Reading Sample 6 DVT
Reading Sample 6 DVT
Reading Sample 6 DVT
Text A
Descriptors
Deep vein thrombosis occurs when a blood clot (thrombus) forms in one or more of the deep veins in the
body, usually in the legs. It can cause leg pain or swelling, but may occur without any symptoms. Deep vein
thrombosis is a serious condition because blood clots in the veins can break loose, travel through the
bloodstream, and obstruct the lungs, blocking blood flow. Although it usually affects the leg veins, DVT can
occur in the upper extremities, cerebral sinuses, hepatic, and retinal veins.
Common symptoms include pain, especially throbbing cramp like feeling, swelling and tenderness in one of
your legs (usually your calf), a heavy ache in the affected area, warm skin in the area of the clot, red skin,
particularly at the back of your leg below the knee.
Text B
• being inactive for long periods – such as after an operation or during a long journey
• blood vessel damage – a damaged blood vessel wall can result in the formation of a blood clot
• having certain conditions or treatments that cause your blood to clot more easily than normal –
such as cancer (including chemotherapy and radiotherapy treatment), heart and lung disease, thrombo-
philia and Hughes syndrome
• being pregnant – your blood also clots more easily during pregnancy
The combined contraceptive pill and hormone replacement therapy (HRT) both contain the female hor-
mone oestrogen, which causes the blood to clot more easily. If taking either of these, the risk of develop-
ing DVT is slightly increased.
Pharmacological Therapy
AMost DVT medications are anticoagulant drugs. Anticoagulants interfere with some part of the body’s
process that causes blood clots to form. This process is called the clotting cascade.
Newer anticoagulants
Two older anticoagulants used to help prevent and treat DVT are heparin and warfarin. If a patient takes
either of these drugs, the healthcare provider will need to monitor the patient often.
END OF PART A
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.
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 is the drug used for pain management?
________________________________________________________________
14. Which type of drugs are used to treat deep vein thrombosis?
________________________________________________________________
Study guide for OET © IRS Group 2018 83
Questions 15-20
Complete each of the sentences, 15-20, with a word or a short phrase from one of the texts. Each answer may
include words, numbers or both.
15. Improving the flow of blodd and decreasing swelling and pain is the advantage of
_____________________________ .
17. Blood clot obstructs the lungs and thereby block the _____________________________ .
18. The female hormone present in contraceptive pill and HRT is _____________________________ .
END OF PART A
1. What is the primary purpose of obtaining a patient’s consent for the review?
Health Surveillance
As part of the monitoring system, health surveillance should be undertaken if appropriate. The health of
employees exposed to hazardous substances can be affected through absorption into the body. The
absorption route can be inhalation, by ingestion, through the skin or a combination of these. When inside
the body the substances are metabolised. Metabolites can target various organs of the body which can
thereby be harmed. Health surveillance therefore requires biological monitoring. At its simplest this could
be a skin inspection ensuring no dermatitic changes have occurred as a result of exposure to an irritant,
through to lung function tests and urine, breath or blood analysis. The criteria used to decide which type of
surveillance is appropriate depend on whether a test is available. Tributyl tin oxide was once used as a
timber preservation treatment; however, it was not known how it was metabolized in the body and therefore
no appropriate test existed. The potential for it to cause harm could not be eradicated and, as many
occupational diseases have a long latency period - up to 40 years for asbestosis, for example - tributyl tin
oxide was withdrawn from use.
Despite best efforts, needle-stick (sharps) injuries do occur. The injured health care worker must balance
his/ her risks with the safety of the client. The following guidelines can help health care workers address
needlestick (sharps) injuries: As soon as it is safe to do so (with regard to client safety), the health care
worker with the needle-stick (sharps) injury should stop what he/she is doing, remove gloves, and wash
both hands and the area of the needle-stick (sharps) injury with soap and plenty of water. No antiseptics or
scrubbing brushes should be used. If the provider is in the middle of a procedure, then another qualified
provider should take over and complete the procedure. If no other qualified provider is present, then the
injured provider should ensure that any critical step is complete, wash both hands and the area of the
needle-stick injury, change gloves, and then complete the procedure. Should inform senior staff or manag-
ers at the clinic and follow clinic protocols for managing the needle-stick (sharps) injury.
