READING TEST 5

PART A

TIME: 15 minutes

 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.

Text A

Branched-Chain Amino Acid Supplements

The concept that the BCAAs may have a unique capacity to stimulate muscle
protein synthesis has been put forward for more than 35 years. In 1981, Buse
reported that in rats the BCAAs may be rate limiting for muscle protein synthesis.
Additional studies supported the concept of a unique effect of BCAAs on muscle
protein synthesis in rats, although few have studied the response to oral
consumption of only BCAAs. Garlick and Grant showed that infusion of a mixture
of BCAAs into rats increased the rate of muscle protein synthesis in response to
insulin, but they did not measure the effects of BCAAs alone. The infusion of
BCAAs alone into rats by Kobayashi et al. was shown to induce an increase in
muscle protein synthesis, but the response was only transient. Presumably the rate
of synthesis quickly became constrained by the availability of the other EAAs.
Text B

Muscle protein is in a constant state of turnover, meaning that new protein is

continuously being produced while older proteins are being degraded. The anabolic
state has no specific definition, but generally refers to the circumstance in which
the rate of muscle protein synthesis exceeds the rate of muscle protein breakdown.
The results in a gain of muscle mass. Conventionally the anabolic state is
considered to be driven by a stimulation of muscle protein synthesis, but
theoretically could also result from an inhibition of muscle protein breakdown. The
overriding metabolic goal of consuming BCAA supplements is to maximize the
anabolic state. It is widely asserted that BCAAs induce an anabolic state by
stimulating muscle protein synthesis. An abundant availability of all EAAs is a
requisite for a significant stimulation of muscle protein synthesis. Muscle protein
synthesis will be limited by the lack of availability of any of the EAAs, whereas a
shortage of NEAAs can be compensated for by increased de novo production of
the deficient NEAAs. In the post-prandial state following a meal containing
protein, all of the EAA precursors required for new muscle protein synthesis can
be derived from either the elevated plasma concentrations resulting from digestion
of the consumed protein or from recycling from protein breakdown. In this
circumstance of abundant availability of EAAs the rate of muscle protein synthesis
exceeds the rate of breakdown, thereby producing an anabolic state.

Text C

Since EAAs cannot be produced in the body and there is a net release of EAAs
from muscle, in the post-absorptive state the only source of EAA precursors for
muscle protein synthesis is intracellular EAAs derived from muscle protein
breakdown. In addition to being reincorporated into muscle protein via synthesis,
some EAAs released from muscle protein breakdown may be partially oxidized
within muscle, thereby making them unavailable for reincorporation into muscle
protein. EAAs released from muscle protein breakdown that are not reincorporated
into muscle protein or oxidized within muscle tissue are released into plasma,
whereupon they can either be taken up by other tissues as precursors for protein
synthesis or irreversibly oxidized. Thus, the rate of muscle protein synthesis will
always be lower than the rate of muscle protein breakdown in the postabsorptive
state, owing to the net flux of EAAs from protein breakdown into plasma and to
oxidative pathways. Expressed differently, it is impossible for muscle protein
synthesis to exceed the rate of muscle protein breakdown when the precursors are
derived entirely from protein breakdown, and thus an anabolic state cannot occur
in the absence of exogenous amino acid intake.

Text D

All EAA precursors for muscle protein synthesis in the post-absorptive state are
derived from muscle protein breakdown. It has been consistently reported that in
normal post-absorptive humans the rate of muscle protein breakdown exceeds the
rate of muscle protein synthesis by approximately 30%. Consumption of BCAAs
alone (i.e., without the other EAAs) can only increase muscle protein synthesis in
the post-absorptive state by increasing the efficiency of recycling of EAAs from
protein breakdown back into protein synthesis, as opposed to either being released
in to plasma or oxidized. This is because all 9 EAAs (as well as 11 NEAAs) are
required to produce muscle protein, and EAAs cannot be produced in the body. If
only 3 EAAs are consumed, as is the case with consumption of BCAAs, then
protein breakdown is the only source of the remaining EAAs required as
precursors for muscle protein synthesis. It is therefore theoretically impossible for
consumption of only BCAAs to create an anabolic state in which muscle protein
synthesis exceeds muscle protein breakdown. If the generous assumption is made
that BCAA consumption improves the efficiency of recycling of EAAs from
muscle protein breakdown to muscle protein synthesis by 50%, then this would
translate to a 15% increase in the rate of muscle protein synthesis (30% recycled in
basal state X 50% improvement in recycling = 15% increase in synthesis). Further,
a 50% reduction in the release of EAAs into plasma from muscle would also
reduce the plasma and intracellular pools of free EAAs.
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 .EAAs obtained from muscle protein will undergo oxidation.

