OccupationalEnglishTest:PreparationBookReadingSub-test

Volume1

ByAnnaHartford

©ProgressiveCoaching2018

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ContentsIntroductionPart1:TestStructurePart2:VocabularyBuildingPart3:Test-takingStrategiesandPreparationPart4:PracticeTests

Test1Test1:AnswerKeyTest1:AnswerGuideTest2Test2:AnswerKeyTest2:AnswerGuideTest3Test3:AnswerKeyTest3:AnswerGuide

IntroductionWelcome!Thisbookwaswrittenforcandidatesacross theworld taking theOccupationalEnglish Test (OET), to provide guidance, tips and practice that will makepassingtheOETeasierandlessstressful.Thecontentof thisbook isbasedon theauthor’smanyyearsofexperience inpreparing candidates for the OET. It includes advice for preparation that hasbeen tried and tested by candidates from a wide variety of backgrounds andlevelsofEnglishability.TherearefourmainareasofpreparationrequiredtopasstheOETReadingSub-test.Theseare:

1. Familiaritywithteststructure2. Vocabularybuilding3. Test-takingstrategies4. Practicetests

Thefirstareainvolvesknowledgeofwhatthetestwillinvolve,sothatyouknowwhat toexpectontestday.Part1of thisbookgivesyouadetailed,up-to-dateoverviewofthestructureoftheReadingSub-test.ThesecondareaisonethatwillprepareyoutosucceedintheReadingSub-testnomatterwhatthesubjectmatterofthetest is.Vocabularybuildingis, infact,thefoundationstoneofyoursuccess.Part2ofthisbookprovidesasimplestudyplanforexpandingandstrengtheningyourvocabulary.The third area, test-taking strategies and preparation, is often covered inOETpreparationcourses.Part3givesanoverviewofthestrategiesthatarethemostuseful for each part of the Reading Sub-test. It is important to know thesestrategiesandhaveachance topracticeusing thembefore thereal test. Italsoprovidescandidateswithspecificguidanceonhowtopreparethemselvesforthetest.Thefourthareaofpreparationiscompletingpracticetests.Thiswillallowyoutostreamlineyourapplicationofthetest-takingstrategiesyou’velearnedandapplyyourvocabularyinasettingthatsimulatestheOET.Part4ofthisbookincludes3 full-length practice tests, including answer keys and guides to help you

understandwhereeachanswercomesfromandwhyitiscorrect.Goodluckwithyourpreparation!

-AnnaHartford(19July2018)

Part1:TestStructure

TheReadingSub-testhasthreepartstobecompletedin60minutes:PartA,PartB and Part C. In comparison to the original version of the OET, the currentversionoftheReadingSub-test(introducedin2018)hasafewdifferences:

Moretextsareused(12ratherthan6)ThereisabroaderrangeoftexttypesTextsaremorerelevanttothehealthcareworkplaceQuestionswilltestabroaderrangeofreadingskills,suchasreadingfor:

Generalideas(the“gist”ofatext)OpinionAttitude

ThestructureofeachpartoftheupdatedReadingSub-testisoutlinedbelow.PartA

PartArequirescandidatestoskimandscan4short,health-relatedtexts(labelledA,B,CandD) and answer20questions relating to the texts.The texts use avocabularyandstructurethatcanbeunderstoodbyallhealthprofessions.TextsAllofthetextscanbefoundintheworkplaceofahealthcareprofessional.Thismeansthatthetextsdonotincludejournalabstracts,whichwerecommoninPartAofthepreviousversionoftheOET.Atleastoneofthetextscontainsvisualornumericalinformation(e.g.agraph,tableorflowchart).

Examplesoftextsthatmaybeusedare:DiagnostictoolsoralgorithmsAdvicetobegiventopatientsDosageoptionsforamedicationTreatmentguidelines

Questions

ThequestionsforPartAwillbegroupedinto3or4sets(mostoften,therewillbe3sets).Eachsetwillhave6-7questions.Thequestionswillbeeasiestinthefirstsetandgetharderascandidatesmovethrougheachset.Allofthequestionsmustbecompletedwithina15minutetimelimit.

Thequestiontypesusedare:

Matchingquestions(alwaysusedforthe1stset)These will require candidates to identify which text featurescertaintypesofinformation.E.g.“Whichtextcontainsinformationabouttreatingmelanoma?”Thecandidateisrequiredtowritetheiransweras“A”,“B”,“C”or“D”,accordingtothetextthattheinformationisfoundin.Thissettestsskimmingandscanningforrelevantinformation.The purpose of this set is to orient candidates to the generalcontentofeachtext.

Shortanswerquestions(usedforthenext2or3sets)Thesewill require candidates to find specific informationwithinthetexts.E.g.“Whatisthefirst-linetreatmentrecommendedforepilepsy?”The answerswill always be taken directly from the texts, in thesamewordform.Thismeansthatcandidatesdonotneedtochangethegrammarorspellingoftheanswerinordertogetitcorrect.Each answerwill be approximately 2 or 3words long, althoughthereisnosetlimit.

GapfillingquestionsThesearesimilartothegapfillingquestionsfoundinPartAofthepreviousversionoftheOETReadingtest.E.g.Asthmaattacksare the____________reasonforemergencyroom presentations (the answer from the text could be “mostcommon”).Asforshortanswerquestions,eachanswerwillbeapproximately2or3wordslong,althoughthereisnosetlimit.

Toreceiveamarkforyouranswer,youmust:

Write legibly (ananswerwithunreadablehandwritingwill receivezeromarks)Use correct spelling and grammar (you will not need to change thegrammarusedinthetext.Simplytransferthewordsexactlyastheyare

found).Be accurate according to the text (even if your answer is generallycorrect,itmustcommunicatethesamemeaningasthetext)

Forgapfillquestions,youshouldalwaysreadthefullsentence,tocheckifyouranswermakessenseinthecontextofthewordsimmediatelyaroundit.

PartBPartBconsistsof6shorttexts(withawordlengthof100-150wordseach).Foreachtext,thereisonemultiplechoicequestion.Texts

Each textusesvocabulary that isunderstandable toallhealthprofessions.Thetypesof texts used are thosewhich canbe found in thehealthcareworkplace.Theyinclude:

PoliciesProceduresStaffupdatesorannouncements.

Although the texts are relatively short, they are also designed to contain asubstantial amount of information.Thismeans that candidateswill need to beabletoreadandunderstandinformationrelativelyquickly.

This is the part of the Reading Sub-test that differs most from the originalversionof theOET.Candidateswhohaveonly taken theoriginal test,orhaveonlyusedoriginaltestsamplestoprepareforthenewOET,willencounternewtexttypesinPartB.QuestionsThequestionforeachtextwillaskcandidatesforoneofthreetypesofinformation:

Generalideaofthetext(the“gist”),Mainpointofthetext,orPurposeofthetext.

The answers may require candidates to infer information that isn’t explicitlyprovidedinthetext.However,candidateswillnotneedtounderstandeverypartofthetexttoanswerthequestioncorrectly.

PartC

PartC requirescandidates to read2 longer,health-related textsandanswer16multiplechoicequestionsbasedonthecontentofthesetexts.ThispartoftheReadingSub-testtestsacandidate’sabilityto:

Understandcomprehensivetexts,Infermeaning,andIdentifypointsofview.

TextsEach text inPartC is approximately 1.5 to 2 pages in length (750-850wordseach) and is divided into paragraphs (the texts in this book will be the samelengthastherealtest,butcover2-3pagesduetothesmallerpagesize).Bothtextswillbeonhealthcare-relatedtopics,buttheprecisetopicforeachtextwillbedifferent.Thetextswillcontain:

Medicalfacts,ANDDifferentperspectivesonthetopic.

Examplesofthetypeofinformationusedinthesetextsinclude:ProgressofresearchinanareaofhealthcareCasestudies

UnlikePartsAandB,PartCwilluse informationfromacademia(e.g. journalarticles)ratherthanjustfromtheworkplace.QuestionsEachquestionwillhave4possibleanswerstochoosefrom(A,B,CorD).Youmust select only one answer. Incorrect answers receive zeromarks, butmarksaren’t taken away for them.Therefore, if you run out of time in the test, youshouldalwaysguesstheanswerstoanyquestionsyouhaven’tansweredyet.

The questions inPartC of the revisedReadingSub-testwillnot test concretefactsasmuchas theoriginalversionofPartB.Theywillbemore focusedonabstract,general information.Eachansweroptionwillhavesimilar formatandassessthesamereadingskillfromthesamesectionoftext.Sixoftheeightquestionsforeachtextwillrequestinformationabout:

GistMainpointsAttitudesOpinions(ortheirsource)

Twooftheeightquestionswillbetestinglexicalreference(2types):

Firsttype:themeaningofvocabularyandexpressionsusedinthetextThis will not necessarily be the exact dictionary definition. Thecorrectmeaningwilldependonthecontextinwhichitisused.By reading the sentences before and after awordor phrase, youmaystillbeable toguess theanswercorrectlyeven ifyoudon’tknowtheexactmeaningofthewords.

Secondtype:comprehensionofcohesiveandotherdevices“Cohesion” is the linking of textwithin a sentence. This can beachieved by using cohesive devices, namely grammar (e.g.pronouns)orvocabulary(e.g.aresearchstudymaybereferredtoas“theinvestigation”laterinthetext).Examplesofwordsorphrasesthatmaybetestedinclude:

Pronouns referring to someone or something, which was

previously mentioned in the text. E.g. the author may use“she”insteadof“DrKarenRogers”toavoidrepetition.Thequestionmayaskwho“she”refersto.References tosomeoneorsomethingbeforeitisidentified.E.g.“Acommonlyuseddiagnostictest,whichhasequivocalvalue in identifying patients at risk of colon cancer, is…”(thediagnostictestisreferredtoas“commonlyused”andof“equivocalvalue”,beforeitisfinallyidentified).Linkingwords/phrases thatconnectpartsofasentenceorparagraph. E.g. “The new drug is highly efficacious,however, it has a narrow therapeutic index” (“however” isused to connect and emphasize contrast between the twopartsofthesentence).

Forthelatestinformationabouttheteststructure,don’tforgettogototheOETCentreofficialwebsite:www.occupationalenglishtest.org.

Part2:VocabularyBuildingOneofthemosthelpfulthingsyoucandotoimproveyourperformanceintheReadingSub-testistobuildupyourvocabulary(includingsynonyms).Thiswillmakeiteasierforyoutorecognizeandunderstandwhatyouheardandread.Youwillthenbeabletoanswerquestionsaboutthetextsinthetestmoreaccurately.Task1:LearnnewwordsFollowthissuggestedstudyapproachonaregularbasis:

1. Usemedicaljournalarticles:a. Gotoanopen-accessmedicaljournal.Somesuggestedonesare:

www.mja.com.auwww.bmj.comwww.racgp.org.au/afp/2017

b. Chooseanarticlethatsoundsinterestingtoyou.c. While reading the article, underline unfamiliarwords and guess

theirmeaning.d. Keepreading.e. At the end of the article, go back and look up the words you

underlinedinadictionary.

2. Categorisethewordsyoulookedupinthedictionaryasfollows:a. GroupA:Wordsthatyouguessedincorrectly,andmightbeusedin

apodcastonadifferenttopic.b. GroupB:Wordsthatyouguessedincorrectly,butareunlikelybe

usedinapodcastonadifferenttopic.c. GroupC:Wordsthatyouguessedcorrectly.

3. Aimtoadd6-8wordstoyourvocabularylisteachday,prioritizingGroup

Awordsfirst,GroupBsecond,etc.Yourvocabularylistmightlooklikethis:Word/Phrase PartofSpeech MeaningNeural Adjective Relatingtonervesorthenervous

system.

4. Reviseyourvocabularylistattheendofeachweek.Youcantestyourself

by covering up the meanings of the words and trying to guess them.Alternatively, cover up the words themselves and try to remember thewordbasedonthemeaning.

Idealfrequency:1article(or6-8words)perday.Minimumfrequency:1article(or6-8words)every2or3days.Task2:CreatewordfamiliesAwordfamilyisagroupofwordsthataremadefromthesameroot(smallwordorpartofaword).Forexample,theroot“infect”canbeusedtocreatemanyotherwordswithsimilarmeanings:

Infection(noun)Infectious(adjective)Infect(verb)Infectiously(adverb)

InanaverageEnglishtext,ithasbeenfoundthatmorethan80%ofthewordscomefromagroupofabout2000commonly-usedEnglishwords(DrPrudentInjeeli,MindYourWords:MastertheArtofLearningandTeachingVocabulary,TraffordPublishing,2013).Therefore,recognizingandbuildingwordfamiliescanbeanextremelyhelpfulandefficientwaytostrengthenyourunderstandingofEnglishtextsingeneral.Itwillalsoextendandsolidifyyourunderstandingofindividualwords.Tocreateyourownwordfamilies:

1. LookupanunfamiliarwordyoufindinanEnglishtext2. Useanonlinedictionary,suchastheOxfordLearner’sDictionary,tolook

upthemeaningandpartofspeech(noun/verb/adjective/adverb)oftheword.

3. Checkthelistundertheheading“nearbywords”tofindothermembers

ofthatwordfamily(wordsthatusethesamerootorpartofaword).Herearesomemoreexamples:

Root:admitAdmission(noun)Admissible(adjective)Admit(verb)

Root:useUse(noun)Useful(adjective)Use(verb)Usefully(adverb)

Root:decideDecision(noun)Decisive(adjective)Decide(verb)Decisively(adverb)

Part3:Test-takingStrategiesandPreparationPartAPartAoftheReadingSub-testisprobablytheonepartoftheOETwherehavinga good strategy is most helpful, since you only have 15 minutes to find theanswers.The following approach has helped many candidates maximize their marksdespitethetimeconstraints:Forthe1stset(e.g.Questions1-7):

1. Read theheading of each text, and underline or circle thekeywords(thesearethewordsthatcarrythemainmeaningoftheheading).

2. Readthefirstquestion,payingattentiontothekeywords.3. Based on thekeywords in the first question, select themost relevant

text.Ifyou'renotsurewhichtextthequestionisreferringto,trythenextquestion!Itmightbemoreobvious.

Fortheremaining2-3sets:

1. Readeachquestion,payingattentiontothekeywords.2. Basedonthekeywordsinthequestion,selectthemostrelevanttext.3. Scan the relevant text for more of the key words you found in the

question. This will lead you to the part of the text that contains therequiredinformation.

Mostimportantlyofall,ifyougetstuck-moveon!Youonlyhave15minutes,andtheremightbeanswersyoucanfindfurtheralongintheset.HOWTOPREPAREFORPARTA:ExposeYourselftoSimilarTextsSincePartAisfocussedoncandidates’abilitytofindspecificinformationwithintexts,itisimportanttopracticereadingdetailedtexts,aswellasskimmingandscanning.

Thetextsareallonesthatcanbefoundinthehealthcareworkplace,socandidateswithworkexperiencemayfindthispartofthetesteasier.Candidateswhodon’tcurrentlyworkinahealthcaresetting(orthosewhodo,butwanttoexposethemselvestoawidevarietyofrelevanttexts)shouldusetheInternettofindthetexttypeslistedinPart1ofthisbook.PracticeSkimmingandScanningPartAisalsodesignedtosimulatesituationsinthehealthcaresetting,whereyouwillberequiredtoreadandunderstandwritteninformationwithouthavingtimetoreadthewholetextindetail.Tohelpyouprepareforthis,youshouldworkonyourabilitytoreadinformationquicklyandaccurately.Skimmingandscanningaretwoessentialskillsthatyoucanpracticebydoingthefollowing:

Skimming(readingjustthemainwordsofatext)Pickatextwithamixtureofwritteninformationandpictures,figuresorgraphs.Readthroughthetext,payingattentiononlytothemainwordsineachsentence,ignoringsmallwordslike“and”or“the”.Lookatheadings,subheadingsandimages.Writedownafewdotpointsofthemainpointsyoupickedupfromskimmingthetext.Dothisregularly–itisaskillthatyoudevelopwithpractice.

Scanning(lookingforparticularinformationinatext)Again,pickatext.Readthefirst1-2sentencesofthetextandunderline2or3keywords.Keepingthese2or3keywordsinmind,lookattherestofthetextandtrytofindanyotherplacesinwhichtheyareused.Ifyoudon’tsucceed,readthetextmoreslowlytomakesureyouhaven’tmissedthem.Ifthekeywordsyouchosedon’tappearagaininthetext,selectdifferentkeywordsanddothisstepagain.Practicedoingthesameexercise,butwithnumbersinsteadofkeywords.

TheBritishBroadcastingCorporation(BBC)alsoprovidessomeusefulexercisestohelpyoupracticeskimmingandscanning:www.bbc.co.uk/skillswise/topic/skimming-and-scanning

PartBInordertoanswerthemultiple-choicequestionsinPartBasaccuratelyaspossible,followtheapproachbelow:

1. ReadthequestionforText1andunderlineorcirclethekeywords.2. ReadansweroptionAandunderlineorcirclethekeywords.3. Scan through the text, looking for the key words in the question and

answeroptionA.Underlineorcirclepiecesof information that supportthisanswer.

4. Readthesecondansweroptionandunderlineorcirclethekeywords.5. Scan through the text, looking for the key words in answer option B.

