OET Reading Test 7 - Part B

Occupational English Test

READING SUB-TEST Part B - Text Booklet Practice test You must record your answers for Part B on the multiple-choice answer sheet using 2B pencil. Please print in BLOCK LETTERS

Candidate number

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Family name



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City



Date of test

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READING PART B Instructions TIME LIMIT: 45 MINUTES

There are TWO reading texts in Part B. After each of the texts you will find a number of questions or unfinished statements about the text, each with four suggested answers or ways of finishing. You must choose the ONE which you think fits best. For each question, 1-20, indicate on your answer sheet the letter A, B, C or D against the number of the question. Answer ALL questions. Marks are NOT deducted for incorrect answers. NOTE: You must complete your Answer Sheet for Part B within the 45 minutes allowed for this part of the sub-test.

NOW TURN TO THE NEXT PAGE FOR TEXTS AND QUESTIONS

OET PART B READING - Passage 1

Pancreatic Islet Transplantation The pancreas, an organ about the size of a hand, is located behind the lower part of the stomach. It makes insulin and enzymes that help the body digest and use food. Spread all over the pancreas are clusters of cells called the islets of Langerhans. Islets are made up of two types of cells: alpha cells, which make glucagon, a hormone that raises the level of glucose (sugar) in the blood, and beta cells, which make insulin. Islet Functions Insulin is a hormone that helps the body use glucose for energy. If your beta cells do not produce enough insulin, diabetes will develop. In type 1 diabetes, the insulin shortage is caused by an autoimmune process in which the body's immune system destroys the beta cells. Islet Transplantation In an experimental procedure called islet transplantation, islets are taken from a donor pancreas and transferred into another person. Once implanted, the beta cells in these islets begin to make and release insulin. Researchers hope that islet transplantation will help people with type 1 diabetes live without daily injections of insulin. Research Developments Scientists have made many advances in islet transplantation in recent years. Since reporting their findings in the June 2000 issue of the New England Journal of Medicine, researchers at the University of Alberta in Edmonton, Canada, have continued to use a procedure called the Edmonton protocol to transplant pancreatic islets into people with type 1 diabetes. According to the Immune Tolerance Network (ITN), as of June 2003, about 50 percent of the patients have remained insulin-free up to 1 year after receiving a transplant. Researchers use specialized enzymes to remove islets from the pancreas of a deceased donor. Because the islets are fragile, transplantation occurs soon after they are removed. During the transplant, the surgeon uses ultrasound to guide placement of a small plastic tube (catheter) through the upper abdomen and into the liver. The islets are then injected through the catheter into the liver. The patient will receive a local anesthetic. If a patient cannot tolerate local anesthesia, the surgeon may use general anesthesia and do the transplant through a small incision. Possible risks include bleeding or blood clots.

Pancreatic Islet Transplantation It takes time for the cells to attach to new blood vessels and begin releasing insulin. The doctor will order many tests to check blood glucose levels after the transplant, and insulin may be needed until control is achieved. Transplantation: Benefits, Risks, and Obstacles The goal of islet transplantation is to infuse enough islets to control the blood glucose level without insulin injections. For an average-size person (70 kg), a typical transplant requires about 1 million islets, extracted from two donor pancreases. Because good control of blood glucose can slow or prevent the progression of complications associated with diabetes, such as nerve or eye damage, a successful transplant may reduce the risk of these complications. But a transplant recipient will need to take immunosuppressive drugs that stop the immune system from rejecting the transplanted islets. Researchers are trying to find new approaches that will allow successful transplantation without the use of immunosuppressive drugs, thus eliminating the side effects that may accompany their long-term use. Rejection is the biggest problem with any transplant. The immune system is programmed to destroy bacteria, viruses, and tissue it recognizes as "foreign," including transplanted islets. Immunosuppressive drugs are needed to keep the transplanted islets functioning. Immunosuppressive Drugs The Edmonton protocol uses a combination of immunosuppressive drugs, also called antirejection drugs, including dacliximab (Zenapax), sirolimus (Rapamune), and tacrolimus (Prograf). Dacliximab is given intravenously right after the transplant and then discontinued. Sirolimus and tacrolimus, the two main drugs that keep the immune system from destroying the transplanted islets, must be taken for life. These drugs have significant side effects and their long-term effects are still not known. Immediate side effects of immunosuppressive drugs may include mouth sores and gastrointestinal problems, such as stomach upset or diarrhea. Patients may also have increased blood cholesterol levels, decreased white blood cell counts, decreased kidney function, and increased susceptibility to bacterial and viral infections. Taking immunosuppressive drugs increases the risk of tumors and cancer as well. Researchers do not fully know what long-term effects this procedure may have. Also, although the early results of the Edmonton protocol are very encouraging, more research is needed to answer questions about how long the islets will survive and

