READING TEXT 2 –PART

A
Morgellons disease Texts
Text A
lf you have fatigue, skin lesions, aches and pains and a sensation that insects

are
crawling around under your skin, you most probably have Morgellons disease.
But this disease may actually not exist. Whether or not Morgellons is a real
disease, no one knows. Something like the symptoms described above,
supplemented by the appearance of strange fibres or filaments growing on or
just beneath the skin, was reported by the 17th-century physician Thomas
Browne. There were no other reported cases, and the disease seemed to
disappear. Then, in 2002, the mother of a child with a skin ailment championed
its comeback. Her child, she insisted, had Morgellons.
Delve into the medical literature, though, and Morgellons disease is
frequently described as “unexplained dermopathy” or “delusional
parasitosis” - a psychiatric illness that results in people mistakenly believing
their
skin to be infested with parasites. We may soon find out more. The US Centers
for Disease Control and Prevention (CDC) is in the middle of a large,
systematic
study into Morgellons. The study aims to determine whether there is actually a
physiological basis to the disease. The CDC is keeping an open mind on
Morgellons, says Michele Pearson, who is leading the study. “CDC has
approached this as an unexplained condition,” she says.

Text B
CDC, Kaiser to study puzzling illness
The Centers for Disease Control and Prevention and Kaiser Permanente‘s

Northern
California
more Division of Research announced they are launching a study to learn
about an unexplained skin condition called Morgellons disease. The CDC will
identify patients with the condition in Kaiser‘s Northern California health plan.
The study is expected to take at least 12 months. Reports of cases have been

made
in every state and 15 countries. Many reported cases have been clustered in
California, Texas and Florida, according to the Mayo Clinic.
Text C
Delusional Parasitosis
Delusional Parasitosis is an uncommon psychiatric disorder presented by
persons with an unremitting false belief that they are infested with
ectoparasites o longstanding and well integrated into the patient’s persona.
Patients with the disorder are predominantly older women, although younger
people and men can be affected. Most cases involve patient beliefs that the
skin has been invaded by insects, but some involve delusions that internal
parasites are the cause of their condition.

Text D
The causes for the disorder are not clear, but sufferers are generally of
average or higher intelligence and are otherwise functional. Patients with
delusional parasitosis generally have a long history of visiting physicians
seeking information of their diagnosis and help with their condition. The
patients have certain characteristics or exhibit behaviors that strongly
suggest the presence of the disorder. Moreover, these patients can be
antagonistic and relentless in their need to find someone who will agree with
their selfdiagnosis and help them. Because these delusional patients may
seek
help from non-physician medical professionals, such as parasitologists,
clinical microbiologists, entomologists, or biologists, such individuals should
be aware of this disorder. Delusional parasitosis can be treated with
antipsychotic medication and psychiatric consultations but generally does
not respond well to such treatment.
Questions 1-7
For each question, 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 minimum expected time period for CDC’s study to

learn
more about Morgellons disease?

2. what are the treatments for Morgellons disease?

3. name the places where Morgellons disease reported so far?
4. what is the aim for CDC’s study to learn more about Morgellons
disease?

5. which are the age groups predominantly affected by Morgellons

disease?

6. what is the current approach of CDC’s towards Morgellons

disease?

7. what are the other names of Morgellons disease?

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, numbers or both.
8. Who reported a medical condition similar to Morgellons disease for
the first time?

9. Name the person who leads CDC’s study to learn more about
Morgellons disease?

10. Name the type of medications used to treat Morgellons disease?

11. How many countries reported Morgellons disease?

12. Name the type of illness under which the Morgellons disease is classified?

13. what is the popular delusion of the people affected by

Morgellons disease?

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, numbers or both.
14. Morgellons disease is frequently described as or “delusional
parasitosis”.

15. Morgellons disease is a psychiatric illness that results in people

mistakenly believing their skin to be infested with .
16. Many reported cases have been clustered in California, Texas
and
Florida, according to the .

17. The will identify patients with the condition in Kaiser‘s Northern
California health plan.
18. The delusion is usually long- standing and well integrated into

the
patient’s .
19. Patients with delusional parasitosis generally have a long

history of
visiting .
20. Patients with delusional parasitosis can be antagonistic and .
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.