Underlineorcirclepiecesofinformationthatsupportthisanswer.6. RepeatthisforansweroptionC.7. Select the answer that has themost supporting information throughout

thetext.If you are not sure which part of the text to go to for a question, use thefollowingstrategies:

1.Rememberthatthequestionsmovethroughthetextinorder.Therefore,ifyouusedthethirdparagraphtofindtheanswerforthelastquestion,youwillprobablyneedtousethefourthparagraphnext.

2. Circle or underline the keywords in the question (or the first answeroption, if thequestionstemisveryshort).Then, read the first sentenceONLYofeachparagraphandlookforsimilarwords.Thiscangiveyoucluesaboutwhichparagraphisrelevanttothatquestion.

HOWTOPREPAREFORPARTB:ExposeYourselftoSimilarTextsPracticereadingthetypesoftextsmentionedinPart1,namely:

PoliciesProceduresStaffupdatesorannouncements

ThesecaneasilybeaccessedbysearchingtheInternet,orbyrequestingcopiesfromyouractualworkplace.

ExpandYourVocabularyObviously,themorewordsyouunderstandwithinatext,themorelikelyyouaretoanswerquestionsaboutitcorrectly.SincetheOETisatestofEnglish,itmakessensetoincreaseyourEnglishvocabularyinpreparationforthetest.Foramethodicalstudyapproachtoincreaseyourvocabulary,seePart2ofthisbook.Inaddition,Volume2ofthisseriesprovidesacomprehensivelistofmedicalprefixesandsuffixes(wordsusedatthebeginningofendofalongerword)thatcanhelpyoutoguessthemeaningofunfamiliarwordsinthetest.Thislistshouldbeusedtosupplementyourstudyofvocabulary.ImproveYourToleranceofAmbiguityToanswerthequestionsinPartBcorrectly,youwillneedtobeabletounderstandthegeneralideaormainpointsofatextwithoutnecessarilyunderstandingallthewordswithinit.Themorereadyyouaretoacceptthis,thelesslikelyyouwillbetospendtoomuchtimeoneachtext.Youcantohelpyourselftobemorecomfortablewithnotunderstandingallofthewordsinatextby:

Obtainingatextsample(suchasthosementionedabove,butothertypesoftextscanbeusedeffectivelyaswell)Skimoneparagraphorsectionoftext(about100-150words)Writedown1or2mainpointsthattheauthorhasmadeintheparagraphorsection.Avoidwritingdownspecificdetails.

Themoreyoudo thisexercise, themoreeffectivelyyouwillbeable to tacklePartB.

PartCThebeststrategytouseforPartCissimilartothatforPartB:ReadthefirstquestionofText1andunderlineorcirclethekeywords.

1. Basedon thekeywords in thequestion, go to the relevantpartof the

Text.Inmanycases,youwillbetoldwhichparagraphtogotointhefirstquestion,sotheparagraphnumberwillbeoneofyourkeywords.

2. ScantherelevantsectionoftheTextforanyofthekeywordsyoufoundinthefirstquestion.Thiswillleadyoutothepartofthetextthatcontainstherelevantinformationforthatquestion.

3. Once you have found the relevant section of the Text, check eachansweroption according to the information in the text.Donot simplyselectthefirstansweryouseethatlookscorrect–theremaybeabetteranswerfurtherdownthelistofoptions.

Sincethereare2textstoreadandanswerquestions,itisrecommendedthatyoudivideupyourtimetomanageiteffectively:

Spendnomorethanabout15minutesansweringquestionsaboutText1.After 15 minutes, move on to Text 2. There may be easier questionsfurther along that youwon’t have a chance to answer if you spend allyourtimeonText1.Spendnomorethan15minutesansweringquestionsaboutText2.AimtofinishPartsBandCwithatleast5minutestospare.Thisisforchecking your answers and returning to questions that you didn’t havetimetocomplete.

HOWTOPREPAREFORPARTC:ExpandYourVocabularySincethefocusofPartCislanguagecomprehension(understanding),itisagainveryimportanttoincreaseyourEnglishvocabularybeforethetest.AsforPartB,youcanfindamethodicalstudyapproachtoincreaseyourvocabularyinPart2ofthisbook.Inaddition,Volume2ofthisseriesprovidesa

comprehensivelistofmedicalprefixesandsuffixes(wordsusedatthebeginningofendofalongerword)thatcanhelpyoutoguessthemeaningofunfamiliarwordsinthetest.Thislistshouldbeusedtosupplementyourstudyofvocabulary.PracticeReadingforOpinions/AttitudesThereisastrongfocusinPartContestingwhethercandidatescanaccuratelyidentifytheopinionsorattitudesoftheauthor,aswellasotherpeoplementionedineachtext.Therefore,whenyouaredoingapracticetestorreadinganyothertextforstudypurposes,youshouldwritedownatleast1-5pointsabouttheopinionsorattitudesexpressedinthetext.Theexactnumberofpointsyouwritedownwilldependonthelengthandcontentofthetext.Rememberthatnotallopinionsorattitudesarestatedexplicitly.Implicitinformationiseitherunstated,orexpressedindirectly.Topracticeidentifyinganimplicitpointinapassageoftext,youcanusethefollowingmethod:

1. Readthepassageoftext2. Askyourself:"Whatdoeachofthedetailsofthepassagehavein

common?"3. Inyourownwords,findthecommonthemeamongallthedetailsof

thepassageandtheauthor'spointaboutthistheme.4. Writeashortsentencestatingthethemeandwhattheauthorsays

aboutit.Thefollowingpassagefromdemonstratesanexampleofthisprocess:“Whenyou'rewithyourfriends, it'sokaytobeloudanduseslang. They'll expect it and they aren't grading you on yourgrammar.Whenyou'restandinginaboardroomorsittingforaninterview,youshoulduseyourbestEnglishpossible,andkeep your tone suitable to theworking environment. Try togaugethepersonalityoftheinterviewerandthesettingoftheworkplace before cracking jokes or speaking out of turn. Ifyou'reever inaposition tospeakpublicly,alwaysaskaboutyour audience, and modify your language, tone, pitch andtopic based on what you think the audience's preferenceswould be. You'd never give a lecture about atoms tochildren!”

Whatdothedetailsinthepassagehaveincommon?In this case, the author iswritingabouthangingoutwith friends,goingonaninterview, and speakingpublicly,which, at firstglance,don't seem to relate toeach other that much. If you find a common theme among all them, though,you'llseethattheauthorisgivingyoudifferentsituationsandthentellingustospeakdifferentlyineachsetting(useslangwithfriends,berespectfulandquietin an interview, modify your tone publicly). The common theme is speakingsituations, and the author’s opinion about it is “different situations requiredifferentwaysofspeaking”.Therefore,theimplicitpointis:“differentsituationsrequiredifferentwaysofspeaking”.ImproveYourGrammarStudyingEnglishgrammarwillhelpyoutoaccuratelyanswerthetwolexicalreferencequestionsforeachtextinPartC.ItisalsoimportanttobeabletouseEnglishcorrectlytoperformwellintheotherSub-testsoftheOET.ThispartofpreparationisespeciallyimportantforcandidateswhohavenotformallystudiedEnglishbefore,ornotforalongtime(e.g.studiedsomeEnglishinschoolbutnotsince).AguidetoEnglishgrammarisbeyondthescopeofthisbook,butthereareplentyofresourcesyoucanaccessforfree(e.g.grammarguidesontheInternetorbooksaboutEnglishgrammaratyourlocallibrary).

TipsforChoosingtheCorrectAnswerinMultipleChoiceTherightapproachtomultiplechoicequestionsisquiteimportantinPartsBandC. The following tipsmay help you tomake up yourmind aboutwhether anansweroptioniscorrect:

Besuspiciousofabsoluteanswers.Thesemightuseabsolutewordssuchas"always","will"or"never".Alternatively,theymightbetoodefinite.

E.g. "Breastfeeding leads to fewer infections inbabies" is averydefinite statement, due to the words "leads to" (rather than"can/mightleadto").Thisdoesn'tallowforthepossibilitythatthismightnotbetrueinallcases.

Answerthequestionsaccordingtotheinformationinthepassage,nottheinformation you know from other sources.You're being tested on howwell you read and understand a sample of English, not whether youagreewithit!Payattentiontowordsthatdescriberelationships.Sometimes,theansweroptionwill soundcorrectbut a singlewordcanmake itwrong.This isusuallyaworddescribingarelationshipbetweentwofacts.Forexample:

"A shows that B" or "A is associated with B" (a definiterelationshipbetweentwofactors,butonedoesn'tnecessarilycausetheother)"AsuggestsB"or"AimpliesB"(apossiblerelationship)"Aismore/greater/less/lesserthanB"(e.g."Adietcontaining toomuch food high in sugar has a greater effect on the risk ofcardiovasculardiseasethanfattyfoods.")"AcausesB"or"AleadstoB"(adefiniterelationship,whereonefactoristhedirectresultofanother)

Part4:PracticeTests

Test1PartA

TIME:15minutes

Lookatthefourtexts,A–D,intheseparateTextBooklet.

Foreachquestion,1–20,lookthroughthetexts,A–D,tofindtherelevantinformation.

WriteyouranswersonthespacesprovidedinthisQuestionPaper.

Answerallthequestionswithinthe15-minutetimelimit.

_____________________________________________________________________

CigaretteSmokingandLungCancer:Questions

Questions1-7

Foreachofthequestions,1–7,decidewhichtext(A,B,CorD)theinformationcomesfrom.Youmayuseanylettermorethanonce.

Inwhichtextcanyoufindinformationabout

1Theeffectsofpassivesmoking?__________

2Thechancesofasmokergettinglungcancer?__________

3Thebenefitstotherespiratorysystemofquittingsmoking?__________

4Waystogethelpwithquittingsmoking?__________

5Thereductioninlungcancerriskifasmokerquits?__________

6Recommendedwebsitesorphonenumbersforsmokers?__________

7Howsmokingleadstoparticularsymptoms?__________

Questions8–14

Answereachofthequestions,8–14,withawordorshortphrasefromoneofthetexts.

Eachanswermayincludewords,numbersorboth.Youranswersshouldbecorrectlyspelled.

8 Howmuchofthelungcancerriskisavoidedbybeingsmoke-freefor10years?

____________________________________________________________

9 WhatisthephonenumberforQuitline?

____________________________________________________________

10 Whatisnormallyexpelledbythealveoliinthelungs?

____________________________________________________________

11 Whateffectcansmokinghaveonasthma?

____________________________________________________________

12 Whattypeofcancercanbeimprovedbyquittingsmoking?

____________________________________________________________

13 Whichtwo(2)cardiovasculardiseasesareassociatedwithpassivesmoking?

____________________________________________________________

14 Inwhichstateisitillegaltosmokeincarscarryingchildrenunder18?

____________________________________________________________

Questions15–20

Completeeachofthesentences,15–20,withawordorshortphrasefromoneofthetexts.Eachanswermayincludewords,numbersorboth.Youranswersshouldbecorrectlyspelled.

Cigarettesmokedamagesthelungsbydestroyingthe_______(15)thatabsorboxygen.

Eventually,thedestructionoflungtissuecanrenderasmokerunableto_______(16)normally.

Cigarettepacketsnowfeaturedepictionsofitshealtheffects,suchas_______(17).

Theeffectofprevioussmokingcanbereversedinsomeways,asthe_______(18)liningtheupperairwayscanrecoverfromdamage.

Passivesmokingincreasestheriskof_______(19)inchildren.

Thegoodnewsisthatifpeople_______(20)smokingbeforetheageof40,theycansignificantlyreducetheircancerrisk.

CigaretteSmokingandLungCancer:TextsTextASmokingandtheRiskofLungCancerForalife-longsmoker,theriskoflungcanceris20timeshigherthananon-smoker.Aswithmany of the health facts about smoking, this is analarmingstatistic–butyoucanmakearealdifferencetoyourhealth outcomes by choosing to quit smoking. Evidenceshowsthat:

Ifyouquitsmokingbytheageof40,youreduceyourriskoflungcancerbyupto90%Quitting by the age of 50 reduces your risk by up to65%After10yearsofbeingsmoke-free,you’llhaveavoidedaround40%oftheriskofevergettinglungcancerEven for someone newly diagnosed with early stagelung cancer, quitting smoking improves prognosis andreducesthechanceoftumourprogression

Source:CancerInstituteofNSW

TextB

Cigarettepackagingrepresentations

Source:AustralianGovernmentDepartmentofHealth

TextCEffectofSmokingontheLungsWhatdoessmokingdotomylungs?It paralyses and can destroy cilia, which line your upperairways and protect you against infection. It destroys thealveoli,orairsacs,whichabsorboxygenandgetridofcarbondioxide.Itdestroyslungtissue,makingthelungslessabletofunction, and irritates the lungs which creates phlegm andnarrowstheairways,makingithardertobreathe.Howdoesthataffectme?Itmakesyoushortofbreath,itmakesyoucough,itgivesyouchronic bronchitis and repeated chest infections, it worsensyourasthmaanditcangiveyoulungcancer.That'sapartfromeffectsonyourheart,fertility,pregnancyandyourchildren.Butmostpeoplewhosmokedon'tgetlungcancer.No.Mostpeopledieofotherthingsfirst,oftenbecausetheysmoked.IfIgiveup,willmylungsimprove?Yes.Cilia thatareparalysed,butnotdestroyed,can recover.You will have less asthma and fewer chest infections. Thesooner you stop, the better your chances of improved lungfunction.Source:AustralianGovernment

TextDPassiveSmoking:Summary

InVictoria,itisillegaltosmokeincarscarryingchildrenwhoareunder18yearsofage.Ifapersonwhosmokescan’tgiveupfortheirownhealth,perhaps the health of their partner or children, or othermembersoftheirhousehold,willbeastrongermotivation.

Passivesmokingincreasestheriskofrespiratoryillnessinchildren,e.g.asthma,bronchitisandpneumonia.Peoplewhohaveneversmokedwholivewithpeoplewhodo smoke are at increased risk of a range of tobacco-relateddiseases, including lungcancer,heartdiseaseandstroke.

Source:VictoriaStateGovernmentENDOFPARTATHISANSWERBOOKLETWILLBECOLLECTED

PartB

Inthispartofthetest,therearesixshortextractsrelatingtotheworkofhealthprofessionals.Forquestions1to6,choosetheanswer(A,BorC)whichyouthinkfitsbestaccordingtothetext._____________________________________________________________________

1. ThetreatmentguidelinesbelowrecommendthatAAllpatientsreceiveparathyroidhormonemonitoringBAllpatientsreceive6-weeklymonitoringCAllpatientsreceivebaselinebloodtests

Table:MedicalMonitoringGuidelinesforHighRiskPatientsonVeryLowEnergyDietsAssessment Baseline

Measures6weeks Completion

ofIntensivePhase

Electrolytes/Creatinine Yes Ifrequired

Yes

Liverfunctiontests Yes Ifrequired

Yes

Fastingglucose Yes Ifrequired

Yes

Cholesterol,triglyceridesandHDL

Yes Ifrequired

Yes

Uricacid Yes Ifrequired

Yes

Fullbloodcount Yes Ifrequired

Yes

Ironstudies Yes Ifrequired

Yes

VitaminD Yes Ifrequired

Yes

CalciumandParathyroidhormone(inpatientsonlongtermanticonvulsants)

Yes Ifrequired

Yes

Source:NestleHealthScience.OptifastVLCDClinicalTreatmentProtocol.In:LtdNA,ed.NottingHillVIC,Australia,2013.

2.ThisnoticeisgivinginformationaboutAThedifferentialmanagementofinfantsusingglucoseBHowtocheckaninfant’sbloodglucoselevelCTheidealglucoseconcentrationininfantswithclinicalsigns

Managementofdocumentedhypoglycemiainbreastfeedinginfants

A.Infantwithnoclinicalsigns1. Continuebreastfeeding(approximatelyevery1–2hours)

orfeed1–5mL/kgofexpressedbreastmilkorsubstitutenutrition.

2. Recheckbloodglucoseconcentrationbeforesubsequentfeedingsuntilthevalueisacceptableandstable.

3. Avoidforcedfeedings(seeabove).4. Iftheglucoselevelremainslowdespitefeedings,begin

intravenousglucosetherapy.5. Breastfeedingmaycontinueduringintravenousglucose

therapy.6. Carefullydocumentresponsetotreatment.

B.Infantwithclinicalsignsorplasmaglucoselevels<20–25mg/dL(<1–1.4mmol/L)1. Initiateintravenous10%glucosesolutionwitha

minibolus.2. Donotrelyonoralorintragastricfeedingtocorrect

extremeorclinicallysignificanthypoglycemia.3. Theglucoseconcentrationininfantswhohavehad

clinicalsignsshouldbemaintainedat>45mg/dL(>2.5mmol/L).

4. Adjustintravenousratebybloodglucoseconcentration.5. Encouragefrequentbreastfeeding.

6. Monitorglucoseconcentrationsbeforefeedingswhileweaningofftheintravenoustreatmentuntilvaluesstabilizeoffintravenousfluids.

