READING TEST 88

READING SUB-TEST : PART A

 Look at the four texts, A-D, in the separate Text Booklet.
 For each question, 1-20, look through the texts, A-D, to find the relevant
information.
 Write your answers on the spaces provided in this Question Paper.
 Answer all the questions within the 15-minute time limit.
 Your answers should be correctly spelt.

PART A -TEXT BOOKLET – MANAGEMENT OF MIGRAINE IN NEW ZEALAND

GENERAL PRACTICE

Text A
OBJECTIVES: To determine the proportion of patients who have a
diagnosis of migraine in a sample of New Zealand general practice
patients, and to review the prophylactic and acute drug treatments used
by these patients.
DESIGN, SETTING AND PARTICIPANTS: A cohort of general
practitioners collected data from about 30 consecutive patients each as
part of the BEACH (Bettering the Evaluation and Care of Health) program;
this is a continuous national study of general practice activity in New
Zealand. The migraine sub study was conducted in June-July 2017 and
December 2017- January 2018.
MAIN OUTCOME MEASURES: Proponion of patients with a current
diagnosis of migraine; frequency of migraine attacks; current and previous
drug treatments; and appropriateness of treatment assessed using
published guidelines.
RESULTS: 191 GPs reported that 649 of 5663 patients (11.5%) had
been diagnosed with migraine. Prevalence was 14.9% in females and
6.1% in males. Migraine frequency in these patients was one or fewer
attacks per month in 77.1% (476/617), two per month in 10.5% (65/617),
and three or more per month in 12.3% (76/617) (missing data excluded).
Only 8.3% (54/648) of migraine patients were currently taking
prophylactic medication.
Patients reporting three or more migraines or two migraines per month
were significantly more likely to be taking prophylactic medication (19.7%
and 25.0%, respectively) than those with less frequent migraine attacks
(3.8%) (P
< 0.0001). Prophylactic medication had been used previously by 15.0%
(96/640). The most common prophylactic agents used currently or
previously were pizotifen and propranolol; other appropriate agents were
rarely used,
and inappropriate use of acute medications accounted for 9% of
‘prophylactic treatments’. Four in five migraine patients were currently
using acute medication as required for migraine, and 60.6% of these
medications conformed with recommendations of the National Prescribing
Service.
However, non-recommended drugs were also used, including opioids
(38% of acute medications).
CONCLUSIONS: Migraine is recognised frequently in New Zealand
general practice. Use of acute medication often follows published
guidelines.
Prophylactic medication appears to be underutilised, especially in patients
with frequent migraine. GPs appear to select from a limited range of
therapeutic options for migraine prophylaxis, despite the availability of
several other well documented efficacious agents, and some use
inappropriate drugs for migraine prevention.

Text B
Table 1: Economic burden of migraine in the USA

Cost element Men (US$) Women(US$) Total(US$)

Medical 193 1,033 1,226

Missed workdays 1,240 6,662 7,902

Lost productivity 1,420 4,026 5,446

Total 14,574
Text C
Case 1:
‘Jane’ experienced pressure from employers due to her migraine
absences. She had three days off work in the first quarter of the year, and
this was deemed unacceptable and unsustainable by her employers;
therefore, she has just resigned from her job and hopes that her future
employers will be more understanding.
Case 2:
‘Sally’s’ employers and colleagues are aware of her migraine symptoms
and are alert to any behaviour changes, which might indicate an
impending attack. In addition, colleagues have supporters’ contact
numbers, should she need to be escorted during a migraine. As her
employers are pan of the government ‘Workstep Programme’, she has
accessed a number of allowances and initiatives: her migraines have
been classified as a long-term health condition rather than sickness
absence, which permits her a higher absence threshold. She now works
flexible hours and has received funding for eye examinations, prescription
glasses, and a laptop to enable her to work from home.

