20……. or
21….. due to poor absorption of calcium or bile etc.

Reading Passage 1

Classification of Seizures

Paragraph 1

In order to communicate about types of seizures, epilepsy specialists have

developed a classification system for seizures. This system is not based on any
fundamental property of seizures, but rather on committee-generated conventions
of terminology. Classification is as follows: Partial Seizures and Generalized
Seizures. Partial seizures are further divided into simple partial seizures with no
alteration of consciousness or memory, or complex partial seizures with alteration
of consciousness or memory. Simple partial seizures can be motor seizures with
twitching, abnormal sensations, abnormal visions, sounds or smells, and distortions
of perception. Seizure activity can spread to the autonomic nervous system,
resulting in flushing, tingling, or nausea. If the patient becomes confused or cannot
remember what is happening during the seizure, then the seizure is classified as
a complex partial seizure. They previously were called ―psychomotor seizures‖,
―temporal lobe seizures‖ or ―limbic seizures‖. During the complex partial seizure
patients may fumble or perform automatic fragments of activity such as lip
smacking, picking at their clothes, walking around aimlessly, or saying nonsense
phrases over and over again. These purposeless activities are called automatisms.
About 75% of people with complex partial seizures have automatisms. Those who
do not simply stop stare and blank out for a few seconds to minutes

Paragraph 2

Generalized seizures are divided into absence seizures and tonic-clonic seizures.
Absence seizures previously were called petit mal seizures. Absence seizures
usually have onset in childhood, but they can persist into adulthood. Absence
seizures present with staring spells lasting several seconds, sometimes in
conjunction with eyelid fluttering or head nodding. These seizures can be difficult

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Reading Test 8

to distinguish from complex partial seizures that also may result in staring.
Absence seizures usually are briefer and permit quicker recovery. Generalized
tonic-clonic seizures previously were called grand mal seizures. These seizures
start with sudden loss of consciousness and tonic activity (stiffening) followed by
clonic activity (rhythmic jerking) of the limbs. The patient’s eyes will roll up at the
beginning of the seizure and the patient will typically emit a cry, not because of
pain, but because of contraction of the respiratory muscles against a closed throat.
Generalized tonic-clonic seizures usually last one to three minutes

Paragraph 3

Seizures that begin focally can spread to the entire brain, in which case a
tonic-clonic seizure ensues. It is important, however, to distinguish those that are
true grand mal, generalized from the start, from those that start focally and
secondarily generalize. Secondarily generalized seizures arise from a part of the
brain that is focally abnormal.
Drugs used to treat primarily and secondarily generalized tonic-clonic seizures are
different. Patients with secondarily generalized tonic-clonic seizures may be
candidates for curative epilepsy surgery whereas, primarily generalized tonic-clonic
seizures are not surgical candidates, because there is no seizure origin site (focus)
to remove.

Paragraph 4

Seizure surgery is discussed below.

Atonic Seizures
Atonic seizures are epileptic drop attacks. Atonic seizures typically occur in children
or adults with widespread brain injuries. People with Atonic seizures suddenly
become limp and may fall to the ground. Football helmets are sometimes required
to protect against serious injuries.

Myoclonic Seizures
Myoclonic seizure is a brief un-sustained jerk or series of jerks, less organized than
the rhythmic jerks seen during a generalized tonic-clonic seizure. Other specialized
seizure types occasionally are encountered.

Tonic Seizures
Tonic seizures involve stiffening of muscles as the primary seizure manifestation.
Arms or legs may extend forward or up into the air. Consciousness may or may
not be lost. By definition, the clonic (jerking) phase is absent.
Classification can be difficult, because stiffening is a feature of many complex partial
seizures. Tonic seizures, however, are much less common than complex partial or
tonic-clonic seizures.

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Reading Test 8

Mixed Seizure Types

Patients can have more than one seizure type. One seizure type may progress into
another as the electrical activity spreads throughout the brain. A typical progression
is from a simple partial seizure, to a complex partial seizure (when the patient
becomes confused), to a secondarily generalized tonic-clonic seizure (when the
electrical activity has spread throughout the entire brain). The brain has control
mechanisms to keep seizures localized. Anti- epileptic medications enhance the
ability of the brain to limit spread of a seizure.

Questions

1 According to paragraph 1, motor seizures are

A Simple partial seizures
B Partial seizures
C Complex seizures
D Complex partial seizures

2 According to paragraph 1, in which type of seizure, the patient doesn’t

generally remember what is happening around
A simple partial
B Complex seizures
C Complex partial seizures
D partial temporal lobe seizures

3 According to passage 1, one of these activities is related to automatism

A fumbling
B lip smacking
C speaking leisurely
D none

4 According to paragraph 2, which seizures lasts for one to three minute

A simple partial seizures
B tonic-clonic seizures
C absence seizures
D none

5 According to paragraph 3, which type of seizure occurs in childhood and

may persist in adulthood
A grand mal seizures
B petit mal seizures
C both A and B
D none

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Reading Test 8

6 According to paragraph 3, which seizures arise from focally abnormal part

of the brain
A petit mal seizures
B grand mal seizures
C Secondarily generalized seizures
D Both B and C

7 According to paragraph 3, who may undergo surgery?

A patients with grand mal seizures
B patients with secondarily generalized seizures
C patients with primarily generalized tonic-clonic seizures
D Both B and C

8 According to paragraph 4, which of the following statements is right?

A jerking phase is absent in tonic seizures and atonic seizures
B stiffening of muscles is associated with atonic seizures
C development of simple to complex seizures is a type of mixed seizure
D jerking is associated with myoclonic seizures only

9 According to paragraph 4, which of the following statements is wrong?

A People with atonic seizures often become extremely limp
B tonic seizures are different from tonic-clonic seizures
C complex partial seizures are as common as tonic seizures
D rhythmic jerking is a characteristic feature of myoclonic Seizures

10 According to paragraph 4, which one of them correctly describe tonic

seizures?
A rhythmic jerking
B stiffening of muscles
C loss of consciousness
D none

Reading Passage 2

Fascioliasis Infection

Paragraph 1

Fascioliasis is a parasitic infection typically caused by Fasciola hepatica, which is

also known as "the common liver fluke" or "the sheep liver fluke." A related
parasite, Fasciola gigantica, also can infect people. Fascioliasis is found in all 5
continents, in over 50 countries, especially where sheep or cattle are reared.
People usually become infected by eating raw watercress or other water plants
contaminated with immature parasite larvae. The immature larval flukes migrate
through the intestinal wall, the abdominal cavity, and the liver tissue, into the bile
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ducts, where they develop into mature adult flukes, which produce eggs. The
pathology typically is most pronounced in the bile ducts and liver. Fasciola infection
is both treatable and preventable.

Paragraph 2

The standard way to be sure a person is infected with Fasciola is by seeing the
parasite. This is usually done by finding Fasciola eggs in stool (fecal) specimens
examined under a microscope. More than one specimen may need to be examined
to find the parasite. Sometimes eggs are found by examining duodenal contents or
bile. Infected people don't start passing eggs until they have been infected for
several months; people don't pass eggs during the acute phase of the infection.
Therefore, early on, the infection has to be diagnosed in other ways than by
examining stool. Even during the chronic phase of infection, it can be difficult to find
eggs in stool specimens from people who have light infections.

Paragraph 3

Fasciola parasites develop into adult flukes in the bile ducts of infected mammals,
which pass immature Fasciola eggs in their feces. The next part of the life cycle
occurs in freshwater. After several weeks, the eggs hatch, producing a parasite form
known as the miracidium, which then infects a snail host. Under optimal conditions,
the development process in the snail may be completed in 5 to 7 weeks; cercariae
are then shed in the water around the snail. The cercariae lose their tails when they
encyst as metacercariae (infective larvae) on water plants. In contrast to cercariae,
metacercariae have a hard outer cyst wall and can survive for prolonged periods in
wet environments.

Paragraph 4

Immature Fasciola eggs are discharged in the biliary ducts and in the stool. Eggs
become embryonated in water; eggs release miracidia, which invade a suitable snail
intermediate host, including the genera Galba, Fossaria and Pseudosuccinea. In the
snail the parasites undergo several developmental stages (sporocysts, rediae, and
cercariae ). The cercariae are released from the snail and encyst as metacercariae
on aquatic vegetation or other surfaces. Mammals acquire the infection by eating
vegetation containing metacercariae. Humans can become infected by ingesting
metacercariae-containing freshwater plants, especially watercress. After ingestion,
the metacercariae excyst in the duodenum and migrate through the intestinal wall,
the peritoneal cavity, and the liver parenchyma into the biliary ducts, where they
develop into adult flukes.

Paragraph 5

No vaccine is available to protect people against Fasciola infection.

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In some areas of the world where Fascioliasis is found (endemic), special control
programs are in place or are planned. The types of control measures depend on
the setting (such as epidemiologic, ecologic, and cultural factors). Strict control of
the growth and sale of watercress and other edible water plants is important.
Individual people can protect themselves by not eating raw watercress and other
water plants, especially from endemic grazing areas. As always, travelers to areas
with poor sanitation should avoid food and water that might be contaminated
(tainted). Vegetables grown in fields that might have been irrigated with polluted
water should be thoroughly cooked, as should viscera from potentially infected
animals.

Paragraph 6

In the early (acute) phase, symptoms can occur as a result of the parasite's
migration from the intestine to and through the liver. Symptoms can include
gastrointestinal problems such as nausea, vomiting, and abdominal pain/tenderness.
Fever, rash, and difficulty breathing may occur.
During the chronic phase (after the parasite settles in the bile ducts), the clinical
manifestations may be similar or more discrete, reflecting inflammation and blockage
of bile ducts, which can be intermittent. Inflammation of the liver, gallbladder, and
pancreas also can occur.

Questions

1 According to paragraph 1, which one of the following statements is right?

A infection caused by Fasciola spreads faster than any other types of infections
B infection by Fasciola is deadly
C infection by Fasciola is treatable
D infection by Fasciola is very common

2 Paragraph 2 talks about

A diagnosis
B treatment
C spread of infection
D none

3 According to paragraph 2, in which phase, it is not easy to find the eggs in

the stool

A chronic phase
B infective phase
C acute phase
D A and B

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Reading Test 8

4 Paragraph 3 talks about

A biology of Fasciola hepatica

B time period in snail
C initial stages of the development of the parasite
D complete life cycle

5 According to paragraph 3, this form survive for longer period of time

A cercariae
B metacercariae
C miracidia,
D Fasciola eggs

6 Paragraph 4 talks about

A how infection occurs in man?

B how animals get infected?
C how plants get infected?
D all of the above

7 According to paragraph excystation occurs in

A Intestinal wall
B Duodenum
C peritoneal cavity
D liver

8 Paragraph 5 talks about

A Prevention and control

B availability of the treatment for the infection
C drugs to be used
D A and C

9 According to paragraph 5, one of the statements is wrong?

A special programs shall be organized for the controlling of the disease

B people should not eat raw watercress
C sale of watercress shall be stopped
D none

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Reading Test 8

10 Paragraph 6 talks about

A how infection is controlled?

B how infection spreads through bile ducts and liver?
C how infection is prevented from spreading to different parts?
D possibility of infection spreading to other parts of the body

END OF READING TEST

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Reading Test 1 – Part ‘A’

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Reading Test 9

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the following summary using the information in the four texts
provided.
 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.
 Gaps may require 1, 2 or 3 words.
 You should write your answers next to the appropriate number in the
right-hand column.
 Please use correct spelling in your responses.

Text 1

Trichinosis (also termed trichinellosis, trichiniasis, or trichinelliasis) is a disease

caused by parasites, called roundworms (Trichinella spp.), that can infect and
damage many body tissues. Although the parasites can pass through the intestinal
tract and other tissues, muscle tissues are where the majority of them persist.
Trichinosis is usually characterized by two phases; the initial phase (intestinal)
of abdominal discomfort, diarrhea, and nausea that begins one to two days after
ingestion and the second phase (muscle) of muscle aches, itching, fever, chills,
and joint pains that begins about two to eight weeks after ingestion.

Text 2

Trichinosis is caused by Trichinella species (also termed parasitic nematodes,

intestinal worms, and roundworms) that initially enter the body when meat
containing the Trichinella cysts (roundworm larvae) is eaten. For humans,
undercooked or raw pork and pork products, such as pork sausage has been the
meat most commonly responsible for transmitting the Trichinella parasites. It is a
food-borne infection and not contagious from one human to another unless infected
human muscle is eaten. However, almost any carnivore (meat eater) such as bear
or cougar or omnivore (eats meat and plants for food) such as domestic pigs or wild
boar can both become infected and, if eaten, can transmit the disease to other
carnivores and omnivores. For example, undercooked or raw bear meat can contain
livable Trichinella cysts. Therefore, if humans, dogs, pigs, rats, or mice eat the meat,
they can become infected. In rare instances, larvae that inadvertently reaches cattle
feed can infect cattle. The signs, symptoms, severity and duration of trichinellosis
vary. Nausea, diarrhea, vomiting, fatigue, fever, and abdominal discomfort are often
the first symptoms of trichinellosis. Headaches, fevers, chills, cough, swelling of
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Reading Test 9

the face and eyes, aching joints and muscle pains, itchy skin, diarrhea, or
constipation may follow the first symptoms. If the infection is heavy, patients may
experience difficulty coordinating movements, and have heart and breathing
problems. In severe cases, death can occur. Symptoms often go away, however
certain symptoms (such as fatigue, muscle pain, diarrhea etc) may last for a few
months.

Text 3

There are no good tests for the early phase of infection of the intestines. The history
from the patient telling the doctor that he or she ate raw or undercooked meat could
be the first clue. Unfortunately, most patients do not seek physician help during the
relatively short intestinal phase. During the muscle phase of the disease, a
presumptive clinical diagnosis can be made in patients that have a history of eyelids
swelling, pain, tenderness, and swelling in muscles, especially skeletal muscles and
small hemorrhages (bleeding into tissues) under the fingernails and the conjunctivae
of the eye that resemble splinters that occur a few weeks after eating raw or
undercooked meat from pork or wild animals. Other laboratory findings that are
elevated, but not specific for trichinosis are creatine kinase, and lactate
dehydrogenase, two enzymes that increase in the blood when muscle cells are
damaged or destroyed. Also, a particular type of white blood cell, eosinophils, are
usually increased several times their normal concentration after the muscle phase
starts, but eosinophil increases can also occur in other parasitic infections.

Text 4

More specific tests (indirect immunofluoresence, latex agglutination, enzyme-linked

immunosorbent assays) are available that detect antibodies developed by the
infected person's immune response to the parasites. However, these tests may not
be positive until three or more weeks after infection and may be falsely positive in
patients with infections with other parasites or autoimmune diseases. The best test
for trichinosis is a biopsy of muscle that shows larvae in the muscle tissue.
In general, biopsies are done infrequently and the diagnosis is based on presumptive
clinical findings, patient history, and associated blood tests outlined above. In
addition, trichinosis often occurs in outbreaks (a number of infections occurring at
about the same time). For trichinosis, outbreaks occur when a number of people eat
infected meat from the same source. For example, in 2007, over 200 patients were
diagnosed with trichinosis in Poland when a meat-processing plant sold Trichinella-
contaminated pork to customers. Knowledge of the source of an outbreak can help
identify and diagnose individuals that may be exposed to the parasites; it can
also allow the source of the infections to be eliminated.

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Reading Test 9

Summary

Trichinellosis, also called trichinosis, is caused by 1………. or undercooked 2……. of

animals infected with the larvae of a species of worm called Trichinella. Infection
occurs commonly in certain wild carnivorous animals such as 3…………, or omnivorous
(meat and plant-eating) animals such as 4………….The signs, symptoms, severity and
duration of trichinellosis 5……. 6……….., 7…….., vomiting, fatigue, fever, and abdominal
discomfort are often the first symptoms of trichinellosis. Aching 8…….and 9…….., itchy
skin, etc may follow the first symptoms. Patients,. If the infection is heavy then may
face difficulty in 10……….., and have 11………..and 12…………. For mild to moderate
infections, most symptoms subside within a few months. 13………, weakness, 14……,
and diarrhea may last for months. A diagnosis of trichinellosis is made in patients
whose signs and symptoms are compatible with 15……, have a 16………. for Trichinella,
and who can recall eating 17…….. pork or wild game meat. 18……….
of Trichinella infection is most often made by a 19…… test. In some cases a 20……..
may be performed.

Reading Test - Part B

Time allowed: 60 minutes

 There are two reading passages in this test. After each passage you will find a
number of questions or unfinished statements about the passage, each with
four suggested answers or ways of finishing.
 You must choose the one which you think fits the best, i.e. the best answer.
For each question, 1-20, indicate on your answer sheet the letter A, B, C or D
against the number of the question.
 Answer all questions. Marks will not be deducted for incorrect answers.

READING PASSAGE A

What is Yersiniosis?

Paragraph 1

Yersiniosis is an infectious disease caused by a bacterium of the genus Yersinia.

In the United States, most human illness is caused by one species, Y. enterocolitica
(not more than one species often). Infection with Y. enterocoliticacan cause a variety
of symptoms depending on the age of the person infected. Infection with Y.
enterocolitica occurs most often in young children, adults may be on a safer side.
Common symptoms in children are fever, abdominal pain, and diarrhea, which is
often bloody. Symptoms typically develop 4 to 7 days after exposure and may last 1
to 3 weeks or longer. In older children and adults, right-sided abdominal pain and
fever may be the predominant symptoms, and may be confused with appendicitis.
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In a small proportion of cases, complications such as skin rash, joint pains, or spread
of bacteria to the bloodstream can occur.

Paragraph 2

Y. enterocolitica belongs to a family of rod-shaped bacteria. Other species of bacteria

in this family include Y. pseudo tuberculosis, which causes an illness similar to Y.
enterocolitica, and Y. pestis, which causes plague. Only a few strains of Y.
enterocolitica cause illness in humans. The major animal reservoir for Y.
enterocolitica strains that cause human illness is pigs, but other strains are also
found in many other animals including rodents, rabbits, sheep, cattle, horses, dogs,
and cats. In pigs, the bacteria are most likely to be found on the tonsils.