Electronic Diagnostic Equipment

There are many items of equipment in a hospital that use electronics for
operation. The maintenance of such equipment is a task for specialised and
trained staff. However, regular inspection and cleaning will help such
equipment last for a long time and deliver safe function. These are tasks that
the equipment user can carry out and should be done regularly, as laid
out on the checklists on the next pages. The types of equipment that might
be included in this category are for instance audiometers, blood gas
analyzers, cardiac monitors, cryoprobes, infusion pumps and stimulators.
The steps in this section can also be applied to most laboratory equipment,
although it should be noted that the WHO publication Maintenance
Manualfor Laboratory Equipment deals with these in much better detail.

1. The type of equipment that might not be included in the category of

Electronic Diagnostic Equipment is
A. cardiac analyzers
B. stimulators
C. audiometers
Electrosurgical Units (ESU) and Cautery Machines
Electrosurgery is the application of a high-frequency electric current to
biological tissue as a means to cut, coagulate, desiccate, or fulgurate
tissue. Its
benefits include the ability to make precise cuts with limited blood loss in
hospital operating rooms or in outpatient procedures. Cautery, or
electrocautery, is the application of heat to tissue to achieve coagulation.
Although both methods are sometimes referred to as surgical diathermy ,
this
chapter avoids the term as it may be confused with therapeutic diathermy,
which generates lower levels of heat within the body.

2. What does this manual tell us about electrocautery?

A. make precise cut with limited blood loss
B. uses high-frequency electric current
C. application of heat to tissue to achieve coagulation
Endoscopy
Endoscopy means looking inside the body using an endoscope, an
instrument used to examine the interior of a hollow organ or cavity of the
body.
Endoscopes are inserted directly into the organ. An endoscope can consist of
a rigid
or flexible tube, a light delivery system (light source), an optical fibre system, a
lens
system transmitting the image to the viewer, an eyepiece and often an
additional
channel to allow entry of medical instruments, fluids or manipulators. There
are many different types of

endoscopy, including arthroscopy, bronchoscopy, colonoscopy,

colposcopy,
cystoscopy, laparoscopy and laryngoscopy.

3. What does this extract from a handbook tell us about endoscopes?

A. are inserted directly into the organ
B. used to examine the exterior of a hollow organ or cavity of the body
C. there are mainly 7 types
Messaging standards
Messaging is the electronic communication of health information
from the point of collection or storage to a point of use. This can be
a
short distance such as within a clinic or larger distances across
facilities or districts.
Messages can be used to retrieve historical data as well as current
data.
A health message includes health data that is expressed in a
standard vocabulary. It may also include metadata about the
definitions or environment of the data. The message itself is in a
precisely defined format so that it can be received by a computer
program which will understand its meaning.

4. The email is reminding staff that the

A. health message should include health data expressed
in a standardvocabulary
B. health message should include metadata about the
definitions orenvironment of the data
C. health message should be precise in any format to be
received by acomputer program
Communication skills during medical examination

An appropriate contact with the patient requires applying professional

knowledge about psychological aspects of interpersonal relations. While
examining the patient, most doctors apply just the experience or abilities to
establish interpersonal contacts that have been acquired on a social level.
This knowledge would definitely be insufficient in unusual and problematic
situations. For many years, clinical and social aspects of doctors’
psychological education have been neglected. The ability of conversation

should be based on appropriate education, not only on personal intuition or

own
experience.
5. The notice is giving information about
A. necessity of communication based on appropriate psychological
education
B. necessity of establishing interpersonal contacts with patient
C. necessity of appropriate contact based on personal experience
Liver Palpation
Liver palpation is performed with the right hand placed flat under right costal
chest border, parallel to the long body axis, then applying pressure at the
depth of inspiration in an attempt to move under the costal border in the right
middle clavicular line and towards its right side. In normal conditions, the
lower liver border is not touched. During the respiration, the lower liver border
is slightly moving down and upwards.
If the liver edge can be detected on palpation, some additional features have
to be determined as there are various abnormalities related with specific
diseases.