Text D
Research brief on migraines in the US

Migraine prevalence is about 7% in men and 20% in women

over the ages 20 to 64.
The average number of migraine attacks per year was 34 for
men and 37 for Women.
Men will need nearly four days in bed every year. Women will
need six.
The average length of bed rest is five to six hours.
Only about 1 in 5 sufferers seek help from a
doctor.
 PART A -QUESTIONS

Questions 1-7
For each of the questions, 1-7, decide which text (A, B, C or D) the information
comes from. You may use any letter more than once
In which text can you find information about
1. what is the average length of bed rest?
2. Does employee experience pressure from employers due to migraine
absences?
3. which patients are more likely to take prophylactic medication?
4. what does ‘BEACH’ stands for?
5. how much economic burden does migraine causes in the US?
6. which government program gives allowances for migraine patients?
7. what type of drugs are popular non-recommended drugs for migraine?

Questions 8-13
Answer each of the questions, 8-13, with a word or short phrase from one of the texts.
Each answer may include words, number of the both. Your answers should be correctly
spelled.
8. Which are the most common prophylactic agents used?
9. What is the migraine prevalence among women over the ages 20 to
64 in the US?
10 .How many migraine patients are currently taking prophylactic medication
in New Zealand?
11. What is the migraine prevalence among men in New Zealand?
12. How many GPs reported patients who had been diagnosed with migraine
in New Zealand ?
13. What is the average length of bed rest for migraine in the US?
Questions 14-20

Complete each of the sentences, 14- 20, with a word or short phrase from one of the
texts. Each answer may include words, number or both. Your answers should be correctly
spelled

14. In the US, only about 1 in 5 sufferers seek help from a

______________

15. _________________ appears to be underutilised in patients with

frequent migraine
16. In New Zealand inappropriate use of _____________ accounted for 9%
of ‘prophylactic treatments’
17. The average number of migraine attacks per year was 37 for
________________ in the U.S
18. The study concluded that migraine is recognized_____________ in New
Zealand general practice.
19. In New Zealand, GPs appear to select from a limited range of
______________________ for migraine prophylaxis.

20.Women will need nearly _____________________ days in bed every

year in the US.
END OF PART A THIS TEXT BOOKLET WILL BE COLLECTED

READING SUB-TEST : 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. Write your answers on the separate Answer Sheet

Questions 1-6
1. The guidelines establish that the healthcare professional should
involve children in
A. all discussions even if consent does not lie with the child
B. most possible discussions even if consent does lie with the child
C. most convenient discussions even if consent does not lie with the
child

Children and consent

The law regarding children’s consent is complicated and regularly
updated. The healthcare professional should involve children as much as
is practicably possible in discussions about their care; this is the case
even if the ultimate decision or ‘consent’ does not lie with the child. In the
UK and most of the developed world a young person is assessed on an
individual basis on their ability to understand and weigh up options, rather
than on their age. This ability to take decisions is known as ‘Gillick’
competence and originated from a court case regarding the prescription
of oral contraceptives to young people under the age of 16.

2. The guidelines require those undertaking a surgical scrub to

A. apply a bactericidal, detergent, surgical scrub solution to warm
hands

B. ensure hands are positioned so as to avoid soap and water

running onto
C. dry thoroughly by patting with non-sterile paper towels

Surgical scrub
This involves the use of a chemical disinfection and prolonged
washing to physically remove and kill surface organisms in the
deeper layers of the epidermis. This should be done before any
invasive or surgical procedure.
• Apply a bactericidal, detergent, surgical scrub solution to wet hands
and massage in using an 8-point technique, extending the wash to
include the forearms.
• Ensure the hands are positioned so as to prevent soap and water
running onto and contaminating the hands from unwashed areas of the
arms.
• Rinse in warm water.
• Dry thoroughly by patting with sterile paper towels.

3. The email is reminding staff that the risk of infection does not
A. vary depending on the type of bloodborne virus
B. varies depending on the infectivity of the source patient
C. varies depending on the contaminated instrument

Needlestick injury
Needlestick or sharps injuries are a daily risk for healthcare workers and
can lead to infection with bloodborne viruses (BBVs) such as hepatitis or
HIV. The risk of infection following a single sharps (percutaneous) injury
varies depending on the type of BBV. The risk is approximately:
• 1 in 3 if the instrument is contaminated with hepatitis B
• 1 in 30 if the instrument is contaminated with hepatitis C
• 1 in 300 if the instrument is contaminated with HIV, though this
depends on the infectivity of the source patient.