7. Carefullydocumentresponsetotreatment.Source:Wight,N.andMarinelli,K.A.ABMClinicalProtocol#1:GuidelinesforBloodGlucoseMonitoringandTreatmentofHypoglycemiainTermandLate-PretermNeonates,Revised2014.BreastfeedingMedicine.20014,9:4(173-9)

3.ThisinformationsheetrecommendsARegularauditingtoensurepainmanagementprogramefficacyBIndicatorstouseinpainmanagementprogramauditsCAtleast50%changeasbeingclinicallyimportant

AuditofPainManagementPrograms:Methods

Itisrecommendedtoconductanauditof20ormoresequentialpatientsundertakingapainmanagementprogram.Datacollectionshouldincludesimpledemographicandprogramdataaswellasdata(preandpostprogramwithaminimumthreemonthintervalbetweendatasets)regardingchangesin:Healthcareutilisation.Depression/anxiety/stress.Painself-efficacy.Paincatastrophising.Percentagechangeinindividualpatientshasbeensuggested(ratherthanaveragepercentagechangeacrossthepopulationaudited)asaveragepercentagechangeisverysensitivetooutliersandsmallauditsmaythereforebesignificantlyinfluencedbyaveragepercentagechange.TheInitiativeonMethods,Measurement,andPainAssessmentinClinicalTrials(IMMPACT)recommendsconsideringclinicalimportantchange(asdistinctfromstatisticallysignificantchange)onthefollowingbasis:Minimalbenefit:10-20percentchange.Moderatelyimportantbenefit:atleast30percentchange.Substantiallyimportantbenefit:atleast50percentchangeSource:Cartwright,S.andThomas,C.(2014)Clinicalauditguide:Interdisciplinarypainmanagementprograms.Accessedfrom:http://www.anzca.edu.au/documents/pmp-interdisciplinary-clinical-audit-guide-v1-2014.pdf

4.ThisregulatorystatementinstructshealthcareprofessionalstoAAdmitallpatientstoNSWpublichospitalswithin48hoursBAssessallpatientsintheEmergencyDepartmentforVTECInitiateVTEprophylaxisforallpatientsidentifiedtobeatrisk

MANDATORYREQUIREMENTS:AlladultpatientsadmittedtoNSWpublichospitalsmustbeassessedfortheriskofVTEwithin24hoursandregularlyasindicated/appropriate.AlladultpatientsdischargedhomefromtheEmergencyDepartmentwhoasaresultofacuteillnessorinjury,havesignificantlyreducedmobilityrelativetonormalstate,mustbeassessedforriskofVTE.PatientsidentifiedatriskofVTEaretoreceivethepharmacologicaland/ormechanicalprophylaxismostappropriatetothatriskandtheirclinicalcondition.AllhealthservicesmustcomplywiththePreventionofVTEPolicy.AllPublicHealthOrganisationsmusthaveprocessesinplaceincompliancewiththeactionssummarisedintheVTEPreventionFramework(Appendix4.1oftheattachment).AVTEriskassessmentmustbecompletedforalladmittedadultpatientsandotherpatientsidentifiedatrisk,anddecisionsupporttoolsmadeavailabletoguideprescriptionofprophylaxisappropriateforthepatient’srisklevel.

Source:NSWHealth.PolicyDirective:PreventionofVenousThromboembolism.In:ClinicalExcellenceCommission,ed.Sydney,Australia:MinistryofHealth,2014.

5.TheadvicebelowcanbestbeappliedtoahealthcaresettingbyATheinclusionofnursesingovernancestructuresBProvidinginformationtopatientsintheirnativelanguageCRedesigningprojectsaccordingtoadvisorygroup

recommendations

Partnershipswithconsumerscancomeinmanyforms.Someexamplesinclude:

workingwithconsumerstocheckthatthehealthinformationiseasytounderstandusingcommunicationstrategiesanddecisionsupporttoolsthattailormessagestotheconsumerincludingconsumersingovernancestructurestoensureorganisationalpoliciesandprocessesmeettheneedsofconsumersinvolvingconsumersincriticalfriends’groupstoprovideadviceonsafetyandqualityprojectsestablishingconsumeradvisorygroupstoinformdesignorredesignprojects

Source:AustralianCommissiononSafetyandQualityinHealthCare.PatientandConsumerCentredCare2018[Availablefrom:https://www.safetyandquality.gov.au/our-work/patient-and-consumer-centred-care/.]

6.ThepurposeofthedocumentbelowistoAPreventMedicareclaimsbeingpaidforpublicpatientsBSpecifywhenservicescanbebilledtoMedicareCEnsurehealthcareprofessionalsdon’tfalsifyclaims

Guidelineforsubstantiatingclaimsfordiagnosticimagingandpathologyservicesrenderedtoemergencydepartment

patientsofpublichospitalsPublichospitalsarefundedunderanarrangementwiththeAustralianGovernmenttoprovidefreepublichospitalservicestoeligiblepatients.Thisincludesdiagnosticimagingandpathologyservicesprovidedtopublichospitalemergencydepartmentpatients.Apatientwhopresentstoapublichospitalemergencydepartmentshouldbetreatedasapublicpatient.Ifthatpatientissubsequentlyadmittedtheymayelecttobetreatedasaprivatepatientforthoseadmittedservices.ForaMedicareclaimtobepaidforapatientinapublichospital,thepatientmustbeadmittedasaprivatepatientatthetimetheservicewasrendered.WhereaserviceforapatientinapublichospitalhasbeenbilledtoMedicare,thehospitalorrenderingpractitionermaybeaskedtosubstantiatetheseclaims.Documentsyoumayuseinclude:

theformwhichthepatient(ornextofkin,carerorguardian)-hassignedindicatingthatthepatienthaselectedtobeadmittedasaprivatepatient,and

patientrecords-thatshowthepatientwasadmittedasaprivatepatientatthetimetheservicewasrendered

Source:DepartmentofHealth.Guidelineforsubstantiatingclaimsfordiagnosticimagingandpathologyservicesrenderedtoemergencydepartmentpatientsofpublichospitals2018[Availablefrom:http://www.health.gov.au/internet/main/publishing.nsf/Content/hpg-di-path-emerg-pub-hosp.]

PartC

Inthispartofthetest,therearetwotextsaboutdifferentaspectsofhealthcare.Forquestions7to22,choosetheanswer(A,B,CorD)whichyouthinkfitsbestaccordingtothetext._____________________________________________________________________Text1:ScopeofPracticeforHealthcareProfessionalsA "scope of practice" refers to the procedures, actions, and processes that ahealthcare practitioner is allowed to undertake according to their professionalcertification.Thescopeofpractice is limited to thatwhich is legallypermittedforahealthcareprofessionalwithacertainlevelofeducationandexperience,aswell as their level of competency. Each level of jurisdiction has their specificlaws,policiesandlicensingbodies,whichdefineandregulatescopeofpractice.Differentfacilities,suchashospitals,mayhavedifferentpolicieswithregardstotheclinicalresponsibilityaffordedtoahealthcareprofessional.There are two types of scope of practice.Core scope of practice refers to theeverydayexpectationsofaclinicianinpractice,withinthatparticularunit.Thesereflecttheclinician'squalificationsandtrainingandareconsideredtobe"usualpractice". Advanced scope of practice refers to additional allowances orresponsibilities, and usually specify particular treatments/procedures orcategories of treatments/procedures to be included in the individual's scope ofpractice.Threecategoriesmaybeuseful in identifyingahealthcareprofessional's scopeofpractice.Thefirstiseducationandtraining–hasthepersonreceivedformaloron-the-jobtrainingandhavedocumentationtoprovethis?Thesecondrelatesto the state or federal government that oversees the individual’s place ofemployment–doesitallowtheskill inquestionandnotexplicitlydisallowit?Finally, the particular institution of employment is also relevant – does it alsoallowtheskillinquestionandnotexplicitlydisallowit?

Some examples of how scope of practice differs are useful. All states and

provinceswhorecognisethelicensingofregisteredrespiratorytherapists(RRTs)allowthemtocarryoutextracorporealmembraneoxygenation(ECMO)support.However, some institutions do not allow this. In this case, it is within theinstitution’s rights to refuse to allow RRTs working there to perform ECMO.Therefore,RRTsworkingattheseinstitutionsarenotallowedtoincludeECMOaspartoftheirscopeofpractice.

Some environments require alterations to bemade to a scope of practice. Forexample,alliedhealthprofessionalswhoworkinaruralorremoteareahaveabroaderscopeofpracticethanthosewhoworkinmetropolitanareas.Theymaybe required to undertake activities or procedures that are outside the scope ofpracticegenerallyacceptedfortheirprofession.Thisallowsthemtobettermeettheneedsofcommunitiesinwhichtheywork.

Apartfromgeographicaldifferences,certainsignificanteventsmayalsoresultinalterations beingmade to the scope of practice. For example, during the 2009H1N1influenzapandemic,anumberofstatesexpandedthescopeofpracticeforanumberofhealthcareprofessionsinordertoincreasethenumberofclinicianseligible to provide vaccinations.Thiswas a temporarymeasure that lasted forthe duration of the emergency andwas legally permitted.Other states did notemploy thismeasure, primarily because the capacity of clinicians to vaccinatethepublicintheseareaswassufficient.State governments annually review the scope of practice for routine (non-emergency) activities to make sure they are meeting the population needs.Changestoscopeofpracticemustbeconsideredwithcaution,astheycanaffectpeople in both positive and negativeways.Changesmay be seen as away toprotectthepublicandgivebroaderaccesstocompetenthealthcareprofessionals,butcanalsoresultinturfbattlesbetweentwoormoredifferentprofessionsovertheexclusiverightstoperformanactivity.Consideringthis,healthcareprofessionalsmustunderstandtheirprofessionalandindividual scope of practice. Some tasks, while they are within the scope ofpracticeforaprofession,maynotbepermittedunderthescopeofpracticeofanindividual.Thisisoftenanissueforalliedhealthstaffwhomovefromruralorremoteareastometropolitanareas,wheretheirscopeofpracticeismorelimited.Conversely,alliedhealthstaffwhoformerlyworkedinametropolitanareamay

findthemselveswithouttheskillsorexperiencetomeettheirscopeofpracticeina ruralor remote area. In the teamenvironmentof thehealthcare system, it iskey that each team member can clearly identify and communicate theirprofessionalandindividualscopeofpractice.

Text1:Questions7to14

7. Inthefirstparagraph,themeaningofthephrase“affordedto”is:A The clinical responsibility that is paid for by healthcare

professionals.B Theclinical responsibility that canbe affordedbyhealthcare

professionals.C The clinical responsibility that is given to healthcare

professionals.D The clinical responsibility that is acceptable to healthcare

professionals.

8. Inthesecondparagraph,corescopeofpracticerefersto:ATheclinician’sexpectationsofwhattheirworkinvolves.B The things that amember of the public can expect from the

clinician.CThethingsthattheunitcanexpectfromtheclinician.DThequalificationsandtrainingoftheclinician.

9. Allofthefollowingarecategoriesthatcanbeappliedtoidentifyscopeof

practiceexcept:A The formal or on-the-job training received by the healthcare

professional.BThestateorfederalgovernment’sallowanceornon-allowanceof

anactivity.CTheinstitution’sallowanceornon-allowanceofanactivity.DAprovenhistoryofformaloron-the-jobtraining.

10. Thesituation forparamedics is similar to that for registered respiratory

therapistsbecause:ATheyarebothinvolvedinemergencypatientcare.BTheybothhavevaryingscopesofpractice.CTheycanbothperformapercutaneouscricothyrotomy.D Theyarebothproceduresused tohelpapatientbreathemore

effectively.

11. According to the fifth paragraph, the benefit of changes to scope ofpracticeis:

A Thecommunities inwhichhealthcareprofessionalsworkcanhavetheirneedsmetmoreeffectively.

B Theservicesprovidedbyalliedhealthprofessionalsinruralorremote areas can be better than those provided in metropolitanareas.

C Allied health professionals can better serve rural or remotecommunities.

D Healthcareprofessionalscanrelymoreontheirjudgmentwhentreating patients, rather than being restricted by their scope ofpractice.

12. Inthesixthparagraph,theauthorimpliesthat:A Somestatesandprovinceswerebetterequippedtopreventthe

spreadofH1N1influenzain2009thanothers.B Healthcare professionals should have their scope of practice

extendedpermanently toprovidevaccinations incaseofanotherinfluenzapandemic.

C Therewasaknee-jerk reactionby somestates tocontain thespreadofH1N1influenzain2009byexpandingtheircapacitytodelivervaccinations.

D Insomestates,healthcareprofessionalshavebeenallowed toprovide vaccinations since 2009 to prevent the spread ofpandemicinfluenza.

13. According to theseventhparagraph, theauthor'sopiniononchanges to

scopeofpracticeisthat:A Suchchangesarenecessary toprotect thepublicandprovide

accesstoabroaderrangeofcompetenthealthcareprofessionals.B Such changes can be politically controversial and have an

ambiguousbenefit.C Suchchangesleadtoconflictbetweentwoormorehealthcare

professionsovertheexclusiverightstoperformanactivity.DSuchchangesshouldbereviewedmorefrequentlythantheyare

currently.

14. Themainmessageofthearticleis:A Scopeofpracticevarieswithineachprofession,sohealthcare

professionalsshouldbe informedofwhat theirscopeofpracticeis.

B Scope of practice is dynamic and depends on geographicalfactors,individualstatesorinstitutions,andsignificantevents.

CDifferenthealthcareprofessionshavedifferentscopesofpractice.D Eachmember of a healthcare team should be aware of their

individual,aswellasprofessional,scopeofpractice.

Text2:AdvancedDementiaDementiaisasignificantcauseofmorbidityandmortalityworldwide.In2014,approximately 5 million people in the United States had a diagnosis ofAlzheimer'sdisease,withanestimated14millionbeingaffectedby2050.Oncediagnosed, patients can survive with the condition for an average of 3 to 12years.Themajorityof this timewill be spent in themost severe stagesof thedisease. As nursing homes are the site of death in most cases, these are animportantfactortoconsiderwhenstudyingAlzheimer'sdisease.At themoment,nocureexists fordementiaor theprogressionof itsdisablingsymptoms.TheGlobalDeteriorationScale,whichrangesfrom1to7,isusedtodescribe the levelofdisability inpatientswithdementia.Stage7characterisesadvanceddementia:profoundmemorydeficits,avirtualabsenceoftheabilitytoverbalise, inability to ambulate independently or perform activities of dailyliving, and urinary and fecal incontinence. These manifestations result incomplicationssuchaseatingproblems,episodesoffeverandpneumonia.Inordertoprovideanestimateofsurvival timeforpatientswithdementia, theFunctionalAssessmentStagingTooliscommonlyused.Althoughimpossibletoquantifyaccuratelyin100%ofcases,thistoolallowsageneralprognosistobemade.Thisis importantbecauseapatient'seligibilityforthehospicebenefit isassessedbasedon theirprojectedsurvival timeaswellashistoryofdementia-related complications. Some clinicians prefer to use a risk score to predictsurvival, as this has slightly better predictive ability. Many consider that theeligibility of patients for nursing home care should be based on the desire forsuchcare,ratherthanprognosis.The care of patients with advanced dementia revolves around advanced careplanning.Thisincludeseducatingthepatient'sfamilyabouttheprognosisofthedisease and its manifestations, counseling about proxy decision making, andrecording the patient's wishes regarding treatment through an advanced caredirective. Some observational studies have shown that patients with advancedcaredirectives havebetter palliative care outcomes: reduced incidenceof tubefeeding,fewerhospitalisationsduringthefinalstages,andgreaterlikelihoodofenrollmentinahospice.

Decisionsabout thecareofpatients shouldalso reflect thegoalsof suchcare.Thesegoalsshouldbeagreeduponbetweentheprovider,theprimarycarers,andideally, the patient themselves. The goals of treatment, and therefore thetreatmentdecisionsthemselves,shouldbealignedwiththepatient'swishesasfaraspossible.Anexampleofhowtreatmentpreferencesmayvaryiswhetherthepatient would like all medical interventions deemed necessary, only certainmedicalinterventions,orcomfortmeasuresonly.In90%ofproxiesinterviewedinprospectivestudies,thelatterwasreportedtobetheprimarygoalofcare.Outofthemostcommoncomplicationsofadvanceddementia,eatingproblemsarethemostprevalent.Thesemayincludeoraldysphagia("pocketing"offoodinthecheek),pharyngealdysphagia(inabilitytoswallow,leadingtotheriskofaspiration), inability to eat independently and refusal. When eating problemsoccur, acute causes should always be considered (e.g. dental pathology). Thereversalofsuchcausesshouldbeguidedbythepreviouslyagreedgoalsofcare.Chronicorsustainedeatingproblemsaremostoftenmanagedbyhandfeeding,tubefeeding,orencouragementoffoodintakethroughsmallermeals,differenttexturesorhigh-caloriesupplementation.Infections are another common clinical problem in patients with advanceddementia, most commonly relating to the urinary or respiratory tract. In 362nursing home residents with advanced dementia, the Study of PathogenResistanceandExposure toAntimicrobials inDementia (SPREAD)found thattwothirdswerediagnosedwithsuspectedinfectionswithina12monthperiod.Approximately 50% of patients with advanced dementia are diagnosed withpneumoniainthelast2weeksoflife,andsuchpatientsexperienceahighrateofdeathfromthiscause.However,theuseofantimicrobialstotreatinfectionshasbeen found to increase length of survival but also the level of discomfort inpatientswithadvanceddementia.Therefore,suchtreatmentmaynotnecessarilyalignwiththepatient'spreferencesorgoalsofcare.Improving the care of patients with advanced dementia is becoming anincreasingly recognised issue amongst healthcare providers. Studies of theexperiencesofpatientswithadvanceddementiahaveshownthatcarewhich isfocused on patient-centred goals and adherence to patient preferences ismosteffectivein improvingoutcomes.Inorder toachievethis,providersneedtobe

betterequippedtoengagepatientsandtheirfamiliesinadvancedcareplanning,reduce theuseof invasive treatmentsof limitedbenefit (such as tube feeding)andbetteraddressdistressingclinicalsymptoms.