6. What must all staff involved in liver palpation do?

A. should place right hand flat under right chest
B. should apply pressure at the depth of aspiration
C. should place left hand flat under right chest
Part C
In this part of the test, there are two texts about different aspects of
healthcare. Choose the answer (A, B, C or D) which you think fits best
according to the text.
Tufts University faculty debunks common dental myths
Paragraph 1
Brushing, flossing, and twice-yearly dental check-ups are standard for oral
health
care, but there are more health benefits to taking care of your pearly whites
than most of us know. In a review article, a faculty member at Tufts University
School of Dental Medicine (TUSDM) debunks common dental myths and
outlines how diet and nutrition affects oral health in children, teenagers,
expectant mothers, adults and elders.

Paragraph 2
Myth 1: The consequences of poor oral health are restricted to the mouth
Expectant mothers may not know that what they eat affects the tooth
development of the fetus. Poor nutrition during pregnancy may make the
unborn child more likely to have tooth decay later in life. “Between the ages of
14 weeks to four months, deficiencies in calcium, vitamin D, vitamin A,
protein and calories could result oral defects,” says Carole Palmer, EdD, RD,
professor at TUSDM and head of the division of nutrition and oral health
promotion in the department of public health and community service. Some

data
also
cleft suggest that lack of adequate vitamin B6 or B12 could be a risk factor for
lip and cleft palate formation

Paragraph 3
In children, tooth decay is the most prevalent disease, about five times more
common than childhood asthma. “If a child’s mouth hurts due to tooth
decay, he/she is less likely to be able to concentrate at school and is more likely
to be foods that are easier to chew but that are less nutritious. Foods such as
donuts and pastries are often lower in nutritional quality and higher in sugar
content than nutritious foods that require chewing, like fruits and vegetables,”
says Palmer. Oral complications combined with poor diet can also contribute to
cognitive and gr problems and can contribute to obesity
Paragraph 4
Myth 2: More sugar means more tooth decay
It isn’t the amount of sugar you eat; it is the amount of time that the sugar has
contact with the teeth. “Foods such as slowly-dissolving candies and soda
are in the mouth for longer periods of time. This increases the amount of time
teeth are exposed to the acids formed by oral bacteria from the
sugars,” says Palmer.

Paragraph 5
Some research shows that teens obtain about 40 percent of their
carbohydrate intake from soft drinks. This constant beverage use increases

the
risk
as of tooth decay. Sugar-free carbonated drinks and acidic beverages, such
lemonade, are often considered safer for teeth than sugared beverages
but can also contribute to demineralization of tooth enamel if consumed
regularly

Paragraph 6
Myth 3: Losing baby teeth to tooth decay is okay
It is a common myth that losing baby teeth due to tooth decay is
insignificant because baby teeth fall out anyway. Palmer notes that tooth
decay in baby teeth can result in damage to the developing crowns of the
permanent teeth developing below them. If baby teeth are lost
prematurely, the permanent teeth may erupt mal-positioned and require
orthodontics later on.
Paragraph 7
Myth 4: Osteoporosis only affects the spine and hips
Osteoporosis may also lead to tooth loss. Teeth are held in the jaw by the face
bone,
the which can also be affected by osteoporosis. “So, the jaw can also suffer
consequences of a diet lacking essential nutrients such as calcium and

vitamins D
and K,” says Palmer. “The jawbone, gums, lips, and soft and hard palates are
constantly replenishing themselves throughout life. A good diet is required to
keep the mouth and supporting structures in optimal shape.”

Paragraph 8
Myth 5: Dentures improve a person’s diet
If dentures don’t fit well, older adults are apt to eat foods that are easy to chew
and low in nutritional quality, such as cakes or pastries. First, denture wearers
should make sure that dentures are fitted properly. In the mthey can still eat
nutritious foods by having cooked vegetables instead of raw, canned fruits
instead of raw, and ground beef instead of steak. Also, they should drink
plenty of
fluids or chew sugar-free gum to prevent dry mouth,” says Palmereantime, if
they are having difficulty chewing or have mouth d
Paragraph 9
Myth 6: Dental decay is only a young person’s problem
In adults and elders, receding gums can result in root decay (decay along the
roots
of teeth). Commonly used drugs such as antidepressants, diuretics,
antihistamines and sedatives increase the risk of tooth decay by reducing
saliva
production. “Lack of saliva means that the mouth is cleansed more slowly.
This
increases the risk of problems,” says Palmer. “In this case,
drinking water frequently can help cleanse the mouth.”
iscomfort,
.