Pancreatic Islet Transplantation how often the transplantation procedure will be successful. Before the introduction of the Edmonton Protocol, few islet cell transplants were successful. The new protocol improved greatly on these outcomes, primarily by increasing the number of transplanted cells and modifying the number and dosages of immunosuppressants. Of the 267 transplants performed worldwide from 1990 to 1999, only 8 percent of the people receiving them were free of insulin treatments one year after the transplant. The CITR's second annual report, published in July 2005, presented data on 138 patients. At six months after patients' final infusions, 67 percent did not need to take insulin treatments. At one year, 58 percent remained insulin independent. The recipients who still needed insulin treatment after one year experienced an average reduction of 69 percent in their daily insulin needs. A major obstacle to widespread use of islet transplantation will be the shortage of islet cells. The supply available from deceased donors will be enough for only a small percentage of those with type 1 diabetes. However, researchers are pursuing avenues for alternative sources, such as creating islet cells from other types of cells. New technologies could then be employed to grow islet cells in the laboratory.

Title: Pancreatic Islet Transplantation Read the text and select the best answer for each of the questions below. 1. The pancreas is a) b) c) d)

in the hand in the stomach above the stomach behind the lower part of the stomach

2.

What is the main purpose of insulin?

a) b) c) d)

It to to to

is a hormone destroy beta cells assist in energy production stimulate the auto immune process

3. According the article, is islet transplantation common practice? a) b) c) d)

Yes, it’s frequently used No, it’s still being trialled Not stated in the article Yes, but only in Canada

Pancreatic Islet Transplantation 4.

What is the Edmonton Protocol?

a) b) c) d)

A trade agreement The journal of Alberta University A way to transplant pancreatic islets Not stated in the article

5. What’s the source of the pancreatic islets that are used in the transplant operation? a) b) c) d)

They They They They

are donated by relatives come from people who have recently died are grown in a laboratory come from foetal tissue

6.

Which one of the sentences below is true?

a) A local anaesthetic is preferred where possible b) A general anaesthetic is preferred where possible c) A general anaesthetic is too risky due to the possibility of blood clots and bleeding. d) An anaesthetic is not necessary if ultrasound is used 7. How soon after the operation can the patient abandon insulin injections? a) b) c) d)

Immediately After about two weeks When the blood glucose levels are satisfactory After the first year

8.

How many islets are required per patient?

a) b) c) d)

About a million 70 kg Whatever is available is used it depends on the size of the patient

9.

Immediately after the operation the patient must take

a) b) c) d)

insulin immunosuppressive drugs both a and b nothing

10.

Patients on immunosuppressive drugs may experience

a)

mouth sores

Pancreatic Islet Transplantation b) c) d)

gastro-intestinal problems increased cholesterol levels and decreased kidney function All of the above

11. Twelve months after the operation, how many more patients were still independent of insulin after the introduction of the Edmonton Protocol compared with before its introduction? a) b) c) d)

8% 50% 58% 67%

Now check your answers.

OET PART B READING - Passage 2 PART B READING : Targeting two important risk factors for cardiovascular disease and other major risk factors that can be lowered by modification, treatment or control