Text2:Questions15to22

15. TheGlobalDeteriorationScaleismostusefulforprovidinghealthcareprofessionalswithinformationabout:AThepatient'sabilitytorecallmemories,verbalise,ambulate

independently,attendtoactivitiesofdailylivingandcontrolurineandfecaloutput.

BAquantificationofthepatient'sdegreeofdisability.CThelikelihoodofdementia-relatedcomplications.DThepatient'spredictedsurvivaltime.

16. Accordingtothethirdparagraph,themainreasonformakingageneral

prognosisaboutsurvivaltimeis:AToprovidefamilymemberswithsomeideaofthetrajectoryof

thedisease.BToinformdecisionsthatprovidersmustmakeabouttreatment.CTodetermineeligibilityfornursinghomecare.DTodetermineeligibilityforthegovernmentsubsidyofhospice

care.

17. Thebestreplacementfortheword"proxy"inthefourthparagraphwouldbe:AsubstituteBadditionalCcarerDtreatment

18. Inthefifthparagraph,theauthor'smainargumentisthat:

ADecisionsaboutcareshouldbeguidedbyitsgoals,whichmostoftenmeanscomfortcareratherthanmedicalinterventions.

BMostpatientswithadvanceddementiaprefercomfortcaretomedicalinterventions.

CThegoalsofcareshouldbeagreeduponinconsultationwiththeprovider,thefamilyandthepatientthemselves.

DTreatmentpreferencesvarybetweenindividualpatientswithadvanceddementia.

19. Accordingtothesixthparagraph,eatingproblemsinadvanceddementia

maybecausedby:Ainappropriateeatingpractices.Brecentdentalprocedures.Caspirationoffood.Drefusaltoeatindependently.

20. Intheseventhparagraph,theauthorsuggeststhat:

AAbout50%ofpeoplewithadvanceddementiawillsufferfrompneumoniaduringthelast2weeksoftheirlife.

BInfectionsinpeoplewithadvanceddementiashouldnotalwaysbetreated.

CWithina12monthperiod,approximatelytwothirdsofnursinghomeresidentswithadvanceddementiaaresuspectedtohaveaninfection.

DUrinaryandrespiratoryinfectionsarethemostcommonclinicalprobleminadvanceddementia.

21. Waysinwhichthecareofpatientswithadvanceddementiacanbe

improvedincludeallthefollowingexcept:AAdherencetopatientpreferencesfortreatment.BBettertreatmentofdistressingsymptoms.CEngagingpatientsandfamiliesinadvancedcareplanning.DHandfeedinginsteadoftubefeeding.

22. Theauthor'sapproachtothecareofpatientswithadvanceddementia

couldbestbedescribedas:Apractical.Bpatient-centred.Canalytical.Dutilitarian.

ENDOFREADINGTEST

Test1:AnswerKeyPartAQuestions1to201 D2 A3 C4 B5 A6 B7 C8 around40%9 13184810 carbondioxide11 worsens12 earlystagelungcancer13 heartdiseaseandstroke14 Victoria

15 alveoli16 breathe17 lungcancer18 cilia19 respiratoryillnesses20 quit

PartBQuestions1to61 C Allpatientsreceivebaselinebloodtests

2 AThedifferentialmanagementofinfantsusingglucose

3 BIndicatorstouseinpainmanagementprogramaudits

4 CInitiateVTEprophylaxisforallpatientsidentifiedtobeatrisk

5 BProvidinginformationtopatientsintheirnativelanguage

6 APreventMedicareclaimsbeingpaidforpublicpatients

PartCQuestions7to147 C Theclinicalresponsibilitythatisgiventohealthcare

professionals.

8 B Thethingsthatamemberofthepubliccanexpectfromtheclinician.

9 A Theformaloron-the-jobtrainingreceivedbythe

healthcareprofessional.10 B Theybothhavevaryingscopesofpractice.

11 C Alliedhealthprofessionalscanbetterserveruralorremotecommunities.

12 A SomestatesandprovinceswerebetterequippedtopreventthespreadofH1N1influenzain2009thanothers.

13 B Suchchangescanbepoliticallycontroversialandhaveanambiguousbenefit.

14 A Scopeofpracticevarieswithineachprofession,sohealthcareprofessionalsshouldbeinformedofwhattheirscopeofpracticeis.

Questions15to2215 B Aquantificationofthepatient'sdegreeofdisability.

16 D Todetermineeligibilityforthegovernmentsubsidyofhospicecare.

17 A Substitute.

18 A Decisionsaboutcareshouldbeguidedbyitsgoals,whichmostoftenmeanscomfortcareratherthanmedicalinterventions.

19 A Inappropriateeatingpractices.

20 B Infectionsinpeoplewithadvanceddementiashouldnotalwaysbetreated.

21 D Handfeedinginsteadoftubefeeding.

22 B Patient-centred.

ENDOFKEY

Test1:AnswerGuide

PartATextA

TextB

TextC

TextD

PartB

1. ThetreatmentguidelinesbelowrecommendthatAIncorrect:thisisonlyrecommendedforpatientstakinglongterm

anticonvulsantsBIncorrect:thisisonlyrecommended“ifrequired”.CCorrect:thisisthegeneralideaofthetext,sinceitiscommon

toallpatients.2.Thisnoticeisgivinginformationabout

ACorrect:thisisthegeneralideaofthetext,sinceitcoversdifferentmanagementapproachesfordifferentglucoselevels.

BIncorrect:theinstructionsforcheckinganinfant’sbloodglucoselevelarenotfoundinthetext.

CIncorrect:Ininfantswithclinicalsigns,theglucoselevelsgivenareanalternativecriterionforfollowingthecorrespondingmanagementapproach.

3.ThisinformationsheetrecommendsAIncorrect:therecommendedregularityofauditingisnotstated.BCorrect:indicatorsarementionedseveraltimethroughoutthe

text,andarethereforeamainpoint.

CIncorrect:atleast30%changeisalsomentionedasbeingclinicallyimportant,butonlymoderately.

4.ThisregulatorystatementinstructshealthcareprofessionalstoAIncorrect:patientswhoarealreadyadmittedmustbeassessedfor

VTEriskwithin24hours.BIncorrect:thisonlyappliestopatientsdischargedhome.CCorrect:thisisstatedinthethirddotpoint.

5.TheadvicebelowcanbestbeappliedtoahealthcaresettingbyAIncorrect:consumersreferstopatients,notnurses.BCorrect:thiswouldaddresstheexampleof“using

communicationstrategiesthattailormessagestotheconsumer”.

CIncorrect:thisdoesn’taddresspartnershipswithconsumers.6.Thepurposeofthedocumentbelowisto

ACorrect:thedocumentoutlineswaysinwhichpatientscanbeprovedtobeprivatepatients,beforeMedicareclaimsarepaid.

BIncorrect:thedocumentgoesfurtherthanthis.CIncorrect:thedocumentguideshealthcareprofessionalsbut

doesn’tpreventfalsificationofclaims.

PartC

7. Inthefirstparagraph,themeaningofthephrase“affordedto”is:A Incorrect: healthcare professionals cannot purchase clinical

responsibility.B Incorrect: “afforded by” refers to themoney that healthcare

professionalscanpayforclinicalresponsibility.CCorrect:“afforded”canmean“allowed”or“given”.DIncorrect:“afforded”doesnotmean“acceptable”.

8. Inthesecondparagraph,corescopeofpracticerefersto:AIncorrect:theclinician’sexpectationsarenotmentioned.Rather,

theexpectationsOFtheclinicianarementioned.B Correct:“expectationsofaclinician inpractice” isbroad,

thereforeitreferstothepublicingeneral.C Incorrect: the unit’s expectations are notmentioned. Rather,

expectationsareinthecontextofworkingataparticularunit.D Incorrect:expectationsreflecttheclinician’squalificationsand

training.

9. Allofthefollowingarecategoriesthatcanbeappliedtoidentifyscopeofpracticeexcept:

A Correct: thiscan’tbeappliedto identifyscopeofpracticeunlessthesearedocumented.

BIncorrect:thisismentionedasacategoryintheparagraph:“stateor federal government that oversees the individual’s place ofemployment”

CIncorrect:thisismentionedasacategoryintheparagraph:“doesitalsoallowtheskillinquestionandnotexplicitlydisallowit?”

D Incorrect: this ismentioned as a category in the paragraph:“formal or on-the-job training andhavedocumentation to provethis.

10. Thesituation forparamedics is similar to that for registered respiratorytherapistsbecause:

AIncorrect:notthereasonfortheirsituationbeingsimilar.B Correct: passage states “A similar situation exists for

paramedics. In some states and provinces, paramedics areallowed to carry out a percutaneouscricothyrotomy….However,inthestatesandprovinceswhichdonotallowparamedicstocarryoutthisprocedure...”

C Incorrect: this is not similar to the situation for respiratorytherapists, which depends on the institution (not thestate/province)inwhichtheywork.

DIncorrect:notthereasonfortheirsituationbeingsimilar.11. Accordingtothefifthparagraph,thebenefitofchangestoscopeof

practiceis:AIncorrect:thisbenefitreferstothescopeofpracticeofALLIED

healthprofessional.BIncorrect:theycanbedifferent,butnotnecessarilybetterdueto

limitedresources.C Correct: passage states “Some environments require

alterationstobemadetoascopeofpractice.Forexample...ina rural or remote area...better meet the needs of thecommunities”

D Incorrect: this is not the reason stated for alternations beingbeneficial.

12. Inthesixthparagraph,theauthorimpliesthat:A Correct: some states were better equipped because “the

capacity of clinicians to vaccinate the public in these areas

wassufficient”BIncorrect:theauthorstatesthatthisonlyhappenedbecauseitwas

necessary.Therefore,theansweristoobroad.C Incorrect:“knee-jerk”describessomethingthatisunplannedor

disorganised.Theauthordoesn’tstateanythingthatsuggeststhis.D Incorrect: thiswasonlyfor thedurationof thepandemic,not

“since2009”,whichimpliesitisstillthecasetoday.13. Accordingtotheseventhparagraph,theauthor'sopiniononchangesto

scopeofpracticeisthat:A Incorrect: thepassagestates“maybeseen(meaning“maybe

perceived”)asawaytoprotectthepublic”.B Correct:ambiguousbenefit ismentioned(“theycanaffect

those affected by the changes in both positive and negativeways”)andsoispoliticalcontroversy(“maybeseenasawayto protect the public...but can also result in turf battlesbetweentwoormoredifferentprofessions”)

CIncorrect:thepassagestates“canresultinturfbattles”,not“willresultinturfbattles”.Therefore,thisansweristoobroad.

D Incorrect: the author doesn’t criticise the frequency of thechanges.

14. Themainmessageofthearticleis:A Correct: this is mentioned in the first (“Each level of

jurisdiction has their specific laws, policies and licensingbodies...Different facilities, such as hospitals, may havedifferentpolicies”)andlast(“itiskeythateachteammembercan clearly identify and communicate their...scope ofpractice”)paragraph,andsupportedthroughoutthearticle.

B Incorrect:thisisfactuallytrue,butnotreallyamessagetothereader.

C Incorrect:thisisfactuallytrue,butnotreallyamessagetothereader.

D Incorrect:thisisfactuallytrue,butnotreallyamessagetothereaderandonlymentionedonce.

15. TheGlobalDeterioration Scale ismost useful for providing healthcareprofessionalswithinformationabout:

AIncorrect:itisMOREusefulfordescribingthelevelofdisability,whichisbasedonthesefactors.

B Correct:thepassagestatesthatitcan“describethelevelofdisabilityinpatientswithdementia”.

CIncorrect:itdoesn’tpredicthowlikelythesecomplicationsare.DIncorrect:notmentionedinthepassage.

16. Accordingtothethirdparagraph,themainreasonformakingageneralprognosisaboutsurvivaltimeis:

AIncorrect:notmentionedasareasonformakingaprognosis.BIncorrect:notmentionedasareasonformakingaprognosis.C Incorrect:eligibilityforthehospicebenefit,notnursinghome

care,isdetermined.D Correct: the passage states it is “important because a

patient'seligibilityforthehospicebenefitisassessedbasedontheirprojectedsurvivaltime”.

17. Thebestreplacementfortheword"proxy"inthefourthparagraphwouldbe:

A Correct: “proxy”means a substitute, delegate, agent orrepresentative.

BIncorrect:“proxy”doesn’tmeanadditionalCIncorrect:“proxy”doesn’tmeancarer(acarerisoneexampleof

aproxy)DIncorrect:“proxy”doesn’tmeantreatment

18. Inthefifthparagraph,theauthor'smainargumentisthat:

A Correct: the author states “decisions about the care ofpatientsshouldalsoreflectthegoals”and“comfortmeasuresonly. In 90% of proxies ...the latter was reported to be theprimarygoalofcare”

B Incorrect: most proxies prefer comfort care to medicalinterventions.

CIncorrect:thisistrue,butnottheMAINargument.DIncorrect:thisistrue,butnottheMAINargument.

19. Accordingtothesixthparagraph,eatingproblemsinadvanceddementiamaybecausedby:

A Correct: inappropriate eating practices include “oraldysphagia”.

B Incorrect: dental pathology is mentioned, but not dentalprocedures.

CIncorrect:thisisanoutcome,notacause,ofeatingproblems.D Incorrect:thepassagestates“refusaltoeat”,not“refusaltoeat

independently”.

20. Intheseventhparagraph,theauthorsuggeststhat:A Incorrect: this is too broad, as the passage only states:

“Approximately 50% of patients with advanced dementia arediagnosed with pneumonia in the last 2 weeks of life” - moremightsuffer,butareundiagnosed.

B Correct: thepassage states that “such treatmentmaynotnecessarily align with the patient's preferences or goals ofcare”andthatgoalsofcareshouldguidetreatmentdecisions(paragraph5).

C Incorrect:“twothirdswerediagnosedwithsuspectedinfectionswithin a 12 month period” (Diagnosed with, not suspected tohave,infections).

DIncorrect:thepassagestatesthatinfectionsare“anothercommonclinicalproblem”notthe“mostcommonclinicalproblem”.

21. Ways in which the care of patients with advanced dementia can beimprovedincludeallofthefollowingexcept:

A Incorrect:thepassagementionsthis(“carewhichisfocusedonpatient-centredgoalsandadherencetopatientpreferences”)

B Incorrect:thepassagementionsthis(“betteraddressdistressingclinicalsymptoms”)

CIncorrect:thepassagementionsthis(“betterequippedtoengagepatientsandtheirfamiliesinadvancedcareplanning”)

D Incorrect:thisismentionedasoneformofmanagementofeatingproblems,butnotnecessarilyanimprovementtocare.

22. The author's approach to the care of patients with advanced dementiacouldbestbedescribedas:

A Incorrect:theauthor’sapproachisn’talwayspractical,suchaswhennottreatinginfections.

BCorrect:throughoutthearticle,theauthorreferstopatient-centred carebeing thebest (e.g. “focused onpatient-centredgoalsandadherencetopatientpreferences”).

C Incorrect:theauthordoesn’tanalysealltheaspectsofcare,butrather,presentsanargumentthatitshouldbepatient-centered.

D Incorrect: thismeansthattheneedsofsocietyshouldbemoreimportantthantheneedsoftheindividual.Theauthorarguestheopposite.

Test2PartA

TIME:15minutes

Lookatthefourtexts,A–D,intheseparateTextBooklet.

Foreachquestion,1–20,lookthroughthetexts,A–D,tofindtherelevantinformation.

WriteyouranswersonthespacesprovidedinthisQuestionPaper.

Answerallthequestionswithinthe15-minutetimelimit.

_____________________________________________________________________

VisionImpairment:Questions

Questions1-7

Foreachofthequestions,1–7,decidewhichtext(A,B,CorD)theinformationcomesfrom.Youmayuseanylettermorethanonce.

Inwhichtextcanyoufindinformationabout

1Thedefinitionofvisionimpairment?__________

2Howtoaddresssomeonewithvisualimpairment?__________

3Theprevalenceofvisualconditions?__________

4Statisticsregardingvisualimpairmentglobally?__________

5Theratesofeyeconditionsinmalesandfemales?__________

6Thelanguageyoushouldusewhentalkingtoablindperson?__________

7Themaincausesofvisionimpairmentglobally?__________

Questions8–14

Answereachofthequestions,8–14,withawordorshortphrasefromoneofthetexts.

Eachanswermayincludewords,numbersorboth.Youranswersshouldbecorrectlyspelled.

8 Howmanypeopleintheworldhavelowvision?

____________________________________________________________

9 Inwhichgenderisvisionimpairmentmostcommon?

____________________________________________________________

10 Howshouldyouactaroundapersonwhoisvisuallyimpaired?

____________________________________________________________

11 Whatshouldyoudoforavisuallyimpairedpersoninagroupsituation?

____________________________________________________________

12 Whatdoes6/60visionmeanlegallyinAustralia?

____________________________________________________________

13 Whatisthedefinitionofnormalvision?

____________________________________________________________

14 Whatisthemaincauseofmoderateandseverevisionimpairmentglobally?

____________________________________________________________

Questions15–20

Completeeachofthesentences,15–20,withawordorshortphrasefromoneofthetexts.Eachanswermayincludewords,numbersorboth.Youranswersshouldbecorrectlyspelled.