Health care workers are at increased risk of accidental exposure to bloodborne pathogens—such as
hepatitis B and C viruses and HIV. A minimum approach to health and safety practices for health care
providers and waste workers includes the following:
• implementation of standardized management approaches
• compulsory vaccination for the hepatitis B virus for all health care workers, including cleaners and staff
who handle medical waste © IRS Group
• provision of sharps disposal boxes for safe disposal of used needles, syringes and other sharps •
compliance with hand hygiene standards
• availability of appropriate personal protective equipment—mask, face shield or goggles, rubber apron and
utility gloves (at the bare minimum, every health care worker handling waste should have a face shield and
utility gloves)
• appointment of a clinic staff member or designated staff to additional or dedicated responsibility for
infection control, including waste management
Immediately after any needle-stick (sharps) injury, the person injured should—as soon as it is safe to do
so—hand over his/her duties to another provider and wash the area with plenty of soap and water. Antisep-
tics or caustic agents, such as bleach, should not be used. Flush any exposed mucous membranes with
plenty of water. The clinic should have a system to quickly report any needle-stick (sharps) injuries to the
nearest health facility that provides post-exposure prophylaxis services so that this can be given to the
injured health care worker according to the national guidelines.
In some countries, it is routine practice to offer pregnant women screening for foetal chromosomal and
structural abnormalities, and, if serious anomalies are diagnosed, the option of terminating the pregnancy.
Screening for chromosomal abnormalities commenced in the 1960s and was initially restricted to women
whose pregnancies were considered to be of increased risk because of an obstetric history of aneuploidy or
advanced maternal age. Over the past five decades, prenatal chromosome screening (PCS) has been expanded
to encompass the entire obstetric population. However, the commonly used aneuploidy screening tests are
plagued by high false-positive rates, typically 4%–5%. Confirmation of an increased screening risk for aneuploidy
involves diagnostic tests such as amniocentesis or chorionic villus sampling, each associated with low but
definite risks of pregnancy loss.
Many women are reluctant to proceed with a diagnostic test after a positive aneuploidy screening result, and
the ability to assess foetal genetic material without directly sampling the amniotic fluid or placenta has long
been a goal of prenatal diagnosis. The recent development of non-invasive prenatal testing (NIPT), a high-level
screening test using cell-free foetal DNA, offers the opportunity to markedly reduce the requirement for invasive
testing while potentially also increasing detection rates of chromosomal anomalies, in particular of trisomy
21. In addition, NIPT may be offered earlier in pregnancy than standard aneuploidy screening and diagnostic
techniques.
Although initially used in pregnancies at high risk for aneuploidy, recent data indicate that NIPT is also a
robust screening test in lower-risk pregnancies. NIPT is now the most sensitive and specific screening test for
the common trisomies, with detection rates greater than 99% for trisomy 21 and false-positive rates of less
than 0.5%. The performance characteristics for trisomies 13 and 18 and the sex chromosome anomalies are
lower than for trisomy 21, although the sensitivity is still typically greater than 90%.
NIPT is not without its limitations. Failure to obtain a result occurs in routine clinical practice in about 3%–4%
of tests, usually due to a low cell-free foetal DNA fraction, which is detectable in the maternal bloodstream,
typically because the sample was collected too early in the pregnancy or because of maternal obesity. False-
positive results have been associated with confined placental mosaicism, the death of a co-twin, maternal
malignancy and maternal mosaicism. Detection rates appear to be lower and the chances of not obtaining a
result are higher in twin than in singleton pregnancies.
Ethical questions, ever present and never fully resolved when discussing prenatal testing, will come more
sharply into focus with the broader introduction of NIPT into obstetric practice. A woman and her partner have
two options after trisomy 21 has been diagnosed: continuation or termination of the pregnancy. The option of
termination is widely regarded in our society as part of the couple's reproductive health rights. If the diagnosis
is made earlier, and termination methods that are less stressful and safer for the woman and more acceptable
to medical staff are available, there could be greater pressure to undergo testing (and termination, when
abnormalities are detected) than is currently the case.