Paragraph 3

Infection is most often acquired by eating contaminated food, especially raw or

undercooked pork products. The preparation of raw pork intestines (chitterlings)
may be particularly risky. Infants can be infected if their caretakers handle raw
chitterlings and then do not adequately clean their hands before handling the infant
or the infant’s toys, bottles, or pacifiers. Drinking contaminated unpasteurized milk
or untreated water can also transmit the infection. Occasionally Y. enterocolitica
infection occurs after contact with infected animals. On rare occasions, it can be
transmitted as a result of the bacterium passing from the stools or soiled fingers of
one person to the mouth of another person. This may happen when basic hygiene
and hand washing habits are inadequate. Rarely, the organism is transmitted
through contaminated blood during a transfusion.

Paragraph 4

Y. enterocolitica is a relatively infrequent cause of diarrhea and abdominal pain.

Based on data from the Food-borne Diseases Active Surveillance Network which
measures the burden and sources of specific diseases over time, approximately one
culture-confirmed Y. enterocoliticainfection per 100,000 persons occurs each year.
Children are infected more often than adults, and the infection is more common in
the winter.

Paragraph 5

Y. enterocolitica infections are generally diagnosed by detecting the organism in the

stools. Many laboratories do not routinely test for Y. enterocolitica, so it is important
to notify laboratory personnel when infection with this bacterium is suspected so that
special tests can be done. The organism can also be recovered from other sites,
including the throat, lymph nodes, joint fluid, urine, bile, and blood. Uncomplicated
cases of diarrhea due to Y. enterocolitica usually resolve on their own without
antibiotic treatment. However, in more severe or complicated infections, antibiotics
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Reading Test 9

such as aminoglycosides, doxycycline, trimethoprim-sulfamethoxazole, or

fluoroquinolones may be useful.

Paragraph 6

There can be lot many things which can prevent the infection or the spread of the
infection.
Avoid eating raw or undercooked pork.
Consume only pasteurized milk or milk products.
Wash hands with soap and water before eating and preparing food, after contact with
animals, and after handling raw meat.
After handling raw chitterlings, clean hands and fingernails scrupulously with soap
and water before touching infants or their toys, bottles, or pacifiers. Someone other
than the food handler should care for children while chitterlings are being prepared.
Prevent cross-contamination in the kitchen: -Use separate cutting boards for meat
and other foods. -Carefully clean all cutting boards, counter-tops, and utensils with
soap and hot water after preparing raw meat.
Dispose of animal feces in a sanitary manner.

Questions

1 According to paragraph 1, Yersiniosis occurs more commonly in

A children
B Americans
C Adults
D Teens

2 According to paragraph 2, symptoms such as fever, diarrhea may be there

for about

A 4 days
B 7 days
C 1-3 weeks
D more than 3 weeks

3 According to paragraph 2, plague is caused by

A Y. pestis
B Y. enterocolitica
C Y. pseudo tuberculosis
D none

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Reading Test 9

4 Paragraph 3 talks about

A how this infection occurs in children?

B how this parasite transfers?
C how this parasite is different from other parasites causing infection
D the severity of the infection

5 According to paragraph 3, one of them is not common forms of

transmission of the parasite

A contaminated unpasteurized milk

B blood transfusion
C raw or undercooked pork products
D after contact with infected animals

6 Paragraph 4 talks about

A Prevention of the disease

B spread of the infection
C how common is infection with Y. enterocolitica?
D reports by Active Surveillance Network

7 Paragraph 5, talks about

A diagnosis
B treatment
C spread of the infection and its control
D A and B

8 What is derived from Paragraph 5 here?

A treatment is not required for the infection caused by Y. enterocolitica

B diarrhea requires no treatment
C complications which are mild can be resolved easily
D none

9 According to paragraph 6, which one of the following statements is true?

A dispose of animal feces is required

B cleaning the hands with soap after handling pork meat is necessary
C eating uncooked or raw pork meat can cause infection
D pasteurized milk is good for health

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Reading Test 9

10 According to paragraph 6, what is said about chitterlings?

A handling raw chitterlings with care is necessary

B contamination occurs more due to the carelessly handling chitterlings
C washing hands with soaps before touching infants or their toys is indispensable
D there should be separate care takers to look after infants, while chitterlings are
prepared.

Reading Passage 2

What is an MRI scan?

Paragraph 1

An MRI (or magnetic resonance imaging) scan is a radiology technique that uses
magnetism, radio waves, and a computer to produce images of body structures.
The MRI scanner is a tube surrounded by a giant circular magnet. The patient is
placed on a moveable bed that is inserted into the magnet. The magnet creates a
strong magnetic field that aligns the protons of hydrogen atoms, which are then
exposed to a beam of radio waves. This spins the various protons of the body, and
they produce a faint signal that is detected by the receiver portion of the MRI
scanner. The receiver information is processed by a computer, and an image is
produced. The image and resolution produced by MRI is quite detailed and can
detect tiny changes of structures within the body. For some procedures, contrast
agents, such as gadolinium, are used to increase the accuracy of the images.

Paragraph 2

An MRI scan can be used as an extremely accurate method of disease detection

throughout the body. In the head, trauma to the brain can be seen as bleeding or
swelling. Other abnormalities often found include brain aneurysms, stroke, tumors
of the brain, as well as tumors or inflammation of the spine. Neurosurgeons use an
MRI scan not only in defining brain anatomy but in evaluating the integrity of the
spinal cord after trauma. It is also used when considering problems associated with
the vertebrae or inter vertebral discs of the spine. An MRI scan can evaluate the
structure of the heart and aorta, where it can detect aneurysms or tears. It provides
valuable information on glands and organs within the abdomen, and accurate
information about the structure of the joints, soft tissues, and bones of the body.
Often, surgery can be deferred or more accurately directed after knowing the results
of an MRI scan.

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Paragraph 3

An MRI scan is a painless radiology technique that has the advantage of avoiding x-
ray radiation exposure. There are no known side effects of an MRI scan. The benefits
of an MRI scan relate to its precise accuracy in detecting structural abnormalities of
the body. Patients who have any metallic materials within the body must notify their
physician prior to the examination or inform the MRI staff. Metallic chips, materials,
surgical clips, or foreign material can significantly distort the images obtained by the
MRI scanner. Patients who have heart pacemakers, metal implants, or metal chips or
clips in or around the eyeballs cannot be scanned with an MRI because of the risk
that the magnet may move the metal in these areas. Similarly, patients with artificial
heart valves, metallic ear implants, bullet fragments, and chemotherapy or insulin
pumps should not have MRI scanning. During the MRI scan, patient lies in a closed
area inside the magnetic tube. Some patients can experience a claustrophobic
sensation during the procedure. Therefore, patients with any history
of claustrophobia should relate this to the practitioner who is requesting the test, as
well as the radiology staff. A mild sedative can be given prior to the MRI scan to help
alleviate this feeling.

Paragraph 4

All metallic objects on the body are removed prior to obtaining an MRI scan.
Occasionally, patients will be given a sedative medication to decrease anxiety and
relax the patient during the MRI scan. MRI scanning requires that the patient lie still
for best accuracy. Patients lie within a closed environment inside the magnetic
machine. Relaxation is important during the procedure and patients are asked to
breathe normally. Interaction with the MRI technologist is maintained throughout the
test. There are loud, repetitive clicking noises which occur during the test as the
scanning proceeds. Occasionally, patients require injections of liquid intravenously to
enhance the images which are obtained. The MRI scanning time depends on the
exact area of the body studied, but ranges from half an hour to an hour and a half.

Paragraph 5

After the MRI scanning is completed, the computer generates visual images of the
area of the body that was scanned. These images can be transferred to film (hard
copy). A radiologist is a physician who is specially trained to interpret images of the
body. The interpretation is transmitted in the form of a report to the practitioner who
requested the MRI scan. The practitioner can then discuss the results with the patient
and/or family.

Questions

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Reading Test 9

1 According paragraph 1, image is produced only when

A when a signal is detected by the receiver portion of the scanner

B when the signal passes through the receiver, after coupling of the protons of the
body
C when the signal is identified by the receiver which is accurately processed by a
computer
D only when the information, detected by the receiver is processed by a computer

2 According to paragraph 1, how the image can be?

A crystal clear with no patches

B self explanatory
C dense
D well enough to give a clear idea of the structures within the body

3 According to paragraph 2, MRI gives clear idea about

A brain aneurysms
B stroke of the brain
C brain tumours and spinal cord injury
D all

4 According to paragraph 2, An MRI can

A detect brain tumors

B give clear picture of the injury to the spinal cord and other soft tissues related to
it
C gives clear picture to evaluate the structure of heart and aorta
D all

5 Paragraph 3 talks about

A detection of the diseases through MRI scan

B importance of taking MRI scan
C risks of an MRI scan
D none

6 According to paragraph 3, metallic materials mentioned include

A surgical clips
B artificial joints, metallic bone plates
C only metal clips in or around the eyeballs
D only A and B

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Reading Test 9

7 Paragraph 4, talks about

A how MRI is performed?

B how does a patient prepare for an MRI scan?
C How does a patient prepare for an MRI scan and how is it performed?
D how MRI scan is different from others?

8 According to paragraph 4, one of the statements is wrong

A clicking noises occurs during the scanning process

B patients will be asked to breathe normally
C sedative medication is just must before MRI scan
D metallic objects shall be removed prior to scanning

9 Paragraph 5 talks about

A process of obtaining MRI results

B how does a patient obtain the results of the MRI scan?
C new invention in field of MRI scanning
D none

10 According to paragraph 5, interpreting the images implies

A identifying the disease through scanning

B analysis of the disease
C decoding the report
D all of the above

END OF READING TEST

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Reading Test 1 – Part ‘A’

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Reading Test 10

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the following summary using the information in the four texts
provided.

 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.

 Gaps may require 1, 2 or 3 words.

 You should write your answers next to the appropriate number in the
right-hand column.

 Please use correct spelling in your responses.

Text 1

Affecting several thousand Americans each year, myocarditis is a disease marked

by inflammation of the heart muscle (myocardium). The real numbers are hard to
know because myocarditis often produces no symptoms. A wide range of infections
and other problems can lead to myocarditis, which often develops in people who
are otherwise healthy. Prevention or prompt treatment of infections is one of the
best ways to prevent myocarditis.

Text 2

Viral infection is the most common cause of myocarditis. When you have an
infection, your body produces cells to fight infection. These cells also release
chemicals. If the disease-fighting cells enter your heart, they can release
chemicals that can damage your heart muscle. Your heart may become thick,
swollen, and weak. Seeking immediate medical care for infections can help prevent
complications.

These are some of the types of infections that can cause myocarditis which include:
Viral infections,, Coxsackie B viruses, Epstein-Barr virus (EBV), Cytomegalovirus
(CMV), Hepatitis C, Herpes, HIV, Parvovirus etc. Bacterial infections include:
Chlamydia (a common sexually transmitted disease), Mycoplasma (bacteria that
cause a lung infection, Streptococcal (strep) bacteria, Staphylococcal (staph)

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Reading Test 10

bacteria, Treponema (the cause of syphilis)etc . Fungal and parasitic infections

can also cause myocarditis.

Other causes of myocarditis include certain chemicals or allergic reactions to

medications or toxins such as alcohol, drugs, lead, spider bites, wasp stings, or
snakebites and chemotherapy and radiation therapy. Having an autoimmune
disease such as lupus or rheumatoid arthritis that causes inflammation throughout
your body may also lead to myocarditis.

Text 3

Myocarditis often has no symptoms but if there are any then they may last for a
few days or weeks In fact, most people recover and never even know they had it.
If you do have symptoms, they may include one or more of these: Shortness of
breath during exercise at first, then at night while lying down, Abnormal heartbeat,
which causes fainting in rare cases, Light-headedness, An often sharp or
stabbing chest pain or pressure, which is very common, may spread to neck and
shoulders, Signs of infection, such as fever, muscle aches, sore throat, headache,
or diarrhea, Swollen joints, legs, or neck veins etc. If you have symptoms like these,
your doctor will do a physical exam to check for an abnormal or rapid heartbeat,
fluid in your lungs, or leg swelling.

To confirm a diagnosis of myocarditis and spot underlying causes, your doctor may
order one or more tests such as: Blood tests to check for infection, antibodies, or
blood cell counts, A chest X-ray to produce an image of your heart, lungs, and other
chest structures, An electrocardiogram (ECG) to produce a recording of your heart's
electrical activity, A heart ultrasound (echocardiogram) to make an image of your
heart and its structures, Less often, doctors order cardiac magnetic resonance
imaging (MRI) scans or heart muscle biopsies to help confirm a diagnosis.

Text 4

The prognosis for long-term damage is not predictable and only becomes evident
as the patient is followed by the doctor over time. After the initial phase of
myocarditis, some patients can experience complete recovery; others may
develop chronic heart failure due to injured heart muscle. Infrequently, some
patients develop fulminant heart failure, a fatal condition without heart
transplantation. Patients who have had myocarditis are at some risk for sudden
unexpected, potentially fatal, heart rhythm abnormalities. These can often be
prevented with implantable defibrillators if the heart muscle damage is severe.

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Reading Test 10

Summary Myocarditis

Myocarditis is 1…………… in some cases. Death occurs if the condition gets worse
and when it becomes 2………………. to treatment. In some cases, sudden death in a
previously healthy person can also be due to an acute myocarditis that develops
rapidly.

Myocarditis is 3………………. of heart muscle. It can be caused by a variety of

infections and conditions such as viruses, sarcoidosis, and 4…………. diseases and
others. The most common cause of myocarditis is infection of the heart muscle by
a 5………….. The virus invades the heart muscle to cause local inflammation.
After the initial infection subsides, the body's immune system continues to inflict
6………….. to the heart muscle.

In serious cases, the signs and symptoms of myocarditis 7………depending on the

cause of the disease. Common myocarditis symptoms include: 8…………pain,
A rapid or abnormal 9…………….. (Arrhythmia), Shortness of breath, at rest or during
physical activity, Fluid retention with swelling of your legs, ankles and feet etc.
Other signs and symptoms you'd have with a viral infection, such as a 10…………,
body aches, 11……… pain, fever, a 12…………..throat or diarrhea. In most cases
of viral myocarditis, the illness goes away on its own and there are no complications.
Symptoms may last only a few days or 13……….. However, some types of
14……….infections are more 15…… and can cause more severe or persistent
16…………. and complications.

Myocarditis is diagnosed by detecting signs of 17……….of heart muscle. Blood tests

for heart muscle enzymes can be elevated. A 18……….. to produce an image of
your heart, lungs, and other 19…………..structures is one of the common ways of
detection. Electrical testing can suggest irritation of 20…………. and demonstrate
irregular beating of the heart (Less often, doctors order cardiac magnetic
resonance imaging (MRI) scans or heart 21………… to help confirm a diagnosis).

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Reading Test 10

Reading Test - Part B

Time allowed: 60 minutes

There are two reading passages in this test. After each passage you will find a
number of questions or unfinished statements about the passage, each with four
suggested answers or ways of finishing.

You must choose the one which you think fits the best, i.e. the best answer. For each
question, 1-20, indicate on your answer sheet the letter A, B, C or D against the
number of the question.

Answer all questions. Marks will not be deducted for incorrect answers.

READING PASSAGE A

A note on Eye Infections – Conjunctivitis

Paragraph 1

Conjunctivitis is a common and often very contagious condition more commonly

referred to as pink eye. Conjunctivitis often involves inflammation and swelling of
the conjunctiva or the clear membrane covering the eye and lining the inner eyelids.
It is very common among young children particularly those in school or daycare
(but now it doesn’t mean that it may not affect elderly people. Even they may get
affected). Conjunctivitis typically poses no real threat to the patient's vision or
wellness.

Paragraph 2

There are multiple causes and risk factors for conjunctivitis. Some of the more
common causes of conjunctivitis include:

Allergic reactions
Viral contamination
Bacterial contamination
Exposure to irritants or chemical pollutants
Infectious conjunctivitis typically results from bacterial or viral contamination. While
bacterial conjunctivitis may be treated with certain antibiotics, there is no traditional

treatment for viral conjunctivitis. Multiple strains of bacteria are responsible for
bacterial conjunctivitis. These include haemophilus influenzae and staphylococcus
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Reading Test 10

aureus. Viral conjunctivitis is a common condition affecting children from the time of
birth through their adult years. Viruses can enter the eye in many ways, resulting
from the common cold or contagion with the flu. Some patients may develop a more
serious form of viral conjunctivitis associated with a herpes infection. In this case
prompt medical attention is necessary to prevent permanent damage to the eye or
vision.

Paragraph 3

One of the more commonly reported signs and symptoms of conjunctivitis include
discomfort and pain in the eye, accompanied by redness or swelling of the eyelid,
hence the name "pinkeye." Patients may experience reddening of the inner and
outer eyelid or may experience swollen eyelids. Some patients may report increased
sensitivity to light and other irritants including the wind. Many patients with
conjunctivitis will have discharge from the eyes that may be clear, white, green or
yellow in color. Yellow or green discharge from the eye may suggest an infection
and may require antibiotics or other forms of aggressive treatment. Conjunctivitis
can spread from person to person or from eye to eye. Simply touching one eye than
the other can spread viral conjunctivitis. Allergic conjunctivitis is a non-contagious
condition. Typically children exposed to bacterial conjunctivitis will have a two to
four day window before symptoms appear.

Paragraph 4 Bacterial and Viral

Bacterial infections mostly come from staphylococci and streptococci organisms that
can come from your own skin or upper respiratory tract. The indicating symptoms of
bacterial infections are thick ropy mucous discharge accompanied with red, irritated
and inflamed eyes. Luckily, bacterial eye infections are easily treated with antibiotic
eye drops and in most cases will clear up within a few short days. Viral infections are
commonly caused by an endovirus and often associated with an upper respiratory
infection or common cold. Eyes are red and inflamed with watery, runny eyes. One
of the most common viral infections is Epidemic Keratoconjunctivitis, also known as
EKC. It is highly contagious and can last up to 2 weeks or more. This viral
conjunctivitis is caused by an adenovirus and does not have a specific treatment to
cure the infection. The doctor may prescribe steroid eye drops and artificial tears to
help decrease inflammation, but mostly the virus just needs to run its course.

Paragraph 5

Conjunctivitis may also result from Chlamydial or Gonococcal infections or STD's.

Usually the inner eyelid becomes infected. This condition is more commonly noted in
teens and young adults who are sexually active. When left untreated, this condition
may affect newborn infants born to mothers infected with an STD. Signs may include
a history of pelvic pain or vaginitis as well. Patients with Gonococcal infections may

feel like a foreign object is chronically present within their eye, and are more likely
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Reading Test 10

to experience burning and inflammation. It is possible to transfer these conditions to

the eye from hand contact. It is important to help prevent the spread of infection
that frequent hand washing is adopted by patients and family members. Treatment
usually involves use of antibiotics taken topically or orally. Concomitant treatment
may be necessary to treat genital and eye infections.