Inmostcases,visionimpairmentresultsinreducedvisualacuity,reduced_________(15),and/orreducedcolourperception.

Whenspeakingtoavisuallyimpairedperson,thereisnoneedto_______(16)wordssuchas“see”or“look”.

However,youshouldnotassumethepersonwillbeableto________(17)byyourvoice.

Itisestimatedthat80%ofcasesofvisualimpairmentcanbe________(18).

Mostofthevisuallyimpairedpeopleintheworldlivein_______(19).

Inthe0-14_______(20),onlyaround10%ofpeoplearediagnosedwithvisualimpairment.

VisionImpairment:Texts

TextASource:WorldHealthOrganisation

TextBFigure:Prevalenceoflong-termeyeconditions,2011–12

Source:AustralianInstituteofHealthandWelfare

TextCSource:RoyalInstituteforDeafandBlindChildren

TextDSource:VisionAustraliaENDOFPARTATHISANSWERBOOKLETWILLBECOLLECTED

PartB

Inthispartofthetest,therearesixshortextractsrelatingtotheworkofhealthprofessionals.Forquestions1to6,choosetheanswer(A,BorC)whichyouthinkfitsbestaccordingtothetext._____________________________________________________________________

1.ThemostlikelyoutcomeofimposinganationalschedulingsystemisAGreatercautionbeingusedwhenpatientstakemedicationBAreductionindeathsrelatedtodeliberatemedicationoverdosingCIncreasedaccesstomedicallynecessarydrugs

Schedulingisaclassificationsystemthatcontrolshowmedicinesandpoisonsaremadeavailabletothepublic.SubstancesaregroupedintoSchedulesaccordingtothelevelofregulatorycontrolovertheiravailabilityrequiredtoprotectpublichealthandsafety.SomeoftheSchedulesare:Schedule2

PharmacyMedicine

Schedule3

PharmacistOnlyMedicine

Schedule4

PrescriptionOnlyMedicineORPrescriptionAnimalRemedy

Schedule5

Caution

Schedule6

Poison

Schedule8

ControlledDrug

Schedule9

ProhibitedSubstance

Schedule Substancesofsuchdangertohealthastowarrantprohibitionof

10 sale,supplyanduse

Source:TherapeuticGoodsAdministration.Schedulingbasics2018[Availablefrom:https://www.tga.gov.au/scheduling-basics.]

2.ThepointbeingmadebelowregardingspirometrytechniqueisAItcanonlybeperformedbyhealthprofessionalsBThepatientshouldbecomfortablefortheprocedureCPatienteffortisanimportantfactordeterminingaccuracy

Conventionally,aspirometerisadeviceusedtomeasuretimedexpiredandinspiredvolumes,andfromthesewecancalculatehoweffectivelyandhowquicklythelungscanbeemptiedandfilled.Tomeasureforcedvitalcapacity(maximumvolumeofairwhichcanbeforciblyexhaledbyapatient),carefullyexplaintheproceduretothepatient,ensuringthathe/sheissittingerectwithfeetfirmlyonthefloor(themostcomfortableposition,thoughstandinggivesasimilarresultinadults,butinchildrenthevitalcapacityisoftengreaterinthestandingposition).Applyanosecliptothepatient'snose(thisisrecommendedbutnotessential)andurgethepatientto:

breatheinfully(mustbeabsolutelyfull)sealhis/herlipsaroundthemouthpieceimmediatelyblastairoutasfastandasfaraspossibleuntilthelungsarecompletelyemptybreatheinagainasforciblyandfullyaspossible(ifinspiratorycurveisrequiredandthespirometerisabletomeasureinspiration).

Source:JohnsDP,PierceR.Spirometry:TheMeasurementandInterpretationofVentilatoryFunctioninClinicalPractice:TheThoracicSocietyofAustraliaandNewZealand,2008

3.ThebestdescriptionoftheCHA2DS2-VAScscorewouldbeAApatient’shistoryofcardiovascularpathologyBAscoreof9pointsintotalCThelikelihoodofsufferingastroke

Inpatientswithnon-valvularatrialfibrillation,thedecisiontostartwarfarinshouldbebasedontheCHADS2score.This

assigns1pointeachforcongestiveheartfailure,hypertension,age75yearsandolder,anddiabetesmellitus,and2pointsforpreviousischaemicstrokeortransientischaemicattack.

TheCHA2DS2-VAScscore,5introducedbytheEuropean

SocietyofCardiology,providesamorecomprehensive

assessmentoftheriskfactorsforstroke.Itisbetterat

identifying‘trulylow-risk’patientswithatrialfibrillation,and

isnowpreferredoverCHADS2.

Score CHA2DS2-VAScRiskCriteria

1point Congestiveheartfailure

1point Hypertension

1point Age≥75years

1point Diabetesmellitus

2points Stroke/transientischemicattack/thromboembolism

1point Vasculardisease(priormyocardialinfarction,peripheralarterydiseaseoraorticplaque)

1point Age65-74years

1point Sexcategory(i.e.female)

Maximumscore 9points

Source:TidemanPA,TirimaccoR,StJohnA,etal.Howtomanagewarfarintherapy.AustralianPrescriber2015;38(2):44-48

4.InpatientstakingthemedicationdescribedbelowATheriskofdevelopingsecondaryleukemiais1.6%BTheriskofsecondaryleukemiaoutweighsthebenefitsCTheriskofdevelopingsecondaryleukemiaincreaseswithtime

Secondaryacutemyelogenousleukemia(AML)hasbeenreportedinmultiplesclerosisandcancerpatientstreatedwithmitoxantrone.InacohortofmitoxantronetreatedMSpatientsfollowedforvaryingperiodsoftime,anelevatedleukemiariskof0.25%(2/802)hasbeenobserved.PostmarketingcasesofsecondaryAMLhavealsobeenreported.In1774patientswithbreastcancerwhoreceivedNOVANTRONEconcomitantlywithothercytotoxicagentsandradiotherapy,thecumulativeriskofdevelopingtreatment-relatedAML,wasestimatedas1.1%and1.6%at5and10years,respectively(seeWARNINGSsection).Secondaryacutemyelogenousleukemia(AML)hasbeenreportedincancer

patientstreatedwithanthracyclines.NOVANTRONEisananthracenedione,arelateddrug.

Source:EMDSerono.Novantrone:PrescriberInformation,2008

5.Accordingtothedirective,healthprofessionalsshouldhaveaccesstoAExposuremanagementpacksforaddressingsharpsinjuriesBNewstafforientationandinductionprogramsCImmediateandextendedmanagementofsharpsinjuries

SharpsInjuryPost-ExposureManagementDirectiveHealthcareworkerswhoincurasharpsinjuryrequireexpedient,timely,considerateandknowledgeablepostexposuremanagement.ThebasisofsuchmanagementmustbeinaccordancewithPD2005_311(HIV,HepatitisBandHepatitisC-ManagementofHealthCareWorkersPotentiallyExposed),thekeyelementsofwhichare:

rapidassessmentofanexposedHCWtoensurethetimelyadministrationofpostexposureprophylaxis(PEP)whenappropriate;availabilityofassessmentandmanagementovera24hourperiod;andtheprocessforreportingandpostexposuremanagementbeingmadeknowntonewstaffduringorientationandinductionprograms.

Exposuremanagementpacksshouldbedevelopedandmadereadyfordistributiontohealthcareworkersandsourcepatientsintheeventofasharpsinjury.StaffnominatedtomanageexposedHCWsshouldreceivespecifictraininginBBVdiseaseprocessesandcounselling.Source:NSWHealth.SharpsInjuries-PreventionintheNSWPublicHealthSystem.In:WorkplaceRelations,ed.Sydney,Australia:MinistryofHealth,2007.

6.ThemanagementofhyperglycemiashouldbeAMoreaggressiveinpatientsdiagnosedatayoungerageBMoreaggressiveinpatientswithvascularsymptomsCMoreaggressiveinpatientswithpotentiallymodifiablefeatures

Source:Inzucchi,S.E.,Bergenstal,R.M.,Buse,J.B.,Diamant,M.,Ferrannini,E.,Nauck,M.,...Matthews,D.R.(2015).Managementofhyperglycemiaintype2diabetes,2015:apatient-centeredapproach:updatetoapositionstatementoftheAmericanDiabetesAssociationandtheEuropeanAssociationfortheStudyofDiabetes.DiabetesCare,38(1),140-149.

PartC

Inthispartofthetest,therearetwotextsaboutdifferentaspectsofhealthcare.Forquestions7to22,choosetheanswer(A,B,CorD)whichyouthinkfitsbestaccordingtothetext._____________________________________________________________________Text1:ProgressiveMuscularAtrophyProgressivemuscularatrophy(PMA),alsoknownasDuchenne-Aranmuscularatrophyandbyvariousothernames, isararesubtypeofmotorneurondisease(MND)thataffectsonlythelowermotorneurons.PMAisthoughttoaccountforaround4%ofallMNDcases.Thiscontrastswithamyotrophiclateralsclerosis(ALS),themostcommonformofMND,whichaffectsboththeupperandlowermotor neurons, or primary lateral sclerosis, another rareMND variant, whichaffectsonlytheuppermotorneurons.ThedistinctionisimportantbecausePMAisassociatedwithabetterprognosisthanclassicALS.Due to lowermotor neuron degeneration, symptoms of PMA include atrophy,fasciculationsandmuscleweakness.Atrophyisthepartialorcompletewastingaway of part of the body. A fasciculation, or muscle twitch, is a small,involuntarymuscle contraction and relaxationwhichmay be visible under theskin.Somepatientshavesymptomsonlyinthearmsorlegs(orinsomecases,justoneofeither).Thesecasesarereferredtoas"FlailArm"or"FlailLeg"andareassociatedwithabetterprognosis.PMAisadiagnosisofexclusion,thereisnospecifictestwhichcanconclusivelyestablishwhetherapatienthasthecondition.Instead,severalotherpossibilitiesmust be ruled out, such as multifocal motor neuropathy or spinal muscularatrophy.TestsusedinthediagnosticprocessincludeMRI,clinicalexamination,andEMG.EMGtests inpatientswhodohavePMAusuallyshowdenervation(neurondeath)inmostaffectedbodyparts,andinsomeunaffectedparts,too.The importance of correctly recognizing progressive muscular atrophy asopposedtoALSisimportantforseveralreasons.Firstly,theprognosisisalittlebetter.Arecentstudyfoundthe5-yearsurvivalrateinPMAtobe33%(vs.20%inALS) and the 10-year survival rate to be 12% (vs. 6% inALS). Secondly,

patientswithPMAdonotsufferfromthecognitivechangeidentifiedincertaingroupsofpatientswithMND.Thirdly,becausePMApatientsdonothaveUMNsigns,theyusuallydonotmeetthe"WorldFederationofNeurologyElEscorialResearch Criteria" for “Definite” or “Probable” ALS and so are ineligible toparticipate in most clinical research trials such as drugs trials or brain scans.Lastly, because of its rarity (even compared toALS) and confusion about thecondition,someinsurancepoliciesorlocalhealthcarepoliciesmaynotrecognizePMAasbeingthelife-changingillnessthatitis.AninitialdiagnosisofPMAcouldturnouttobeslowlyprogressiveALSmanyyearslater,sometimesevendecadesaftertheinitialdiagnosis.Theoccurrenceofuppermotorneuron symptoms suchasbrisk reflexes, spasticity,or aBabinskisignwould indicate a progression toALS.The correct diagnosis is sometimesmadeonautopsy.Since its initial description in 1850, there has been debate in the scientificliteratureoverwhetherPMAisadistinctdiseasewithitsowncharacteristics,orifliessomewhereonaspectrumwithALS,PLS,andPBP.Jean-MartinCharcot,whofirstdescribedALSin1870,felt thatPMAwasaseparatecondition,withdegenerationofthelowermotorneuronsthemostimportantlesion.Hepointedout that inALS itwas theuppermotorneurondegeneration thatwasprimary,with lowermotorneurondegenerationbeingsecondary.Throughout thecourseofthelate19thcentury,otherconditionswerediscoveredwhichhadpreviouslybeen thought to be PMA, such as pseudo-hypertrophic paralysis, hereditarymuscularatrophyandprogressivemyopathy.The neurologists Joseph Jules Dejerine and William Richard Gowers wereamong those who felt that PMA was part of a spectrum of "motor neuronedisease" which included ALS, PMA, and PBP, in part because it was almostimpossible to distinguish the conditions at autopsy. Other researchers havesuggested that PMA is just ALS in an earlier stage of progression, becausealthough the upper motor neurons appear unaffected on clinical examinationthereareinfactdetectablepathologicalsignsofuppermotorneurondamageonautopsy. In favour of considering PMA a separate disease, some patientswithPMAlivefordecadesafterdiagnosis,whichwouldbeunusualintypicalALS.

Text1:Questions7-14

7. Accordingtothefirstparagraph,oneoftheuniquefeaturesofprogressivemuscularatrophyis:

AItaffectsonly4%ofthepopulation.BIthasabetterprognosisthanamyotrophiclateralsclerosis.CItisararesubtypeofmotorneurondisease.DItaffectsonlythelowermotorneurons.

8. Lowermotorneurondegenerationcanleadto:

AWastingawayofthepatient’sarmsandlegs.BVoluntarymusclecontractionandrelaxationwhichmaybe

visibleundertheskin.CFlailarmorleg,whichindicatesaninferiorprognosis.DReducedmuscletone.

9. Accordingtothethirdparagraph,whichofthefollowingisnecessaryto

diagnosePMA?AProofofdenervationinaffectedbodyparts.BClinicalexamination,MRIandEMGtests.CExclusionofmultifocalmotorneuropathyandspinalmuscular

atrophy.DNoneoftheabove.

10. Accordingtothefourthparagraph,whymightsomeinsurancecompanies

notrecognisePMAasalife-changingillness?AItisveryrareandpoorlyunderstood,evencomparedtoALS.BThe5-yearand10-yearsurvivalratesarebetterthanforALS.CPMApatientsdonotexperienceUMNsignsorcognitivechange.DPMApatientsareineligibletoparticipateinmanyresearch

studies.

11. AllofthefollowingcanindicateprogressiontoALSexcept:ABabinskisignBReducedreflexesCSpasticity

DUppermotorneuronsymptoms

12. AccordingtoJean-MartinCharcot:APMAisaresultofprogressive,secondaryALS.BUppermotorneuronlesionsaretheprimaryfeatureofALS.CSeveralconditionspreviouslythoughttobePMAare,infact,

separatedisorders.DALSwasfirstdescribedin1870.

13. Thetoneoftheauthorinthelastparagraphcanbestbedescribedas:

ACritical.BAnalytical.CSpeculative.DSupportive.

14. Thebestalternativeheadingforthisarticlewouldbe:

AManifestationsofdifferentmotorneurondiseases.BThehistoryofprogressivemuscularatrophy.CChallengestodiagnosingprogressivemuscularatrophy.DThedifferencesbetweenPMAandALS.

Text2:Cross-culturalCompetenceCross-culturalcompetencereferstotheknowledge,skills,andaffect/motivationthat enable individuals to adapt effectively in cross-cultural environments.Cross-cultural competence is defined here as an individual capability thatcontributes to intercultural effectiveness regardless of the intersection ofcultures. Although some aspects of cognition, behavior, or affect may beparticularlyrelevantinaspecificcountryorregion,evidencesuggeststhatacoresetofcompetenciesenablesadaptationtoanyculture(Hammer,1987).Cross-cultural competence is not an end in itself, but is a set of variables thatcontribute to intercultural effectiveness.Whereaspreviousmodelshave tendedto emphasize subjective outcomes, by focusing primarily on adjustment,outcomes of interest here include both subjective and objective outcomes.Objectiveoutcomes,suchasjobperformance,havebeenaddressedinpreviousresearch,buttoalesserdegreethanthesubjectiveoutcomes.Researchindicatesthattheoutcomesarelinked,withpersonalandinterpersonaladjustment linked towork adjustment,whichhas in turnbeen linkedwith jobperformance(Shay&Baack,2006).However,theserelationshipsaresmall,andsome research has demonstrated that subjective outcomes can diverge fromobjective outcomes (Kealey, 1989), with expatriates sometimes showingrelativelypooradjustmentbuthigheffectivenessintheirorganizationalrole.The basic requirements for cross-cultural competence are empathy, anunderstandingofotherpeople'sbehaviorsandwaysofthinking,andtheabilitytoexpressone'sownwayofthinking.Itisabalance,situativelyadapted,amongfour parts: knowledge (about other cultures and other people's behaviors),empathy(understandingthefeelingsandneedsofotherpeople),self-confidence(knowledgeofone'sowndesires,strengths,weaknesses,andemotionalstability)andculturalidentity(knowledgeofone'sownculture).In an attempt to offer solutions for developing cross-cultural competence,Diversity Training University International (DTUI) isolated four cognitivecomponents: (a) Awareness, (b) Attitude, (c) Knowledge, and (d) Skills.Awareness is consciousness of one's personal reactions to people who aredifferent. DTUI added the attitude component in order to emphasize thedifferencebetweentrainingthatincreasesawarenessofculturalbiasandbeliefsingeneralandtrainingthathasparticipantscarefullyexaminetheirownbeliefsandvaluesaboutculturaldifferences.