Answer_________________

2 .Are BCAAs anabolic in the postabsorptive state?

Answer______________

3 .Muscle protein turnover and dietary protein intake.

Answer____________

4 .The rate of muscle protein synthesis will always be lesser than rate of
muscle protein breakdown.

Answer_____________

5 .Addition of BCAAs can enhance protein synthesis.

Answer _____________

6 .Synthesis of protein could have been curbed by presence of EAA.

Answer __________

7 .When EAAs are in large quantity protein synthesis enhances.

Answer ___________
Questions 8-14

Answer each of the questions, 8-14, with a word or short phrase from one of the
texts. Each answer may include words, numbers or both.

8 .What happens with the consumption of BCAA supplements?

Answer ____________

9 .What will drive anabolic state more theoretically?

Answer_____________

10 .What are the limitations of Kobayashi?

Answer _____________

11 .What can lead to 15% increase in the rate of muscle protein synthesis?

Answer______________

12 Muscle protein synthesis often get limited by the lack of availability of?

Answer______________

13 What gets stimulated with induction of BCAAs?

Answer _____________

14 What is requisite for the production of muscle protein?

Answer ______________
Questions 15-20

Complete each of the sentences, 15-20, with a word or short phrase from one of the
texts. Each answer may include words, numbers or both.

15. ______________ were failed to measure the effects of BCAAs alone.

16 .EAA which is needed for muscle protein synthesis can be obtained from
increased ____________

17. EAAs derived from________________ which are not added to the muscle
protein will be released into plasma.

18. Body doesn`t have the capability to produce ________________

19. When there is curtailment of the amount of EAAs into plasma by 50% and
more, there will be reduction

In _________________

20. When rate of muscle protein synthesis increases or goes above the levels of
muscle protein

Breakdown, ________________ may get enhanced.

 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.

Questions 1-6

1 .What is correct about the heartbeat sensor?

A This signal in form of DC signal is related to the total amount of blood

B The signal in form of AC will conjoin with the DC signal

C The detector output is in form of electrical signal and is proportional to the

heartbeat rate.

Heartbeat Sensor

The basic heartbeat sensor consists of a light emitting diode and a detector like a
light detecting resistor or a photodiode. The heartbeat pulses cause a variation in
the flow of blood to different regions of the body. When a tissue is illuminated by
the light source, i.e., light emitted by the led, it either reflects (a finger tissue) or
transmits the light (earlobe). Some of the light is absorbed by the blood and the
transmitted or the reflected light is received by the light detector. The amount of
light absorbed depends on the blood volume in that tissue. The result as shown by
detector based on the electrical signal will be as per the changes in the heartbeat
rate.

This signal is actually a DC signal relating to the tissues and the blood volume and
the AC component synchronous with the heartbeat and caused by pulsatile changes
in arterial blood volume is superimposed on the DC signal. Thus the major
requirement is to isolate that AC component as it is of prime importance.
2 .The notice talks about;

A How BIS technology works?

B BIS and Sedatives used.

C Relation between Sedatives and BIS calculations.

BIS Technology

Raw EEG data are obtained through a sensor placed on the patient’s forehead.

The BI system processes the EEG information, and calculates a number between 0
and 100 that provides a direct measure of the patient’s level of consciousness and
response to sedation

A BIS value of 100 indicates the patient is fully awake.

A BIS value of 0 indicates the absence of brain activity.

Using BIS technology to Guide ICU Sedation Care.

Sedatives may be titrated to a variety of BIS values, depending on the goals for
each patient. Publications demonstrate that BIS values may be used as a measure
of hypnotic drug effect in the ICU. The movement may occur regardless of BIS
values. Natural sleep cycles may affect the hypnotic level.
3 .The word analogue may mean;

A Similar in functioning.

B Similar in structure.

C Something that is similar to or can be used instead of something else.