Questions

1 According to paragraph 1, which part of the eye is affected in

conjunctivitis?

A conjunctiva
B white membrane
C eye lids
D only and b

2 According to paragraph 1, conjunctivitis is common among:

A children
B teens
C school goers
D daycare children

3 Paragraph 2 talks about

A causes
B risk factors
C prevention
D A and B

4 According to paragraph 2, what is linked with herpes infection?

A bacterial infection
B viral infection
C allergic reactions
D exposure to chemical pollutants

5 According to paragraph 3, what is the most common thing in

conjunctivitis?
A mild pain in the eye
B watery eyes
C reddening of the inner and outer eyelid
D all of the above

6 According to paragraph 3, color of discharge from eyes may be

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Reading Test 10

A yellow and green

B white, yellow and green
C yellow or green
D white or green

7 Paragraph 4 is focused more on

A types of conjunctivitis
B types of bacterial conjunctivitis
C types of viral conjunctivitis
D types of bacterial and viral conjunctivitis

8 According to Paragraph 4, viral infections are caused by

A androvirus
B adenovirus
C endovirus
D adenonvirus

9 Acording to paragraph 5, other causes of conjunctivitis include

A STDs
B chlamydial
C viral
D bacterial

10 According to paragraph 5, which is more common in Gonococcal

infections?
A pain around pelvis
B discharge or pus
C inflammation of the eyes
D reddening of the eyes

Reading passage two : Osteomyelitis is infection of bone.

Paragraph 1

Osteomyelitis is infection in the bone. Osteomyelitis can occur in infants, children,

and adults. Different types of bacteria typically affect the different age groups. In
children, osteomyelitis most commonly occurs at the ends of the long bones of the
arms and legs, affecting the hips, knees, shoulders, and wrists. In adults, it is more
common in the bones of the spine (vertebrae), feet, or in the pelvis. There are
several different ways to develop the bone infection of osteomyelitis. The first is for
bacteria to travel through the bloodstream (bacteremia) and spread to the bone,
causing an infection. This most often occurs when the patient has an infection
elsewhere in the body, such as pneumonia or a urinary tract infection that spreads

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Reading Test 10

through the blood to the bone. An open wound over a bone can lead to osteomyelitis.
A recent surgery or injection around a bone can also expose the bone to bacteria
and lead to osteomyelitis. Patients with conditions or taking medications that weaken
their immune system are at a higher risk of developing osteomyelitis. Risk factors
include cancer, chronic steroid use, sickle cell disease, human immunodeficiency
virus (HIV), diabetes, hemodialysis, intravenous drug users, and the elderly.

Paragraph 2

Symptoms of osteomyelitis can vary greatly. In children, osteomyelitis most often

occurs more quickly. They develop pain or tenderness over the affected bone, and
they may have difficulty or inability to use the affected limb or to bear weight
or walk due to severe pain. They may also have fever, chills, and redness at the site
of infection. In adults, the symptoms often develop more gradually and include
fever, chills, irritability, swelling or redness over the affected bone, stiffness,
and nausea. In people with diabetes, peripheral neuropathy, or peripheral vascular
disease, there may be no pain or fever. The only symptom may be an area of skin
breakdown that is worsening or not healing. Acute osteomyelitis occurs with a rapid
onset and is usually accompanied by the symptoms of pain, fever, and stiffness. It
generally occurs after a break in the skin from injury, trauma, surgery, or skin
ulceration from wounds. Chronic osteomyelitis is insidious in onset. It may be the
result of a previous infection of osteomyelitis. Despite multiple courses of antibiotics,
it may reoccur. Symptoms of chronic osteomyelitis are subtle but may include
fever, pain, redness, or discharge at the site of infection.

Paragraph 3

The diagnosis of osteomyelitis begins with a complete medical history and physical
examination. During the medical history, the doctor may ask questions about recent
infections elsewhere in the body, past medical history, medication usage, and family
medical history. The physical examination will look for areas of tenderness, redness,
swelling, decreased or painful range of motion, and open sores. The doctor may then
order tests to help diagnose osteomyelitis. Several blood tests can be used to help
determine if there is an infection present. These include a complete blood
count (CBC), the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP),
and blood cultures. None of these is specific for osteomyelitis but they can suggest
that there may be some infection in the body. Imaging studies may be obtained of
the involved bones. These can include plain radiographs (X-rays), bone
scans, computed tomography (CT) scans, magnetic resonance imaging (MRIs),
and ultrasounds. These imaging studies can help identify changes in the bones
that occur with osteomyelitis.

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Reading Test 10

Paragraph 4

In many cases, osteomyelitis can be effectively treated with antibiotics and pain
medications. If a biopsy is obtained, this can help guide the choice of the best
antibiotic. The duration of treatment of osteomyelitis with antibiotics is usually four
to eight weeks but varies with the type of infection and the response to the
treatments. In some cases, the affected area will be immobilized with a brace to
reduce the pain and speed the treatment. Sometimes, surgery may be necessary. If
there is an area of localized bacteria (abscess), this may need to be opened, washed
out, and drained. If there is damaged soft tissue or bone, this may need to be
removed. If bone needs to be removed, it may need to be replaced with bone graft
or stabilized during surgery.

Paragraph 5

With early diagnosis and appropriate treatment, the prognosis for osteomyelitis is
good. Antibiotics regimes are used for four to eight weeks and sometimes longer in
the treatment of osteomyelitis depending on the bacteria that caused it and the
response of the patient. Commonly, patients can make a full recovery without
longstanding complications.

However, if there is a long delay in diagnosis or treatment, there can be severe

damage to the bone or surrounding soft tissues that can lead to permanent deficits
or make the patient more prone to reoccurrence. If surgery or bone grafting is
needed, this will prolong the time it takes to recover.

Questions

1 Which of the following statements is not in accordance to the information

provided in paragraph 1?

A osteomyelitis is common among people of all ages

B it can be because of the bacteria
C in most of the cases, people who have pneumonia may develop osteomyelitis
D osteomyelitis is commonly observed in people who are prone to bacterial
infections

2 According to paragraph 1 ….can lead to osteomyelitis

A bacterial infection
B an open wound
C under rated bone operation
D none

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Reading Test 10

3 According to paragraph 2, symptoms of osteomyelitis in children may

include

A tenderness in the bone

B high fever
C inability to walk
D all of the above

4 According to paragraph 2, which type of osteomyelitis is slow in the

beginning?
A chronic
B acute
C both chronic and acute
D none

5 According to paragraph 3, which group is more specific for diagnosis?

A CBC and ESR only
B Only ESR and CRP
C CRP, ESR and CBC
D None

6 According to paragraph 3, involved bone suggests

A wounded bone
B operated bone area
C bacterial infected bone
D bone with tenderness

7 According to paragraph 4 which one of the following statements is not

right?
A treatment may get completed within 4 to 8 weeks
B the duration of the treatment depends much more upon the type of osteomyelitis
C working of the affected area is stopped in order to speed up the treatment
D bone is often replaced with bone graft for perfect treatment

8 Paragraph 4 stresses more on

A removal of the localized bacteria
B how to treat osteomyelitis in short duration of time
C bone replacement for effective results
D need of undergoing surgery for clear treatment

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Reading Test 10

9 What paragraph 5 suggests here?

A use of the antibodies in treatment of osteomyelitis depends more on what type of

osteomyelitis it is
B osteomyelitis is effective in all cases
C four to eight weeks are common for treatment
D none

10 According to paragraph 5, delay in treatment of diagnosis may result in

A inability to walk properly

B permanent damage to bone
C removal of affected bone
D none

END OF READING TEST

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Reading Test 1 – Part ‘A’

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Reading Tests 1-10 Answers

TEST 6

Part A Part B

Passage 1 Passage 2

1 morbidity D C

2 childhood C A

3 stools C B

4 watery D C

5 acute A D

6 5-10 days B D

7 fluid C A

8 intestinal B A

9 infants A A

10 young children D C

11 rotavirus

12 food poisoning

13 bacteria Salmonella

14 Campylobacter

15 medical treatment

16 severe

17 diarrhoea

18 adults

19 fluid

20 mineral water

21 carbohydrate

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Reading Tests 1-10 Answers

TEST 7

Part A Part B

Passage 1 Passage 2

1 large intestine D C

2 functional disorder C C

3 bowel D B

4 intestinal disorder A B

5 women D C

6 inherited C C

7 cancerous B B

8 abnormal muscle contraction B D

9 colon A A

10 constipation B C

11 diarrhea

12 emotional stress

13 nervous system

14 abdomen

16 diagnose

17 x-ray study

18 reduced

19 diet

20 fibre

21 stress

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Reading Tests 1-10 Answers

TEST 8

Part A Part B

Passage 1 Passage 2

1 intestinal tract A C

2 surgically C A

3 baby B A

4 short B C

5 volvulus B B

6 Crohn’s disease, C B

7 intestinal pseudo-obstruction B B

8 abnormally short C A

9 Poor weight gain C C

10 Bloating C D

11 Fatigue

12 Vomiting

13 SBS

14 weight

15 Dehydration

16 deficiencies

17 intestine

18 Ulcers

19 Bacterial

20 stones

21 gallstones

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Reading Tests 1-10 Answers

TEST 9

Part A Part B

Passage 1 Passage 2

1 eating raw A D

2 meat C C

3 bear or cougar A D

4 domestic pigs or wild boar. A D

5 vary B C

6 Nausea C D

7 Nausea D C

8 joints D C

9 muscle pains B B

10 coordinating movements C D

11 heart

12 and breathing problems

13 Fatigue

14 muscle pain

15 trichinellosis

16 positive laboratory test

17 raw or undercooked

18 Laboratory diagnosis

19 Trichinella antibody

20 muscle biopsy

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Reading Tests 1-10 Answers

TEST 10
Part A Part B

Reading Passage A Reading Passage B

1 fatal D C

2 unresponsive D B

3 inflammation D D

4 immune B A

5 virus C D

6 inflammatory damage B C

7 vary A D

8 Chest pain C B

9 heartbeat A and B (both are correct) C

10 headache C B

11 joint

12 sore

13 weeks

14 viral infection

15 serious

16 inflammation

17 irritation

18 chest X-ray

19 chest

20 heart muscle

21 muscle biopsies

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Reading Test 1 – Part ‘A’

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Reading Test 11

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the summary of Part A - Answer booklet using the information in

the four texts (A1-4) below.

 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.

 Gaps may require 1, 2 or 3 words. Answer ALL questions. Marks are NOT
deducted for incorrect answers.

 You should write your answers next to the appropriate number in the right-
hand column.

 Please use correct spelling in your responses. Do not use abbreviations

unless they appear in the texts.

Text 1

Relapsing fever, as the name implies, is characterized by recurrent acute episodes of

fever. These are followed by periods of defervescence of increasing duration
.Relapsing fever is a vector-borne infection that is spread by lice (Pediculus humanus)
and ticks (Ornithodoros species). The infection is caused by various spirochete species
of the Borrelia gen ( Spirochetes are a morphologically unique species of bacteria and
also cause Syphilis, Lyme disease, Leptospioris). Louse-borne relapsing fever (LBRF)
is caused by Borrelia recurrentis, while tick-borne relapsing fever (TBRF) is caused by
at least 15 different Borrelia species (eg, Borrelia hermsii, Borrelia turicatae, Borrelia
parkeri,Borrelia duttonii). LBRF and TBRF vary significantly in terms of epidemiology.
The human body louse transmits B recurrentis, which causes an epidemic form of
relapsing fever, while a soft-bodied tick (Ornithodoros) transmits multiple Borrelia
species that cause endemic relapsing fever. Unlike hard ticks, Ornithodoros adult ticks
are able to live for many years, feed repeatedly on blood meals, lay eggs, and
perpetuate their life cycle. In addition, Ornithodoros ticks may survive long periods in
a fasting state. In fact, Ornithodoros turicata ticks have been known to transmit
spirochetes in the laboratory setting after 7 years without a blood meal.

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Reading Test 11

Text 2

Louse-borne relapsing fever (LBRF) is caused by Borrelia recurrentis, while tick-borne

relapsing fever (TBRF) is caused by at least 15 different Borrelia species (eg, Borrelia
hermsii, Borrelia turicatae, Borrelia parkeri,Borrelia duttonii). LBRF and TBRF vary
significantly in terms of epidemiology. The human body louse transmits B recurrentis,
which causes an epidemic form of relapsing fever, while a soft-bodied tick
(Ornithodoros) transmits multiple Borrelia species that cause endemic relapsing fever.
Unlike hard ticks, Ornithodoros adult ticks are able to live for many years, feed
repeatedly on blood meals, lay eggs, and perpetuate their life cycle. In addition,
Ornithodoros ticks may survive long periods in a fasting state. In fact, Ornithodoros
turicata ticks have been known to transmit spirochetes in the laboratory setting after
7 years without a blood meal. Humans are the sole host of B recurrentis, while
mammals (eg, cattle, pigs, prairie dogs, ground and tree squirrels, chipmunks) and
reptiles (lizards, snakes, gopher tortoises) may serve as a reservoir for tick-borne
Borrelia species.

Text 3

The incidence and prevalence of the diseases is very hard to estimate as they often
go unrecognised or are misdiagnosed in the current era of easily available antibiotics.
Endemic relapsing fever is only encountered in the very southernmost regions of
Europe (particularly Mediterranean Spain and Asia Minor), but has an appreciable
presence throughout the rest of the world's continents, with the exception of
Australasia. On the whole, endemic relapsing fever is found to be lesser in number in
Britain (just more or less equivalent to unheard of) and rare throughout other
European countries, except in travellers returning from areas where it is found to be
present. Clusters of cases can occur in groups of returning travellers who camp in
rural settings where the disease is endemic. Presently, this fever is noted to be
present only in Ethiopia and other neighbouring countries. The prevalence or the
occurrence of this fever among homeless people of industrialised European cities has
been suspected but not confirmed.

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Reading Test 11

Text 4

The hallmark of both louse-borne relapsing fever (LBRF) and tick-borne relapsing
fever (TBRF) is two or more episodes of high fever (usually >39°C), headaches, and
myalgias. The clinical manifestations are also similar. The mean incubation time is 7
days (range, 4-18 or more days)
Fever occurs in conjunction with spirochetemia. In TBRF, the initial febrile episode
lasts an average of 3 days (range, 12 h to 17 d, with an average of 7 days between
the initial episode and first relapse. In LBRF, the first febrile episode usually lasts
longer, 5.5 days on average (range, 4-10 d), with an average of 9 days between the
first episode and first relapse. Patients may feel well between episodes, but the febrile
periods are characterized by crises marked by labile blood pressures and pulse. The
risk of death is greatest during and immediately following the period of hypotension.
Other symptoms of relapsing fever include chills, arthralgias, abdominal pain, mental
status changes, nonproductive cough, diarrhea, dizziness, neck pain, photophobia,
rash, bleeding, coma, headache, joint aches (arthralgia), muscle aches (myalgia),
nausea and vomiting, sagging of one side of the face (facial droop), sudden onset of
high fever, seizure , weakness, unsteady while walking etc. LBRF is associated with a
higher incidence of jaundice, petechiae, hemoptysis, epistaxis, and CNS involvement.
On average, individuals with TBRF experience three relapses, while those with LBRF
experience only one. Fever tends to be milder with relapses, which result from
antigenic variation of the spirochete's outer-surface proteins.

Summary

Relapsing fever is an umbrella term used to describe characteristic patterns of

1………... caused by 2………. of the 3…………... It owes its name to the classical
presentation of a 4…………. that spontaneously remits and 5……….., helping,
historically, to distinguish it from other infectious diseases that caused fever. It can
be classified into two broad categories dependent upon the 6…………….. it to people
and thus the particular species causing the 7………... There are two major forms of
relapsing fever: Tick-borne relapsing fever (TBRF) and Louse-borne relapsing fever
(LBRF). Tick-borne relapsing fever (TBRF) is transmitted by the 8……………. and occurs
in Mediterranean Spain and 9……….. The bacteria species associated with 10…….. are
11…………., Borrelia hermsii, and 12………... Louse-borne relapsing fever (LBRF) is
transmitted by 13……….. and is most common too. The bacteria species associated
with LBRF is Borrelia recurrentis. Sudden fever occurs within 14……... In LBRF, the
fever usually lasts 3-6 days and is usually followed by a single, 15……….. In TRBF,
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Reading Test 11

multiple episodes of fever occur and each may last up to 3 days. Individuals may be
free of fever for up to 2 weeks before it 16………….... In both forms, the fever episode
may end in "crisis." This consists of shaking chills, followed by intense sweating,
17…………., and low blood pressure. This stage may result in death in up to 10% of
people. Other symptoms may include: 18……….., Coma, Headache, Joint aches
(arthralgia), 19………….. (myalgia), Nausea and vomiting, Sagging of one side of the
face (facial droop), Stiff neck, Sudden onset of high fever, shaking chills, seizure ,
Vomiting, weakness, unsteady while 20 …………… etc.

The 21…… of the diseases is very difficult to estimate as they often go unrecognised
or are misdiagnosed in the current era of easily available antibiotics. Endemic
relapsing fever is has appreciable presence throughout the 22………... On the whole,
23………... fever is 24……..in 25………. and rare throughout 26…………..., except in
27……………... from areas where it is encountered. Now, clusters of cases are found
only in 28…………... countries, although its occurrence among
29……………...industrialised European cities has been suspected but not confirmed.

End of Part A

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Reading Test 11

Part B - Text Booklet

Instructions

TIME LIMIT: 45 MINUTES

❏ There are TWO reading texts in Part B. After each of the texts you will find a
number of questions or unfinished statements about the text, each with four
suggested answers or ways of finishing.
❏ You must choose the ONE, which you think, fits best. For each question, 1-20,
indicate on your answer sheet the letter A, B, C or D against the number of the
question.
❏ Answer ALL questions. Marks are NOT deducted for incorrect answers.

NOTE: You must complete your Answer Sheet for Part B within the 45 minutes
allowed for this part of the sub-test.

