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 PART B
In this part of the test, there are six short extracts relating to the work of health professionals.
For questions 1-6, choose the answer (A, B or C) which you think fits best according to the text.

1. What does this manual extract tell us about?

A. To project I-dopa is not an ideal drug for long term treatment.

B. Treatment is not always ideal for Premature Parkinson’s disease
C. To project that the I-dopa is very effective in removing brain cells

Treatment
Treatment isn't always needed in the early stages of Parkinson's disease – mild tremor, for
instance, may be inconvenient and cause social embarrassment but otherwise life can go on
pretty much as normal.
As the disease progresses, it will usually be treated with drugs. Several different drugs are
available. These drugs act to increase signally within the dopamin pathways in the basal ganglia.
The best known of these is levodopa, also called l-dopa. When this drug was introduced in the
1960s it was a revolution in the treatment of Parkinson's disease. It crosses easily from the
bloodstream into the brain tissue, where it is converted by surviving brain cells to become
dopamine. The symptoms of tremor and rigidity are often dramatically improved.
The effect of the drug is not as potent in patients after several years of treatment as fewer
remaining brain cells are able to convert the l-dopa to dopamine.

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 2. Where to use panic door exit devices:

A. Public buildings, visitor rooms

B. Smoke control rooms, schools.
C. Community centers, schools, and hospitals.

EMERGENCY EXIT DOOR

PANIC DOORS

In panic situations the safety and rescue possibilities for people in the building are the main
concern. In Europe uniform standards for emergency exit door fittings are in application.
Within the meaning of these standards, emergency exit door systems are subdivided in
emergency exit devices according to EN 179, and panic door Exit devices according to EN
1125. Emergency exits acc. to EN 179 are designated to buildings to which the general
public does not have access and whose visitors understand the function of the emergency
doors.
Panic door exit devices acc. to EN 1125 are used in public buildings where the visitors are
not familiar with the function of emergency doors, like schools, hospitals, shopping malls.
The WICSTYLE door systems offer a comprehensive range of applications, which can also
be combined with other functions and design options.

TECHNICAL PERFORMANCE
Profile technology:
• Doors in accordance with EN 179 (emergency Exit devices) or with EN 1125 (panic exit
devices)
• Many system options for the emergency application, allowing for a unified door design
within the builiding, irrespective of additional functions
• Single or double leaf possible
• Combination with burglar resistance in classes RC1 and RC2 possible
• Execution in combination with fi re protection in classes T30 and T60 and in combination
with smoke control possible (national regulations must be respected)

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 3. What led for confrontation in resolving patient’s grievances or complaints by
many organizations?

A. Lack of uniform rules across the country in dealing with complaints

B. No clear guidelines for channeling patients' grievances to appropriate
C. Overriding the guidelines lay down by CMHCs.

Responding to complaints and grievances: Requirements for certain providers

Certain entities participating in Medicare and Medicaid are required to have specific
grievance policies and procedures.
For example, under the Centers for Medicare and Medicaid Services’ (CMS) Conditions of
Participation for Community Mental Health Centers (CMHCs) , CMHCs must inform clients
that they have the right to voice grievances. CMHCs must also distribute written information
to clients on filing a grievance during the patient’s initial evaluation. Although the Conditions
of Participation for CMHCs only apply to a narrow subset of community behavioral health
organizations, the standards are similar to expectations related to client rights in many
states.
For hospitals, CMS’ Conditions of Participation require more in terms of a specific patient
grievance process, including suggested time frames to investigate, resolve and follow-up on
grievances. CMS also differentiates between a “complaint” and a “grievance.” While many
organizations use these terms interchangeably, the definitions/distinctions laid out by CMS
can help to determine the appropriate response when a patient makes a complaint or
grievance.

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 4. The purpose of these notes about a counseling agent is

A. To aid and advice patient’s caretakers at home

B. To consider various aspects while treating a patient
C. Modify himself as patient’s caretaker.

Counseling: a Service to Society

Counselors advise and assist individuals, families, groups and organizations. The American
Counseling Association describes counseling as a collaborative effort between counselors
and their clients. To be an effective counselor, a trained professional needs to be able to
work on numerous levels. For example, counselors help people of all ages identify
problems, strengths and goals; work through issues; improve interpersonal and coping
skills; address mental health concerns; change behavior and focus on personal growth.

Often, when one person is seeing a counselor, the effect goes beyond what the individual
gains. Families and family dynamics are affected when someone who has been grappling
with difficult problems begins working with a trained counselor. As the individual client
learns what is causing her distress and how to manage it, family members open to evolving
may benefit from knowledge, understanding and improvements acquired through
counseling sessions. Other beneficiaries include extended family, employers, colleagues
and friends, community groups and society.