4. The email is reminding staff that the

A. immobile patients must be very attentive
B. immobile patients must be well taken care of
C. immobile patients must be also taken care of

Equipment for patient safety

The side rails are the most commonly used equipment in order to reduce
the risk of falling. Older types are removable side rails, although side rails
that are part of the bed are more frequently used. Side rails can be
lowered.
Procedure for lowering side rails: First, press the small tab on the side of
the rails, then the round button and hold the rails with your other hand
while lowering them. Staff must be very attentive with immobile patients –
i.e, check the position of the parts of the body (e.g. hands) when lowering
the side rails to avoid injury.
5. What does this extract from a handbook tell us about
immobility problems?
A. are addressed by rehabilitation by a physiotherapist doctor prescribed
B. are seen patients with coma and lower limb fractures
C. are seen patients with coma, lower limb fractures and bronchial
asthma

Immobility levels:
• Complete immobility – e.g. patient in a coma
• Partial immobility – e.g. patients with lower limb fractures
• Limited activity associated with disease – e.g. patients with
bronchial asthma
Mobility and immobility problems are addressed by rehabilitation, which
extends to physiotherapy knowledge and practical skills. The job of the
physiotherapist and as prescribed by a doctor, is to practice movement,
deep breathing using breathing techniques etc. with the patient. The
nurse, in collaboration with the patient, continues with the exercise and
in maintaining mobility throughout the day and checks the functioning of
the patient’s proper position, while the position of immobile patients is
adjusted at regular intervals.

6. When preparing patients for a procedure, it is necessary to

A. clearly explain, describe and possibly demonstrate on them

B. include both verbal and nonverbal communication
C. inform of the procedure they will be partaking in

Patient preparation
It is important that the patient is informed of the procedure they will be
partaking in. The procedure should be clearly explained, described, and
possibly demonstrated on them. Verbal and nonverbal communication
between the staff and the patient is very important. Communication with
the patient should be by short and simple sentences according to their
mental level, their ability to receive and follow instructions and the
degree of willingness to cooperate. Communicating with understanding
and open minded people makes it easier to gain their trust and
cooperation.
 READING SUB-TEST : 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. Write your answers on the separate Answer Sheet

Part C -Text 1

OBESITY IS THE BIGGEST PUBLIC HEALTH HURDLE OF

THE CENTURY
Like many nations, Australia is in the throes of an unprecedented
epidemic of obesity and type 2 diabetes – an epidemic in acceleration
mode. Over the last week, more than 2500 scientists have been in
Sydney for the 10th International Congress of Obesity. The theme of the
congress was “From Science to Action”. Its aim has been to produce
workable strategies to counter the obesity pandemic and to deliver to
communities and governments the leadership that only a meeting of this
significance and magnitude can offer.

Obesity is the single most important challenge for public health in the
21st century. More than 1.5 billion adults worldwide and 10 per cent of
children are now overweight or obese. Yes the world’s waistline in
bulging – some cynics call the phenomenon “Globesity”. Professor
Phillip James, chairman of the International Obesity Task Force,
warned the congress that it is sweeping the world with terrifying
rapidity.

Obesity is the driving force behind type 2 diabetes, which causes

significant cardiovascular complications, kidney failure, blindness and
amputations. This is leading to decreased life expectancy from type 2
diabetes, cardiovascular disease and some forms of cancer.
The selection of Sydney as the host city for the conference was made
eight years ago, but in the meantime Australia has assumed the not-
so-welcome honour as the nation with one of the fastest-growing rates
of obesity in the world. The 2000 AusDiab study, undertaken by the
International Diabetes Institute, showed that more than 60 per cent of
our adult population is overweight or obese, along with 20 per cent of
our children. It is a tripling in numbers over the last 20 years.

The Pharmaceutical Benefits Scheme subsidised the obesity-related

conditions diabetes and heart disease by more than $2 billion last year,
and the costs are still rising. This is replicated in many nations and this
“diabesity” pandemic is now set to bankrupt health budgets all over the
world. Emerging from the conference was some important new
scientific research.