Text B1 - All About Agoraphobia

Paragraph 1

A phobia is generally defined as the unrelenting fear of a situation, activity, or thing

that causes one to want to avoid it. The definition of agoraphobia is a fear of being
outside or otherwise being in a situation from which one either cannot escape or from
which escaping would be difficult or humiliating. Phobias are largely underreported,
probably because many phobia sufferers find ways to avoid the situations to which
they are phobic. The fact that agoraphobia often occurs in combination with panic
disorder makes it even more difficult to track how often it occurs. Other facts about
agoraphobia include that researchers estimate it occurs in less than 1% to almost 7%
of the population and that it is specifically thought to be grossly underdiagnosed.

Paragraph 2

There are a number of theories about what can cause agoraphobia. One hypothesis is
that agoraphobia develops in response to repeated exposure to anxiety-provoking

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Reading Test 11

events. Mental-health theory that focuses on how individuals react to internal

emotional conflicts (psychoanalytic theory) describes agoraphobia as the result of a
feeling of emptiness that comes from an unresolved Oedipal conflict, which is a
struggle between the feelings the person has toward the opposite-sex parent and a
sense of competition with the same-sex parent. Although agoraphobia, like other
mental disorders, is caused by a number of factors, it also tends to run in families,
and for some people, may have a clear genetic factor contributing to its development.

Paragraph 3

The symptoms of agoraphobia include anxiety that one will have a panic attack when
in a situation from which escape is not possible or is difficult or embarrassing.
Examples of such situations include using public transportation, being in open or
enclosed places, being in a crowd, or outside of the home alone. The panic attacks
that can be associated with agoraphobia, like all panic attacks, may involve intense
fear, disorientation, rapid heartbeat, dizziness, or diarrhea. Agoraphobic individuals
often begin to avoid the situations that provoke these reactions. Interestingly, the
situations that people with agoraphobia avoid and the environments that cause people
with balance disorders to feel disoriented are quite similar. This leads some cases of
agoraphobia to be considered as vestibular function (related to balance disorders)
agoraphobia.

Paragraph 4
Interestingly, physicians often diagnose and treat agoraphobia, like other phobias,
when patients seek treatment for other medical or emotional problems rather than as
the primary reason that care is sought. As with other mental disorders, there is no
single, specific test for agoraphobia. The primary-care doctor or psychiatrist will take
a careful history, perform or refer to another doctor for a physical examination, and
order laboratory tests as needed. If someone has another medical condition that he or
she knows about, there may be an overlap of signs and symptoms between the old
and the new conditions. Just determining that anxiety does not have a physical cause
does not immediately identify the ultimate cause. Often, determining the cause
requires the involvement of a psychiatrist, clinical psychologist, and/or other mental-
health professional. In order to establish the diagnosis of agoraphobia, the
professional will likely ask questions to ensure that the anxiety of the sufferer is truly
the result of a fear of being in situations that make it impossible, difficult, or
embarrassing to escape rather than in the context of another emotional problem.

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Reading Test 11

Paragraph 5

There are many treatments available for agoraphobia, including specific kinds of
psychotherapy as well as several effective medications. A specific form of
psychotherapy that focuses on decreasing negative, anxiety-provoking, or other self-
defeating thoughts and behaviors (called cognitive behavioral therapy) has been
found to be highly effective in treating agoraphobia. In fact, when agoraphobia occurs
along with panic disorder, cognitive behavioral therapy, with or without treatment
with medication, is considered to be the most effective way to both relieve symptoms
and prevent their return. In fact, sometimes patients respond equally as well when
treated with group cognitive behavioral therapy or a brief course of cognitive
behavioral therapy as they do when treated with traditional cognitive therapy.
Psychotherapy for agoraphobia is effective for many people when they receive it over
the Internet, which is optimistic news for people who live in areas that are hundreds
of miles from the nearest mental-health professional.

Paragraph 6

Another form of therapy that has been found effective in managing agoraphobia
includes self-exposure. In that intervention, the person either imagines or puts him or
herself into situations that cause increasing levels of agoraphobic anxiety, using
relaxation techniques in each situation in order to master their anxiety. As people
gain access to the Internet, there is increasing evidence that exposure therapy can
also be done effectively through that medium. Phobias are also sometimes treated
using beta-blocker medications, which block the effects of adrenaline on the body. An
example of a beta-blocker medication is propranolol.

Part B -Text B1: Questions 1-11

1 Agoraphobia as per the information given here means

A Fear of going outside

B Fear of being in an open spaces or public spaces
C Fear of being lonely
D A and B

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Reading Test 11

2 Tracking down Agoraphobia is

A Easier as this is associated with pain disorders
B Difficult as this is related to mood fluctuations
C Sometimes difficult and sometimes easy
D Not given

3 Agoraphobia occurs due to

A Anxiety-provoking events
B Internal emotional conflicts
C Unresolved Oedipal conflict
D All of the above

4 Agoraphobia is

A Genetic related
B Non-genetical
C Sometimes genetics
D Can’t say

5 Agoraphobic individuals often avoid

A Being in open spaces
B Public Transportation Facilities
C Playing
D None

6 Virtually all of the medical conditions like Agoraphobia have

A No specific tests
B Specific tests
C A and B
D It is not given

7 The patient suffering from Agoraphobia will have to undergo

A Physical examination
B Laboratory tests
C Mental Health tests
D None

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8 Cognitive behavioral therapy is considered to be highly effective

A With medications
B Without medications
C With or without medications
D in providing relief and stopping the re-occurence of the disease

9 As per the information given, what is considered to be the best?

A Cognitive Behavioral Therapy
B Group Cognitive Therapy
C Psychotherapy
D Traditional Cognitive Therapy

10 Self Exposure Therapy is

A For mild to intense agoraphobia issues
B For people with years of agoraphobia
C A and B
D Not given

11 What are beta-blocker medications?

A Drugs that block the adrenal secretions
B Drugs that block the effect of adrenaline on body
C Drugs that help in reducing the anxiety or restlessness among agoraphobia patients
D None

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Reading Test 11

Text B2 - Xerostomia

Paragraph 1

Dry mouth is a condition that usually results from decreased production of saliva. At
times, xerostomia can make it difficult to speak and may lead to malnutrition.
Extreme dry mouth and salivary gland dysfunction can produce significant and
permanent mouth and throat disorders and can impair a person's quality of life. Dry
mouth is also called xerostomia. It affects about 10% of all people and is more
prevalent in women than men (childrens in some of the rare cases). Disorders of
saliva production affect elderly people and those who are taking prescription and
nonprescription medications most frequently.

Paragraph 2

There are many causes of dry mouth. Dry mouth most commonly occurs as a side
effect of medications that cause decrease saliva production, including blood pressure
medications, antihistamines,antidepressants, diuretics, nonsteroidal anti-
inflammatories, and many others. Other causes of dry mouth are radiation treatments
to treat cancerous tumors of the head and neck, salivary gland diseases, diabetes,
hormonal imbalance, mouth breathing, sleep apnea, and autoimmune disorders such
as Sjögren's syndrome, rheumatoid arthritis, and systemic lupus erythematosus.
Eating disorders, such as bulimia and anorexia, are other risk factors for developing
xerostomia. Salivary production can be decreased if a major salivary duct becomes
blocked, such as from a stone or infection. Dry mouth will often occur during
pregnancy or breastfeeding due to dehydration and hormonal changes. Other
causative factors include stress, anxiety, depression, and dehydration.

Paragraph 3

People complaining of dry mouth may have trouble speaking, eating, tasting food,
and swallowing. Frequently, a dry mouth may be most manifest at night during
sleeping, especially in mouth-breathers. The dryness may cause chapped or cracked
lips, dry eyes, dry throat, pale gums, headaches,dizziness, bad breath or a persistent
cough. Those affected may also complain of sores in their mouth, or a white tongue
indicative of a fungal infection like yeast (candidiasis). Fungal infections occurring in
an individual with dry mouth may be associated with another underlying disease or
disorder such as Addison's disease, HIV, or diabetes. A burning tongue or throat,
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Reading Test 11

periodontitis, ulcers, sores, and inflamed soft tissue are also all effects of oral
dryness. Without a sufficient quantity of saliva to wash food particles off teeth,
neutralize acids in the mouth, and battle the bacteria population, a person frequently
develops multiple cavities - especially around the gum line.

Paragraph 4

When dry mouth is noticed, the dentist can be helpful to obtain a proper diagnosis.
The diagnosis will help in developing a plan for management and treatment. The
dentist will inspect the main salivary glands and ducts to check for blockages and may
measure both stimulated and unstimulated salivary flow. The lips, tongue, and oral
tissues will all be inspected for dryness. Sometimes a patient will still complain of dry
mouth even if salivary flow is adequate. Since the symptoms of dry mouth vary
greatly from individual to individual, treatments vary. Sometimes treatments are
given for prolonged, chronic complaint of dry mouth, even without clinical signs of
changes within the mouth. There is really no way to prevent dry mouth, only the side
effects of dry mouth. It is vital to detect, diagnose, and treat xerostomia as early as
possible to avoid the devastating effects of dry mouth on dental and overall health.

Part B -Text B2: Questions 12-20

12 Xerostomia may lead to

A Malnutrition
B Difficulty in swallowing
C Difficulty in speaking
D All of the above

13 Xerostomia is found in
A Women
B Men
C Children
D Women and Men

14 One of these can be the cause of Dry Mouth

A Antihistamins and Antidepressants
B Blood pressure medications and non-steroidals
C Anti-inflammatory drugs
D Only B and C

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Reading Test 11

15 Dry mouth occurs due to

A an injury to the salivary glands or the blocking of the salivary ducts
B Pregnancy in women
C Chronic conditions of other neck related diseases
D None

16 Dryness of mouth may lead to

A Difficulty in swallowing
B Difficulty in swallowing and speaking
C Chapped lips or cracked lips
D Sore throat

17 As per the information given, most commonly a white tongue is an indicative of

A Diabetes
B Fungal infections
C HIV
D Addison's disease

18 Effects of oral dryness include

A Burning tongue
B Burning throat
C Ulcers and Sores
D All of the above

19 As per the information given, a dentist will focus more on

A Assessing the stimulated or unstimulated salivary flow
B Inspection of the tongue and the oral tissues
C A and B
D None

20 Is it possible to prevent dry mouth?

A Yes
B No
C Sometimes it can be possible to prevent
D Not given

End of Part B

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Reading Test 1 – Part ‘A’

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Reading Test 12

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the summary of Part A - Answer booklet using the information in

the four texts (A1-4) below.

 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.

 Gaps may require 1, 2 or 3 words. Answer ALL questions. Marks are NOT
deducted for incorrect answers.

 You should write your answers next to the appropriate number in the right-
hand column.

 Please use correct spelling in your responses. Do not use abbreviations

unless they appear in the texts.

Text 1

The term hydrocephalus is derived from the Greek words "hydro" meaning water and
"cephalus" meaning head. As the name implies, it is a condition in which the primary
characteristic is excessive accumulation of fluid in the brain. Although hydrocephalus
was once known as "water on the brain," the "water" is actually cerebrospinal fluid
(CSF)--a clear fluid that surrounds the brain and spinal cord. The excessive
accumulation of CSF results in an abnormal widening of spaces in the brain called
ventricles. This widening creates potentially harmful pressure on the tissues of the
brain.

Text 2
Hydrocephalus may be congenital or acquired. Congenital hydrocephalus is present at
birth and may be caused by either events or influences that occur during fetal
development, or genetic abnormalities. Acquired hydrocephalus develops at the time
of birth or at some point afterward. This type of hydrocephalus can affect individuals
of all ages and may be caused by injury or disease. Hydrocephalus may also be
communicating or non-communicating. Communicating hydrocephalus occurs when
the flow of CSF is blocked after it exits the ventricles. This form is called
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Reading Test 12

communicating because the CSF can still flow between the ventricles, which remain
open. Non-communicating hydrocephalus - also called "obstructive" hydrocephalus -
occurs when the flow of CSF is blocked along one or more of the narrow passages
connecting the ventricles. One of the most common causes of hydrocephalus is
"aqueductal stenosis." In this case, hydrocephalus results from a narrowing of the
aqueduct of Sylvius, a small passage between the third and fourth ventricles in the
middle of the brain.

Text 3

There are two other forms of hydrocephalus which do not fit exactly into the
categories mentioned above and primarily affect adults: hydrocephalus ex-vacuo and
normal pressure hydrocephalus. Hydrocephalus ex-vacuo occurs when stroke or
traumatic injury cause damage to the brain. In these cases, brain tissue may actually
shrink. Normal pressure hydrocephalus, a potentially treatable cause of dementia, can
happen to people at any age, but it is most common among the elderly or old or of
age 55 around. It may result from a subarachnoid hemorrhage, head trauma,
infection, tumor, or complications of surgery. However, many people develop normal
pressure hydrocephalus even when none of these factors are present for reasons that
are unknown.

Text 4

The causes of hydrocephalus are still not well understood. Hydrocephalus may result
from inherited genetic abnormalities (such as the genetic defect that causes
aqueductal stenosis) or developmental disorders (such as those associated with
neural tube defects including spina bifida and encephalocele). Other possible causes
include complications of premature birth such as intraventricular hemorrhage,
diseases such as meningitis, tumors, traumatic head injury, or subarachnoid
hemorrhage, which block the exit of CSF from the ventricles to the cisterns or
eliminate the passageway for CSF into the cisterns.

Text 5

The signs and symptoms of hydrocephalus vary generally by age of onset. Common
signs and symptoms of hydrocephalus in infants include: An unusually large head, A
rapid increase in the size of the head, A bulging or tense soft spot (fontanel) on the
top of the head, Vomiting, Sleepiness, Irritability, Poor feeding, Seizures, Eyes fixed
downward (sunsetting of the eyes), Deficits in muscle tone and strength,
responsiveness to touch, and expected growth etc. Among toddlers and older

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Reading Test 12

children, signs and symptoms may include: Abnormal enlargement of a toddler's

head, Headache, Nausea or vomiting, Fever, Delays in walking or talking, Problems
with previously acquired skills, such as walking or talking, Blurred or double vision
etc. Common signs and symptoms among young and middle-aged adults include:
Headache, Difficulty in remaining awake or waking up, Loss of coordination or
balance, Loss of bladder control or a frequent urge to urinate, Impaired vision etc.
Among adults 60 years of age and older, the more common signs and symptoms of
hydrocephalus are: Loss of bladder control or a frequent urge to urinate, Memory
loss, Progressive loss of other thinking or reasoning skills, Difficulty walking, often
described as a shuffling gait or the feeling of the feet being stuck etc.

Summary
Hydrocephalus is a condition that occurs when fluid builds up in the 1…………….. and
causes the 2……. to 3………... The name literally means “water on the brain.” Brain
damage can occur as a result of the 4……….. This can lead to impaired developmental,
physical, and 5……. functions. It requires treatment to prevent serious complications.
Hydrocephalus mainly occurs in children and adults over 60, but younger adults can
get it too. Types of hydrocephalus include: Congenital hydrocephalus and Acquired
hydrocephalus. Congenital hydrocephalus may be caused by physical problems with
6……….. or is made or absorbed, by infections or trauma during 7……….., or by
teratogens. It may be linked with other 8……… defects that affect 9………. , especially
open neural tube defects. Acquired hydrocephalus develops at the time of birth or
10…….... It can be caused by 11……….. such as meningitis, bleeding, 12………..or
……………...

14………………., which usually develops in people who are age 55 or older is a

potentially 15………… dementia This type of hydrocephalus often occurs after head
16….., infections, and bleeding 17……….. Ex-vacuo hydrocephalus, which occurs when
there is damage to the brain caused by 18……………...or 19……….... This type of
20……….. may not be a 21………... for some people, in which case treatment is not
needed. With all types of hydrocephalus, early 22……...and 23……………. are important
to minimize or prevent long-term problems. It shall also be mentioned here that the
causes of hydrocephalus are still not well understood. Hydrocephalus may result from
24……………. or developmental disorders Other possible causes may include
complications of premature birth such as 25…………., diseases such as meningitis,
tumors, traumatic head injury etc. The characteristic symptom seen in infants is
enlargement of the head. An infant's skull expands to accommodate excess CSF
because the 26………….have not closed yet. Very young children commonly experience
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Reading Test 12

irritability, poor feeding, and lethargy. Children and adults may experience the
following symptoms: Blurred or double vision, 27………….., Downward gaze or "sun-
setting eyes", Headaches, Imbalance and dizziness, Incontinence, Irregular gait,
28…………., 29………...etc.

End of Part A

Part B - Text Booklet

Instructions
TIME LIMIT: 45 MINUTES

❏ There are TWO reading texts in Part B. After each of the texts you will find a
number of questions or unfinished statements about the text, each with four
suggested answers or ways of finishing.
❏ You must choose the ONE, which you think, fits best. For each question, 1-20,
indicate on your answer sheet the letter A, B, C or D against the number of the
question.
❏ Answer ALL questions. Marks are NOT deducted for incorrect answers.

NOTE: You must complete your Answer Sheet for Part B within the 45 minutes
allowed for this part of the sub-test.

Text B1 - Renal Artery Stenosis

Paragraph 1

Renal artery stenosis (narrowing) is a decrease in the diameter of the renal arteries.
The resulting restriction of blood flow to the kidneys may lead to impaired kidney
function (renal failure) and high blood pressure (hypertension), referred to as
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Reading Test 12

renovascular hypertension, or RVHT ("reno" for kidney and "vascular" for blood
vessel). Renovascular hypertension is as likely to occur with bilateral stenosis (when
arteries to both kidneys are narrowed) as with unilateral stenosis (when the artery to
one kidney is narrowed). The decreased blood flow to the kidneys impairs renal
function. Renal artery stenosis may cause renal failure in some patients. There is no
predictable relationship between renal failure and renal artery stenosis. Some patients
have very severe bilateral stenosis and normal renal function. Most cases of renal
failure are related to diabetes, hypertension, glomerular sclerosis, contrast
nephropathy, drug toxicity and other causes.

Paragraph 2

The majority of renal artery stenosis is caused by atherosclerosis (hardening

and narrowing of blood vessel wall from the inside) similar to the process that
occurs in blood vessels in the heart and other parts of the body. Risk factors for
atherosclerosis include: high cholesterol levels, high blood pressure, age,
cigarette smoking, diabetes etc. Less common causes of renal artery stenosis
are fibromuscular dysplasia of the vessels (narrowing of the vessel due to
internal thickening of the blood vessel wall), arteritis (inflammation of the
blood vessel), or dissection (tearing and division of the blood vessel wall).