Amino Acid Analogues

In recent years, it has been possible to introduce amino acid analogues into
proteins by supplying the analogue under circumstances in which the amino acid
itself is not easily available. For example in Escherichia co fluorophenylalanine
has been incorporated in place of phenylalanine and tyrosine and it has even
proved possible to replace completely the sulphur-containing amino acid
methionine by its selenium analogue. Of the enzymes produced by the cell in these
various ways some were active and some were inactive, as might have been
expected.
4 .The notice talks about;

A Data transformation and display.

B Data storage and display.

C Data surveillance and display.

Data and heartbeat rate

The 24C256 serial EEPROM, which has eight kbytes capacity, is used to store up
to eight ECG signals. At each variation within the number of heartbeats in a
minute, three bytes representing the new number and time corresponding are stored
in the EEPROM. The output unit consists of a set of LED to indicate some diseases
such as bradycardia and tachycardia. It also contains a buzzer to prevent the patient
from detected problem and time to transfer data by email.
5 .Patient affected with CKD;

A will show reduced GFR.

B Albumin excretion in large quantity.

C Both.

Chronic Kidney Disease

CKD is a serious health condition and a worldwide public health problem. The
incidence and prevalence of CKD are increasing in the United States and are
associated with poor outcomes and a high cost to the US healthcare system.

CKD is usually defined as a curtailment of the Glomerular filtration rate (<60

mL·min−1·1 73 m−2), excess urinary albumin excretion (≥30 mg/d or mg/gCr), or
to be more precise, it can be a combination of both. In 2002, the National Kidney
Foundation Kidney Disease Outcome Quality Initiative defined stages of CKD
according to the level of eGFR and whether there was other evidence of kidney
damage (eg, presence of albuminuria) The KDIGO working group released a 2012
update recommending classification of CKD by cause, GFR, and albuminuria
category. The CKD-EPI Collaboration has developed equations to more accurately
estimate GFR from serum creatinine compared with the previously established
MDRD Study equation.
6 .What is correct about ICU Sedation?

A Fear and anxiety are common.

B Necessitate neurological examination.

C More than 69% of patients in an ICU were found to be inappropriately

sedated.

ICU Sedation

Complications of over-sedation Complications of under-sedation

Increased time on mechanical

ventilation.

Increased length of stay in ICU and/or

Fear, anxiety and agitation. Unpleasant
hospital. An additional cost of care.
recall. Medical device removal. An
Need for additional diagnostic testing.
additional costs. Increased nursing time
Increased risk of delirium. Decreased
wound healing and GI motility.
Impaired reliability of neurological
examinations
 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: Auricular hematoma

An auricular hematoma is an injury to the outer ear. This injury can occur when the
outer ear is either hit directly or receives repetitive blows. Athletes involved in any
contact sport can suffer a contusion to the ear which may result in a "cauliflower"
ear (also called an auricular hematoma). It is a deformity of the outer ear most
commonly seen in wrestling, rugby, boxing, football and judo. Cauliflower ear
occurs after someone gets a blow or repeated blows to the ear, enough for a large
blood clot (lump of blood) to develop under the skin or for the ear's skin to be
stripped away from the cartilage (the flexible material that gives the ear its shape).
The body normally absorbs excess fluid or blood at an injury site over time, but not
always in the ear because of its special structure. The cartilage of the ear has no
blood supply except that supplied by the ear’s skin. When the cartilage receives
little or no blood flow because of tearing of the skin, bruising or a blood clot, it
eventually dies and is replaced by scar tissue. An acute cauliflower ear is often
painful and causes swelling. If left untreated, it results in deformation of the ear
which may last a lifetime.

Unfortunately, most athletes do not seek care until the bleeding and swelling have
stabilized and resulted in deformity. By not seeking medical care immediately,
they increase their risk of infection, recurrence, scarring and deformity. After a
cauliflower ear has formed and hardened, it will not recover its normal shape
without surgery. But if it is caught and treated early enough, a person usually will
not get a lifelong deformity. In high school and college wrestling, the rules require
the use of protective headgear, but problems still occur. Not wearing headgear or
wearing poorly fitting headgear is a big factor in causing cauliflower ear.

