JT-RT-43 READING TEXT

Snakebite including sea snake

TEXT-A

 Every snakebite should be treated as potentially venomous

 Snakebite patients must be managed in a hospital with a monitored resuscitation area, access
to 24 hour formal pathology laboratory and available antivenom, by staff able to manage the
complications of anaphylaxis and envenomation
 Current 'Point of Care' testing has been proven unreliable for use in case of snake bite as
false negatives have been reported in envenomed patients - Do not use point of care testing
e.g. bedside INR tests
Signs and symptoms of envenomation:
– sudden collapse
– non-specific systemic effects e.g. nausea, vomiting, abdominal pain, headache
– coagulopathy: bleeding of gums, coughing, spitting or vomiting blood, prolonged bleeding
from the bite or IV puncture site, blood in urine
– neurotoxicity: progressive paralysis - drooping of eyelids, uncoordinated eye movements,
double vision, difficulty in swallowing, breathing or speaking, fatigue and irregular shallow
breathing, gait disturbances, including weakness or poor coordination
– myotoxicity: muscle and back pain, tenderness, weakness

TEXT-B

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TEXT-C
Procedure for pressure immobilisation bandage

 Use an elastic bandage relevant to size of patient

 Start at bite site using firm pressure (should be unable to easily slide a finger between the
bandage and skin)
 Cover the bitten area first and then bandage upwards from the lower portion of the limb to cover
as much of the affected limb as possible (see diagram). This includes application of the
bandage, over the top of the clothes if necessary. The patient should be kept calm and still.
Firm pressure bandages can be applied to bites on the trunk provided respiratory movement is
not impeded
 Apply a splint including joints on either side of the bite to restrict limb movement (see illustration)
 If the bite is on the trunk, MO/NP may request to apply local pressure over the site
and immobilize the patient
 Never let the patient walk
 Indicate on bandage the location of the snakebite (as per illustration)
 If a snakebite occurs and only one other person is present and no vehicular transport is
available, it is probably safest to apply a pressure bandage and splint, then leave the
bitten patient to get help
 In isolated areas, if bitten when alone, apply local pressure if possible. The patient should move
themselves to seek urgent help

TEXT-D
Snake Venom Detection Kits (SVDK)

 SVDK are expensive and should only be used in conjunction with clinical and
biochemical examinations.
 They should be kept only at locations that stock a range of antivenoms e.g. Rural
Hospitals with an MO/NP, access to 24 hour pathology, monitored resuscitation area.
 There is no place for SVDK in locations that carry no antivenom or only polyvalent antivenom
 The SVDK is a guide only in the choice of antivenom. More often than not the local
geography in association with the clinical examination and blood test results determine
the choice of antivenom
 A positive skin SVDK does not indicate envenomation nor does it indicate antivenom use. In
the context of an abnormal clinical examination and/or blood tests it may assist in
antivenom use
 A negative skin SVDK test does not indicate a non-venomous snake and does not alter
management
 A positive urine SVDK may indicate envenomation, however false positives can
occur especially for brown snake

When definite envenomation has occurred, delay in treatment could be life threatening. Consult
MO/NP and give snake antivenom as ordered. The choice of antivenom will be based on clinical
examination. Rarely a patient will be so unwell that they will require antivenom before appropriate
assessment

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 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.

Snakebite including sea snake: Texts

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 a qualified treatment facility should have?

2. The likely after-math of a snake bite?

3. The specific size of an IV to be used?

4. Frequency of conducting blood tests?

5. The extent to which the patient can be allowed to move

6. The type of the bandage to be applied on the bitten area?

7. The bases for choosing the suitable antivenom?

Questions 8-12

Answer each of the questions, 8-12, with a word or short phrase from one of the texts. Each answer may
include words, numbers or both.

8. How should every snake bite be considered?

9. What complications must the snakebite-handling staff be able to deal with?

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 10. Who should be consulted if clinical evidence of envenomation is inconclusive?