In the last decade, fat has moved from being viewed as inert “blubber” to
probably the most active endocrine (hormonal) organ in the human
body. It makes a vast range of chemical substances vital to body
function – from control of appetite, energy balance, our immunity and
blood clotting, to regulation of insulin and other hormonal actions. Fat in
the abdominal cavity, the “Aussie beer gut” makes chemicals that cause
type 2 diabetes and heart disease.

On the public health side, VicHealth CEO Robert Moodie, noted that
there was a role for government regulation and, without it, we will not
be able to curb the epidemic. He said that the contemporary
environment promotes obesity. The obesity diabetes epidemic will
continue unless we accept that many years of health promotion aimed
at individuals seem to have had virtually no effect.

Our own state and local governments may have inadvertently

contributed to this epidemic by allowing developers to create urban
social problems. New developments lack proper attention to sidewalks,
bike paths, public transport corridors, playing fields and friendly
exercise areas that are essential to maintain a healthy lifestyle.

We can rejoice that obesity has implanted itself firmly on government

radars. Tackling obesity and its consequences has been taken to a new
political level. Our federal and state governments have recognised the
need for action to tackle obesity and diabetes through the Better Health
Initiative. Federal Health Minister Tony Abbot and John Howard have
been powerful advocates of action – with certain reservations such as in
the area of banning TV advertising

We don’t have the luxury of time to deal with the epidemic – it’s as big
a threat as global warming and bird flu. Solutions are urgently needed,
and involve more basic issues than more exercise and correcting diet.
The way ahead for us to address this “globesity” crisis is not for obesity
researchers, scientists, health professionals and politicians to live in
their silos with pet beliefs on issues of taxing junk foods and banning
TV advertising. What is needed is a big- picture approach, and to
acknowledge our lives and the environment have changed in the last
20 or 30 years.

Just three weeks ago, Professor Phillip James and I wrote an editorial
for the Medical Journal of Australia (2006;185:187-8) which outlined
some key legislative and regulatory measures that are required to turn
the epidemic around, particularly in relation to childhood obesity. We
need urban planning to help people exercise more, physical activity
reintroduced into curricula, nutrition education in schools, production
and availability of cheap healthy foods, and responsible labelling and
advertising.

At the congress, a major topic was the call by many for bans on
marketing and TV advertising to children. While this seems sensible,
the evidence that it translates into reduced obesity rates is not yet
available. Certainly stronger guidelines are needed, and we may need
to implement guidelines for food labelling. Currently, labels cannot be
understood by consumers – and health claims are often misleading.
Looking at the big picture, the prevention of obesity and type 2 diabetes
requires co-ordinated policy and legislative changes, with greater
attention on our urban environment, transportation infrastructure, and
workplace opportunities for education and exercise. Governments –
local, state and federal should commit to optimising opportunities for
exercise in a safe environment. A multidisciplinary, politically driven, co-
ordinated approach in health, finance, education, sports and agriculture
can contribute to reversing the underlying causes of the obesity
epidemic. This may well be the single and most important challenge for
public health in the 21st century. It is a battle than we can and must win.

Part C -Text 1: Questions 7-14

7. According to the article, in Australia
a) There are more overweight children than adults
b) Australia has the fastest growth rate of obesity
c) In the past 2 decades Australia’s rate of obesity has increased 3 fold.
d) None of the above

8. Which among the following describes the term ‘inadvertently’?

a. Without knowledge
b. Without advertising
c. Without acting or without participating
d. without intending to or without realizing

9. According to Robert Moodie

a) Government regulation will not help lessen the epidemic
b) Modern lifestyle encourages obesity
c) Health promotion is a good way to reduce obesity
d) Obesity is a bigger problem than diabetes
10. ‘to curb something’ means

a. To destroy something
b. To cut something
c. To control or limit something
d. To stop something

11. Which of the following statements are true

a) New suburbs do not encourage people to develop a healthy routine
b) Australians have too much time to enjoy luxury foods
c) John Howard and Tony Abbot support prohibiting TV advertisements
d) obesity is a greater danger than bird flu & global warming