Paragraph 10
Adults and elders are more likely to have chronic health conditions, like
diabetes, which are risk factors for periodontal disease (which begins with

an
inflammation of the gums and can lead to tooth loss). “Type 2 diabetes
patients have twice the risk of developing periodontal disease of people
without diabetes. Furthermore, periodontal disease exacerbates diabetes
mellitus, so meticulous oral hygiene can help improve diabetes control,”

says
Palmer.
QUESTIONS( 7-14)
7. This article is about
a. how the nutritional needs of children, teenagers and expectant
mothers
hasan effect on oral health
b. how the oral health is affected by nutritional needs of children,
teenagers,expectant mothers and other groups.
c. how diet and nutritional needs of children, teenagers, mothers-

to-be,
and adults affects one’s oral health
d. disproving some long held beliefs

.8 Carole Palmer observes that

a. pies and pastries have low food value and require more
chewing
b. lower nutritional quality food needs more chewing
c. nutritious foods like fruits and vegetables have less sugar and
require
morechewing
d. too much vitamin B6 or B12 could lead to problems with cleft
palateformation
”
9. According to Palmer
a. asthma is five times less common in childhood than tooth
decay
b. school kids with tooth decay pain may have concentration
problems
atschool
c. mouth and dental problems plus a poor diet can affect thinking

abilities
andbe a factor later on in obesity
d. all of the above
10.According to the article :
a. it’s important to make sure you retain baby teeth
b. It’s important that teeth are not exposed for a long time to acids formed
byoral bacteria as a result of eating sugary foods
c. it’s important to look after your baby teeth
d. it’s important that teeth are not exposed to acids formed by oral bacteria
from sugary foods

11. According to the article, baby teeth a. are

a . dispensable
b. develop to help eat food
c. if lost prematurely, may result in poor development of permanent teeth
d. help with correct development of permanent teeth
12. Dental health in older people requires
a. properly fitting dentures
b. a calcium rich diet
c. nutritious food containing vitamins D and K
d. all of the above

13. The article says that Osteoporosis

a. may prevent loss of teeth
b. may affect jaw bones
c. jaw bone health may be affected by chewing sugar-free
gum
d. none of the above

14. Lack of saliva

a. all of the following
b. results in mouth being cleansed more slowly
c. can be addressed by chewing sugar-free gum
d. may increase the risk of tooth decay
Part C
In this part of the test, there are two texts about different aspects of
healthcare. Choose the answer (A, B, C or D) which you think fits best
according to the text.
Global Health Care Workforce
Paragraph 1
Health care systems worldwide continue to be plagued by difficulties in
recruiting and retaining health workers, resulting in a shortage of health care
professionals that is now considered a global crisis. However, although the
gap
between the need for health care workers and the supply is experienced
globally, it widens disproportionately, so that the regions with
the greatest need have the fewest workers. For example sub-Saharan Africa
and southeast Asia together have 53% of the global disease burden but only
15% of the world’s health care workforce. Moreover, the shortage
experienced by countries that can least afford it is exacerbated by health
worker migration to high-income countries. South Africa, for example, has
fewer than 7 doctors per 10,000 people, but reported in 2002 that 14% of the
physicians who had trained there had emigrated to the US or to Canada.
Paragraph 2
And
23% the
C: problem is not going away as in the UK, US, Canada and Australia,
to 28% of all physicians are international graduates. Efforts to reduce

migration
usually focus on reducing recruitment by high-income countries, and these
efforts are gaining a higher profile. Improving the working conditions in
source countries has not received the same attention, however, even though
this would help counter the factors that push health professionals to seek

better
conditions
in elsewhere. It would also make work healthier for those who remain
lo income countries, and thereby reduce occupational concerns such as

injuries
violence and stress, and exposure to biological, chemical and physical
hazards.