11. What should be marked on the bandage?

12. In the cases of confirmed envenomation, what could prove life-threatening?

Questions 13-20

Complete each of the sentences, 13-20, with a word or short phrase from one of the texts. Each answer may
include words, numbers or both.

13. Point of care testing like should not be used because it has not
proven to be reliable in snakebite cases.

14. Myotoxic symptoms include back pain, muscle pain, weakness and

15. After finding positive clinical evidence of envenomation, be vial of brown and one of
antivenom need be administered.

16. If the lab test for envenomation is negative, the patient can be discharged but only
during hours.

17. need to be applied before inserting IV and drawing blood samples.

18. Unless is affected, tight pressure bandage can be applied to the

bites on the trunk.

19. In most cases, a positive SVDK points to envenomation.

20. Antivenom can be administered even before appropriate assessment only when the
patient is extremely .

END OF PART A
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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 to 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.

1. Application of MeTro involves

A. sutures
B. electric-magnetic waves
C. non-degradable enzyme

MeTro

A highly elastic and adhesive surgical glue named MeTro that quickly seals wounds without the
need for common staples or sutures could transform how surgeries are performed. MeTro’s
high elasticity makes it ideal for sealing wounds in body tissues that continually expand and
relax – such as lungs, hearts and arteries – that are otherwise at risk of re-opening.
It sets in just 60 seconds once treated with UV light, and the technology has a built- in degrading
enzyme which can be modified to determine how long the sealant lasts
– from hours to months, in order to allow adequate time for the wound to heal. It also seems to
remain stable over the period that wounds need to heal in demanding mechanical conditions
and later it degrades without any signs of toxicity.

2. The guidelines inform that

A. it must be ensured that a set procedure is not performed for a wrong patient
B. when the patient is a child, staff from an earlier location should be consulted
C. patient should first be given the identification details and asked for confirmation

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 Guidelines For Staff: Patient identification

The patient’s identity must be confirmed before any procedure commences.

Staff must confirm they have the correct patient by asking the patient, or their person
responsible, to state the patient’s full name and date of birth. Staff must not state the
patient’s name or date of birth and then ask the patient, or their person responsible, if this
information is correct.
The response must be confirmed against the details on the consent form / request form /
referral / treatment plan and patient identification band.
Where patient details are incomplete or there is a discrepancy with the information received
from the patient, or their person responsible, the correct information must be verified before
commencing the procedure and actions taken documented in the patient’s health care
record. If the patient is unable to participate in the patient identification step, for example
due to physical incapacity, language issues, or is a child, and their person responsible is
not present, a member of staff from the preceding location of the patient (e.g. ward or
emergency department) must act as the patient’s advocate to confirm the patient’s identity

3. The main purpose of the article is to

A. raise awareness among health staff about HCAIs

B. recommend ways to avoid spread of pathogens through a particular routine
C. describe the right way to wash nurses' uniforms at home

Extract From Hospital Meeting:

With rises in healthcare-acquired infections (HCAIs) and antibiotic resistance, understanding

transmission routes of bacteria is paramount. One possible route is nurses’ uniforms,
which they wash at home.
Increasing staff awareness, improving their education on infection prevention, and
standardising domestic laundering policies at national level would be useful steps towards
ensuring that staff know how to effectively wash their uniforms at home. Providing suitable
changing facilities so staff can easily change in and out of their uniforms in the workplace
would reduce the need for them to wear their uniforms to and from work. However, the
ideal solution would be a change from home laundering to in-house industrial laundering of
uniforms. This would avoid cross- contamination in the domestic setting altogether and
increase the chances of uniforms being washed according to guidance.

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 4. "whistleblower" is entitled to legal protection when

A. the concern raised is in the public interest

B. the employer tries to harm the "whistleblower"
C. the concern raised is in accordance with the set guidelines

What is ‘whistleblowing’?