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 5. What we understood form the manual extract is

A. Technological progress made product delivery easy to the required.

B. Digital copies made user friendly for the Nurses despite costly
C. Criticism in Manuals will not be the sole criteria in evaluating writer’s
works.

Medical device user manuals:

Shifting Towards Computerization

Consider the challenges facing technical communicators (i.e., technical writers) who design
and produce medical device user manuals: First, their work must address the needs of an
especially diverse audience, starting with caregivers and extending to trainers, biomedical
engineers, sales personnel, government regulators, and many others. Because of its broad
potential audience, the typical medical device user manual must be several documents in
one. Second, technical communicators often have only limited resources and time to
produce high-quality manuals as their companies speed products to market. Third, a user
manual's primary audience—arguably the nurses, physicians, and technicians who deliver
direct care to patients—tend to prefer engaging in hands-on training over reading user
manuals. The popularity of the hands-on approach creates a perception of user manuals as
perfunctory—a perception that could take the wind out of any technical writer's sails.
As computer technology grows ever more ubiquitous, a popular trend toward computerizing
learning tools is cause for new excitement among technical communicators and allied
professionals alike. As more caregivers gain computer access, the practicality of their
viewing instructions on a medical device's computer display, on the Web, or on an
interactive CD-ROM, for example, will increase. Such technological progress will enable
content developers to think beyond the printed page and embrace alternative delivery
mechanisms that may be more compatible with a particular user's learning style. In addition
to the benefits it might afford users, computerization will assist manufacturers in updating
content as readily as they install new versions of software into devices. As a result of this
emerging multimedia approach, the hard-copy medical device user manual is swiftly
evolving toward a system of both print and electronic components.

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 6. Nursing registration guidelines states that

A. A nurse has to complete her full education in vocational schools

B. To proclaim as a registered Nurse, she has to complete preregistration
program study.
C. 5 years full term course completion is the only the criteria for registering
as a Nurse.

Registered nurses and registered midwives

If you are applying for registration as a registered nurse and/or a registered midwife, you
must provide evidence of the completion of five (5) years*(full-time equivalent) of education
taught and assessed in English, in any of the recognised countries.
NOTE:
a) The Board will only accept the completion of five (5) years* (full-time equivalent) of:
i) tertiary and secondary education taught and assessed in English; or
ii) tertiary and vocational education taught and assessed in English; or
iii) combined tertiary, secondary and vocational education taught and assessed in English;
or
iv) tertiary education taught and assessed in English
from one or more of the recognised countries listed in this registration standard.
b) The five (5) years referred to in paragraph a above must include evidence of a minimum
of two (2) years full-time equivalent pre-registration program of study approved by the
recognised nursing and/or midwifery regulatory body in any of the recognised countries
listed in this registration standard.

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 PART C
In this part of the test, there are two texts about different aspects of healthcare. For questions 7-
22, choose the answer (A, B, C or D) which you think fits best according to the text.

TEXT: 1
When health anxiety set my mind (and heart) racing
" You’re too young to be here."

I couldn't agree more. I look around the cardiologist's waiting room, guessing that I'm the
youngest person by at least 20 years. Everyone else is slightly crumpled; soft, wrinkled and
grey. But, despite my youthful vigour – well, maybe slightly worn around the edges after 39
years – I did need to be there. You see a month or so prior to my walking into the waiting room,
my heart had started doing something weird. Every now and then – roughly every 10 or 20
minutes – it would do an extra big beat, or an odd beat, or something like that. I discovered that
it's hard to listen to your own heart. It's a bit like a quantum physics problem: the act of
observing it changes its behaviour. For a few weeks, I ignored it, thinking it was probably related
to the horrible cold I was experiencing.

But it continued. And continued. So I did what all internet-equipped hypochondriacs do, I
consulted Dr Google. Being a health journalist whose search history tends to demand the good
stuff, I like to think that I found some slightly more authoritative and less hysterical sources than
your average search would hand up; but it was still enough to make me decide a trip to the
doctor was in order. My GP couldn't find anything. My blood tests were normal, my ECG
healthy, so he sent me to a cardiologist. It wasn't an urgent referral, so I was faintly reassured
that the GP wasn't worried that I was going to do the clutch-heart-and-drop Hollywood thing just
yet. Then I had to wait. It was two weeks between seeing the GP and my cardiology
appointment, and for the first time in my life, I experienced something that I have read and
written about so often: the anxiety of the so-called 'worried well'.

This is one of the reasons why, even though we have so many tests for so many diseases, we
don't use them on everyone. Because while a test might pick up one person in a hundred with a
medical problem (which may not even have been life-threatening), for the other 99 people in
that population, the time between having the test and getting the all-clear is for many a time of
great anxiety and stress. For many, that stress will be in the background. We might not even be
aware of it, but no matter how bullet-proof we try to convince ourselves that we are, ultimately,
we're all waiting for the bomb with our name on it. It will, on some level, eat away at our psyche.