Paragraph 3
Although concerns about healthy work conditions exist to varying degrees
around the world, they are greatest in nations with few resources, and
particularly in Africa, where work conditions are the most challenging. It is we]
documented that health workers in low and middle-income countries
experience fear and frustration when caring for patients with tuberculosis and
blood—borne diseases, and that they do so often in difficult work
environments. Health workers may also be ostracised by their own
communities due to the ever present stigma associated with exposure. It is

now
also well established that health workers are indeed at higher risk of acquiring
numerous infectious diseases.
Paragraph 4
International organizations are recognizing the importance of promoting and
protecting the health of the global health care workforce, which is
conservatively estimated to be 59 million, and are undertaking constructive
initiatives to do so. The World Health Organization (WHO) has explicitly
recognized the need to improve the environment of health care workers in
order to increase retention and is promoting the use of workplace audit
checklists to help guide the reduction of infectious disease transmission in
health care. WHO
is also promoting the immunization of all health care workers against hepatitis
B, and, is working to move forward specific Healthy Hospital Initiatives, which
include projects that involve both infection control and occupational health
practitioners, and that train practitioners along with health and safety
representatives in conducting workplace inspections.
Paragraph 5
Canada and other countries that receive health care workers from low
resource settings compromise the workforce in the source country as they
supplement their own. The situation is inequitable and, over time, will
undermine those low resources further, worsening the already challenging
working conditions and creating even more pressure for health care workers
to
emigrate. To offset this effect, high-income countries can reciprocate by
improving working conditions in source countries. British Columbia, which
attracts the highest number of South African physicians of all Canadian
provinces, has taken a step in this positive direction by sharing expertise in
occupational health and infectious p disease transmission control through
the
Pelonomi Hospital project.
”
Paragraph 6
At the university level, researchers and practitioners can contribute to this
knowledge exchange by partnering with their colleagues in low-income
countries. Such collaborations are essential. Also needed are intensified
efforts
to promote further integration of worker safety and patient safety. To ensure
information systems being developed support this goal, we need
to promote evidence based decision making and share our information with
those who can; benefit from it. That way, each region will not need to find
millions of dollars annually to design, implement and maintain separate
systems that could b easily shared and reproduced.
Paragraph 7
To achieve this aim, we need international collaboration in order to reach
consensus on a data dictionary and complete the programming of
nonproprietary information systems such as OHASIS, which can be tailored to
different technological environments and made widely available using
Creative Commons licensing. Much of what needs to be done can be
accomplished with simple and effective solutions that benefit both patients and
workers. What it will take is commitment from high-income countries to assist in
the development, refinement and implementation of these tools in
collaboration with low-income countries. Such endeavours can be made
possible by making them a priority at the national funding level.
QUESTIONS(15 – 22)

15. The main idea presented in paragraph 1 is

a. Recruiting health care workers is a problem in most countries
b. There is a shortage of health care workers in Sub-Saharan Africa and
Southeast Asia
c. There are not enough health care Workers in places which have the
highestneed for medical treatment
d. A significant number of South African doctors are migrating to the US and
Canada

16. The main point raised by the authors in paragraph 2 is that

a. there are too many international graduates in UK, US, Canada and
Australia
b. High income countries must reduce recruitment of overseas heal
professionals .
c. More effort is required to improve work conditions in source.
d.Work conditions in poorer countries are dangerous.

17.according to paragraph 3 which of the following is false regarding

.. conditions in low and middle class countries ?

a. Work conditions are more difficult in Africa

b.Health workers fear exposure to contagious diseases
c.Health workers feel frustration towards patients
d.Being exposed to infectious disease may lead to shame ….
.. within local communities
18. Regarding the size of the global health care workforce, we can infer
paragraph 4 that
a. there may be more than 59 million Workers
b. there may be less than 59 million workers
c. there are exactly 59 million Workers
d. the number of health care workers in unknown

19. According to paragraph 4, which of the following statements is true

regarding
WHO?
a. WHO realises that improvements in the working environment of
health careworkers is necessary
b. WHO wants to increase immunisation rates of health care workers
against hepatitis B
c. WHO is advancing Healthy Hospital Initiatives including training
and infection control
d. All of the above
20. In paragraph 5 the authors infer that
a. High-income countries have a responsibility to help build better
working conditions in low-income countries
b. High income countries should not recruit health professionals from

low-
income countries
c. The working conditions in low-income countries is improving
d. British Columbia has stopped recruiting South African doctors

21. Which of the following is closest in meaning to the word reciprocate?

a. help
b. give back
c. support
d. take back

22. According to paragraph 6, which of the following statements is true?

a. Researchers and medical practitioners in low & high income
countries
have expressed a desire to work together
b. Improved safety of health workers and patients is a priority
c. Millions of dollars are needed to develop information systems that
can
beshared between countries
d. None of the above