Whistleblowing is when a worker, including a student nurse or student midwife, raises a concern
about wrongdoing in the public interest. Whistleblowing can take place within an organisation or,
if the worker feels they are unable to do this, to a third person known as a ‘prescribed person’.
The NMC is named as a prescribed person in the law.
There is a difference between raising concerns and whistleblowing. The law sets out several
criteria that must be met for raising concerns to qualify as whistleblowing.
If all of the conditions set out in the law are met, the person who is blowing the whistle has legal
protections to stop them suffering any disadvantage from their employer because of what they
have done.

5. The key to a continuous supply of oxygen to patient is

A. efficiency of zeolite granules

B. availability of multiple canisters
C. changing pressures in canisters

Manual Extract: Oxygen Concentrator: Mechanism

An oxygen concentrator uses air as a source of oxygen by separating oxygen and

nitrogen. It utilizes the property of zeolite granules to selectively absorb nitrogen
from compressed air.

Atmospheric air is gathered, filtered and raised to a pressure of 20 pounds per

square inch (psi) by a compressor. The compressed air is then introduced into one
of the canisters containing zeolite granules where nitrogen is selectively absorbed
leaving the residual oxygen available for patient use. After about 20 seconds the
supply of compressed air is automatically diverted to the second canister where the
process is repeated enabling the output of oxygen to continue uninterrupted. The
zeolite is then regenerated and ready for the next cycle. By alternating the pressure
between the two canisters, a constant supply of oxygen is produced and the zeolite
is continually being regenerated.

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 6. Which of the following require a process before disposal?

A. Liquid drugs
B. Contents of part used ampoules
C. Used syringes

Management of Controlled Drugs in wards and departments:

Destruction and disposal

Unused doses, part doses or partly used prepared doses of CDs must be destroyed promptly
and witnessed by a Registered Nurse. The CD to be discarded must be rendered
irretrievable by emptying the contents of ampoule/vial, syringe or infusion bag into a
pharmaceutical waste bin (generally blue lidded). Liquids should be rendered secure by use
of a self-setting compound (such as Pre-Gel or equivalent). Tablets should be crushed,
where possible and capsules should be opened prior to disposal. Full details of the
destruction must be recorded in the CD register (for part ampoules or other unused doses)
or on the patient's prescribing/recording chart (for partly used prepared doses) including the
names and signatures of those involved.

Part C
In this part of the test, there are two texts about different aspects of health care. For questions 1 to 8, 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.

Text 1:

THE doctors were stumped. After months of cancer treatment at the University of Tokyo Hospital, the patient
– a woman in her 60s – was not getting much better. So the medical team plugged the woman’s
symptoms into IBM’s Watson, the supercomputer that once famously trounced human champs in the TV
quiz show Jeopardy! Watson rifled through its storehouse of oncology data and announced that she had a
rare form of secondary leukemia. The team changed the treatment, and she was soon out of hospital.
Watson spotted in minutes what could otherwise have taken weeks to diagnose, one doctor told The
Japan Times. “It might be an exaggeration to say AI saved her life, but it surely gave us the data we
needed in an extremely speedy fashion.”

Is this the future of medicine? Artificial intelligence researchers have long dreamed of creating machines
that can diagnose health conditions, suggest treatment plans to doctors, and even predict how a
patient’s health will change. The main advantage of such an AI wouldn’t be speed, but precision. A
study published earlier this year found that medical error is the third leading cause of death in the US,

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 and a significant chunk of that is incorrect diagnoses.