Paragraph 3

Narrowing of the kidney arteries is more common in individuals 50 years of age

and older. It is estimated that some degree of narrowing (greater than 50%) is
found in about 18% of adults between 65-75 years of age and 42% of those
older than 75 years of age. This may be due to the fact that atherosclerosis is
more common in this age group. In younger patients, the narrowing of the
renal artery usually is due to the thickening of the artery (fibromuscular
dysplasia) and it is more common in women than men. It is estimated that
renal artery stenosis accounts for approximately 1% of mild to moderate cases
of high blood pressure. It may be responsible for more than 10% of cases of
severely elevated or difficult to treat high blood pressure (hypertension).

Paragraph 4

In general, renal artery stenosis is not associated with any obvious or specific
symptoms. Suspicious signs for renal artery stenosis include: high blood pressure that
responds poorly to treatment; severe high blood pressure that develops prior to age
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Reading Test 12

30 or greater than age 50; an incidental finding (discovered through routine tests or
tests performed for another condition) of one small kidney compared to a normal
sized one on the other side. Typically, unilateral (one-sided) renal artery stenosis may
be related to high blood pressure whereas bilateral (two-sided) renal artery stenosis
is more often related to diminished kidney function.

Paragraph 5

Several tests exist to detect any evidence of renal artery stenosis. They can be
divided into imaging tests and functional tests. The imaging tests provide a
picture of the blood vessel and its anatomy and reveal the degree of narrowing.
The functional tests provide information about whether the narrowing is
significant enough to cause the high blood pressure or kidney dysfunction. Each
of these tests has advantages and shortcomings.

Paragraph 6

In bilateral (both-sided) and unilateral (one-sided) renal artery stenosis associated

with high blood pressure, controlling the blood pressure with usual blood pressure
medications is the first and the safest treatment. ACE inhibitors or ARB medications
with or without a diuretic (water pill) may be tried first. This approach may be
associated in some patients with worsening of their kidney function. Therefore, kidney
function needs to be followed closely and if worsening of kidney function is evident,
these medications may need to be stopped. It is worth noting that if renal artery
stenosis is found incidentally when performing a test for another disease and there is
no evidence of kidney dysfunction or high blood pressure then no treatment may be
necessary. Sometimes even significant stenosis may not be associated with high
blood pressure or kidney dysfunction. In these situations, periodic monitoring of blood
pressure and kidney function may be advised.

Part B

Text B1 - Renal Artery Stenosis

Questions 1-11

1 Renovascular hypertension is as likely to occur with

A bilateral stenosis
B unilateral stenosis

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Reading Test 12

C both bilateral and unilateral stenosis

D when arteries to one or both kidneys are narrowed

2 Which one of these statements is right according to paragraph 1?

A the increase or decrease in blood flow leads to improper functioning of the kidneys
B renal failure and renal artery stenosis are closely connected to each other
C a patient may have normal renal function even if there is higher bilateral stenosis
D in some cases, bilateral stenosis may affect renal functions too.

3 Renal Artery Stenosis is caused by

A hardening of the blood vessel wall from inside
B hardening of the blood vessels similar to that of the blood vessels in heart
C narrowing and hardening of the walls like that of blood vessels in the heart
D hardening and narrowing of the blood vessels from inside

4 One of the common causes include

A high cholesterol level
B high blood pressure
C thickening of the blood vessels
D arteritis

5 Thickening of the arteries is more common among

A men
B women
C children
D all of the above

6 According to paragraph 4, which one of these following statements is true?

A there are no specific symptoms of the renal artery stenosis
B higher bp which develops before the age of 30 or after the age of 50 can become
the cause of the renal artery stenosis
C untreatable high bp can be the cause of the renal artery stenosis
D differences in sizes of the kidneys can be a major cause of the renal artery stenosis

7 Which one of these statements is true, according to paragraph 4?

A untreatable high blood pressure can be the cause of renal artery stenosis
B renal artery stenosis is divided into unilateral and bilateral stenosis
C poor function of the kidney can be associated with unilateral stenosis
D bilateral stenosis can occur when the kidney stops functioning properly

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Reading Test 12

8 According to paragraph 5, which one of the following statements is not correct?

A imaging tests are the best to detect renal artery stenosis
B functional tests are fairly better in detection of the narrowing or thickening of the
blood vessels.
C both imaging and functional tests can provide a clear picture of the blood vessel
and its anatomy.
D none of the above

9 Functional tests provide

A a clear picture of the blood vessels and its functions
B a clear idea of whether narrowing is significant to cause high bp or kidney
dysfunction
C anatomy of blood vessels
D clear idea of the thickening of the blood vessels

10 The best possible treatment for renal artery stenosis is

A controlling the blood pressure
B using ARB medications for quality functioning of the kidneys
C improving the function of the kidney through proper medications
D none

11 Renal artery stenosis is closely associated with

A kidney dysfunction
B high blood pressure
C low blood pressure
D A and B

Part B
Text B2 - Hematochezia

Paragraph 1

Rectal bleeding (hematochezia, the medical term) is used to describe the presence of
blood with a bowel movement. That blood, whether it fills the commode, or is a streak
on the toilet paper when wiping, or just a few drops in the toilet bowl, is not a normal
finding and should not be ignored. The source of bleeding can be anywhere in the

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Reading Test 12

digestive tract, from the nose and mouth to the rectum and anus. The color can range
from bright red to maroon to black or any shade in between, depending on how much
the blood has been exposed to the digestive juices. Anytime there is blood within the
gastrointestinal system, it will eventually be excreted in stool (feces, bowel
movement, BM). The color of stool will depend upon the amount of blood, the source
of the bleeding and how quickly the stool moves through the digestive tract.
Sometimes, the bleeding is too little to be seen by the naked eye but can be tested
for by the health care professional.

Paragraph 2

Depending upon where and why the bleeding has taken place in the digestive
tract, the stool consistency and color may vary greatly: The stool color may be
bright red, maroon, dark red or black. The bleeding might be hidden, unseen to
the naked eye, but able to be detected by a fecal occult blood test. There may
be just in the bowel movement or there may be associated feces. If the feces
are formed, the blood may be mixed in with the stool or it may just coat the
surface. The stool may be well formed or it may loose and diarrhea like. It may
be normal in shape in size or it may become pencil thin. There may be
associated abdominal pain or the bleeding may be painless.

Paragraph 3

Hemorrhoids are the most common cause of blood in the stool. Blood vessels
located in the walls of the rectum can swell, become inflamed and bleed.
Hemorrhoids can be caused by straining at stool, diarrhea,pregnancy, obesity
and prolonged sitting on the commode. All these factors increase the pressure
within the hemorrhoidal vessels causing them to swell. The bleeding is often
associated with anal burning or itching. Bleeeding can also occur because of
ananal fissure, or a split in the skin of the anus. Hard constipated stool may
cause the skin to split. Other causes include pregnancy and anal intercourse.
Anal fissures are also associated with other diseases including inflammatory
bowel disease (Crohn's disease, ulcerative colitis),cancer and infections. Anal
fissures tend to be very painful, even when sitting. The blood in the stool can
also be due to swallowed blood from a nosebleed, dental work, or other mouth
injuries that cause bleeding.

Paragraph 4

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Rectal bleeding is often diagnosed by history. The health care professional may ask
questions about the circumstances surrounding the rectal bleeding including the color,
the amount of bleeding, any associated symptoms and past medical history.A variety
of medications and food can mimic blood in the stool. Iron supplements and bismuth
(Pepto-Bismol, Kaopectate) can turn stool black, as can beets and licorice. Red food
coloring and beets can turn stool a reddish hue. Patients who take blood thinners
(anticoagulation medications) are more prone to rectal bleeding. Examples of blood
thinners include warfarin (Coumadin),enoxaparin (Lovenox), aspirin and other
antiplatelet drugs including clopidogrel(Plavix), prasugrel (Effient) and rivoroxiban
(Xarelto).

Paragraph 5

Physical examination is important to assess the patient's stability. Vital signs are
important and may include orthostatic vital signs, where the blood pressure and pulse
rate are taken both lying and standing. In a patient with reduced blood volume, the
blood pressure may fall, the pulse rate may rise, and the patient may become
lightheaded and weak when standing. Palpation of the abdomen is performed to look
for tender areas, masses or enlarged organs, especially the liver and spleen. Rectal
examination is performed by inserting a finger into the rectum, with the purpose of
feeling for a mass or other abnormality. The stool color and consistency may be
examined when the finger is withdrawn. The anus also may be examined. Blood tests
may be considered if there is concern about the amount of bleeding or other
associated diseases. A complete blood count (CBC) measures the number of red blood
cells, white blood cells and platelets. Blood clotting tests include PT (protime), INR
(international normalized ratio) and PTT (partial thromboplastin time). Depending
upon the situation, other tests may be ordered to measure electrolytes, and kidney
and liver functions.

Paragraph 6

Most diseases that cause rectal bleeding are likely preventable, but it is not
often possible Hemorrhoids can be avoided with proper diet and hydration to
prevent constipation and straining to pass stool, but normal pregnancy
increases the risk of hemorrhoid formation as does the patient with an acute
diarrheal illness. Avoiding constipation also decreases the risk of diverticulosis,
outpouchings in the lining of the colon, and the risk of a diverticular bleed but
this may be a consequence of a Western diet. Alcohol abuse increases the risk

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Reading Test 12

of rectal bleeding in a variety of ways, from directly irritating the lining of the
GI tract, to decreasing clotting capabilities of blood.

Part B

Text B2 - Hematochezia

Questions 12-20

12 Rectal bleeding describes

A blood in the bowels
B blood in the digestive tract
C blood in the stools
D blood in the rectum

13 Paragraph 2 talks more about

A What symptoms are associated with rectal bleeding?
B Causes of the rectal bleeding
C Variations in the color of the stools
D None

14 “Blood in the stool can originate anywhere in the gastrointestinal tract.”

A False
B True
C Not given
D Sometimes true and sometimes false

15 Hemorrhoids can be well defined by one of the following

A swelling of the rectal walls
B inflammation and bleeding of the rectal walls
C straining
D all of the above

16 Causes of anal fissure may include

A formation of the constipated stool
B inflammatory bowel disease
C cancer and infections
D all of the above

17 According to paragraph 4, which of the following statements is true?

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Reading Test 12

A blood thinners can cause rectal bleeding

B blood thinners may sometimes cause rectal bleeding
C it is not fully established that the rectal bleeding is the direct result of the use of
blood thinners
D none

18 Which one of the following statements is not included in the paragraph 5?

A physical examiners will always look for orthostatic vital signs
B a patient may have low blood pressure with higher pulse rate
C Palpitations of the abdomen is performed to look for tender areas
D rectal bleeding is identified through stool sample taken

19 Which one is the preferred Blood clotting test?

A PT
B INR
C PTT
D not given

20 Paragraph 6 talks more about

A preventive measures related to rectal bleeding
B other reasons related to rectal bleeding
C can blood in the stool (rectal bleeding) be prevented?
D not given

End of Part B

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Reading Test 1 – Part ‘A’

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Reading Test 13

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the summary of Part A - Answer booklet using the information in

the four texts (A1-4) below.

 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.

 Gaps may require 1, 2 or 3 words. Answer ALL questions. Marks are NOT
deducted for incorrect answers.

 You should write your answers next to the appropriate number in the right-
hand column.

 Please use correct spelling in your responses. Do not use abbreviations

unless they appear in the texts.

Text 1

Nasopharyngeal cancer, very rare in US but common in most of the south east asian
parts, is a disease in which malignant (cancer) cells form in the tissues of the
nasopharynx. The nasopharynx is the upper part of the pharynx (throat) behind the
nose. The pharynx is a hollow tube about 5 inches long that starts behind the nose
and ends at the top of the trachea (windpipe) and esophagus (the tube that goes
from the throat to the stomach). Air and food pass through the pharynx on the way to
the trachea or the esophagus. The nostrils lead into the nasopharynx. An opening on
each side of the nasopharynx leads into an ear. Nasopharyngeal cancer most
commonly starts in the squamous cells that line the oropharynx (the part of the
throat behind the mouth).

Text 2

Ethnic background and exposure to the Epstein-Barr virus can affect the risk of
developing nasopharyngeal cancer. Anything that increases your risk of getting a
disease is called a risk factor. Risk factors may include the following: Chinese or Asian

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Reading Test 13

ancestry, Exposure to the Epstein-Barr virus: The Epstein-Barr virus has been
associated with certain cancers, including nasopharyngeal cancer and some
lymphomas. Possible signs of nasopharyngeal cancer include trouble breathing,
speaking, or hearing. These and other symptoms may be caused by nasopharyngeal
cancer. Other conditions may cause the same symptoms. A doctor should be
consulted if any of the following problems occur:

● A lump in the nose or neck.

● A sore throat.
● Trouble breathing or speaking.
● Nosebleeds.
● Trouble hearing.
● Pain or ringing in the ear.
● Headaches.

Text 3

Tests that examine the nose and throat are used to detect (find) and diagnose
nasopharyngeal cancer. The following tests and procedures may be used:

● Physical exam of the throat: An exam in which the doctor feels for swollen
lymph nodes in the neck and looks down the throat with a small, long-handled
mirror to check for abnormal areas.
● Nasoscopy: A procedure to look inside the nose for abnormal areas. A
nasoscope is inserted through the nose. A nasoscope is a thin, tube-like
instrument with a light and a lens for viewing. It may also have a tool to
remove tissue samples, which are checked under a microscope for signs of
cancer.
● Neurological exam: A series of questions and tests to check the brain, spinal
cord, and nerve function. The exam checks a person's mental status,
coordination, and ability to walk normally, and how well the muscles, senses,
and reflexes work. This may also be called a neuro exam or a neurologic exam.

Text 4

There are different types of treatment for patients with nasopharyngeal cancer.
Different types of treatment are available for patients with nasopharyngeal cancer.
Some treatments are standard (the currently used treatment), and some are being
tested in clinical trials. Before starting treatment, patients may want to think about
taking part in a clinical trial. A treatment clinical trial is a research study meant to
help improve current treatments or obtain information on new treatments for patients
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Reading Test 13

with cancer. When clinical trials show that a new treatment is better than the
standard treatment, the new treatment may become the standard treatment. Clinical
trials are taking place in many parts of the country. Information about ongoing clinical
trials is available from the NCI Web site. Choosing the most appropriate cancer
treatment is a decision that ideally involves the patient, family, and health care team.
Three types of standard treatment are used: Radiation Therapy, Chemotherapy,
surgery.

Summary

Nasopharyngeal carcinoma is cancer that occurs in the1……………., which is located

behind your nose and above the back of your 2……….. Nasopharyngeal carcinoma is
rare in the but in other parts of the world - specifically 4……... - nasopharyngeal
carcinoma occurs much more frequently. Nasopharyngeal carcinoma is difficult to
5……….. That's probably because the nasopharynx isn't easy to 6……...and 7…….. of
nasopharyngeal carcinoma 8………. those of other more 9……….... Treatment for
nasopharyngeal carcinoma usually involves 10…………, 11…………..or a combination
12…….... You can work with your doctor to determine the 13………... depending on
your 14……….. Researchers have identified 15…….. that appear to increase your risk
16……….. nasopharyngeal carcinoma, including:17……. virus. This common virus
usually produces 18………... and symptoms, such as those of a cold. Epstein-Barr
virus is also linked to several rare cancers, including nasopharyngeal carcinoma.
Family history. Having a family member with nasopharyngeal carcinoma increases
your risk 19…………...

Tests and procedures used to diagnose nasopharyngeal carcinoma include: Physical

exam. Diagnosing 20…………..usually begins with a general examination. Your doctor
will ask questions about your 21….... He or she may press on your neck to feel for
22…….. in your 23………… If nasopharyngeal carcinoma is suspected, your doctor may
recommend a nasal 24………... You and your doctor work together to devise a
treatment plan based on several factors, such as the stage of your cancer, your
treatment goals, your overall health and the side effects you're willing to tolerate.
Treatment for nasopharyngeal carcinoma usually begins with radiation therapy or a
combination of 25………..and 26…………....

End of Part A

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Reading Test 13

Part B - Text Booklet

Instructions

TIME LIMIT: 45 MINUTES

❏ There are TWO reading texts in Part B. After each of the texts you will find a
number of questions or unfinished statements about the text, each with four
suggested answers or ways of finishing.
❏ You must choose the ONE, which you think, fits best. For each question, 1-20,
indicate on your answer sheet the letter A, B, C or D against the number of the
question.
❏ Answer ALL questions. Marks are NOT deducted for incorrect answers.

NOTE: You must complete your Answer Sheet for Part B within the 45 minutes
allowed for this part of the sub-test.

Text B1 - What is Creutzfeldt-Jakob Disease?

Paragraph 1

Creutzfeldt-Jakob disease is a degenerative brain disorder that leads to dementia and,

ultimately, death. Symptoms of Creutzfeldt-Jakob disease (CJD) sometimes resemble
those of other dementia-like brain disorders, such as Alzheimer's, but Creutzfeldt-
Jakob disease usually progresses much more rapidly. Creutzfeldt-Jakob disease
captured public attention in the 1990s when some people in the United Kingdom
developed a form of the disease — variant CJD (vCJD) — after eating meat from
diseased cattle. However, "classic" Creutzfeldt-Jakob disease has not been linked to
contaminated beef. Although serious, CJD is rare, and vCJD is the least common
form. Worldwide, there is an estimated one case of Creutzfeldt-Jakob disease
diagnosed per million people each year, most commonly in older adults, if not among
children.

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Reading Test 13

Paragraph 2

Creutzfeldt-Jakob disease is marked by rapid mental deterioration, usually within a

few months. Initial signs and symptoms of CJD typically include: Personality changes,
Anxiety, Depression, Memory loss, Impaired thinking, Blurred vision, Insomnia,
Difficulty speaking, Difficulty swallowing and Sudden, jerky movements. As the
disease progresses, mental symptoms worsen. Most people eventually lapse into a
coma. Heart failure, respiratory failure, pneumonia or other infections are generally
the cause of death. The disease usually runs its course in about seven months,
although a few people may live up to one or two years after diagnosis. In people with
the rarer vCJD, psychiatric symptoms may be more prominent in the beginning, with
dementia — the loss of the ability to think, reason and remember - developing later in
the course of the illness. In addition, this variant affects people at a younger age than
classic CJD does, and appears to have a slightly longer duration - 12 to 14 months.