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While there's no blood test or sliding scale to really quantify that stress, it is real, and it is a cost.
During this time I had lunch with a dear friend, who was off to get a lump in her breast checked.
Our faces mirrored each other's unspoken anxiety over our obscenely large midday breakfasts.
We talked about the fact that ultimately, everyone has to die of something. I said, "Somehow, I
don't think my ticker and your bosom are it for us," probably sounding a lot more confident
than I felt. Lying in bed at night, I would listen intently for my heart's occasional mega-thump,
trying to glean just a little bit more information from the errant beats that might reassure me this
wasn't atrial fibrillation or a dangerous arrhythmia. Instead, my heartbeat began to sound faster
and louder than I had ever noticed before. Even when I tried to ignore it and go to sleep, it
pounded in my chest like the war drum of Impending Doom.

Finally the day comes for my trip to the cardiologist. The night before, I'm plagued with intensely
stressful dreams, including one in which I'm due to perform on stage right after Tim Minchin. If
that isn't a hard act to follow, I don't know what is. I wake up with my guts tight, possessed with
a slightly hysterical mania that sees me charging around the house, washing, cleaning, tidying. I
get the kids out the door for school earlier than usual, much to their and my confusion at the
lack of the usual screaming "HURRY UP!" routine. The cardiologist is running late, so I have
nearly an hour in the waiting room watching other patients shuffle in and out of the rooms. My
heart flip-flops regularly, reassuring me that I'm not going to be wasting his time.

The nurse beckons me in for my stress test. My chest is decorated with sticky dots, like I'm
waiting to be digitally rendered as a female Gollum, and I'm connected to a tangle of electrical
leads. Then up onto the treadmill, and my test begins. Oh, the irony. My heart problem has
stage fright. The nurse cranks up the treadmill until I'm puffing and sweating under the heavy
ECG belt, yet my recalcitrant heart steadfastly refuses to give even a single performance of its
aberration. Instead it defiantly beats strong, solid, and regularly, as if trying to prove that it's all
simply a product of my paranoid imagination.

Even after the test is finished, and I'm cooling off in the waiting room while the doctor reviews
the results, my heart beats as reliably as an atomic clock. Despite the absence of anything on
the ECG, he diagnoses me as having ventricular ectopic beats. These are occasional misfiring,
like an extra heartbeat that happens in the lower chamber of the heart (the ventricle). In
otherwise healthy individuals, they are no cause for alarm. In fact, they reassure me that my
heart is healthy enough that I could apply for a job with police rescue.

He schedules an echocardiogram to check there's not some other valve weirdness going on,
but by that stage I'm skipping out the door, feeling like a possible death sentence has been lifted
and instead I'm contemplating doing a half-marathon for the first time in my life.

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Questions 7-14

7. Why does she heard the words “you’re too young to be here”

A. Because she is not having any problem

B. She is healthy, so, not to come there
C. They think her age is not ideal to have problems
D. It is an restricted area for minors

8. Why the author does compare her increased heartbeat with quantum physics?

A. Probably it was her perception that she had high heartbeat

B. She overwhelmingly responded to the difficult problem in physics
C. Used in the context of her ideas to actions conflicting in her mind.
D. Unable to define a proper form, instead she used.

9. Why she delayed to consult Cardiologist?

A. She thinks it's unnecessary

B. She was willing consult another GP, instead cardiologist
C. Because it was not an urgent referral
D. Undermined the importance of referral

10. Why she used the words “worried well” in the second paragraph?

A. She is afraid of what going to face, when she meet cardiologist.

B. She is anxious to meet cardiologist
C. It is hard to digest, until she gets positive report
D. Worried to get appointment after two weeks

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 11. What do you understand from the last sentence in the third paragraph?

A. Stress cannot be in varied from person to person

B. It projects surprisingly at sometimes
C. Stress cannot be hidden at all times
D. Nothing

12. Why does she talk about some quoted words in the fifth paragraph?

A. To regain their confidence

B. To refrain from stress
C. To mobilize themselves to meet doctor regularly
D. To verify that theirs GP have referred correctly

13. The word “Beacons” means

A. Searches
B. Signs
C. Signals
D. Warns

14. Who does the word “they” refers to?

A. Doctors
B. Cardiologists
C. Nurses
D. Patients

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TEXT: 2
News reports about a study from Germany may provide the ultimate excuse for men to dress
more casually for work, finding neckties reduce blood supply to the brain.