There are just too many health conditions and the literature is changing too rapidly for a primary care
physician to retain it all, says Herbert Chase, who works on biomedical informatics at Columbia University
in New York City. “We’ve exceeded where it’s humanly possible for doctors to know what they need to
know,” he says. “There are dozens of conditions that are being missed that could easily be diagnosed by
a machine.” Chase once advised the IBM Watson team. These days, he is working on an algorithm that
scours doctors’ notes for subtle clues that patients may be developing multiple sclerosis. He imagines a
future in which software will automatically analyse electronic health records and spit out warnings or
recommendations. “It’s a partnership. The machine makes a recommendation, then the human gets
involved,” says Chase. But the spectrum of human illness is complex, so “algorithms will have to be built
brick by brick”, with the focus on one medical question at a time.These building blocks often rely on
machine learning, a branch of artificial intelligence that seeks patterns in mounds of statistics.

For example, a team at Stanford University in California recently unveiled a machine-learning algorithm
trained to scrutinise slides of cancerous lung tissue. The computer learned to pick out specific features
about each slide, like the cells’ size, shape and texture. It could also distinguish between samples from
people who had only lived for a short time after diagnosis – say, a few
Months – and ones from those who survived much longer. The study verified the algorithm’s
results by testing it on historical data, so now the AI could in principle be used with patients.

Stanford’s slide-reader is just one in a long string of AIs that are learning to perform medical tasks. At a
conference on machine learning and healthcare in Los Angeles, researchers presented new algorithms to
detect seizures, predict the progression of kidney or heart disease, and pick out anomalies in pregnant
women or newborn babies. Participants in one programming challenge are getting AIs to listen to
recordings of heartbeats, sorting the normal rhythms from the abnormal.Yet other projects are trying to
make medical judgments using more obscure or indirect sources. A Microsoft algorithm, published in
June, makes guesses about who has pancreatic cancer based on their web searches. Google Deep
Mind, based in London, is using masses of anonymised data from the UK’s National Health Service to
train an AI that will help ophthalmologists. The aim here is to spot looming eye disease earlier than a
human can, although the project does raise questions about whether commercial firms are gaining access
to health data too cheaply.

Some fear that AI diagnosis may backfire, encouraging doctors to overdiagnose and overtest patients. Even if
the algorithms work well, there’s the question of how to integrate them seamlessly into clinical practice.
Doctors, notoriously overworked, aren’t likely to want to add yet more items to their checklist. Chase
thinks that artificially intelligent diagnostics will end up being integrated right into databases of electronic
health records, so that seeking machine insights becomes as routine as getting hold of a patient’s data.

Apps that offer diagnostic help already exist, like Isabel, which doctors can run on Google Glass in order to
keep their hands free. But Chase says this approach is unpopular, as doctors must spend time inputting
patient data to use them. AI diagnostics will only take off when it imposes no additional time pressure.
There are social roadblocks, too, says Leo Anthony Celi, a doctor at the intensive care unit of the Beth-
Israel Deaconess Medical Center in Boston. Down the line, Celi thinks, doctors will function more “like the
captain of a ship”, delegating most daily tasks either to machines or to highly trained nurses, medical
techs and physician’s assistants. For that system to succeed, doctors must first cede some control,
admitting that the machine can perform better than them in some domains. That’s a tough ask in a career
in which everyone from medical school professors to patients expects that doctors will always have the
right answers.
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Ultimately, there needs to be a cultural shift toward respect for big data and AI’s potential in medicine,
argues Celi. Only then can we let machines and humans do what each does best. “No one can really
replace doctors’ ability to talk to patients,” he says. “Doctors should focus on what they do better, which
is talking to patients and eliciting their values and their advance directives, and leave it up to the machine
to make the complex decisions. We’re not really good at it.”

Questions: 7 to 14

7. By quoting a doctor the author infers that

A) without Watson, the patient would have died

B) technology can help save human life
C) the role of AI in medicine is often exaggerated
D) The Japan Times published an article on IBM Watson.