At first, the swelling will be soft and there will be mushy fluid. It is at this early
stage that immediate treatment can help decrease or avoid permanent scarring. If
the fluid is allowed to solidify, it will cause significant permanent disfiguration.
The use of ice on the affected area is suggestive of great pain management. A head
wrap should also be applied and elastic gauze with packing material in front and
behind the ear, applying moderate pressure, can be used. This wrapping should not
cause a headache, block vision, or cover the other ear. After that, the next step is
one of the following: drainage (aspiration) and compression; drainage and splinting
with various materials; or incision and drainage with clot removal. Sometimes
stitches are needed if there is a tear in the skin. Your doctor may prescribe
antibiotics to prevent an infection.

A doctor can drain the blood from the ear either with a syringe or through a cut and
then help the skin reconnect to the cartilage by applying the pressure with a tight
bandage. Splinting is a medical procedure that keeps pressure on the area of
hematoma formation. Sometimes sutures through the ear keep the special gauze in
place, or sometimes special materials (pediplast or silicone) are molded to the ear.
After a splint is in place, the ear should be rechecked by your doctor after seven
days. Sutures typically stay in for 14 days, but may be removed if redness or
tenderness occurs. The risk of recurrence decreases the longer the splint stays in
place. Wrestlers may be able to return to wrestling 24 hours after splint application.
This is a surgical procedure for more serious cauliflower ears, and should only be
done by an Ear, Nose and Throat surgeon (also called an ENT or otolaryngologist)
or a plastic surgeon.

Wearing sturdy headgear when you are participating in a contact sport or other
sports, such as baseball, hockey or biking, in which you might experience head
trauma, is always requisite. Athletes should take the time to make certain that their
headgear is not too tight or too loose. The Nano Hospital Sports Medicine doctors
in the US emphasize that athletes can easily prevent cauliflower ear by using
effective head protection and seeking medical help at the first sign of an ear
problem.

Text 1: Questions 7-14

7 According to paragraph 1, what is true about cauliflower ear?

A Cauliflower ear results from repetitive blows to the ear
B Cauliflower ear occurs due to clotting of the blood on the bruised area
C Cauliflower ear occurs because the ear skin is stripped and is not able to
supply oxygen to the cartilage and surrounding area that is badly hit
D Cauliflower ear may often lead to distortion of the shape of the ear.

8 In paragraph 1, what does the word contusion imply?

A Being hit by the opponent
B A bruise
C A serious injury
D A very painful blow

9 According to paragraph 2, which one of the following statements is not true?

A Once infection grows, it can bring changes in the shape of the ear.
B Athletes often do not pay attention to injuries to their ear which may later
develop into cauliflower ear.
C The occurrence of this cauliflower ear among athletes is very common.
D It is suggested that sports should be played using all necessary safety
equipment.

10 What is headgear in passage 2?

A Covering of the head
B Soft helmet
C Boxing helmet
D A metal hat used for protection in games like rugby
11 According to paragraph 3, what is the first step towards injury treatment and
management?
A Ice should be applied on the bruised ear
B Ice and a head wrap should be applied
C Drainage and compression
D Splinting

12 According to paragraph 4, in the drainage and compression method, the doctor

would;
A Remove blood from the ear.
B Try to connect the skin with the cartilage.
C Apply pressure on the affected area.
D Stitch the ruptured parts.

13 Paragraph 4 talks about;

A Three types of treatment procedures for cauliflower ear.
B Three immediate actions are taken to prevent cauliflower ear.
C How easy it is to treat cauliflower ear.
D None of the above.

14 What does paragraph 5 indicate?

A Preventive measures for cauliflower ear.
B What experts suggest athletes should do.
C The importance of wearing headgear for sports.
D Advice from experts at Nano Hospital Sports Medicine in the US.
Text 2: Rosacea

Rosacea is a chronic facial skin condition characterized by marked involvement of

the central face with interim or persistent erythema, inflammatory papules or
pustules, telangiectasia, or hyperplasia of the connective tissue. Erythema, or
flushing, usually lasts less than five minutes and may spread to the neck and chest,
often accompanied by a feeling of warmth. Less common findings include
erythematous plaques, scaling, edema, phymatous changes (thickening of skin due
to hyperplasia of sebaceous glands), and ocular symptoms. Rosacea can be
associated with low self-esteem, embarrassment, and diminished quality of life. In
a national survey, 65% of patients with rosacea reported symptoms of depression.
The exact prevalence of rosacea in the United States is unknown; however, it is
probably between 1.3% and 2.1%, and may be as high as 5%. Women are affected
more often than men, but men are more likely to have phymatous changes,
especially rhinophyma.