A NIPT is proving reliable for finding strong and durable lower-risk rates
B NIPT is considered to be a strong and reliable screening process
C NIPT is considered a significantly reliable robotic testing format
D NIPT mainly finds aneuploidy in lower-risk screening processes
12. The phrase ‘will come more sharply into focus,’ in paragraph 5 means ethical questions
A will be visually clear and free from debate for all people.
B will become a topic of greater discussion and debate among people.
C will become a topic of much hostile criticism among the community.
D will rise quickly into focus and force complacency among the community
13. Which of the following best describes the author’s use of the term non-lethal in paragraph six?
A unimpressive
B dangerous
C unintentional
D nonnoxious
In the paediatric intensive care unit at the University of California San Francisco (UCSF) Medical centre, four
nurses are clustered around the bed of an unconscious 7-year-old Cambodian boy who was hit by a truck
several days earlier. A plastic respirator tube snakes out of his mouth, and other tubes and wires connect him
to IV drips, evacuation bags, and a series of monitors that provide second-by-second displays of his heart and
respiratory rhythms. His right leg, bent at the knee, is held up in traction. His face is so swollen that visitors
find it too grueling to stare for too long. He is sedated to shield him from what would be excruciating agony and
to stave off any further threat of injury.
Janet Craig, a nurse educator based in the paediatric intensive care unit is comforting the boy’s family as they
keep an anxious bedside vigil. As they talk, a sudden commotion diverts Craig’s attention. She rushes
towards the room of another patient, hastily explaining that this 17-year-old girl has been a frequent visitor to
the ICU. She was born with a congenital heart defect that has required a number of surgeries, and recently
she may have suffered a heart attack. Five days earlier surgeons had implanted a permanent pacemaker, but
also decided that a heart transplant would be necessary if she were to survive over the long term.
In such an hour of intense activity, and in the time she spends each day attending to complex cases such as
those in the ICU, Janet Craig, an intensive care nurse for over 14 years, tries her utmost to embody the very
heart of the nursing profession – that unique relationship between caring and curing. In hospitals and communities
throughout the world, nursing staff are treating not only the patient’s complex physical needs but their interlinked
emotional needs as well. While doctors focus on limb, heart, or lung, nurses carry out the medical regimens
that physicians prescribe, as well as monitoring intricate human needs.
Nurses take care of patients 24 hours a day, 7 days a week. If a patient with a broken leg complains of chest
pain, it is the nurse’s duty to inform the physician of a suspected pulmonary embolism. If a patient with
metastatic breast cancer comes in for chemotherapy and complains of dizziness, shivering, and simply not
feeling like herself, the nurse will alert the oncologist to the possibility that the cancer may have travelled to
the brain. In addition to following the physicians’ treatment plan, nurses establish treatment plans of their
own. They assess patients’ basic needs and do for them what they cannot do alone; they help educate
people about how to cope with a disease or the aftermath of surgery; they become deeply involved – as
patient advocates – in helping patients and families make informed decisions about major surgery and
termination of life-support systems. All of these responsibilities should make nurses major participants in the
evolving debate about national health care. Yet to most of the public and policy-makers, they remain almost
invisible.
Real health care involves far more than paying physicians to intervene when disease is well established or
financing dazzling research into potential ‘cures.’ It involves education in disease prevention and health
maintenance from childhood through old age, as well as providing skilled nursing care in hospitals when
patients are acutely ill. A truly humane system would not push futile treatment on patients with terminal
diseases, but would permit them to die in comfort and with dignity. A genuinely economical health-care
system would finance a cohesive network of long-term care to be provided outside of big hospitals in the home
and the community.
15. In paragraph one, what is meant by the use of the word ‘clustered’?
A Anxious
B Silent
C Motionless
D Gathered
A completely excluded nurses and their insight into the health industry.
B left policy-makers and the public no alternative but to exclude nurse
C evolved without proper input from nurses
D remained nearly invisible to policy-makers and the public
22. Which word can be best described for the term “futile” in paragraph five?
A expensive
B flashy
C needless
D unprofitable