Paragraph 3

Creutzfeldt-Jakob disease and its variants belong to a broad group of human and
animal diseases known as transmissible spongiform encephalopathies (TSEs). The
name derives from the spongy holes, visible under a microscope, that develop in
affected brain tissue. The cause of Creutzfeldt-Jakob disease and other TSEs appears
to be abnormal versions of a kind of protein called a prion. Normally, these proteins
are harmless, but when they're misshapen they become infectious and can wreak
havoc on normal biological processes. The risk of CJD is low. The disease can't be
transmitted through coughing or sneezing, touching, or sexual contact. The three
ways it develops are: Sporadically: Most people with classic CJD develop the disease
for no apparent reason. CJD that occurs without explanation is termed spontaneous
CJD or sporadic CJD and accounts for the majority of cases. By inheritance: In the
United States, about 5 to 10 percent of people with CJD have a family history of the
disease or test positive for a genetic mutation associated with CJD. This type is
referred to as familial CJD. By contamination: A small number of people have
developed CJD after being exposed to infected human tissue during a medical
procedure, such as a cornea or skin transplant. Also, because standard sterilization
methods do not destroy abnormal prions, a few people have developed CJD after
undergoing brain surgery with contaminated instruments. Cases of CJD related to
medical procedures are referred to as iatrogenic CJD. Variant CJD is linked primarily
to eating beef infected with bovine spongiform encephalopathy (BSE), the medical
term for mad cow disease.

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Paragraph 4

Most cases of Creutzfeldt-Jakob disease occur for unknown reasons, and no risk
factors can be identified. However, a few factors seem to be associated with different
kinds of CJD. Age: Sporadic CJD tends to develop later in life, usually around the age
of 60. Onset of familial CJD occurs only slightly earlier. On the other hand, vCJD has
affected people at a much younger age, usually in their late 20s. Genetics: People
with familial CJD have a genetic mutation that causes the disease. The disease is
inherited in an autosomal dominant fashion, which means you need to inherit only
one copy of the mutated gene, from either parent, to develop the disease. If you have
the mutation, the chance of passing it on to your children is 50 percent. Genetic
analysis in people with iatrogenic and variant CJD suggest that inheriting identical
copies of certain variants of the prion gene may predispose a person to developing
CJD if exposed to contaminated tissue. Exposure to contaminated tissue: People
who've received HGH derived from human pituitary glands or who've had dura mater
grafts may be at risk of iatrogenic CJD. The risk of contracting vCJD from eating
contaminated beef is difficult to determine. In general, if countries are effectively
implementing public health measures, the risk is virtually nonexistent.

Paragraph 5

Only a brain biopsy or an examination of brain tissue after death (autopsy) can
confirm the presence of Creutzfeldt-Jakob disease. But doctors often can make an
accurate diagnosis based on your medical and personal history, a neurological exam,
and certain diagnostic tests. The exam is likely to reveal such characteristic
symptoms as muscle twitching and spasms, abnormal reflexes, and coordination
problems. People with CJD also may have areas of blindness and changes in visual-
spatial perception. In addition, doctors commonly use these tests to help detect CJD:
Electroencephalogram (EEG): Using electrodes placed on your scalp, this test
measures your brain's electrical activity. People with CJD and vCJD show a
characteristically abnormal pattern. Magnetic resonance imaging (MRI): This
technique uses radio waves and a magnetic field to create cross-sectional images of
your head and body. It's especially useful in diagnosing brain disorders because of its
high-resolution images of the brain's white matter and gray matter. Spinal fluid tests:
Cerebrospinal fluid surrounds and cushions your brain and spinal cord. In a test called
a lumbar puncture — popularly known as a spinal tap - doctors use a needle to
withdraw a small amount of this fluid for testing. The presence of a particular protein
in spinal fluid is often an indication of CJD or vCJD.
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Paragraph 6

No effective treatment exists for Creutzfeldt-Jakob disease or any of its variants. A

number of drugs have been tested - including steroids, antibiotics and antiviral agents
- and have not shown benefits. For that reason, doctors focus on alleviating pain and
other symptoms and on making people with these diseases as comfortable as
possible.

Questions 1-11

1 Which disease progresses faster?

A Alzheimer
B Jakob
C Both Alzheimer and jakob
D Not given

2 Creutzfeldt-Jakob disease is commonly found among adults or elderly people

A False
B True
C False, because it is found among children too
D Not given

3 One of these is not the symptom of the disease

A Personality changes
B Difficulty in swallowing
C Loss of memory
D Loss of Vision

4 The people affected with the disease may die after

A one year
B two year
C 12-14 months
D not given

5 Paragraph 3 talks more about it

A symptoms
B occurrence
C transmission
D prevention

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6 CJD is
A transmitted by virus
B genetic
C develops more commonly after brain surgery in some people
D can’t say

7 One of the most common risk factors include

A exposure to contaminated tissue
B age
C genetics
D b and c

8 “People who may have got human growth hormone derived from human pituitary
glands may be at risk of iatrogenic CJD.”
A 100% true
B 100% false
C 50% true
D 50% false

9 “Confirmation of the Creutzfeldt-Jakob disease can be done only after the death of
the person.”
A true
B false
C true in some cases
D not given

10 What is most helpful in detecting CJD?

A electroencephalogram (EEG)
B spinal fluid exams
C MRI
D all of the above

11What can be most effective in treating CJD?

A steroids
B antibiotics
C antiviral agents
D not given

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Reading Test 13

Part B

B2 - Heat Rash

Paragraph 1

The skin's job is to protect the inside of the body from the outside world. It acts as a
preventive barrier against intruders that cause infection, chemicals, or ultraviolet light
from invading or damaging the body. It also plays an important role in the body's
temperature control. One way that the body cools itself is by sweating, and allowing
that sweat or perspiration to evaporate. Sweat is manufactured in sweat glands that
line the entire body (except for a few small spots like fingernails, toenails, and the ear
canal). Sweat glands are located in the dermis or deep layer of the skin, and are
regulated by the temperature control centers in the brain. Sweat from the gland gets
to the surface of the skin by a duct. A heat rash occurs when sweat ducts become
clogged and the sweat can't get to the surface of the skin. Instead, it becomes
trapped beneath the skin's surface causing a mild inflammation or rash. Heat rash is
also called prickly heat or miliaria.

Paragraph 2

It is uncertain why some people get heat rashes and others don't. The sweat gland
ducts can become blocked if excessive sweating occurs, and that sweat is not allowed
to evaporate from a specific area. Some examples of how blockage may occur include
the following: Creases in the skin like the neck, armpit, or groin have skin touching
adjacent skin, which makes it difficult for air to circulate, and prevents sweat
evaporation. Tight clothing that prevents sweat evaporation. Bundling up in heavy
clothing or sheets. This may occur when a person tries to keep warm in wintertime or
when chilled because of an illness with fever. Heavy creams or lotions can clog sweat
ducts. Babies have immature sweat glands that aren't able to remove the sweat they
produce. They can develop heat rash if they are exposed to warm weather, are
overdressed, excessively bundled, or have a fever. Heat rash may occur as a side
effect of some medications (for example, isotretinoin [Accutane] or clonidine
[Catapres]).

Paragraph 3

The common symptoms of heat rash are red bumps on the skin, and an itchy or
prickly feeling to the skin. These are due to inflammation of the superficial layers of
the skin (the epidermis) and the prickly sensation is similar to the feeling of mild
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Reading Test 13

sunburn. The symptoms of heat rash are the same in infants and adults; however,
since an infant can't complain about the rash sensation, he or she may be fussy.
Newborns, infants, the elderly, and obese individuals with large areas with skin-on-
skin contact areas (for example, a large overlapping area of abdominal fat or
panniculus) are at risk for developing heat rash. They all are especially at risk if they
are immobile for long periods of time and parts of the skin aren't exposed to
circulating air, which results in the inability of the sweat ducts to "breathe"
(evaporative cooling). Heat rashes are more common in places with hot, humid,
climates because people sweat more. Intense exercise associated with lots of
sweating may cause a heat rash, especially if the clothing worn does not allow
adequate air circulation.

Paragraph 4

The appearance of the heat rash depends upon where the excess sweat gets
deposited in the skin. Tiny blisters that look like small beads of sweat are seen if the
sweat is blocked at the most superficial layers of the skin where the sweat duct opens
on the skin surface. Called miliaria crystalline, it has no symptoms other than these
"sweat bubbles." Classic heat rash or miliaria rubra occurs if the sweat causes
inflammation in the deeper layers of the epidermis. Like any other inflammation, the
area becomes red and the blisters become slightly larger. Because the sweat glands
are blocked and don't deliver sweat to the skin's surface, the area involved is dry and
can be irritated, itchy, and sore. This rash is also called prickly heat. Less commonly,
after repeated episodes of prickly heat, the heat rash may inflame the deeper layer of
the skin called the dermis, and cause miliaria profunda. This rash is made up of
larger, harder bumps that are more skin colored. The rash begins almost immediately
after exercise, and again no sweat can be found on the affected areas. Rarely, this
type of heat rash may be potentially dangerous if enough skin is involved, since the
lack of sweating can lead to heat-related illnesses like heat cramps, heat exhaustion,
or heat stroke.

Paragraph 5

Heat rash or prickly heat is detected by physical examination. Knowing that the rash
appears during sweating or heat, appreciating the location on the body (in skin
creases or where clothes fit tightly) and seeing what the rash looks like is enough to
make the diagnosis. As with many rashes, the health care professional may look at
the involved skin and because of previous experience, immediately make the
diagnosis. Effective recovery process may depend more on treating heat rash include

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Reading Test 13

with remedies such as over-the-counter creams and sprays. Medical treatment for
heat rash may involve antibiotics if the sweat glands become infected.

Questions 12-20

12 Heat rash develops when

A sweat ducts become clogged
B sweat can't come out onto the skin
C skin stops developing sweat
D none

13 One of the common reasons given for the blockage of the sweat glands
A excessive sweat is not allowed to evaporate from the skin
B creases in the skin which makes circulation difficult
C tight clothing
D heavy creams and lotions

14 In babies, heat rash often develops due to

A warm weather
B overdressing
C fever
D not given

15 Paragraph 3 talks more about

A risk factors
B who is at the risk?
C symptoms
D development of the disease

16 Heat rash is common in

A cold areas
B areas with higher humidity
C desert areas
D B and C

17 Paragraph 4 talks more about

A heat rash symptoms
B mode of occurrence
C what does heat rash look like?
D B and C
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18 Heath rash may cause “miliaria profunda.”

A true in some cases
B false
C 100% true
D not given

19 Paragraph 5 talks more about

A diagnosis
B treatment
C 50 % treatment and 50 % diagnosis
D not given

20 Medical treatment for heat rash is effective

A when the blockage is high
B when the blockage is mild
C when the blockage is low
D when home remedies are ineffective

End of Part B

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Reading Test 1 – Part ‘A’

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Reading Test 14

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the summary of Part A - Answer booklet using the information in

the four texts (A1-4) below.

 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.

 Gaps may require 1, 2 or 3 words. Answer ALL questions. Marks are NOT
deducted for incorrect answers.

 You should write your answers next to the appropriate number in the right-
hand column.

 Please use correct spelling in your responses. Do not use abbreviations

unless they appear in the texts.

Text 1

Optic neuritis is an inflammation of the optic nerve, the bundle of nerve fibers that
transmits visual information from your eye to your brain. Pain and temporary vision
loss are common symptoms of optic neuritis. Optic neuritis is highly associated with
multiple sclerosis, a disease that causes inflammation and damage to nerves in your
brain and spinal cord. In some people, signs and symptoms of optic neuritis may be
the first indication of multiple sclerosis. Most people who have a single episode of
optic neuritis eventually recover their vision. Treatment with steroid medications may
speed up vision recovery after optic neuritis.

Text 2

Optic neuritis usually affects one eye. Symptoms might include:

● Pain. Most people who develop optic neuritis experience eye pain that's
worsened by eye movement. Sometimes the pain feels like a dull ache behind
the eye.

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● Vision loss. Most people experience at least some temporary reduction in vision,
but the extent of vision loss varies. Noticeable vision loss usually develops over
hours or days (1 to 2 weeks as well). Exercise or a hot bath or shower may
exaggerate the vision loss. Vision loss is permanent in some cases.
● Loss of color vision. Optic neuritis often affects color perception. You might
notice that colors appear less vivid than normal.
● Flashing lights. Some people with optic neuritis report seeing flashing or
flickering lights.

Text 3

The exact cause of optic neuritis is unknown. However, optic neuritis is believed to
develop when the immune system mistakenly targets the substance covering your
optic nerve (myelin), resulting in inflammation and damage to the myelin. Normally,
the myelin helps electrical impulses travel quickly from the eye to the brain, where
they're converted into visual information. Optic neuritis disrupts this process, affecting
vision.

The following autoimmune conditions often are associated with optic neuritis:

● Multiple sclerosis. Multiple sclerosis is a disease in which your auto immune

system attacks the myelin sheath covering nerve fibers in your brain and spinal
cord. In people with optic neuritis, the risk of developing multiple sclerosis
following one episode of optic neuritis is about 50 percent over a lifetime.
● Your risk of developing multiple sclerosis after optical neuritis increases further
if an MRI scan shows lesions on your brain.
● Neuromyelitis optica. In this condition, inflammation occurs in the optic nerve
and spinal cord. Neuromyelitis optica has similarities to multiple sclerosis, but
neuromyelitis optica doesn't cause damage to the nerves in the brain as often
as multiple sclerosis does. Optic neuritis arising from neuromyelitis optica tends
to be more severe than optic neuritis associated with multiple sclerosis.

Other autoimmune conditions, such as sarcoidosis and systemic lupus erythematosus,

have also been associated with optic neuritis. Other factors that have been linked to
the development of optic neuritis include: Infections: Bacterial infections, including
Lyme disease, cat-scratch fever and syphilis, or viruses such as measles, mumps and
herpes can cause optic neuritis. Drugs: Some drugs have been associated with the
development of optic neuritis. One of these drugs is ethambutol (Myambutol), which
is used to treat tuberculosis.

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Text 4

Risk factors for optic neuritis arising from autoimmune disorders include:
● Age. Optic neuritis most often affects young adults ages 20 to 40 years.
● Sex. Women are much more likely to develop optic neuritis than men are by a
ratio of 3-to-1.
● Race. In the United States, optic neuritis occurs more frequently in whites than
it does in blacks.
● Genetic mutations. Certain genetic mutations might increase your risk of
developing optic neuritis or multiple sclerosis.

Text 5

You're likely to see an ophthalmologist for a diagnosis, which is generally based on

your medical history and an exam. The ophthalmologist likely will perform the
following eye tests:
● A routine eye exam. Your eye doctor will check your vision and your ability to
perceive colors.
● Ophthalmoscopy. During this examination, your doctor shines a bright light into
your eye and examines the structures at the back of your eye. This eye test
evaluates the optic disk, where the optic nerve enters the retina in your eye.
The optic disk becomes swollen in about one-third of people with optic neuritis.
● Pupillary light reaction test. Your doctor may move a flashlight in front of your
eyes to see how your pupils respond when they're exposed to bright light.
Pupils in eyes affected by optic neuritis don't constrict as much as those in
healthy eyes do when stimulated by light.

Other tests to diagnose optic neuritis may include:

● Visual evoked response. During this test, you sit before a screen on which an
alternating checkerboard pattern is displayed. Attached to your head are wires
with small patches to record your brain's responses to the visual stimuli. This
type of test detects the slowing of electrical conduction resulting from damage
to the optic nerve.
● Magnetic resonance imaging (MRI) scan. An MRI scan uses a magnetic field and
pulses of radio wave energy to make pictures of your body. During an MRI to
check for optic neuritis, you may be injected with a contrast solution to make
the optic nerve and other parts of your brain more visible on the images.

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Reading Test 14

● An MRI is important to determine whether there are damaged areas (lesions) in

your brain, which indicate a high risk of developing multiple sclerosis. An MRI
can also rule out other causes of visual loss, such as a tumor.
● Blood tests. A blood test is available to check for antibodies for neuromyelitis
optica. People with severe optic neuritis may undergo this test to determine
whether they're likely to develop neuromyelitis optica (Blood tests like sed rate,
thyroid function, antinuclear antibodies, etc. that can be performed to look for
other causes of optic neuritis/neuropathy).

Summary

Optic neuritis is an 1………. that affects the 2……………. of the optic nerve, which
transmits 3…………………….. to the brain. The optic nerve is actually a nerve tract of
axons that originate in the 4………………. of the retina. Nerve tracts are the information
pathways in the brain. The "optic nerves" are the only nerve tracts not located
entirely within the brain. The optic nerves carry visual information from the retina to
the brain stem, where the 5…………...to the area of the brain that recognizes vision
(the occipital cortex). Optic neuritis can occur in 6……………. or 7…………… and may
involve either one or both optic nerves. Optic neuritis typically affects young adults
ranging from 8…………..age. The precise cause of optic neuritis is unknown, but it is
thought to be a type of 9………….. The immune system is generally used to fight
infection by creating a reaction that combats bacteria, viruses, fungi, and other
foreign proteins. In autoimmune diseases, this reaction is 10…………. against a normal
part of the body, creating 11……... and potential damage. In the case of optic neuritis,
the optic nerve becomes 12………...and its function is 13…….... There are a variety of
conditions that can affect the optic nerve causing symptoms similar to optic neuritis
(optic neuropathies). The major symptom of optic neuritis is 14…….., usually in one
eye, often developing within hours to a couple of days and peaking in 1 to 2 weeks. It
may vary from a small area of blurring to 15…….... Affected individuals may also
notice distorted vision, reduced color vision, 16………. and washed-out or less vivid
vision than normal. Symptoms may be worsened by heat or 17…….. Vision loss is
usually 18…..., but it may be permanent in some cases. Most people who develop
optic neuritis experience eye temporary 19…….. that is worsened by eye movement.
The intensity of the pain usually follows the course of the vision loss. Because optic
neuritis usually affects one eye, patients may be unaware of subtle visual loss or
changes in the color vision until they or doctors close or cover the healthy eye. Optic
neuritis is suspected based on the characteristic history of eye pain and vision loss.
The standard exam includes visual acuity, 20………….., visual field evaluation, color
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Reading Test 14

vision testing, and visualization of the optic disc by direct and indirect 21……….. A
person experiencing a first episode of optic neuritis should undergo an 22……. brain to
look for the central nervous system lesions associated with MS. The MRI may also
show an enlarged optic nerve. Visual symptoms usually progress for the first couple
weeks, and then start to improve within the first month. If the course of recovery is
not typical, then there are a number of 23……..like the sed rate, 24……….., 25…………..
etc. that can be performed to look for other causes of optic neuritis/neuropathy.