8. What point is made about incorrect diagnoses in the second para?

A) They often lead to fatalities in the U S

B) They mostly result from medical errors
C) They are the third leading cause of deaths in the United States
D) They are the reason for one in every three deaths in the U S

9. Why does Herbert Chase say that algorithms should be built brick by brick?

A) It is ideal to focus on one medical question at a time

B) Human involvement would be useful only after the machine makes
recommendation
C) Literature on human conditions is changing very quickly
D) An ailment involves a wide range of factors

10. The phrase "in principle" in the fourth paragraph could best be replaced by

A) finally
B) mainly
C) practically
D) theoretically

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11. Which title best synopsises the fifth paragraph?

A) Who is planning what

B) What happened where
C) How to do what
D) What to do why

12. What point is made about algorithms in the sixth paragraph?

A) Their success may not ensure the success of AI diagnosis

B) They might add burden to doctors
C) They cannot be integrated into clinical practice
D) They could prompt doctors to overdiagnose and overtest patients

13. Leo Anthony Celi mentions which of the following as one of the social roadblocks
for doctors to function like “captain of the ship"

A) additional time to be spent by doctors

B) doctors delegating duties to other staff and machines
C) the expectations that patients have on doctors
D) machines performing as well as doctors in some domains

14. What is meant by "it" in the last para?

A) making advance directives

B) speaking to patients
C) making difficult choices
D) the machine

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 Text 2:
Cannabis
Cannabis is in the headlines for its potential medical benefits after the recent confiscation of cannabis oil
medication from the mother of a 12-year-old British boy with severe epilepsy. The furore that ensued is
shining a light on campaigns for cannabis oils to be made legal for medical reasons, and the UK
government has now announced a review into the use of medicinal cannabis. Cannabis oil is extracted
from the cannabis plant Cannabis sativa. The plants medicinal properties have been touted for more than
3,000 years. It was described in the ancient Eygyptian Ebers papyrus around 1550BC, and it had likely
been used as a medicine in China before that. Some varieties of the plant contain high levels of the
psychoactive substance tetrahydrocannabinol (THC), which is responsible for the “high” that comes from
smoking or eating cannabis leaves or resin. The plant’s other major chemical component is cannabidiol,
which has no psychoactive effect. Both act on the body’s natural cannabinoid receptors which are
involved in many processes such as memory, pain and appetite. The cannabis plant also contains more
than 100 other different cannabinoid compounds at lower concentrations.

Whether it can make you high depends on the THC content. Some types of Cannabis sativa plant, known as
hemp, contain very little THC. The extracts from these plants contain mainly cannabidiol, so will not get
anyone stoned. In the UK cannabidiol is legal. Cannabis plant extracts (known as hemp or CBD oils) are
available in high-street stores but the THC content must be below 0.2 per cent. “THC is not psychoactive
at this level,” says David Nutt, a neuropsychopharmacologist at Imperial College London. But cannabidiol
is illegal in many other countries. In the USA for example, cannabidiol is classed as a schedule 1
controlled substance, and can only be sold in states where cannabis use is legal.

However, the tide may turn in favour of cannabidiol after a recent World Health Organisation review. This
concluded that cannabidiol “exhibits no effects indicative of any abuse or dependence potential” but “has
been demonstrated as an effective treatment of epilepsy … and may be a useful treatment for a number
of other medical conditions.” Although there is some scientific evidence that THC has potential to control
convulsions, its mind-altering effects mean that much of the focus has turned to cannabidiol – particularly
for childhood epilepsies that conventional drugs fail to control. Two recent high quality randomised and
placebo controlled trials showed that cannabidiol is an effective treatment for Lennox-Gastaut syndrome
and Dravet syndrome, severe forms of epilepsy. The mechanism of action is unknown, but it may be due
to a combination of effects, such as inhibiting the activity of neurons and dampening inflammation in the
brain. The situation is less clear when it comes to the use of commercial cannabis oils to control seizures,
where the evidence is mainly anecdotal, and the oils can contain differing concentrations of cannabidiol
and THC,