Socialscienceresearchindicatesthatourvaluesandbeliefsaboutequalitymaybe inconsistent with our behaviors, and we ironically may be unaware of it.SocialpsychologistPatriciaDevineandhercolleagues,forexample,showedintheir research thatmany peoplewho score low on a prejudice test tend to dothingsincrossculturalencountersthatexemplifyprejudice(e.g.usingoutdatedlabels such as "illegal aliens" or "colored".). This makes the Knowledgecomponent an important part of cultural competence development. The Skillscomponentfocusesonpracticingcross-culturalcompetencetoperfection.Oneoftheseskillsiscommunication-thefundamentaltoolbywhichpeopleinteractinorganizations.This includesgestures andothernon-verbal communication thattendtovaryfromculturetoculture.Notice that the set of four components of our cross-cultural competencedefinition—awareness, attitude, knowledge, and skills— represents the keyfeatures of each of the popular definitions. The utility of the definition goesbeyond the simple integration of previous definitions, however. It is thediagnosticand interventiondevelopmentbenefits thatmake theapproachmostappealing.Regardless of whether our attitude towards cultural differences matches ourbehaviors,wecanallbenefitbyimprovingourcross-culturaleffectiveness.Onecommongoalofdiversityprofessionals,suchasDr.HicksfromURI,istocreateinclusivesystemsthatallowmemberstoworkatmaximumproductivitylevels.This is important, because cross-cultural competence is becoming increasinglynecessaryforwork,home,communitysociallives.

Text2:Questions15-2215. Accordingtothesecondparagraph,thegoaloftheindividualcapability

describedinthefirstparagraphis:ACross-culturalcompetence.BSubjectiveandobjectiveoutcomes.CInterculturaleffectiveness.DImprovedjobperformance.

16. Anexampleofthelinkedoutcomesofcross-culturalcompetenceis:

AInterpersonaladjustmentandjobperformance.BPersonaladjustmentandhighorganisationaleffectiveness.CPersonaladjustmentandinterpersonaladjustment.DNoneoftheabove.

17. Inthefourthparagraph,theauthorarguesthatcross-culturalcompetence

isabalancebetween…ASituativeadaptation,knowledge,empathy,self-confidenceand

culturalidentity.BEmpathy,anunderstandingofotherpeople'sbehaviorsandways

ofthinking,andtheabilitytoexpressone'sownwayofthinking.CHavingaculturalidentity,understandingothers,self-confidence

andadequateknowledge.DEmpathy,anunderstandingofothers,self-expressionandgood

balance.

18. Accordingtothesixthparagraph:APeoplewhoscorelowonprejudicetestsusuallydisplayprejudice

incross-culturalsituations.BWeareoftenunawarewhenourbehaviourisatoddswithour

valuesandbeliefsaboutequality.CTheSkillscomponentisafundamentaltoolbywhichpeople

interactinorganisations.DNon-verbalcommunicationstaysrelativelyconsistentfrom

culturetoculture.

19. Inthesixthparagraph,theword“exemplify”couldbestbereplacedwith:

ADemonstrate.BMakeanexampleof.CAmplify.DExempt.

20. Intheseventhparagraph,theauthorpresentstheopinionthat:

AThefourcomponentsofcross-culturalcompetenceareallrepresentedacrossitsdifferentdefinitions.

BThecurrentdefinitionwasdevelopedbyintegratingpreviousdefinitions.

CThecurrentdefinitionismoreusefulthanpreviousdefinitions.DDiagnosticandinterventionalbenefitsmakecross-cultural

competencemostappealing.

21. Accordingtothelastparagraph:ADiversityprofessionalsareaimingatcreatingmoreinclusive

systemsatwork.BDiversityprofessionalsareinvestigatingwaystoimproveour

cross-culturalcompetenceinourwork,homeandcommunitylife.CIfattitudetowardsculturaldifferencesmatchesourbehaviours,

weareabletomoresuccessfullyimproveourcross-culturaleffectiveness.

DCross-culturalcompetenceisn’tasimportantnowasitwasinthepast.

22. Overall,theauthorarguesthat:AApproachingcross-culturalcompetenceasabalancebetween

fourpartsisthebestwaytodefineit.BCross-culturalcompetence,definedasanindividualcapability,is

becomingmoreimportantinourdailyinteractions.CCross-culturalcompetenceisamulti-factorialapproachto

improvingworkperformance.DCommunicationisakeypartofcross-culturaleffectiveness.

Test2:AnswerKeyPartAQuestions1to201 C2 D3 B4 A5 B6 D7 A8 246million9 Females10 Naturally11 Introduceothers12 Blindness13 6/614 Uncorrectedrefractiveerrors15 Visualfields16 Avoid17 Recogniseyou18 Preventedorcured19 Low-incomesettings20 Agegroup

PartBQuestions1to6

1 B Areductionindeathsrelatedtodeliberatemedicationoverdosing.Patienteffortisanimportantfactordetermining

2 C accuracy.

3 A Apatient’shistoryofcardiovascularpathology.

4 C Theriskofdevelopingsecondaryleukemiaincreaseswithtime.

5 C Immediateandextendedmanagementofsharpsinjuries.

6 A Moreaggressiveinpatientsdiagnosedatayoungerage.

PartCQuestions7to147 D Itaffectsonlythelowermotorneurons.8 A Wastingawayofthepatient’sarmsandlegs.9 B Clinicalexamination,MRIandEMGtests.10 A Itisveryrareandpoorlyunderstood,even

comparedtoALS.11 B Reducedreflexes.12 B Uppermotorneuronlesionsaretheprimaryfeature

ofALS.13 B Analytical.14 C Challengestodiagnosingprogressivemuscular

atrophy.Questions15to2215 C Interculturaleffectiveness.

16 A Interpersonaladjustmentandjobperformance.

17 C Havingaculturalidentity,understandingothers,self-confidenceandadequateknowledge.

18 B Weareoftenunawarewhenourbehaviourisatoddswithourvaluesandbeliefsaboutequality.

19 A Demonstrate.

20 C Thecurrentdefinitionismoreusefulthanprevious

definitions.21 A Diversityprofessionalsareaimingatcreatingmore

inclusivesystemsatwork.22 B Cross-culturalcompetence,definedasan

individualcapability,isbecomingmoreimportantinourdailyinteractions.

ENDOFKEY

Test2:AnswerGuidePartA

TextA

TextB

TextC

TextD

PartB

1.ThemostlikelyoutcomeofimposinganationalschedulingsystemisAIncorrect:thecautionusedbypatientsislesslikelytobeaffected.BCorrect:thisisbecauseschedulingincreasestheregulationof

accesstomedications,thusmakingithardertoobtainenoughforanoverdose.

CIncorrect:accesstomedicallynecessarydrugsismorelikelytobedecreased,asmostofthemwillonlybeavailableonprescription.

2.ThepointbeingmadebelowregardingspirometrytechniqueisAIncorrect:thetextdoesn’tstipulatewhocanperformthe

spirometry.BIncorrect:thetextmentionsthemostcomfortablepositionfor

spirometry,butthisisaminorpoint.CCorrect:thisisthebestanswer,sincetheimportanceofpatient

effortismentionedseveraltimesthroughoutthetext.3.ThebestdescriptionoftheCHA2DS2-VAScscorewouldbe

ACorrect:thisoptioncoversthemostcriteriawithintheCHA2DS2-VAScscore.

BIncorrect:thisisaresult,notadescriptionofthescoreitself.CIncorrect:thisisamoreindirectoption,anddescribesthepotential

consequenceofascoreratherthanthescoreitself.4.Inpatientstakingthemedicationdescribedbelow

AIncorrect:theriskis1.6%at10yearsofNovantronetherapy,butnotat5years.

BIncorrect:risksandbenefitsarenotadequatelycomparedinthetext.

CCorrect:theriskis1.1%at5yearsand1.6%at10years,whichisincreasing.

5.Accordingtothedirective,healthprofessionalsshouldhaveaccesstoAIncorrect:thisanswerisnotascomprehensiveasoptionC.BIncorrect:thetextmentionstheseprogramsbutdoesn’texplicitly

statethathealthcareworkersshouldhaveaccesstothem.CCorrect:thisismentionedinthedotpoints(extendedcould

refertothe24hourperiodintheseconddotpoint).6.Themanagementofhyperglycemiashouldbe

ACorrect:thisanswerinvolvestheassumptionthatpatientsdiagnosedatayoungeragehavealongerlifeexpectancy.Inthetext,thisnecessitatesmorestringentmanagement.

BIncorrect:thetextrecommendslessstringentmanagementinpatientswithmoresevereestablishedvascularcomplications.

CIncorrect:itisthenatureofthesefeatures,ratherthantheirmodifiableornon-modifiableclassification,thatdeterminesmanagementinthetext.

PartC7.Accordingtothefirstparagraph,oneoftheuniquefeaturesofprogressive

muscularatrophyis:AIncorrect:thepassagestatesthatitaccounts“foraround4%ofall

MNDcases”.BIncorrect:thisisnotauniquefeature,asothersubtypesalsohave

abetterprognosisthanALS.CIncorrect:thepassagerefersto“primarylateralsclerosis,another

rareMNDvariant”.D Correct:thepassagestatesit“affectsonlythelowermotor

neurons”.8.Lowermotorneurondegenerationcanleadto:

A Correct:thepassagestatesthat“symptomsofPMAincludeatrophy...thepartialorcompletewastingawayofapartofthebody”

BIncorrect:theseare“involuntary”.CIncorrect:thisindicatesa“betterprognosis”.DIncorrect:musclesweaknessismentioned,buttoneisnot.

9.Accordingtothethirdparagraph,whichofthefollowingisnecessarytodiagnosePMA?

AIncorrect:thepassagestatesthatthey“usuallyshowdenervation”not“always”.

B Correct: the passage states “tests used in the diagnosticprocessincludeMRI,clinicalexamination,andEMG.”

CIncorrect:theseareonlytwoexamplesofconditionsthatmustberuledout(“suchas”)-therefore,therearemore.

DIncorrect:thepassagedoesn’tstatethatthisoccurs“equally”.10.Accordingtothefourthparagraph,whymightsomeinsurancecompanies

notrecognisePMAasalife-changingillness?

A Correct: the passage states “because of its rarity (evencomparedtoALS)andconfusionaboutthecondition”.

BIncorrect:notstatedasareasonwhyinsurancecompaniesmightnotrecognisedPMA.

CIncorrect:notstatedasareasonwhyinsurancecompaniesmightnotrecognisedPMA.

DIncorrect:notstatedasareasonwhyinsurancecompaniesmightnotrecognisedPMA.

11.AllofthefollowingcanindicateprogressiontoALSexcept:A Incorrect: this IS mentioned as a factor that could indicate

progressiontoALS.B Correct: the passage mentions “brisk”, not “reduced”

reflexes.C Incorrect: this IS mentioned as a factor that could indicate

progressiontoALS.D Incorrect: this IS mentioned as a factor that could indicate

progressiontoALS.

12.AccordingtoJean-MartinCharcot:AIncorrect:thepassagestatesthathe“feltthatPMAwasaseparate

condition”.BCorrect:thepassagestatesthathefeltthat“itwastheupper

motorneurondegenerationthatwasprimary”CIncorrect:true,butnotafactattributedtoJean-MartinCharcot.DIncorrect:true,butnotafactattributedtoJean-MartinCharcot.

13.Thetoneoftheauthorinthelastparagraphcanbestbedescribedas:AIncorrect:“critical”meansdisapprovingornegative.B Correct: the author gives a balanced, analytical view by

providing arguments for and against PMA being a separatecondition.

CIncorrect:“speculative”meansnotbasedonfactsorknowledge.D Incorrect: theauthordoesn’tsupportanyparticularopinionor

theoryaboutPMA.14.Thebestalternativeheadingforthisarticlewouldbe:

AIncorrect:“manifestations”meanssignsandsymptoms,andtheseareonlymentionedinparagraphs3,4,6and8.

BIncorrect:thisisonlyinparagraphs2,7and8,andthereforenotanappropriateheadingforthewholearticle.

C Correct:issuesarounddiagnosisarementionedmanytimesthroughoutthearticle.

DIncorrect:thisisaminorpoint.15. Accordingtothesecondparagraph, thegoalof theindividualcapability

describedinthefirstparagraphis:A Incorrect: this IS the individual capability, not a goal of

individualcapability.BIncorrect:an“outcome”isnotnecessarilyagoal.C Correct: this is found by combining information in

paragraph 1 (“Cross-cultural competence is defined here asanindividualcapability”)withinformationfromparagraph2(“Cross-cultural competence...is a set of variables thatcontributetointerculturaleffectiveness”).

D Incorrect: an “outcome” such as job performance is notnecessarilyagoal.

16.Anexampleofthelinkedoutcomesofcross-culturalcompetenceis:A Correct:thepassagestatesthat“outcomesarelinked,with

personal and interpersonal adjustment linked to workadjustment, which has in turn been linked with jobperformance”

B Incorrect: according to the passage, personal adjustment andorganisational effectiveness are independent of each other(“subjectiveoutcomescandivergefromobjectiveoutcomes”).

C Incorrect:thepassagestatesthattheseareboth“linkedtoworkadjustment”,nottoeachother.

DIncorrect:OptionAissupportedbythepassage.

17. Inthefourthparagraph,theauthorarguesthatcross-culturalcompetenceisabalancebetween…

AIncorrect:itis“situativelyadapted”.B Incorrect: these are the “basic requirements”, not balanced

componentsofcross-culturalcompetence.C Correct: the passage states “It is a

balance...among...knowledge...understandingthefeelingsandneedsofotherpeople,self-confidence...andculturalidentity”.

D Incorrect:thefourpartsmustbebalanced,and“goodbalance”couldrefertoanindividual’sphysicalability.

18.Accordingtothesixthparagraph:AIncorrect:thepassageonlystatesthat“many”peopledothis,not

peopleingeneral(i.e.allpeople),sothisansweristoobroad.BCorrect:thepassagestatesthat“ourvaluesandbeliefsabout

equality may be inconsistent with our behaviors, and weironicallymaybeunawareofit”.

CIncorrect:accordingtothepassage,thisiscommunication(“Oneoftheseskillsiscommunication-thefundamentaltoolbywhichpeopleinteractinorganizations”).

D Incorrect: the passage states that non-verbal communicationdiffers(“tendtovaryfromculturetoculture:).

19.Inparagraph6,theword“exemplify”couldbestbereplacedwith:ACorrect:othersynonymsare"illustrate"and"represent".BIncorrect:thismeans“topunishasawarning/deterrenttoothers”.CIncorrect:othersynonymsincludeintensify,escalate,raise.DIncorrect:thismeans“freefromobligation/liability”.

20.Intheseventhparagraph,theauthorpresentstheopinionthat:A Incorrect:itisactuallythekeyfeaturesofpreviousdefinitions

thatarerepresentedacrossthefourcomponents.B Incorrect:itdoesrepresentfeaturesofthepreviousdefinitions,

butthisisn’tthesameasbeingdevelopedoutofthosedefinitions.CCorrect:thisismostclearinthestatement“Theutilityofthe

definition goes beyond the simple integration of previousdefinitions”.

D Incorrect: this is stated in the article, but it is not themainopinion(rather,itisasupportingpointforoptionC).

21.Accordingtothelastparagraph:A Correct: the passage states that “One common goal of

diversity professionals...is to create inclusive systems thatallowmemberstoworkatmaximumproductivitylevels”.

BIncorrect:thepassageonlystatesthatdiversityprofessionalsareworkingtoimprovecross-culturalcompetenceatwork.

C Incorrect: thepassagestates that: “Regardlessofwhetherourattitude…matchesourbehaviors,wecanallbenefit…”,meaningthat our attitudedoesn’t have tomatchourbehaviours for us toimproveourcross-culturaleffectiveness.

D Incorrect: the passage states “cross-cultural competence isbecoming increasingly necessary”,whichmeans the opposite tothisanswer

22.Overall,theauthorarguesthat:AIncorrect:thisisatruepoint,butnotan“overall”argument,asit

istoonarrow.B Correct: thisanswercombinesthemainpoints inthefirst

andfinalparagraph(themostimportantpartsofanessayforstatinganargument).

CIncorrect:thisisatruepoint,butnotan“overall”argument,asitistoonarrow.

DIncorrect:thisisatruepoint,butnotan“overall”argument,asitistoonarrow.

Test3

PartA

TIME:15minutes

Lookatthefourtexts,A–D,intheseparateTextBooklet.

Foreachquestion,1–20,lookthroughthetexts,A–D,tofindtherelevantinformation.

WriteyouranswersonthespacesprovidedinthisQuestionPaper.

Answerallthequestionswithinthe15-minutetimelimit.

_____________________________________________________________________

VaccinesandImmunisation:Questions

Questions1-7

Foreachofthequestions,1–7,decidewhichtext(A,B,CorD)theinformationcomesfrom.Youmayuseanylettermorethanonce.

Inwhichtextcanyoufindinformationabout

1

Pastratesofdiphtheria?__________

2WhatvaccinesaregiventochildreninNewSouthWales?__________

3Themechanismofactionofvaccines?__________

4Howvaccinesaffecttheimmunesystem?__________

5Theintroductionofthediphtheriavaccine?__________

Howchildrenarevaccinatedagainstthe

6 flu?__________

7Whichdiseasesaretargetedbyvaccines?__________

Questions8–14

Answereachofthequestions,8–14,withawordorshortphrasefromoneofthetexts.