End of Part A

Part B - Text Booklet

Instructions

TIME LIMIT: 45 MINUTES

❏ There are TWO reading texts in Part B. After each of the texts you will find a
number of questions or unfinished statements about the text, each with four
suggested answers or ways of finishing.
❏ You must choose the ONE, which you think, fits best. For each question, 1-20,
indicate on your answer sheet the letter A, B, C or D against the number of the
question.
❏ Answer ALL questions. Marks are NOT deducted for incorrect answers.

NOTE: You must complete your Answer Sheet for Part B within the 45 minutes
allowed for this part of the sub-test.

B1 - Ulcerative colitis

Paragraph 1

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Reading Test 14

Ulcerative colitis is a chronic inflammation of the large intestine (colon). The colon is
the part of the digestive system where water is removed from undigested material,
and the remaining waste material is stored. The rectum is the end of the colon
adjacent to the anus. In patients with ulcerative colitis, ulcers and inflammation of the
inner lining of the colon lead to symptoms of abdominal pain, diarrhea, and rectal
bleeding. Ulcerative colitis is closely related to another condition of inflammation of
the intestines called Crohn's disease. Together, they are frequently referred to as
inflammatory bowel disease (IBD). Ulcerative colitis and Crohn's diseases are chronic
conditions that can last years to decades. They affect approximately 500,000 to 2
million people, in the United States. Men and women are affected equally. They most
commonly begin during adolescence and early adulthood, but they also can begin
during childhood and later in life. It is found worldwide, but is most common in the
United States, England, and northern Europe. It is especially common in people of
Jewish descent. Ulcerative colitis is rarely seen in Eastern Europe, Asia, and South
America, and is rare in the black population. For unknown reasons, an increased
frequency of this condition has been observed recently in developing nations.

Paragraph 2

The cause of ulcerative colitis is not known. To date, there has been no convincing
evidence that it is caused by infection or is contagious. Ulcerative colitis likely involves
abnormal activation of the immune system in the intestines. Normally, the immune
system is activated only when the body is exposed to harmful invaders. In patients
with ulcerative colitis, however, the immune system is abnormally and chronically
activated in the absence of any known invader. The continued abnormal activation of
the immune system causes chronic inflammation and ulceration. The susceptibility to
abnormal activation of the immune system is genetically inherited. First degree
relatives (brothers, sisters, children, and parents) of patients with IBD are thus more
likely to develop these diseases. In the last 1 to 2 years, there have been multiple
studies using genome wide association scans investigating genetic susceptibility in
ulcerative colitis. These studies have found there to be approximately 30 genes that
might increase susceptibility to ulcerative colitis including immunoglobulin receptor
gene FCGR2A, 5p15, 2p16, ORMDL3, ECM1, as well as regions on chromosomes
1p36, 12q15, 7q22, 22q13, and IL23R. At this early point in the research, it is still
unclear how these genetic associations will be applied to treating the disease, but
they might have future implications for understanding pathogenesis and creating new
treatments.

Paragraph 3

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Common symptoms of ulcerative colitis include rectal bleeding, abdominal pain, and
diarrhea, but there is a wide range of symptoms among patients with this disease.
Variability of symptoms reflects differences in the extent of disease (the amount of
the colon and rectum that are inflamed) and the intensity of inflammation. The
different types of ulcerative colitis are classified according to the location and the
extent of inflammation: Ulcerative proctitis refers to inflammation that is limited to
the rectum. In many patients with ulcerative proctitis, mild intermittent rectal
bleeding may be the only symptom. Other patients with more severe rectal
inflammation may, in addition, experience rectal pain, urgency (sudden feeling of
having to defecate and a need to rush to the bathroom for fear of soiling), and
tenesmus (ineffective, painful urge to move one's bowels caused by the
inflammation). Proctosigmoiditis involves inflammation of the rectum and the sigmoid
colon (a short segment of the colon contiguous to the rectum). Symptoms of
proctosigmoiditis, like that of proctitis, include rectal bleeding, urgency, and
tenesmus. Pancolitis or universal colitis refers to inflammation affecting the entire
colon (right colon, left colon, transverse colon and the rectum). Symptoms of
pancolitis include bloody diarrhea, abdominal pain and cramps, weight loss, fatigue,
fever, and night sweats. Some patients with pancolitis have low-grade inflammation
and mild symptoms that respond readily to medications. Generally, however, patients
with pancolitis suffer more severe disease and are more difficult to treat than those
with more limited forms of ulcerative colitis. Fulminant colitis is a rare but severe form
of pancolitis.

Paragraph 4

The detection of ulcerative colitis is suggested by the symptoms of abdominal pain,

rectal bleeding, and diarrhea. As there is no gold standard for diagnosis, the ultimate
diagnosis relies on a combination of symptoms, the appearance of the colonic lining at
the time of endoscopy, histologic features of biopsies of the colonic lining, and studies
of stool to exclude the presence of infectious agents that may be causing the
inflammation. Stool specimens are collected for analysis to exclude infection and
parasites, since these conditions can cause colitis that mimics ulcerative colitis. Blood
tests may show anemia and an elevated white blood cell count or sedimentation rate
(commonly referred to as sed rate). An elevated white blood cell count and sed rate
both reflect ongoing inflammation, but may be elevated with any type of chronic
inflammation including UC and Crohn's disease. Other blood tests also may be
checked including kidney function, liver function tests, iron studies, and C-reactive
protein (another sign of inflammation). There is some evidence that a stool test for a
protein called calprotectin could be useful in identifying patients who would benefit
from colonoscopy. Calprotectin seems to be a sensitive marker of intestinal
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Reading Test 14

inflammation meaning that it can be elevated before symptoms become severe and
the signs of inflammation are unclear.

Paragraph 5

Patients with ulcerative colitis limited to the rectum (proctitis) or colitis limited to the
end of the left colon (proctosigmoiditis) usually do quite well. Brief periodic
treatments using oral medications or enemas may be sufficient. Serious complications
are rare in these patients. In those with more extensive disease, blood loss from the
inflamed intestines can lead to anemia and may require treatment with iron
supplements or even blood transfusions. Rarely, the colon can acutely dilate to a
large size when the inflammation becomes very severe. This condition is called toxic
megacolon. Patients with toxic megacolon are extremely ill with fever, abdominal pain
and distention, dehydration, and malnutrition. Unless the patient improves rapidly
with medication, surgery usually is necessary to prevent colonic rupture. In a
published Scandinavian study of over 500 patients with ulcerative colitis followed for
up to 10 years after diagnosis, it was found that their mortality rate did not differ
from the general population. Also, the cumulative need for colectomy after 10 years
was 9.8%, nearly 50% of the patients were relapse free in the last five years of the
study, and only 20% of the patients with proctitis or left-sided disease progressed to
pancolitis. Complications of ulcerative colitis can involve other parts of the body. Ten
percent of the patients can develop inflammation of the joints (arthritis). Some
patients have low back pain due to arthritis of the sacroiliac joints. Others can have
painful, red eyes (uveitis, episcleritis). Because these particular complications can risk
permanent vision impairment, eye pain or redness are symptoms that require a
physician's evaluation. Diseases of the liver and bile ducts also may be associated
with ulcerative colitis.

Questions 1-11

1 Ulcerative colitis can be direct cause of

A abdominal pain
B diarrhea
C rectal bleeding
D not given

2 Who are more affected?

A men
B women
C men and women
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Reading Test 14

D children

3 One of the major causes for the development of the ulcerative colitis
A intense inflammation due to poor immunity
B low defence mechanism of the body
C abnormal functioning of the immune system
D not given
4 Commonest immuno globin receptor gene(s
A FCGR2A
B 5p15, and 2p15
C ORMDL3, ECM5,
D Not given here

5 Rectal bleeding, urgency, and tenesmus are common symptoms of

A ulcerative proctitis
B pancolitis or universal coliti
C proctosigmoiditis
D B and C

6 What is more difficult to treat?

A ulcerative proctitis
B proctosigmoiditis
C pancolitis
D not given here

7 Paragraph 4 talks more about

A how is the Diagnosis of Ulcerative Colitis Made?
B how treatment is offered?
C detection methodologies
D symptoms in general

8 Which test can be more effective in identifying the disease?

A stool test like calprotectin
B blood test
C both stool and blood tests
D not given in the paragraph

9 Calprotectin can be elevated well before the symptoms become hard to tackle
A 50% true
B false
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C 100% true
D not related to the paragraph given

10 According to paragraph 5, blood can occur more due to

A ulcerative colitis
B anemia
C loss of iron supplements
D blood drainage

11As per paragraph 5, commonest complications involve

A development of the inflammation of the joints
B low back pain
C vision impairment
D Not given

End of B1

B2 - What is Idiopathic Thrombocytopenic Purpura (ITP)?

Paragraph 1

Idiopathic thrombocytopenic purpura (ITP) is a bleeding condition in which the blood

doesn't clot as it should. This is due to a low number of blood cell fragments called
platelets (PLATE-lets). Platelets also are called thrombocytes (THROM-bo-sites).
They're made in your bone marrow along with other kinds of blood cells. Platelets
stick together (clot) to seal small cuts or breaks on blood vessel walls and stop
bleeding. You can understand the name of this disease by an explanation of its three
parts. "Idiopathic" (id-ee-o-PATH-ick) means that the cause of the condition isn't
known. "Thrombocytopenic" (throm-bo-cy-toe-PEE-nick) means there's a lower than
normal number of platelets in the blood. "Purpura" (PURR-purr-ah) refers to purple
bruises caused by bleeding under the skin.

Paragraph 2

People who have ITP often have purple bruises that appear on the skin or on the
mucous membranes (for example, in the mouth). The bruises mean that bleeding has
occurred in small blood vessels under the skin. A person who has ITP also may have
bleeding that results in tiny red or purple dots on the skin. These pinpoint-sized dots
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are called petechiae (peh-TEE-kee-ay). Petechiae may look like a rash. People who
have ITP also may have nosebleeds, bleeding from the gums when they have dental
work done, or other bleeding that's hard to stop. Women who have ITP may have
menstrual bleeding that's heavier than usual. More extensive bleeding can cause
hematomas (he-mah-TO-mas). Ahematoma is a collection of clotted or partially
clotted blood under the skin. It looks or feels like a lump. Bleeding in the brain as a
result of ITP is very rare, but can be life threatening if it occurs. In most cases, an
autoimmune response is believed to cause ITP. Normally your immune system helps
your body fight off infections and diseases. But if you have ITP, your immune system
attacks and destroys its own platelets. The reason why this happens isn't known. ITP
can't be passed from one person to another.

Paragraph 3
There are two types of ITP: acute (temporary or short-term) and chronic (long-
lasting). Acute ITP generally lasts less than 6 months, if not for more than 8 to 10
months (as it can be in some cases, depends more on the treatment procedure). It
mainly occurs in children, both boys and girls, and is the most common type of ITP.
Acute ITP often occurs after an infection caused by a virus. Chronic ITP is long-lasting
(6 months or longer) and mostly affects adults. However, some teenagers and
children can get this type of ITP. Chronic ITP affects women 2 to 3 times more often
than men. In most cases, it's believed that an autoimmune response causes idiopathic
thrombocytopenic purpura (ITP). Normally, the immune system makes antibodies
(proteins) to fight off germs or other harmful things that enter the body. In ITP,
however, the immune system attacks and destroys the body's platelets by mistake.
Why this happens isn't known. Children who get acute (short-term) ITP often have
had recent viral infections. It's possible that the infection somehow "triggers" or sets
off the immune reaction that leads to ITP in these children. ITP in adults, on the other
hand, doesn't seem to be linked to infections.

Paragraph 4
Both children and adults can develop idiopathic thrombocytopenic purpura (ITP).
Children usually get the acute (short-term) type of ITP. Acute ITP often develops after
an infection caused by a virus. Adults tend to get the chronic (long-lasting) type of
ITP. Women are 2 to 3 times more likely than men to get chronic ITP. ITP is a fairly
common blood disorder, with 50 to 150 new cases per every 1 million people each
year; about half of these cases are children. However, the number of cases of ITP is
rising because routine blood tests that can detect a low platelet count are being done
more often. ITP can't be passed from one person to another. Having a low platelet
count doesn't cause symptoms. However, the bleeding that a low platelet count can
cause may have the following signs and symptoms: Pinpoint red spots on the skin
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Reading Test 14

that often are found in groups and may look like a rash. Bruising or purplish areas on
the skin or mucous membranes (such as in the mouth) due to bleeding under the
skin. More extensive bleeding can cause hematomas. A hematoma is a collection of
clotted or partially clotted blood under the skin. It looks or feels like a lump.
Nosebleeds or bleeding from the gums (for example, when dental work is done).
Blood in the urine or stool (bowel movement). Any kind of bleeding that's hard to stop
could be a sign of ITP. This includes menstrual bleeding in women that's heavier than
usual. Bleeding in the brain is rare, and the symptoms of bleeding in the brain may
vary in severity. A low number of platelets doesn't cause pain, fatigue (tiredness),
problems concentrating, or any other symptoms.

Paragraph 5

Your doctor will diagnose idiopathic thrombocytopenic purpura (ITP) based on your
medical history, a physical exam, and test results. Your doctor will want to make sure
that your low platelet count isn't due to another condition (such as an infection) or a
side effect of medicines you're taking (such as chemotherapy medicines or aspirin).
Your doctor may ask about: Your signs and symptoms of bleeding and any other signs
or symptoms you're having, Whether you have illnesses that could lower your platelet
count or cause bleeding, Medicines or any other over-the-counter supplements or
remedies you take that could cause bleeding or lower your platelet count. Your doctor
will give you a physical exam and look for signs of bleeding and infection. For
example, your doctor may look for pinpoint red spots on the skin and bruising or
purplish areas on the skin or mucous membranes. These are signs of bleeding under
the skin. You'll likely have blood tests to check your platelets. These tests usually
include: A complete blood count: This test shows the numbers of different kinds of
blood cells, including platelets, in a small sample of your blood. In ITP, the red and
white blood cell counts are normal. A blood smear: During this test, some of your
blood is put on a slide. A microscope is then used to look at your platelets and other
blood cells. In ITP, the number of platelets is lower than normal. You also may have a
blood test to check for the antibodies that attack platelets. If blood tests show that
you have a low number of platelets, your doctor may recommend more tests to
confirm a diagnosis of ITP. For example, bone marrow tests may be used to see
whether your bone marrow is making platelets.

Questions 12-20

12 ITP refers to a condition in which

A blood clots more than often
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Reading Test 14

B blood clots as it should

C blood doesn’t clot as it should
D blood clots very rare

13A person with ITP may face

A frequent loss of blood
B blood clotting problems
C blood transfusion problems
D not given

14 An autoimmune response can be a major cause of ITP

A true
B false
C sometimes true, sometimes false
D not given

15 ITP that is of acute type may ends within

A 6 months
B after 6 months
C 8 months
D 10 months

16 Short term ITP may develop

A viral infections very often
B viral infections in some cases
C viral infections in 9 out of 10
D not given

17 Paragraph 4 talks more about

A spread of the disease
B risk factors associated with the disease
C common symptoms
D B and D

18 The most severe symptoms of the diseases include blood in urine

A true
B false
C true-false
D not given in the paragraph

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19 “Some people who have mild ITP have few or no signs of bleeding.”
A true
B false
C true-false
D not given

20 Which of the following statements is taken from the paragraph 5?

A blood count is often the best way to diagnose the disease
B the number of platelets is always lesser than normal.
C bleeding can be the cause of not just ITP alone
D bone marrow tests are more effective than others

End of Part B

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Reading Test 1 – Part ‘A’

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Reading Test 15

Reading: Part A

TIME LIMIT: 15 MINUTES

Instructions:

 Complete the summary of Part A - Answer booklet using the information in

the four texts (A1-4) below.

 You do not need to read each text from beginning to end to complete the task.
You should scan the texts to find the information you need.

 Gaps may require 1, 2 or 3 words. Answer ALL questions. Marks are NOT
deducted for incorrect answers.

 You should write your answers next to the appropriate number in the right-
hand column.

 Please use correct spelling in your responses. Do not use abbreviations

unless they appear in the texts.

Text 1

Gastroenteritis (often referred to as the "stomach flu," however, it is not related to

the influenza virus) is a nonspecific term for various problems in the gastrointestinal
tract with the most common symptoms and signs of diarrhea, nausea, vomiting, and
abdominal pains. As previously mentioned, although it is not caused by influenza
viruses, it is commonly referred to as the "stomach flu" because most people have
acute symptoms that last a day or so, and then begin to resolve, like the more benign
flu strains. In the U.S., less than 2% of the estimated 100 million persons with
symptoms per year ever require hospitalization, but in developing countries it is a
leading cause of death, mainly due to dehydration. Severe gastroenteritis can cause
dehydration. Also, people with symptoms of diarrhea, bloody diarrhea,fever greater
than 101 F (38.33 C) for longer than 5 days, or have severe infection (sepsis), and
other problems will be considered to have another disease (for example, shigellosis).
Not all doctors agree on the nonspecific term of gastroenteritis so for this article, the
parameters are presented.

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Text 2

Infectious agents such as bacteria and viruses are the most frequent causes of
gastroenteritis in the US and worldwide. Infections cause diarrhea and other
symptoms by causing inflammation of the gastrointestinal (GI) tissue. The infections
increase the fluid content in the intestines and colon by changing the gastrointestinal
tract's ability to absorb water and by increasing the speed of transit (motility) for
things you ingest. This, in turn, causes diarrhea. Infectious agents may physically
damage intestinal cells directly or indirectly with secreted toxins. The most prevalent
cause of gastroenteritis in the U.S. and the world is Norovirus. It causes about 50%
to 70% of viral gastroenteritis while Rotavirus, Astrovirus, Adenovirus, and Sapovirus
strains cause most of the other viral gastroenteritis infections. In 2013, Norovirus was
also listed as the leading cause of gastroenteritis in children under 5 years old
according to the Centers for Disease Control (CDC). Bacterial causes of gastroenteritis
that occur worldwide are Salmonella, Shigella, Campylobacter Aeromonas, and
Escherichia coli (E. coli) strains of bacteria. Other bacteria like Clostridium, Vibrio,
Campylobacter, and Yersinia spp can cause outbreaks occasionally. Parasites such as
Giardia, Cryptosporidium, and Entamoeba infections can cause gastroenteritis and
occasionally, other parasites have outbreaks such as the Cyclospora outbreak that
occurred in 2012 to 2013 in the U.S. There are many other less frequent causes of
gastroenteritis such as food allergies, antibiotics, and toxins. Gastroenteritis
symptoms are frequently listed as possible side effects of many medicines.