The National Rosacea Society Expert Committee defined four subtypes and one
variant. Granulomatous rosacea is the sole variant with firm, indurated papules or
nodules. Many dermatologists consider rosacea fulminans and perioral dermatitis
as rosacea variants. Patients may experience fluctuation in symptoms and overlap
of symptoms between subtypes. The etiology of rosacea is unknown but is likely
multifactorial. Factors involved in the pathophysiology include the dense presence
of sebaceous glands on the face, the physiology of the nerve innervation, and the
vascular composition of the skin. Numerous triggers initiate or aggravate the
clinical manifestations of rosacea, including ultraviolet light, heat, spicy foods, and
alcohol. A predilection for fair-skinned individuals of Celtic or northern European
descent suggests a genetic component to rosacea; however, no specific gene has
been identified. Patients with the genetic predisposition have a receptor that
mediates neo-vascular regulation. When exposed to triggers, neuropeptide release
(flushing, edema) occurs, resulting in the recruitment of proinflammatory cells to
the skin.

Frequent redness (flushing) of the face is common. Most redness is at the center of
the face (forehead, nose, cheeks, and chin). There may also be a burning feeling
and slight swelling. Small red lines under the skin show up when blood vessels
under the skin get larger. This area of the skin may be somewhat swollen, warm,
and red. There can be constant redness along with bumps on the skin. Sometimes
the bumps have pus inside (pimples), but not always. Solid bumps on the skin may
later become painful. In some people (mostly men), the nose becomes red, larger,
and bumpy. The skin on the forehead, chin, cheeks, or other areas can become
heavier with the usual compactness because of rosacea.

The genesis of rosacea is more confusing. As there are various symptoms and
conditions associated with it, it is difficult to track how it comes into being.
Doctors surmise rosacea happens when blood vessels expand too easily, causing
flushing. People who blush a lot may be more likely to get rosacea. It is also
thought that people inherit the likelihood of getting the disease. Though not well-
researched, some people say that one or more of these factors make their rosacea
worse: heat (including hot baths); vigorous exercise; sunlight; winds; very cold
temperatures; hot or spicy foods and drinks; drinking alcohol; menopause;
emotional stress; and long-term use of steroids on the face. People with rosacea
and pimples may think the pimples are caused by bacteria; but no one has found a
clear link between rosacea and bacteria. Unfortunately, there is no cure for rosacea,
but it can be treated and controlled. In time, the skin may look better. A
dermatologist (a doctor who works with diseases of the skin) often treats rosacea.
Text 2: Questions 15-22

15 In paragraph 1, the word interim may mean;

A Severe
B Transient
C May last for a longer time
D Often permanent

16 According to paragraph 1, what is not true about rosacea?

A Rosacea is a condition in which the redness of skin may last only for a short
period of time.
B Rosacea is a condition where the patient can feel the warmth around the
affected skin.
C Rosacea is common among women living in the US.
D Scaling is a feature that is often connected with rosacea.

17 The phrase 'the clinical manifestations of rosacea' in paragraph 2 may

suggest;
A Subtypes of rosacea.
B How rosacea changes itself into various other forms.
C Features of rosacea.
D The potentiality of rosacea to appear in multiple ways.

18 According to paragraph 2, what is true about rosacea?

A The symptoms of rosacea vary depending on the subtypes.
B Each and every type of rosacea shows a specific set of features.
C It is possible that one type of rosacea may show features of other advanced
types of rosacea.
D None of the above

19 What is the central idea presented in paragraph 3?

A How the skin reacts to rosacea
B What does rosacea look like?
 C Symptoms of rosacea
DA&B

20 .According to paragraph 3, in rosacea;

A Skin becomes redder
B Skin becomes thicker
C Skin becomes bumpy
D All of the above

21 The word genesis in paragraph 4 may mean;

A The beginning
B The truth
C The reason
D Basis

22 Pick the correct statement as per information is given in paragraph 4;

A Rosacea is a bacterial disease.
B Doctors do not know how it occurs.
C Drinking alcohol leads to rosacea.
D Exposure to heat causes rosacea.