Eachanswermayincludewords,numbersorboth.Youranswersshouldbecorrectlyspelled.

8 WhatisthefirstvaccinegiventoachildborninNewSouthWales?

____________________________________________________________

9 Whateffectdovaccineshaveonachild’snaturalimmunity?

____________________________________________________________

10 WhenwasthediphtheriavaccinationfirstusedinAustralia?

____________________________________________________________

11 WhoisFluQuadriJuniorgivento?

____________________________________________________________

12 Howmanydosesofthefluvaccinearegiventochildrenundereight?

____________________________________________________________

13 AtwhatagearechildrenfirstvaccinatedagainstMeningococcalC?

____________________________________________________________

14 Whatdovaccinestrainababy’simmunesystemtodotobacteriaandviruses?

____________________________________________________________

Questions15–20

Completeeachofthesentences,15–20,withawordorshortphrasefromoneofthetexts.Eachanswermayincludewords,numbersorboth.Youranswersshouldbecorrectlyspelled.

InNSW,childrenareimmunisedagainstdiseasesaccordingtothe_______(15)releasedbyNSWHealth.

Forsomechildren,thelastrecommendedvaccineprotectsthemagainstmeasles,_______(16)andrubella.

Vaccinestakeadvantageofthewaythatababy’simmunesystemisdesignedtoexperience_______(17)tonewpathogens.

Childrenwhoareoverorunder_______(18)receivedifferentbrandsoftheinfluenzavaccine.Vaccinestraintheimmunesystemabitlike_______(19)muscles.Ifababyreceivesallthevaccinesintheschedulesimultaneously,a_______(20)ofitsimmunecellswouldbeoccupied.

VaccinesandImmunisation:TextsTextAVaccineFAQsHowdovaccinesaffectimmunity?Vaccinesstrengthennaturalimmunity.Howdovaccineswork?Vaccinestrainababy’simmunesystemtorecogniseandclearoutbacteriaandvirusesthatcancauseillness.Thisisabitlikeexercisestrengthensmuscles.Canvaccinesoverwhelmmybaby’simmunesystem?No.Frombirth,babiesareexposedtocountlessbacteriaandviruses.Babies’immunesystemsaredesignedtodealwiththisconstantexposuretonewthings,learningtorecogniseandrespondtothingsthatareharmful.Evenifallthevaccinesonthescheduleweregivenatonce,onlyasmallfractionoftheirimmunecellswouldbeoccupied.Source:ImmuniseAustraliaProgram

TextBDiphtherianotificationrateandvaccineuse,Australia,

1917–2010

Source:ChiuC,DeyA,WangH,etal.VaccinepreventablediseasesinAustralia,2005to2007.CommunicableDiseasesIntelligence2010;34(Suppl):S1-167

TextC

InfluenzavaccinationinchildrenChildrencanbegin tobe immunisedagainst theflufromsixmonths of age.Children aged eight years and under requiretwo doses, at least four weeks apart in the first year theyreceivethevaccine.Onedoseofinfluenzavaccineisrequiredfor subsequent years and for children aged nine years andover.All vaccines currently available in Australia must passstringent safety testingbeforebeingapproved foruseby theTherapeuticGoodsAdministration(TGA).Specific brands of flu vaccine are registered for use inchildren. In 2016, two age-specific flu vaccines will beavailable – one for children under three years of age, andanotherforpeopleagedthreeyearsandover:

FluQuadriJuniorforchildrenunderthreeyearsofage.FluarixTetraforpeopleagedthreeyearsandolder.

Source:ImmuniseAustraliaProgram

TextD

NSWCHILDHOODIMMUNISATIONSCHEDULE

Source:NewSouthWales(NSW)HealthENDOFPARTATHISANSWERBOOKLETWILLBECOLLECTED

PartB

Inthispartofthetest,therearesixshortextractsrelatingtotheworkofhealthprofessionals.Forquestions1to6,choosetheanswer(A,BorC)whichyouthinkfitsbestaccordingtothetext._____________________________________________________________________

1.ThemainmessagetoworkersinthenoticebelowisAWorkersshouldbeproactiveandresponsibleBWorkersshouldnotifypeoplewhoseactionsaredisagreeableCWorkersshouldpreparedetailedreportsformanagers

WorkplaceBullying:RolesandResponsibilitiesofWorkers

Recognisetheirindividualroleindevelopingandmaintainingharmoniousworkplacerelationsand

promotingapositiveandcooperativeworkplaceculture.Takeresponsibilityfortheirownactionsintheworkplaceand,wheretheactionsofothersaredisagreeabletothem,attempttosettlemattersdirectlywiththeotherperson(s)whereappropriateinarespectfulandcollaborativemannerthatreflectstheCOREvalues.Raisemattersofconcernatanearlystageandactivelyparticipateinthebullyingcomplaintmanagementprocess.Providemanagerswithspecificinformationregardingperceivedbullyingandbepreparedtohavetheircomplaintmadeknowntothepersontheyaremakingthecomplaintabout,toallowforfairmanagementofthecomplaint.

Source:NSWHealth.PreventionandManagementofWorkplaceBullyinginNSWHealth.In:Personnel/Workforce,ed.Sydney,Australia:MinistryofHealth,2018.

2.TheflowchartbelowwouldmostlikelybefollowedifAThepatienthassymptomsofautonomicdysreflexiaBThepatientissymptomaticwithaBP25mmHgabovenormalCThepatientexperiencessymptomsoutsideofthehospitalsetting

Source:TheCentreforFamilyMedicine.AutonomicDysreflexia:OntarioNeurotraumaFoundation;2012[Availablefrom:http://eprimarycare.onf.org/AutonomicDysreflexia.html]

3.Accordingtothetext,whatshouldcliniciansdowhenprescribingantibiotics?

ADiscussthesideeffectsofantibioticswithpatientsandcarersBDiscusstheantibioticregimeindetailwithpatientsandcarersCDiscussthepurposeofantibioticswithpatientsandcarers

AntimicrobialStewardshipQualityStatement–Taking

antibioticsasprescribedWhenapatientisprescribedantibiotics,informationaboutwhen,howandforhowlongtotakethem,aswellaspotentialsideeffectsandareviewplan,isdiscussedwiththepatientand/ortheircarer.Whatthequalitystatementmeans:

Forpatients.Ifyouareprescribedantibiotics,yourdoctorornursediscusseswithyouand/oryourcareraboutwhenandhowtotakeyourantibiotics,howlongtotakethemandanypotentialsideeffects.Youmayneedtobeseenagaintoreviewyourprogress.Forclinicians.Discusswiththepatientand/ortheircarertheimportanceoftakingantibioticsasprescribed,howlongtotakethem,anypotentialsideeffectsandwhetherthetreatmentwillneedtobereviewed.

Forhealthservices.Ensuresystemsareinplacesothat

cliniciansdiscusswithpatientsand/ortheircarersthe

needtotakeantibioticsasprescribed,howlongtotake

them,anypotentialsideeffectsandwhethertheir

treatmentrequiresreview.Source:AustralianCommissiononSafetyandQualityinHealthCare.AntimicrobialStewardshipClinicalCareStandard.Sydney:ACSQHC,2014

4.ThepurposeofeffectiverecordkeepingisAToprotecttheprivacyofpatientmedicalrecordsBToenhancestaffsatisfactionwithinmedicalpracticesCTomaximisethelegalaccountabilityofmedicalpractices

Effectiverecordkeepingbenefitsallmedicalpractices.Itimprovestheefficientday-to-dayoperationofyourpractice,helpsrecordandmaintainyourpatientinformationandenablestransparentreporting.Thereareotherbenefitsrelatedtoeffectiverecordkeeping.Theseincludemaintainingthesecurityofconfidentialclinicalfiles,supportingstafftodotheirworkmoreeffectively,improvingstaffretention,andenhancedbusinesscontinuity.HavingadequateadministrativerecordswillsignificantlyassistifyouareeveraskedtoparticipateinanAustralianTaxationaudit,healthprovidercomplianceauditorforaccreditationpurposes.Itisimportanttounderstandthatrecordkeepingobligationsdifferdependingonthepurposeoftherecords,buttheirobjectiveisultimatelytomaintainthetransparencyandintegritythatisrequiredofmedicalpracticesbynationallegislation.Source:DepartmentofHealth.Administrativerecordkeepingguidelinesforhealthprofessionals:AustralianGovernment;2018[Availablefrom:http://www.health.gov.au/internet/main/publishing.nsf/content/admin-record-keeping-book#support.]

5.ForthetreatmentofwarfarinoverdoseAPCCcanbeusedtogetherwithfreshfrozenplasmaBPCCcanbeusedwithorwithoutvitaminK1CFFPdoesnotrequireProthrombinextobeadded

WarfarinReversal:PracticePointsForpatientswithelevatedINR(4.5–10.0),nobleedingandnohighriskofbleeding,withholdingwarfarinwithcarefulsubsequentmonitoringseemssafe.VitaminK1canbegiventoreversetheanticoagulanteffectofwarfarin.WhenoralvitaminK1isusedforthispurpose,theinjectableformulation,whichcanbegivenorallyorintravenously,ispreferred.Forimmediatereversal,prothrombincomplexconcentrates(PCC)arepreferredoverfreshfrozenplasma(FFP).Prothrombinex-VFistheonlyPCCroutinelyusedforwarfarinreversalinAustraliaandNewZealand.ItcontainsfactorsII,IX,XandlowlevelsoffactorVII.FFPisnotroutinelyneededincombinationwithProthrombinex-VF.FFPcanbeusedwhenProthrombinex-VFisunavailable.VitaminK1isessentialforsustainingthereversalachievedbyPCCorFFP.Source:HuyenATran,SanjeevDChunilal,PaulLHarper,HuyTran,EricaMWoodandAlexSGallus,onbehalfoftheAustralasianSocietyofThrombosisandHaemostasis,MedJAust2013;198(4):198-199.doi:10.5694/mja12.10614

6.Reducinghealthcareworkers’exposuretoradiationshouldmainlyinvolve

ADesigningworkspacesandupdatingequipmentasneededBReducingtheexposuretimerequiredforadentalx-rayCWearingleadglovesandapronswheneverx-raysaretaken

ExposuretoionizingradiationwhentakingdentalX-rays:ControlStrategies

Engineering:Workplacedesigntoprovidedistancebetweenworkerandsource.Appropriateshieldingmaterials(permanentwherepossible).Interlocksystems.Equipmentdesignedtominimizescatter.Positioningdevicesforpatients.Audiblesignalsonmachineswhenexposureisended.ReplacementofolderdentalX-rayequipmentwithnewerequipmentwithadditionalsafetyfeatures.Administrative:Workereducation.Safeworkproceduresreduceexposuretime(proceduresrequiringfewerworkersinarea,etc.).Scheduling.Radiationsafetyprogram.Exposuremonitoring.PPE:Leadgloves,aprons,etc.asrequired.Source:GovernmentofAlberta.HandbookofOccupationalHazardsandControlsforDentalWorkers.MinistryofLabour,Canada,2011.

PartC

Inthispartofthetest,therearetwotextsaboutdifferentaspectsofhealthcare.Forquestions7to22,choosetheanswer(A,B,CorD)whichyouthinkfitsbestaccordingtothetext._____________________________________________________________________Text1:FallsintheElderlyFalls in older adults are a significant cause of morbidity, mortality andpreventableinjury.Nearlyone-thirdofolderpersonsfalleachyear,andhalfofthemfallmorethanonce.Duetounderlyingosteoporosisandreducedmobilityandreflexes,fallsoftenresult inhipandotherfractures,headinjuries,orevendeath.Inaround75%ofhipfractures,recoveryisincompleteandoverallhealthdeteriorates. In older women, falls can be particularly troublesomebecauseosteoporosis(weakeningofthebones)isawidespreadissue,increasingthechanceofafracturefollowingafall.InAustralia,injuriescausedbyfallsarethemostcommoncauseofdeathinpeopleover75.Thecauseoffallinginoldageisoftenmultifactorial,andtherefore,itrequiresamultidisciplinaryapproach to treat any injuries sustainedand toprevent futurefalls.Fallsincludedroppingfromastandingposition,orfromexposedpositionssuch as those on ladders or stepladders. The severity of injury is generallyrelatedtotheheightofthefall.Thestateofthegroundsurfaceontowhichthevictimfallsisalsoimportant,withharderonescausingmoresevereinjury.Afalloccurswhenaperson'scentreofmassgoesoutsideofthebaseofsupport.Most research on postural instability has focused on the anterior/posteriordirections, due to the structure of the legs and the frequency of falls in thosedirections.However,Maki,Holliday,&Topper(1994)havestatedthatswayinthe medial/lateral directions can be just as important: “Results show strongevidencelinkingdeficitsin…thecontrolofm–lstabilitywithanincreasedriskof falling”. Hence, the consequences of postural instability have not yet beenfullyexplored.

Vision is integral to the maintenance of a stable posture. Visual acuity,adaptation to the dark, peripheral vision, contrast sensitivity, andaccommodation, all ofwhich are related to stability,may be affected by age-relatedchanges.Forexample,age-relateddeteriorationinperipheralvisionmayaffectanolderperson’sability touse information in theperipheralvisual fieldforreference.Suchnarrowingofthevisualfieldalsomeansthatthepartofthevisual field that is most sensitive to movement is lost. As a result, posturalcontrolmaybecompromised.Afallermaylivecomfortablywithmanyriskfactorsforfallingandonlyhaveproblemswhenanotherfactorappears.Assuch,managementisoftentailoredtotreatingthefactorthatcausedthefall,ratherthanalloftheriskfactorsapatienthasforfalling.Fallscanbepreventedbyensuringthatcarpetsaretackeddown,thatobjectslikeelectriccordsarenotinone'spath, thathearingandvisionareoptimized, dizziness isminimized, alcohol intake ismoderated and that shoeshavelowheelsorrubbersoles.Multifactorialpreventioninvolvesaddressingbothintrinsicandextrinsicfactors.Although further research is needed, preventative measures with the greatestlikelihoodofapositiveeffect include strengthandbalance training,home riskassessment,withdrawingpsychotropicmedication,cardiacpacingforthosewithcarotidsinushypersensitivity,andT'aichi.T'aichiexerciseshavebeenshowntoprovide47%reductioninfallsinsomestudiesbutitdoesnotimprovemeasuresof postural stability. Assistive technology can also be applied, although it ismostlyreactiveincaseofafall.General practitioners are well placed to identify those at risk of falls andimplement prevention strategies utilising other healthcare professionals asrequired. An Enhanced Primary Care plan may facilitate implementing fallspreventionstrategies.Highriskpatientswithrecurrent,unexplainedorinjuriousfallsshouldespeciallybeconsideredforspecialistreferralandmultidisciplinaryintervention.Thegeneralpractitioner’sroleineducatingandsupportingpatientbehaviourchangeiscriticaltotheuptakeoffallspreventionrecommendations.

Text1:Questions7-14

7. Inthefirstparagraph,theauthorisarguingthatAFallsareanimportantpublichealthissue.BFracturesareasignificantcauseofdeathanddisability.CWomenareparticularlyvulnerabletofractures.DOsteoporosisisawidespreadproblem.

8. Inthesecondparagraph,“ones”refersto

AFalls.BPeople.CSurfaces.DLadders.

9. Accordingtothethirdparagraph,theauthorsopinionontheresearchis

that:AIthasmostlyfocusedonanterior/posteriorstability.BStudiessofarhavehadinadequatescope.CThereisincreasingevidenceonstabilitydeficits.DMostofithasbeenpoorlyconducted.

10. Anappropriateheadingforthefourthparagraphwouldbe:

AVisioncontributesinvariouswaystoposturalstability.BThecentralvisualfieldisanimportantreference.CThemechanismsofvisualfunction.DVisionisaffectedbyage-relatedchanges.

11. Theword“moderated”inthefifthparagraphcouldbestbereplacedwith:

AMonitored.BObserved.CControlled.DMinimised.

12. Whatistheauthor’sviewonassistivetechnologyinthesixthparagraph?

AItisaviableoption.BItimprovesreactions.

CItmainlyhelpsafterthefall.DNoneoftheabove.

13. Accordingtothelastparagraph,themainroleofgeneralpractitionersinfallspreventionis:

AInvolvingotherhealthcareworkersinthepatient’scare.BProvidingreferralstospecialistsandmultidisciplinaryteams.CSupportingpatientsthrougheducationandbehaviourchange.DProvidingat-riskpatientswithanEnhancedPrimaryCarePlan.

14. Whichofthefollowingwouldbeanappropriateheadingforthelast

paragraph?ATheroleofthegeneralpractitionerinfallsprevention.BAmultidisciplinaryapproachtofallsprevention.CTheimplementationoffallspreventionstrategies.DAholisticapproachtohigh-riskpatients.