There are few cannabis-based epilepsy drugs on the market yet. The UK government announced that it
would review the use of medical cannabis. The first part of the review will look at the evidence for the
therapeutic value of cannabis-based products. It can recommend any

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promising ones for the second part of the review. This will be carried out by the government’s Advisory Council
for the Misuse of Drugs, which can recommend a change to the legal medical status of cannabis and
cannabinoids. This will hopefully lead to a relaxation of the rules surrounding research into cannabis-based
medicines says Tom Freeman, a clinical psychopharmacologist at King’s College London. The US Food
and Drug Administration recommended the approval of a drug called Epidiolex for Lennox-Gastaut
syndrome and Dravet syndrome. Its active ingredient is cannabidiol, and final approval is due soon.

However, it is possible the drug is not as effective as cannabis oil containing THC, says Nutt. For example, the
cannabis oil used to treat Billy Caldwell, the boy at the centre of the recent cannabis oil confiscation furore,
contained cannabidiol and a low dose of THC, because cannabidiol alone did not stop all his seizures. This
is one of the big unknowns. It is important to remember that there is currently very little scientific evidence to
support cannabis oil containing both THC and cannabidiol as a treatment for epilepsy. Interestingly, a
synthetic version of THC called Nabilone has been used since the 1980s to treat nausea after
chemotherapy and to help people put on weight. A drug called Sativex is also approved for the treatment of
pain and spasms associated with multiple sclerosis. It contains an equal mix of THC and cannabidiol, but
would not be suitable for the treatment of children with epilepsy such as Billy.

.In the UK cannabis currently has Schedule 1 status, the most restrictive category, which is for drugs which are not
used medicinally such as LSD. “This creates a Catch 22 situation,” says Freeman. “You can’t show that
cannabis and cannabis-based products have medicinal value because of restrictions on medical research.” If
cannabis is moved to the Schedule 2 category, it will join substances such as morphine and diamorphine
(heroin) which can be prescribed by doctors if there is a clinical need.

Questions: 15-22

15. What do we learn about cannabis in the first paragraph?

A) It has been in use for over three millennia

B) Use of cannabis oil for medical purposes is legal in China
C) It has been in use in Egypt only for the past 1550 years
D) Cannabis is highly addictive

16. In the second paragraph the writer does Not confirm that

A) cannibdiol is is prohibited in parts of America

B) cannabidiol is relatively harmless
C) 0.2 per cent of THC content is safe
D) cannabis plant extracts are available for sale in the UK

17. According to the third paragraph, Cannabidiol is preferred to THC because

A) THC is ineffective in treating epilepsy

B) cannabidiol does not have the side-effects that THC has
C) conventional drugs cannot control childhood epilepsy
D) WHO review declared cannabidiol safe
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 18. What does the word "anecdotal" refer to in the third paragraph?

A) Factual
B) Empirical
C) Unscientific
D) Unreliable

19. What point can be made about medicinal cannabis in the fourth paragraph?

A) Cannbis-based epilepsy drugs are not available in the market now

B) The rules governing research into cannabis-based medicines will soon be
relaxed.
C) Some cannabis-based drugs for epilepsy are available in the market now
D) Epidolex is currently being used to treat Lnnox-Gestaut syndrome in the US.

20. In the fifth paragraph, the author cites Billy Caldwell's case in order to

A) reccommend using cannabis oil to control paediatric convulsions

B) support that cannabidiol cannot control seizures
C) highlight the importance of THC in treating epilepsy
D) question the potential of Epidiolex

21. The author expresses surprise because

A) the existing THC based drugs have not proven useful for paediatric epileptics
B) Nibalone, a synthetic form of THC has been in use for decades
C) Sativex is used to provide relief for multiple sclerosis patients
D) use of THC is illegal in many countries

22. What does "this" refer to in the final paragraph?

A) LSD not being used for medicinal purposes

B) the status given to cannabis
C) medical research into cannabis
D) prescription of heroin
END OF READING TEST
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