(ARA) - It's well known that the prevalence of diabetes is on the rise. According to the Centers for Disease Control and Prevention (CDC), about 23.6 million, or nearly 8 percent of people in the United States, have diabetes, and 1.6 million new cases are diagnosed each year in people aged 20 and older. Type 2 diabetes is the most common form, accounting for about 90 to 95 percent of those diagnosed, and occurs when the body either does not produce enough insulin or does not respond to insulin. But something that many people may not know is that in addition to having diabetes, 70 percent of adults with type 2 diabetes also have high LDL cholesterol (LDL-C), the "bad" cholesterol that can cause build-up in the arteries, greatly increasing their risk for cardiovascular disease. Cholesterol is needed for the body to function normally, but when there is too much LDL-C in the bloodstream, it is deposited in arteries, including those of the heart, which can limit blood flow and lead to heart disease. The American Diabetes Association (ADA) and the American College of Cardiology (ACC) emphasize that it is critical to control both cholesterol and blood sugar levels. The ADA recommends that patients with type 2 diabetes aim for an A1C level, which reflects your average blood sugar level for the past two to three months, of less than 7 percent. The National Cholesterol Education Program (NCEP) ATP III recommends that patients with type 2 diabetes target an LDL-C goal of less than 100 mg/dL. Treating these two diseases can take a combination of efforts, including a healthy diet and increased exercise. Medications are also sometimes needed. While there are many drugs approved by the U.S. Food and Drug Administration (FDA) to treat type 2 diabetes and others available to lower LDL-C, a drug called Welchol (colesevelam HCl) is the first and only medication approved as an adjunct to diet and exercise to reduce both A1C in adults with type 2 diabetes and LDL-C in adults with elevated cholesterol. Welchol addresses both of these chronic health conditions with one medication and offers the convenience of two formulations, Welchol tablets and Welchol for Oral Suspension. Welchol can be taken alone or with other cholesterol lowering medications known as statins and can be added to other anti-diabetic medications (metformin, sulfonylureas, or insulin). "For patients with type 2 diabetes and high LDL cholesterol, it is important to manage both conditions," said Yehuda Handelsman, MD, FACP, FACE, Medical Director of the Metabolic Institute of America in Tarzana, Calif. "Welchol reduces these two risk factors for cardiovascular disease in adults with type 2 diabetes by significantly lowering A1C and LDL-C or 'bad' cholesterol, providing a unique therapeutic option." It is important to note that the affect of Welchol on cardiovascular morbidity and mortality has not been determined.

OET PART B READING What are the major uncontrollable risk factors for coronary heart disease? The American Heart Association has identified several risk factors for coronary heart disease. Some of them can be modified, treated or controlled, and some can’t. The more risk factors a person has, the greater the chance that he or she will develop heart disease. Also, the greater the level of each risk factor, the greater the risk. For example, a person with a total cholesterol of 300 mg/dL has a greater risk than someone with a total cholesterol of 240 mg/dL, even though all people with a total cholesterol of 240 or higher are considered high risk. Increasing age — About 82% of people who die of coronary heart disease are 65 or older. Male sex (gender) — The lifetime risk of developing CHD after age 40 is 49% for men and 32% for women. The incidence of CHD in women lags behind men by 10 years for total CHD and by 20 years for more serious clinical events such as MI and sudden death. Heredity (including Race) — Children of parents with heart disease are more likely to develop it themselves. African Americans have more severe high blood pressure than Caucasians and a higher risk of heart disease. Heart disease is also higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This is partly due to higher rates of obesity and diabetes. Most people with a strong family history of heart disease have one or more other risk factors. Just as you can't control your age, sex and race, you can't control your family history. Therefore, it's even more important to treat and control any other risk factors you have. Other major risk factors that can be lowered by modification, treatment or control. Tobacco smoke — Smokers’ risk of developing CHD is two to four times that of nonsmokers'. Smokers who have a heart attack are more likely to die and die suddenly (within an hour) than nonsmokers. Cigarette smoking also acts with other risk factors to greatly increase the risk for coronary heart disease. People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke), but their risk isn't as great as cigarette smokers'. Constant exposure to other people's smoke — called environmental tobacco smoke, secondhand smoke or passive smoking — increases the risk of heart disease even for nonsmokers. High blood cholesterol levels — The risk of coronary heart disease rises as blood cholesterol levels increase. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more. A person's cholesterol level is also affected by age, sex, heredity and diet. High blood pressure — High blood pressure increases the heart’s workload, causing the heart to enlarge and weaken over time. It also increases the risk of stroke, heart attack, kidney failure and heart failure. When high blood pressure exists with