12. Professor Philip James believes

a) Advertisements must be labelled
b) Make healthy food more affordable
c) Physical education reduces academic levels
d) Education is necessary to encourage people to exercise

13. According to the article it can be concluded that

a) Lack of exercise is the number one cause of obesity
b) Modern lifestyle is not as healthy as a traditional lifestyle
c) Obesity and type 2 diabetes can only be reduced if governments
are involved in the process
d) None of the above
14. Which among the following describes the word ‘cynic’ in the passage?
a. Somebody who is crucial to society
b. Somebody who is critical and sarcastic
c. Somebody who is determined
d. Somebody who hates people

Part C -Text 2

Medical staff working the night shift: can naps help?

Delivering medical care is a 24-hour business that inevitably involves
working the night shift. However, night shift requires the health
professional to work when thebody’s clock (circadian system)
demands sleep. Added to this is the problem of “sleep debt”, arising
from both prolonged prior wakefulness on the first night shift and
cumulative sleep debt after several nights’ work and repeated
unsatisfactory daytime sleeps.

A further aggravation, particularly for trainee medical staff in teaching

hospitals, has been the demand for excessive work hours across the
working week. As has been dramatically shown in recent well controlled
studies, the net result of this assault on the sleep of health professionals
can be impaired patient safety, and the health and safety of health
professionals themselves.

The good news is that health organisations and regulators are beginning
to treat the matter seriously. In Australia, the United States and Europe,
work hours of medical staff have recently been shortened by
government regulation, and bodies such as the Australian Medical
Association and professional colleges are advising their members on
strategies to improve their sleep health and thus work safety.
A recent publication prepared by the Royal College of Physicians
(London) (RCP), Working the night shift: preparation, survival and
recovery. A guide for junior doctors, is an excellent example. One
proposed countermeasure for excessive sleepiness is the use of
strategically placed naps both before and during the night shift. But does
napping either before or during the night shift reduce sleepiness and
improve performance, and, if so, how practical is it?

There are two important, independent mechanisms of sleep and

sleepiness that hold the key to these questions. Probably the more
potent mechanism impairing night-shift alertness is the circadian
system. For most individuals, even those working permanent night shift,
the circadian system is in sleep mode during the night. This causes
slowed reactions, increased feelings of fatigue, impaired concentration,
and increased sleep propensity

The second important mechanism affecting night-time alertness is

homeostatic sleep drive. This increases in intensity the longer we are
awake and, like appetite which is sated by eating, homeostatic sleep
drive is reduced by sleeping. If the first night shift starts at midnight
following a normal wake time at about 8 am, about 16 hours of wake
sleep debt has already been accrued and the rest of the night shift will
be performed under intense homeostatic, in addition to circadian, sleep
drive.

Performance decrements during this night period can be similar to those

measured in the daytime with a blood alcohol concentration of 0.05%–
0.10%. Day sleep in the home environment is likely to be shorter and
less effective than night sleep so, even though second and subsequent
night shifts may follow fewer wakeful hours (8–10 hours), homeostatic
sleep drive is likely to remain elevated during night shifts because of
incomplete repayment of the previous sleep debt.
To a limited extent, it is possible to “bank” sleep (or pay off residual sleep
debt) before the first night shift, potentially reducing subsequent night-
time homeostatic sleep drive and improving alertness and work safety. A
long (1–2 hours) nap in the afternoon, as recommended in the RCP
report, is best. Afternoon sleep is more efficient than early evening sleep
as it uses the natural afternoon “dip” in circadian physiology and avoids
the risk of post-sleep grogginess or sleep inertia impinging on the start
of night duty. Between subsequent night shifts, the aim should be to
maximise daytime sleep length (at least 7 hours) and efficiency by
including the afternoon sleepy period (1–4 pm).