Text 3

The primary symptom of gastroenteritis is diarrhea (non-bloody). Nausea, vomiting,

and some abdominal cramping may accompany the diarrhea; mild fever (about 100 F
or 37.77 C), chills, headache, and muscle aches along with feeling tired may occur in
some individuals. Vomiting is occasional and the symptoms usually last about 2 to 5
days and begin to resolve. Severe gastroenteritis means the person has signs of
dehydration: this is a medical emergency. Children with gastroenteritis usually have
diarrhea, but may have other symptoms, sometimes conflicting, of refusing to eat or
drink or are very thirsty, either increased or low or no urine output. Weight loss,
lethargy, and pinched skin that does not rapidly go back to normal are signs of
dehydration, along with decreased fluid intake.

Text 4
Most people with gastroenteritis require no formal treatment. The key to a rapid and
safe recovery at home (home remedy) is proper hydration. Home treatment consists
of adequate fluid intake so dehydration is prevented. Clear fluids are recommended
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Reading Test 15

(Pedialyte especially for young children, Gatorade, PowerAde and other sports drinks),
but not fruit juices or milk as they may prolong the symptoms. If dehydration occurs,
the patient should be evaluated by a doctor. Many healthcare professionals choose to
begin IV fluids, the treatment of choice for rapid rehydration. Other medications may
be prescribed to reduce the symptoms of gastroenteritis. To reduce vomiting,
promethazine (Phenergan), prochlorperazine (Compazine), or ondansetron (Zofran)
are often used. Some physicians suggest using these agents only as a suppository or
rapidly disintegrating tablet on the tongue since patients may vomit the pills up.
Others may prescribe diphenoxylate and atropineomotil (Lomotil) or lopermadine
(Imodium) to slow diarrhea while others do not as they may prolong the disease.
Many doctors recommend no medical treatment for gastroenteritis symptoms as all of
the drugs have side effects and if the patient stays well hydrated, the symptoms
usually stop soon anyway.

Summary

Gastroenteritis is an 1………… and 2……... of the stomach lining and intestines that
causes 3………. and/or diarrhea. In most cases, it is caused by a 4……….(in the U.S.,
usually a member of the norovirus family). Bacteria, toxins, and 5…... also can cause
gastroenteritis. People often attribute the cause to “something I ate;” however, true
food poisoning is a rare occurrence. Illnesses with these symptoms are commonly
referred to as “6………..” but it is not really the flu and is not caused by an 7………..
Gastroenteritis can be very contagious. Direct contact with a person who is infected
can be a 8…….. for infection. Eating or drinking contaminated food and water, or
touching contaminated surfaces or 9……..., and then touching your hand to your face
can spread infection. Gastroenteritis usually is not “10……..,” although people who are
11…….with it might not agree. Symptoms usually come on suddenly. People often feel
very sick with: nausea, vomiting and watery non-bloody 12…….. with stomach
cramps. There may also be: chills, headache, low-grade fever, 13…….aches and
14……...of tiredness. Viral infections can last from a few hours to 15…….. days. On
average they last 24 to 16……..hours. Illness caused by other organisms, such as
17………..or parasites, can last over a18……... Unfortunately, antibiotics are ineffective
against viral 19…….... They may help in the case of bacterial illness, but in some
cases antibiotics can make symptoms 20……….. People usually get better without
medical treatment in 1 to 3 days. Because there is a risk for 21……... due to vomiting
and 22…….., it is very important to drink to 23……. fluids.

End of Part A

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Reading Test 15

Part B - Text Booklet

Instructions

TIME LIMIT: 45 MINUTES

❏ There are TWO reading texts in Part B. After each of the texts you will find a
number of questions or unfinished statements about the text, each with four
suggested answers or ways of finishing.
❏ You must choose the ONE, which you think, fits best. For each question, 1-20,
indicate on your answer sheet the letter A, B, C or D against the number of the
question.
❏ Answer ALL questions. Marks are NOT deducted for incorrect answers.

NOTE: You must complete your Answer Sheet for Part B within the 45 minutes
allowed for this part of the sub-test.

B1 - What is glaucoma?

Paragraph 1

Glaucoma is a disease of the major nerve of vision, called the optic nerve. The optic
nerve receives light-generated nerve impulses from the retina and transmits these to
the brain, where we recognize those electrical signals as vision. Glaucoma is
characterized by a particular pattern of progressive damage to the optic nerve that
generally begins with a subtle loss of side vision (peripheral vision). If glaucoma is not
diagnosed and treated, it can progress to loss of central vision and blindness.
Glaucoma is usually, but not always, associated with elevated pressure in the eye
(intraocular pressure). Generally, it is this elevated eye pressure that leads to
damage of the eye (optic) nerve. In some cases, glaucoma may occur in the presence
of normal eye pressure. This form of glaucoma is believed to be caused by poor
regulation of blood flow to the optic nerve.

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Paragraph 2

Worldwide, glaucoma is the second-leading cause of irreversible blindness. In fact, as

many as 6 million individuals are blind in both eyes from this disease. In the United
States alone, according to one estimate, more than 3 million people have glaucoma.
As many as half of the individuals with glaucoma, however, may not know that they
have the disease. The reason they are unaware is that glaucoma initially causes no
symptoms, and the subsequent loss of side vision (peripheral vision) is usually not
recognized.

Paragraph 3

Elevated pressure in the eye is the main factor leading to glaucomatous damage to
the eye (optic) nerve. The optic nerve, which is located in back of the eye, is the main
visual nerve for the eye. This nerve transmits the images we see back to the brain for
interpretation. The eye is firm and round, like a basketball. Its tone and shape are
maintained by a pressure within the eye (the intraocular pressure), which normally
ranges between 8 mm and 22 mm (millimeters) of mercury. When the pressure is too
low, the eye becomes softer, while an elevated pressure causes the eye to become
harder. The optic nerve is the most susceptible part of the eye to high pressure
because the delicate fibers in this nerve are easily damaged.

Paragraph 4

The front of the eye is filled with a clear fluid called the aqueous humor, which
provides nourishment to the structures in the front of the eye. This fluid is produced
constantly by the ciliary body, which surrounds the lens of the eye. The aqueous
humor then flows through the pupil and leaves the eye through tiny channels called
the trabecular meshwork. These channels are located at what is called the drainage
angle of the eye. This angle is where the clear cornea, which covers the front of the
eye, attaches to the base (root or periphery) of the iris, which is the colored part of
the eye. The cornea covers the iris and the pupil, which are in front of the lens. The
pupil is the small, round, black-appearing opening in the center of the iris. Light
passes through the pupil, on through the lens, and to the retina at the back of the
eye.

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Reading Test 15

Paragraph 5

Glaucoma is often called "the sneak thief of sight." This is because, as already
mentioned, in most cases, the intraocular pressure can build up and destroy sight
without causing obvious symptoms. Thus, awareness and early detection of glaucoma
are extremely important because this disease can be successfully treated when
diagnosed early. While everyone is at risk for glaucoma, certain people are at a much
higher risk and need to be checked more frequently by their eye doctor. The major
risk factors for glaucoma include the following: Age over 45 years, Family history of
glaucoma, Black racial ancestry, Diabetes, History of elevated intraocular pressure,
Nearsightedness (high degree of myopia), which is the inability to see distant objects
clearly, History of injury to the eye, Use of cortisone (steroids), either in the eye or
systemically (orally or injected), Farsightedness (hyperopia), which is seeing distant
objects better than close ones (Farsighted people may have narrow drainage angles,
which predispose them to acute [sudden] attacks of angle-closure glaucoma)

Paragraph 6

Patients with open-angle glaucoma or wide angle glaucoma and chronic angle-closure
glaucoma (narrow-angle glaucoma) in general have no symptoms early in the course
of the disease. Visual field loss (side vision loss) is not a symptom until late in the
course of the disease. Rarely patients with fluctuating levels of intraocular pressure
may have haziness of vision and see haloes around lights, especially in the morning.
On the other hand, the symptoms of acute angle-closure are often extremely
dramatic with the rapid onset of severe eye pain, headache, nausea and vomiting,
and visual blurring. Occasionally, the nausea and vomiting exceed the ocular
symptoms to the extent that an ocular cause is not contemplated. The eyes of
patients with open-angle glaucoma or chronic angle-closure glaucoma may appear
normal in the mirror or to family or friends. Some patients get slightly red eyes from
the chronic use of eyedrops. The ophthalmologist, on examining the patient, may find
elevated intraocular pressure, optic-nerve abnormalities, or visual field loss in
addition to other less common signs. The eyes of patients with acute angle-closure
glaucoma will appear red, and the pupil of the eye may be large and nonreactive to
light. The cornea may appear cloudy to the naked eye. The ophthalmologist will
typically find decreased visual acuity, corneal swelling, highly elevated intraocular
pressure, and a closed drainage angle.

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Paragraph 7

Although nerve damage and visual loss from glaucoma cannot usually be reversed,
glaucoma is a disease that can generally be controlled. That is, treatment can make
the intraocular pressure normal and, therefore, prevent or retard further nerve
damage and visual loss. Treatment may involve the use of eyedrops, pills (rarely),
laser ,or surgery. In the United States, eyedrops are usually used first in treating
most types of open-angle glaucoma. In contrast, in Europe, laser or surgery is
sometimes the first choice of treatment. One or more types of eyedrops may have to
be taken up to several times a day to lower intraocular pressure. These drops work
either by reducing the production of the aqueous fluid (shutting the faucet) or by
increasing the drainage of the fluid out of the eye. Each type of therapy has its
benefits and potential complications.

Questions 1-11

1 First sign of glaucoma can be

A blurred vision
B loss of vision
C difficulty in identifying objects
D all of the above

2 Damage of optic nerve can be due to

A poor regulation of blood flow
B intraocular pressure
C hardening of the eye
D none

3 Paragraph 2 talks more about (please, select the most appropriate heading)
A glaucoma and its occurrence
B prevalence of the disease in the US
C how common is glaucoma?
D symptoms of glaucoma

4 Paragraph 3 talks more about

A origin of glaucoma and its symptoms
B effects of glaucoma
C A and B
D what causes glaucoma?
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5 After passing through various channels, the fluid called, aqueous humor travels
through trabecular meshwork.”
A 50% true
B 50% false
C 100% true
D not given

6 Paragraph 5 talks more about

A associated factors that lead to glaucoma
B commonality of the disease
C prevalence and its factors
D risk factors

7 Who is at more risk for glaucoma?

A people with diabetes
B people with over 45 years old
C people with hyperopia
D all of the above

8 Paragraph 5 deals with

A two types of glaucoma
B three types of glaucoma
C four types of glaucoma
D B and C

9 Intense eye pain is often seen in

A open angle glaucoma
B angle closure glaucoma
C narrow angle closure
D A and B

10 Patients with angle closure glaucoma will show

A redness in eye, pupil will become large and nonreactive to light
B damaged cornea with cloudy appearance
C unusual visual acuity and swelling around cornea
D B and C

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11 In treating glaucoma, the main goal would be to

A reduce the production of the aqueous fluid
B increasing the drainage of the fluid out of the eye
C decrease intraocular pressure
D A and B

End of Part B1

B2 - Introduction to treating arrhythmias with ablation

Paragraph 1

Ablation is used to treat abnormal heart rhythms, or arrhythmias. The type of

arrhythmia and the presence of other heart disease will determine whether ablation
can be performed surgically or non-surgically. Non-surgical ablation, used for many
types of arrhythmias, is performed in a special lab called the electrophysiology (EP)
laboratory. During this non-surgical procedure a catheter is inserted into a specific
area of the heart. A special machine directs energy through the catheter to small
areas of the heart muscle that causes the abnormal heart rhythm. This energy
"disconnects" the pathway of the abnormal rhythm. It can also be used to disconnect
the electrical pathway between the upper chambers (atria) and the lower chambers
(ventricles) of the heart. Surgical ablation procedures used for treating atrial
fibrillation can be "minimally invasive" or traditional "open" surgery and may be
combined with other surgical therapies such as bypass surgery, valve repair, or valve
replacement.

Paragraph 2

(i) The Maze procedure: During this traditional open-heart surgical procedure, the
surgeon makes small cuts in the heart to interrupt the conduction of abnormal
impulses and to direct normal sinus impulses to travel to the atrioventricular node (AV
node) as they normally should. When the heart heals, scar tissue forms and the
abnormal electrical impulses are blocked from traveling through the heart. Minimally
invasive surgical ablation: Unlike traditional heart surgery, there is no large chest wall
incision and the heart is not stopped. These techniques utilize smaller incisions and
endoscopes (small, lighted instruments that contain a camera). (ii) The modified
Maze procedure: The surgeon uses a special catheter to deliver energy that creates
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Reading Test 15

controlled lesions on the heart and ultimately scar tissue. This scar tissue blocks the
abnormal electrical impulses from being conducted through the heart and promotes
the normal conduction of impulses through the proper pathway. One of four energy
sources may be used to create the scars: radiofrequency, microwave, laser, or
cryothermy (cold temperatures). The modified Maze procedure involves a single
incision in the left atrium.

Paragraph 3

Doctors recommend ablation therapy to treat: Atrial fibrillation and atrial flutter, AV
Nodal re-entry tachycardia (AVNRT), Accessory pathways, Ventricular tachycardia. In
addition to re-establishing a normal heart rhythm in people with certain arrhythmias,
ablation therapy can help control the heart rate in people with rapid arrhythmias, and
reduce the risk of blood clots and strokes.

Paragraph 4

The ablation preparation may vary, depending on whether you're having surgical or
nonsurgical ablation. These are general guidelines; your doctor or nurse will give you
specific instructions. To prepare for ablation, there are several steps you should take.
Among them: (i) Ask your doctor which medications you should stop taking and when
to stop them. Your doctor may ask you to stop certain drugs (such as those that
control your heart rate or blood thinners including aspirin products) one to five days
before your procedure. If you are diabetic, ask your doctor how you should adjust
your diabetic medications (ii) Do not eat or drink anything after midnight the evening
before the procedure. If you must take medications, drink only with a small sip of
water. (iii) When you come to the hospital, wear comfortable clothes. You will change
into a hospital gown for the procedure. Leave all jewelry and valuables at home.

Paragraph 5

(i) During traditional ablation, the doctor will use a pacemaker-like device to send
electrical impulses to the heart to increase your heart rate. You may feel your heart
beating faster or stronger when the pacemaker delivers the impulses. If your
arrhythmia occurs during the procedure, the nurse will ask you how you are feeling. It
is very important to tell the doctor or nurse the symptoms you feel. The doctor will
then move the catheters around your heart to see which area(s) your arrhythmia is
coming from. Once the doctor finds the area of your arrhythmia, energy is applied.
You may feel some discomfort or a burning sensation in your chest, but you must
stay quiet, keep very still, and avoid taking deep breaths. If you are feeling pain, ask
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your doctor or nurse to give you more medication. (ii) During pulmonary vein ablation
(for atrial fibrillation), the doctor delivers energy through a catheter to the area of the
atria that connects to the pulmonary vein (ostia), producing a circular scar. The scar
will then block any impulses firing from within the pulmonary veins, thus preventing
atrial fibrillation from occurring. The process is repeated to all four pulmonary veins.
In some cases, ablation may also be performed to other parts of the heart such as the
subclavian veins and coronary sinus. The catheter is a special "cool tip" catheter. Fluid
circulates through the catheter to help control the intensity of the temperature. Once
the ablation is complete, the electrophysiologist will use monitoring devices to
observe the electrical signals in the heart to ensure that the abnormal heart rhythm
was corrected. The procedure usually takes about four to eight hours, but may take
longer.

Paragraph 6
(i) The doctor will remove the catheters from your groin and apply pressure to the
site to prevent bleeding. You will be on bed rest for one to six hours. Keep your legs
as still as possible during this time to prevent bleeding. (ii) After your procedure, you
may be admitted to the hospital. During your recovery, a special monitor, called
telemetry, will be used to follow your heart rate and rhythm. Telemetry consists of a
small box connected by wires to your chest with sticky electrode patches. The box
allows your heart rhythm to be displayed on several monitors on the nursing unit. The
nurses will be able to observe your heart rate and rhythm. In most cases, you will be
able to go home the next day after the catheter ablation procedure but in some cases
you may be able to go home the same day of the procedure. (iii) You and your family
will receive the results of the procedure afterwards. Your doctor will also discuss when
you can resume activities and how often you will need to visit your doctor etc.

Questions 12-20

12 Paragraph 1 talks more about

A how ablation is performed?
B procedure used to treat heart rhythm
C non-surgical method of treatment of heart rhythm
D B and C

13 Paragraph 2 talks more about

A non-surgical ablation procedure
B effectiveness of the surgical procedures over non-surgical procedures
C surgical ablation procedures
D maze procedure
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Reading Test 15

14 Energy sources discussed are …………….. in number

A two
B three
C four
D five

15 Ablation therapy can effectively

A lower the risk of blood clotting
B lower the heart rate among people with increased heart rhythm
C decrease the number of strokes
D A and B

16 Paragraph 4 lays emphasis much more on

A how one shall get prepared for catheter ablation?
B how catheter ablation is performed?
C what to do before catheter ablation?
D B and C

17 One of these statements is not taken from paragraph 5

A pacemaker-like device may increase heartbeat
B during the process of pva the occurrence of the atrial fibrillation is restricted or
controlled.
C the process of pulmonary vein ablation may take about 4 hours
D A and B

18 What is suggested for the patients in the paragraph 5?

A stay quiet even if you are unable to bear the discomfort
B it is necessary to keep very still and need to stop the breath for a while
C shall not take deep breaths
D burning sensation can be common so staying quiet and silent is required

19 Paragraph 6 talks more about

A procedure after catheter ablation
B procedure after non-surgical catheter ablation
C what happens after catheter ablation?
D B and C

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Reading Test 15

20 After catheter ablation, a patient may

A have to stay for a whole day at the hospital
B have to stay for two days at the hospital
C leave right after the procedure
D opt for staying for a day at the hospital

End of Part B

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