Text2:PhysicalInactivityandHeartDiseaseCoronary heart disease (CHD) is the most common form of heart disease inAustralia,affectingaround3%ofthepopulation.Itstwokeymanifestationsaremyocardialinfarctionandangina.In2012,CHDwastheleadingcauseofdeathinAustralia,responsiblefor14%ofalldeaths.WhilstdeathratesfromCHDaredeclining, mainly due to reduction in risk factors such as smoking, highcholesterolandhighbloodpressure,andimprovements in treatment,CHDstillplacesasignificantburdenon theAustralianhealthcaresystem. It isestimatedthat in 2008-09,CHD cost the nation $2.03 billion, including $1.52 billion inhospital-relatedcosts.Alackofphysicalactivityhasbeenidentifiedasthefourthleadingriskfactorforglobalmortality,andtheprincipalcauseofapproximately30%ofthecoronaryheartdiseaseburden.Physicalinactivityisdefinedasnotmeetingtheminimumguidelinesofatleast150minutesofmoderateintensityexerciseperweek.Thischaracterizesbetween60-70%oftheAustralianpopulation.However,levelsofactivityappeartobegrowing.Regular,moderatetovigorousphysicalactivityisbeingwidely promoted as ameasure for preventing andmanagingCHD. It isimportant to note that a lack of physical activity is not the same as beingsedentary. Many Australians may meet the minimum guidelines for beingphysicallyactive,butstillspendexcessiveamountsoftimebeingsedentary(i.e.sitting).Sedentarybehaviourhasbeenfoundtocontributetoall-causeprematuremortalityandcardiovasculardiseasemortalityindependentlyofphysicalactivitylevels.Severalstudieshavefoundthatincreasedsedentarybehavior,measuredthroughTVviewingtime, isassociatedwithanincreasedriskof type2diabetes,acutecoronary syndrome,metabolic syndromeand abnormal glucose tolerance.Oneproposed mechanism for this is metabolic dysfunction, characterised byincreasedplasma triglycerides, decreasedHDL-cholesterol and reduced insulinsensitivity. This has been attributed to reduced activity of lipoprotein lipase(LPL), an enzyme that facilitates the uptake of free fatty acids into skeletalmuscleandadiposetissue.ReducedLPLactivityhasbeennotedinresponsetosedentarybehaviour. Inaddition,sedentarybehaviourmayaffectcarbohydratemetabolismthroughdecreasedmuscleglucosetransporterproteinconcentrationandsubsequentglucoseintolerance.

Although the beneficial effect of exercise in the prevention of CHD is wellestablished, only about 35% of this effect can be attributed to improved lipidprofiles and cholesterol levels, increased insulin sensitivity andbloodpressurecontrol.Thismeans that forabout65%of theeffect, themechanismbywhichexerciseproducescardiacbenefitsisunknown.Severalmechanismsforthebenefitofexercisehavebeenproposed.Thijssenetalfoundthatexercisehasadirect“vascularconditioningeffect”bystimulatingenlargement of arterioles and improvements in endothelial function. Regularexercise also produces hemodynamic stimuli in vasculature, such as increasedpulse pressure and shear stress. This may enhance vasodilatory responses toincreasedcardiacoutputandreduceischemia-reperfusioninjuryassociatedwithbrief periods of ischemia. Also, exercise stimulates development of collateralvasculatureintheheart, increasingperfusionof themyocardium.Somestudieshave also shown that exercise may reduce the levels of circulating pro-inflammatory cytokines and increase expression of antioxidant and anti-inflammatory mediators in endothelial cells. This may directly inhibit thedevelopmentofatherosclerosisandassociatedCHD.Apointcommonlyagreeduponisthattheintensityanddurationofexercisearekeydeterminantsofwhetherornot ithasacardio-protectiveeffect.Thedose-responserelationshipbetweenphysicalactivityandriskofCHDwasquantifiedina recentmeta-analysis,which found that individualswhomet theminimumUS physical activity guidelines for health (150minutes of moderate intensityexercise perweek) had a 14% lower risk ofCHD compared to thosewith noleisure-time physical activity. Those who met the advanced guidelines (300minutesperweek)hada20%lowerriskofCHD.Theeffectsofphysicalactivitywerefoundtobemorebeneficialinwomenthanmen.The beneficial effects of moderate exercise for the prevention of CHD arestrongly supportedby the literature. Inaddition, theminimisationof sedentarybehaviour is an important, independent factor associated with a reduction inCHD risk. The evidence supporting physical activity is of great clinicalsignificance todoctors,whoshouldstronglyencourage theirpatients to followtheAustraliangovernmentguidelineswithregardstominimumlevelsofweekly

physical activity, and reduce time spent in sedentary behaviour, as importanthealthmaintenancemeasures.

Text2:Questions15-22

15. Accordingtothefirstparagraph,whatisthemainimpactofCHD?ACHDleadstohighdeathratesinthecommunity.BCHDleadstohighcholesterolandhighbloodpressure.CCHDleadstoadversehealthinonlyaminorityofpeople.DCHDleadstobillionsofdollarsofassociatedcosts.

16. Inthesecondparagraph,“this”refersto:APhysicalinactivity.B60-70%oftheAustralianpopulation.C150minutesofmoderateintensityexerciseperweek.DLevelsofactivity.

17. Regardingphysicalactivityandsedentarybehaviour:

AThebenefitsoftheformercanbeoffsetbythelatter.BBotharedetrimentaltohealthinsimilarways.CWedonotenoughoftheformerandtoomuchofthelatter.DIncreasedphysicalactivitycancompensateforbeingsedentary.

18. Themainmechanismsforthebenefitsofexerciseforcoronaryhealth:

AAreduetoimprovedlipidprofileandcholesterollevels.BAreduetoincreasedinsulinsensitivity.CAreduetobettercontrolofbloodpressure.DAremostlyunknown.

19. Theword“collateral”inthefifthparagraphcouldbestbereplacedwith:

AAlternate.BCorollary.CSecondary.DLarge.

20. Thebestheadingforthesixthparagraphis:

AExercisemaynotalwaysbebeneficialtohealth.BTherelationshipbetweenphysicalactivityandhearthealth.CHowtomaximisethecardio-protectiveeffectofexercise.

DExercisereducestheriskofCHD.

21. Thebeneficialeffectsofmoderatephysicalactivity:AWillreducetheriskofCHDiftheymeettheminimum

guidelines.BAreofgreatclinicalsignificance.CArestronglyencouragedbydoctors.DAlloftheabove.

22. Thebestalternativetitleforthisarticleis:

AGovernmentrecommendationsforphysicalactivity.BRiskfactorsforcoronaryheartdisease.CPhysicalactivityforthepreventionofCHD.DDifferencesbetweenphysicalinactivityandsedentarybehaviour.

Test3:AnswerKeyPartAQuestions1to201 B2 D3 A4 A5 B6 C7 D8 HepatitisBORH-B-VAXII9 Strengthen10 193211 Childrenunder3yearsofage12 Two13 12months14 Recogniseandclearout15 Schedule16 Mumps17 Exposure18 Threeyears(ofage)19 Exercisestrengthens20 SmallfractionPartBQuestions1to61 A Workersshouldbeproactiveandresponsible

2 BThepatientissymptomaticwithaBP25mmHg

abovenormal

3 BDiscusstheantibioticregimeindetailwithpatientsandcarers

4 CTomaximisethelegalaccountabilityofmedicalpractices

5 A PCCcanbeusedtogetherwithfreshfrozenplasma

6 ADesigningworkspacesandupdatingequipmentasneeded

PartCQuestions7to147 A Fallsareanimportantpublichealthissue.

8 C Surfaces.

9 B Studiessofarhavehadinadequatescope.

10 A Visioncontributesinvariouswaystoposturalstability.

11 C Controlled.

12 C Itonlyhelpsafterthefall.

13 C Supportingpatientsthrougheducationandbehaviourchange.

14 A Theroleofthegeneralpractitionerinfallsprevention.

Questions15to2215 D CHDleadstobillionsofdollarsofassociatedcosts.

16 A Physicalinactivity.

17 A Thebenefitsoftheformercanbeoffsetbythelatter.

18 D Aremostlyunknown.

19 C Secondary.

20 C Howtomaximisethecardio-protectiveeffectofexercise.

21 B Areofgreatclinicalsignificance.

22 C PhysicalactivityforthepreventionofCHD.

ENDOFKEY

Test3:AnswerGuidePartATextA

TextB

TextC

TextD

PartB

1.ThemainmessagetoworkersinthenoticebelowisACorrect:thisanswersummarisesthe“main”message.BIncorrect:thisonlyreferstoaminorpoint,“attempttosettle

mattersdirectly”.CIncorrect:thisonlyreferstoaminorpoint,“providemanagers

withspecificinformation”.2.Theflowchartbelowwouldmostlikelybefollowedif

AIncorrect:accordingtothefirststep,thepatientshouldalsohaveaBP>20mmHgabovenormal.

BCorrect:thissummarisesthefirststepoftheflowchart.CIncorrect:thisisnotreferredtointheflowchart.

3.Accordingtothetext,whatshouldcliniciansdowhenprescribingantibiotics?

AIncorrect:thisisaminorpointinthetext.BCorrect:thisisthemainpointofthetext,sinceitisreferredto

inthedotpointsforpatients,cliniciansandhealthservices.

CIncorrect:thisisaminorpointinthetext.4.Thepurposeofeffectiverecordkeepingis

AIncorrect:thisisaminorpointinthetext.BIncorrect:thisisonlyreferredtoindirectly(“supportingstaff”and

“improvingstaffretention”),soitisaminorpoint.CCorrect:thisisputforwardinthelastsentenceofthetext:“to

maintainthetransparencyandintegrity…required…bynationallegislation.”

5.ForthetreatmentofwarfarinoverdoseACorrect:thisisimpliedinthesentence“FFPisnotroutinely

neededincombinationwithProthrombinex-VF”.Thephrase“notroutinely”impliesthatsometimesitis.

BIncorrect:thetextstatesthatvitaminK1isessentialtosustainthebenefitofPCC.

CIncorrect:similartotheexplanationforanswerA,sometimesFFPisusedwithPCC,soitmustsometimesberequired.

6.Reducinghealthcareworkers’exposuretoradiationshouldmainlyinvolve

ACorrect:thetextreferstoworkplacedesignandequipmentupdates(changes)severaltimes,sothisisamainpoint.

BIncorrect:thisisaminorpointinthetext.CIncorrect:thisisaminorpointinthetext.

PartC

7. Inthefirstparagraph,theauthorisarguingthatACorrect:theauthorreferstotheconsequencesoffallsseveral

times,anduseslanguagesuchas“significant”,“oftenresultin…evendeath”,and“particularlytroublesome”.

BIncorrect:thisisaminorpointinthetext.CIncorrect:thisisaminorpointinthetext.DIncorrect:thisisaminorpointinthetext,andadifferenttopicto

“falls”.8. Inthesecondparagraph,“ones”refersto

AIncorrect:althoughwecanrefertoafallasbeing“hard”,thisisslang.

BIncorrect:harderpeopledonotcausemoreinjuryinthiscontext.CCorrect:hardersurfacescausemoreinjury.DIncorrect:harderladdersdonotcausemoreinjuryinthiscontext.

9. Accordingtothethirdparagraph,theauthorsopinionontheresearchisthat:

AIncorrect:thisisafact,notanopinion.BCorrect:thisisimpliedinthestatement“notyetbeenfully

explored”andtheauthor’sreferencetothelimitedfocusofmostresearch.

CIncorrect:thisisafact,notanopinion.DIncorrect:theauthordoesn’tadequatelyrefertohowthestudies

havebeendone.10. Anappropriateheadingforthefourthparagraphwouldbe:

ACorrect:thesignificanceofvisionisreferredtointhetopicsentence,andmechanismsaredescribedinthesupportingsentences.

BIncorrect:thetextstatesthatolderpeople“useinformationintheperipheralvisualfieldforreference”.

CIncorrect:thisansweristoogeneral(itincludesallfunction,eventhatnotrelatingtopostureorfalls).

DIncorrect:thisansweristoogeneral,astheparagraphisspecificallyreferringtotheimpactofthesechangesonposturalcontrol.

11. Theword“moderated”inthefifthparagraphcouldbestbereplacedwith:A Incorrect: this is too passive (monitoring won’t necessarily

changethelevelofintakeifitistoohigh).B Incorrect: this is too passive (monitoring won’t necessarily

changethelevelofintakeifitistoohigh).CIncorrect:thisisclose,butnotasaccurateasoptionD.D Correct: “to moderate” means “to make less

extreme/excessive”.

12. Whatistheauthor’sviewonassistivetechnologyinthesixthparagraph?

AIncorrect:thisistoogeneral,andmorepositivethantheauthor’sspecificview.

BIncorrect:itseffectonreactionsisnotstated.CCorrect:thisisreferredtobythephrase“mostlyreactive”.DIncorrect:answerCiscorrect.

13. Accordingtothelastparagraph,themainroleofgeneralpractitionersinfallspreventionis:

A Incorrect: this is only a small part of theGP’s role (not the“main”roleasperthequestion).

B Incorrect: this is only a small part of theGP’s role (not the“main”roleasperthequestion).

CCorrect:thisisparaphrasingthepassage,whichmentionstheGP’s “role in educating and supporting patient behaviourchange”.

D Incorrect: this is only a small part of theGP’s role (not the“main”roleasperthequestion).

14. Whichofthefollowingwouldbeanappropriateheadingforthelastparagraph?

A Correct:thisisthemainpointreferredtomultipletimesintheparagraph.

BIncorrect:thisismentioned,butitisonlyonepartofthemessageintheparagraph.

CIncorrect:thisismentioned,butitisonlyonepartofthemessageintheparagraph.

DIncorrect:theparagraphreferstoallpatients,notjust“high-risk”.15. Accordingtothefirstparagraph,whatisthemainimpactofCHD?

AIncorrect:thisansweristoonarrow.BIncorrect:therelationshipistheotherwayaround(high

cholesterolandhighbloodpressureleadtoCHD).CIncorrect:thisistrueaccordingtothetext,butitisnotthe

“main”impact.DCorrect:thisisreferredtotwiceintheconcludingsentenceof

theessay,soitisamainimpact.16. Inthesecondparagraph,“this”refersto:

ACorrect:physicalinactivityisthesubjectoftheprevioussentence.

BIncorrect:althoughphysicalinactivitycharacterises60-70%oftheAustralianpopulation,thisanswerisnotasdirectasanswer

A.CIncorrect:thereferencetoa“lackofphysicalactivity”inthe

topicsentencemeansthatmostAustraliansdonotdothislevelofactivity,so“this”cannotreferto“moderateintensityexercise”.

DIncorrect:sincethenoun“levels”isplural,“these”wouldberequiredtorefertoit.

17. Regardingphysicalactivityandsedentarybehaviour:ACorrect:inthe2ndparagraph,theauthorstatesthat

“Sedentarybehaviourhasbeenfoundtocontributetoall-causeprematuremortality…independentlyofphysicalactivitylevels”

BIncorrect:physicalactivityisnotarguedasbeingdetrimentaltohealth.

CIncorrect:thephrase“wedonotenoughoftheformer”isinaccurateaccordingtothetext,asthetextstatesthat“manyAustraliansmaymeettheminimumguidelinesforbeingphysicallyactive”.

DIncorrect:seeexplanationforoptionA.18. Themainmechanismsforthebenefitsofexerciseforcoronaryhealth:

A Incorrect:lipidprofilesandcholesterollevels,increasedinsulinsensitivityandbloodpressurecontrolaccountforonlyabout35%oftheeffect,sothisisnotamainmechanism.

B Incorrect:lipidprofilesandcholesterollevels,increasedinsulinsensitivityandbloodpressurecontrolaccountforonlyabout35%oftheeffect,sothisisnotamainmechanism.

C Incorrect:lipidprofilesandcholesterollevels,increasedinsulinsensitivityandbloodpressurecontrolaccountforonlyabout35%oftheeffect,sothisisnotamainmechanism.

D Correct:inparagraph5,thepassagestatesthat“forabout65%oftheeffect,themechanismbywhichexerciseproducescardiacbenefitsisunknown.”

19. Theword“collateral”inthefifthparagraphcouldbestbereplacedwith:AIncorrect:thedefinitionof“alternate”is“everyother;every

second”.BIncorrect:thedefinitionof“corollary”is“associatedor

supplementary”.

CCorrect:thedefinitionof“collateral”is“additionalbutsubordinate;secondary”.

DIncorrect:thedefinitionof“large”is“ofconsiderableorrelativelygreatsize,extent,orcapacity”

20. Thebestheadingforthesixthparagraphis:AIncorrect:thisisnotstatedinthetext.BIncorrect:thispointistoogeneral.CCorrect:thisisreferredtointhetopicsentenceandthe

supportingsentencesdescribehowdoingdifferentlevelsofexercisereducestheriskofCHDbydifferentamounts.

DIncorrect:thispointistoogeneral.

21. Thebeneficialeffectsofmoderatephysicalactivity:AIncorrect:thepassagestatesthatpatientsmustalso“reducetime

spentinsedentarybehaviour”.B Correct:this isfoundbycombiningtheinformationinthe

firstsentence(“beneficialeffectsofmoderateexerciseforthepreventionofCHDarestronglysupported”)withinformationinthe3rdsentence(“evidencesupportingphysicalactivity isofgreatclinicalsignificance”).

C Incorrect:thepassageonlystatesthatdoctors“shouldstronglyencouragetheirpatients”,notthattheyactuallydo.

DIncorrect:onlyBiscorrectaccordingtothepassage.22. Thebestalternativetitleforthisarticleis:

A Incorrect:governmentrecommendationsareonlymentionedinparagraphs 7 and 8, so this is not the best overall title for thearticle.

B Incorrect: this answer is too broad, as the article is mostlyconcernedwith physical inactivity and sedentary behaviour, notallriskfactors.

CCorrect:thisisthebestsummaryofthearticle.

DIncorrect:thesedifferencesareonlydescribedinparagraph2,sothisisnotthebestoveralltitleforthearticle.

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