What about napping during a night shift to improve alertness and reduce
errors and accidents? Brief afternoon naps of 10–30 minutes (so-called
power naps) improve alertness and performance. We compared
afternoon naps of 5, 10, 20, and 30 minutes of total sleep. The 10 minute
sleep (about a 15 minute nap opportunity) produced improvements over
the 3 hour post- nap period in all eight alertness and performance
measures, without any of the post-nap impairment of sleep inertia that
followed the 20 and 30 minute naps. Whether these results would be
replicated at, say, 3 am in a night- shift environment, with considerably
greater homeostatic and circadian sleep drive, is now being tested.

Only a few studies have measured the effects of night-shift napping. Long
naps of about 2 hours appear as effective at about 3 am as at 3 pm.
However, 1–2 hour naps were followed by sleep inertia, during which
alertness was impaired for up to an hour. Longer naps, although beneficial
once sleep inertia has been dissipated, may be used reluctantly by
medical staff wishing to maintain continuity of patient care. Briefer naps
(18–26 minutes) have also improved performance in night-shift
environments

Therefore, the picture emerging from night-shift napping studies is

similar to that from the afternoon studies. Very brief naps (10–15
minutes of sleep) may improve alertness immediately without the
negative effects of sleep inertia. How long this improvement lasts and
what is the optimal nap length on the night shift remains to be
determined. In the meantime, as recommended in the recent RCP
guide, health professionals who work night shift should, for the sake of
their own health and safety and that of their patients, consider the
benefits of night-shift napping. Optimal benefit and a higher take-up rate
are likely for sleep lengths of 10–15 minutes.

Part C -Text 2: Questions 15-22

15. Which of the following is not mentioned a cause of sleep debt?

a) Regular lack of sleep during the day

b) Staying awake for a long period before the first night shift
c) Poor health among health professionals
d) A build up of sleep debt during the night shift period

16. Which of the following statements is not mentioned?

a) Lack of sleep among health professionals can affect the safe
treatment of patients
b) Lack of sleep among health professionals can affect the health of
health professionals
c) Long hours are very common for trainee medical staff
d) Most health professionals don’t get adequate sleep

17. According to the article which of the following statement is false?

a) people who work the night shift during sleep mode may have
increased appetite
b) people who work the night shift during sleep mode may feel exhausted
c) people who work the night shift during sleep mode may be unable to
keep their mind on the job
d) people who work the night shift during sleep mode may respond
slowly to certain situations
18. Which of the following statements is true?
a) It is beneficial to sleep between 1- 4 p.m.
b) If you sleep in the early evening you will be fully alert at work
c) Do not sleep more than 7 hours during the day before your night shift
d) All of the above

19. Recent studies have shown that

a) Long 2 hour naps are more beneficial at night
b) Short naps are equally effective at night as they are during the day
c) Short daytime naps are less beneficial than longer daytime naps
d) none of the above

20. Overall the purpose of the article is to explain that

a) Health professionals don’t get enough sleep
b) Both short and long naps during night shift will improve
work performance and patient treatment
c) Short naps during night shift may be the best way to improve
work performance and patient treatment
d) Tired health professionals are less efficient than alert health
professionals

21. What is the duration of Briefer naps?

a) 18–26 minutes
b) 10–15 minutes
c) 20–26 minutes
d) 5–10minutes
22. Which naps are known as power naps?
a) Very brief afternoon naps
b) Briefer afternoon naps
c) Brief afternoon naps
d) Briefer forenoon naps

END OF READING TEST, THIS BOOKLET WILL BE COLLECTED

Reading test 88 : Answer Key

Part A - Answer key 1 – 7

1. D
2. C
3. A
4. A
5. B
6. C
7. A

Part A - Answer key 8 – 14

8. pizotifen and propranolol
9. 20%
10. 54
11. 6.1%
12. 191
13. 5 to 6 hours
14. doctor
Part A - Answer key 15 – 20
15. prophylactic medication
16. acute medications
17. women
18. frequently
19. therapeutic options
20. six

Reading test - part B – answer key

1. C
2. B
3. C
4. B
5. A
6. C
Reading test - part C – answer key
Text 1 - Answer key 7 – 14

7. c
8. d
9. b
10. c
11. a
12. b
13. c

14. b

Text 2 - Answer key 15 – 22

15. c
16. d
17. a
18. a
19. b
20. c
21. a
22. c