OET PART B READING

obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke increases several times. Physical inactivity — An inactive lifestyle is a risk factor for coronary heart disease. Regular, moderate-to-vigorous physical activity is important in preventing heart and blood vessel disease. Obesity and overweight — People who have excess body fat — especially if a lot of it is in the waist area — are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases the strain on the heart, raises blood pressure and blood cholesterol and triglyceride levels, and lowers HDL (good) cholesterol levels. It can also make diabetes more likely to develop. Many obese and overweight people have difficulty losing weight. If you can lose as little as 10 to 20 pounds, you can help lower your heart disease risk. Diabetes mellitus — Diabetes seriously increases the risk of developing cardiovascular disease. Even when glucose levels are under control, diabetes greatly increases the risk of heart disease and stroke. From two-thirds to three-quarters of people with diabetes die of some form of heart or blood vessel disease. What other factors contribute to heart disease risk? Stress — Individual response to stress may be a contributing factor. Some scientists have noted a relationship between coronary heart disease risk and stress in a person’s life, their health behaviors and socioeconomic status. These factors may affect established risk factors. For example, people under stress may overeat, start smoking or smoke more than they otherwise would. Excessive alcohol intake — Drinking too much alcohol can raise blood pressure, cause heart failure and lead to stroke. It can contribute to high triglycerides, cancer and other diseases, and produce irregular heartbeats. It also contributes to obesity, alcoholism, suicide and accidents. The risk of heart disease in people who drink moderate amounts of alcohol (an average of one drink for women or two drinks for men per day) is lower than in nondrinkers. One drink is defined as 1–1/2 fluid ounces (fl oz) of 80-proof spirits (such as bourbon, Scotch, vodka, gin, etc.), 1 fl oz of 100proof spirits, 4 fl oz of wine, or 12 fl oz of beer. It’s not recommended that nondrinkers start using alcohol or that drinkers increase their intake.

OET PART B READING

Targeting two important risk factors for cardiovascular disease and other major risk factors that can be lowered by modification, treatment or control

Q1 According to paragraph 1 of the article: (Circle the correct option) a. Diabetes has stabilised b. 1.6 million people aged 20 and older have diabetes c. Type 2 diabetes is the most common d. Type 2 diabetes occurs when there is an over-production of insulin

Q2 In addition to having diabetes: (Circle the correct options) a. 30% of adult with Type 2 diabetes do not have high counts of low density lipids b. 70% of adults with Type 2 diabetes do have high counts of low density lipids c. Too many LDLs in the bloodstream go straight to the heart d. LDLs in the bloodstream can hinder blood flow

Q3 According to the ADA and the ACC (Circle the correct options) a. Both blood sugar levels and cholesterol levels need to be controlled if diabetes is to be avoided b. Blood sugar levels need to be controlled if diabetes is to be avoided c. ACA believes less than 7% average blood sugar level over a one month period indicates no diabetes risk d. The NCEP recommends Type 2 diabetics aim for less than 100 mg/dL of low density lipids

Q4 Welchol, a drug to lower the level of LDLs in the blood: (circle the correct options) a. has been approved by the U.S. FDA b. Welchol must be taken with other statins c. Welchol should not be added to medications such as metformin, sulfonylureas or insulin. d. Welchol needs to be taken together with a healthy diet and an exercise program to reduce A1C in Type 2 diabetics and LDL-C in adults with elevated cholesterol levels.

Q5 Welchol’s affect on cv mobidity and mortality a. is supported by the evidence b. has not been positively established c. has been positively established d. none of the above

OET PART B READING

Q6 Some risk factors can be controlled, or lowered; some cannot be controlled: such as advancing age, one’s gender, and one’s genetic inheritance. However, there are some major risk factors that can be lowered – by modifying one’s lifestyle - or by medical intervention. Risk factors such as : (circle correct options) a. high blood pressure b. high cholesterol levels c. obesity d. all of the above

Q7 The article states that stress : (circle correct options) a. causes overeating and/or habitual smoking b. interacts with lifestyle and socioeconomic status c. depends on how one reacts to it d. may depend on how one reacts to it

Q8 Alcohol contributes to heart failure and strokes : (circle correct options) a. if you drink too much b. moderate alcohol intake leads to less risk of heart disease c. might contribute to high triglycerides d. is not a factor in developing cancer

Q9 To have just “one drink” of alcohol, means : (circle correct options) a. to consume no more than 1½ fluid ounces b. to consume 4 fluid ounces c. to consume 12 fluid ounces d. depends on the type of alcohol

Q10 High blood pressure and physical inactivity: (circle the correct options) a. are contributing factors for coronary heart disease b. people with high blood pressure should not do physical activities c. people with high blood pressure have increased risk of renal failure d. to prevent heart disease, one should have regular mild physical activity

OET PART B READING

PASSAGE 2

1–c 2 – b, d 3 – a, d 4 - a, d 5- b 6- d 7 - b, d 8 - a, b, c 9 - d 10 – a, c Passage 1 1. D 2. C 3. B 4. C 5. B 6. A 7. C 8. D 9. B 10. D 11. B

Para 1, line 4 Para 2 Para 3 Para 4 Last sentence, p1 Page 3, para 4 Page 3, last para Page 3, last para, line 6 Page 2 High Blood Pressure and page 3 – Physical Inactivity -