The study showed that wearing a tie that causes slight discomfort can reduce blood flow to the
brain by 7.5 per cent, but the reduction is unlikely to cause any physical symptoms, which
generally begin at a reduction of 10 per cent. Past research shows that compression of the
jugular vein in the neck reduces blood flow to the brain. In this new study, published recently in
the journal Neuroradiology, the researchers tested whether the pressure of a necktie could
induce these changes.

They recruited 30 young men aged 21 to 28 years and split them into two groups: those wearing
neckties and those without. Using magnetic resonance imaging (MRI), the researchers tested
the cerebral blood flow (total blood flow to the brain) using a technique that showed changes to
the flow via a colour change. They also tested the blood flow from their jugular vein.

The first MRI took a "baseline" scan, while the participants in both groups had an open collar
(and those in the tie-wearing group had a loosened tie). For the second scan, the men's collars
were closed and participants in the tie group tightened their Windsor knot until they felt slight
discomfort. A third scan followed, in the same conditions as the baseline scan. All scans lasted
15 minutes.

The authors found that wearing a necktie with a Windsor knot tightened to level of slight
discomfort for 15 minutes led to a 7.5 per cent drop in cerebral blood flow, and a 5.7 per cent
drop in the 15 minutes after the tie was loosened. The men's blood flow in the control group —
those who weren't wearing a tie — didn't change. No change was found in jugular venous flow
between the two groups.

The study didn't go into any detail about the effects, so let's consider what they might be. The
researchers found a reduction in blood flow to the brain of 7.5 per cent, which is unlikely to
cause problems for most men. Healthy people are likely to begin experiencing symptoms when
blood flow to the brain reduces by about 10 per cent — so, a larger reduction than the study
found. Along with an increase in blood pressure at the site, a 10 per cent reduction in blood flow
can cause dizziness, light-headedness, headaches and nausea. But even with a 7.5 per cent
drop in blood loss to the brain, a person could still experience some temporary dizziness,
headaches or nausea.

Compounded with other factors, such as smoking or advanced age, a 7.5 per cent decrease
could bring some people over this 10 per cent threshold of blood flow loss, placing extra stress
on their already strained bodies and increasing their risk of losing consciousness or developing
high-blood pressure. It's unclear why there was no change to the jugular, but this may be due to
the circular nature of the restriction: the pressure is equally distributed across the neck, rather
than just the jugular.

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Further research is needed to assess the impact of wearing a tie for longer periods and wearing
different knots. Any pressure on the neck is slightly discomforting, and men's style guides
advise tightening a necktie to be "tight but not too tight". Whether this tightness aligns with the
participants' classification of "slight discomfort" is unclear. This study had a sample size of 30
participants, which is relatively small. Most human studies investigating blood pressure and
cerebral blood flow have at least 40 to 60 participants.

Another limitation is that the study did not include a discussion about the potential impact of the
blood restriction, or the finding that jugular blood flows didn't change. But overall, the study is
simple and well-designed. It adds to a small but growing body of research about the problems
with neckties: they can lead to higher rates of infection, as they're infrequently washed; and they
may increase intraocular pressure (blood pressure in the eyes) to the point of increasing the risk
of glaucoma.

Perhaps it's time to get rid of this unwelcome guest from our wardrobe, or restrict it to special
occasions.

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Questions 15-22

15. As per the new study report on using neckties by professionals will result in

A. Causing pain to Brian

B. Causes physical changes
C. Will not have major impact on blood supply to brain
D. No relation in causing physical symptoms.

16. How the researchers identified the blood flow change to brain

A. By using a specially designed meter

B. Based on colour
C. With the help of nerves blood flow density
D. Based on samples collected from research

17. The word ‘Baseline' defines that

A. The first scan was taken as referral mark

B. They considered it as the minimum level to conduct the research
C. It was considered as the highest level to check
D. It was the first stage in process

18. What was the researcher’s conclusion at the end?

A. There was the change of color in blood flow to brain

B. Identified no relation to jugular venous flow
C. Had developed a new technique to check this instead
D. It was a disappointing result for them

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 19. What will cause, if an aged patient using his necktie continuous for 2-3 hours?

A. May develop additional symptoms to the existing

B. Will develop resistance to blood flow to brain
C. Nothing will happen in prolonged exposure
D. Unable to determine the impacts

20. What was the major limitation in study report?

A. It doesn’t include many other aspects of the study

B. It focuses mainly on analyzing the impact of jugular venous flow.
C. It includes only a small group of people
D. Lack of technical support.

21. What does the word “it” refers to?

A. The study
B. The jugular venous flow
C. Blood flow
D. Infection

22. What does the word “this” refers to?

A. Necktie
B. Infection
C. Blood pressure
D. Research

END OF PART B & C

End of the Reading Test.

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