OET Reading

Text A
Fractures (buckle or break in the bone) often occur following direct or indirect injury, e.g. twisting, violence to bones. Clinically, fractures are either:
• closed, where the skin is intact, or
• compound, where there is a break in the overlying skin

Dislocation is where a bone is completely displaced from the joint. It often results from injuries away from the affected joint, e.g. elbow dislocation after falling on an outstretched hand.

Sprain is a partial disruption of a ligament or capsule of a joint.

Text B

Simple Fracture of Limbs

Immediate management:

• Halt any external haemorrhage by pressure bandage or direct pressure

• Immobilise the affected area
• Provide pain relief
Clinical assessment:
• Obtain complete patient history, including circumstances and method of injury - medication history – enquire about anticoagulant use, e.g. warfarin
• Perform standard clinical observations. Examine and record: - colour, warmth, movement, and sensation in hands and feet of injured limb(s)
• Perform physical examination
Examine:
- all places where it is painful
- any wounds or swelling
- colour of the whole limb (especially paleness or blue colour)
- the skin over the fracture
- range of movement
- joint function above and below the injury site
Check whether:
- the limb is out of shape
– compare one side with the other
- the limb is warm
- the limb (if swollen) is throbbing or getting bigger
- peripheral pulses are palpable

Management:
• Splint the site of the fracture/dislocation using a plaster backslab to reduce pain
• Elevate the limb – a sling for arm injuries, a pillow for leg injuries
• If in doubt over an injury, treat as a fracture
• Administer analgesia to patients in severe pain. If not allergic, give morphine (preferable); if allergic to morphine, use fentanyl
• Consider compartment syndrome where pain is severe and unrelieved by splinting and elevation or two doses of analgesia
• X-ray if available

Text C




Text D
Technique for plaster backslab for arm fractures – use same principle for leg fractures

1. Measure a length of non-compression cotton stockinette from half way up the middle finger to just below the elbow. Width should be 2–3 cm more than the width of the distal forearm.
2. Wrap cotton padding over top for the full length of the stockinette — 2 layers, 50% overlap.
3. Measure a length of plaster of Paris 1 cm shorter than the padding/stockinette at each end. Fold the roll in about ten layers to the same length.
4. Immerse the layered plaster in a bowl of room temperature water, holding on to each end. Gently squeeze out the excess water.
5. Ensure any jewellery is removed from the injured limb.
6. Lightly mould the slab to the contours of the arm and hand in a neutral position.
7. Do not apply pressure over bony prominences. Extra padding can be placed over bony prominences if applicable.
8. Wrap crepe bandage firmly around plaster backslab.

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.  1 procedures for delivering pain relief?  

2. the procedure to follow when splinting a fractured limb? 

3. what to record when assessing a patient? 

4. the terms used to describe different types of fractures?  

5.  the practitioners who administer analgesia?  

6.  what to look for when checking an injury?  

7.   how fractures can be caused?  

Please read the text below the following answers for answers to the questions.

11. The manual informs us that the Blood Pressure Monitor.

Instruction Manual: Digital Automatic Blood Pressure Monitor Electromagnetic Compatibility (EMC)

With the increased use of portable electronic devices, medical equipment may be susceptible to electromagnetic interference. This may result in incorrect operation of the medical device and create a potentially unsafe situation. In order to regulate the requirements for EMC, with the aim of preventing unsafe product situations, the EN60601-1-2 standard defines the levels of immunity to electromagnetic interference as well as maximum levels of electromagnetic emissions for medical devices.
This medical device conforms to EN60601-1-2:2001 for both immunity and emissions. Nevertheless, care should be taken to avoid the use of the monitor within 7 metres of cellphones or other devices generating strong electrical or electromagnetic fields.

12. The notice is giving information about: 

NG feeding tubes

Displacement of nasogastric (NG) feeding tubes can have serious implications if undetected. Incorrectly positioned tubes leave patients vulnerable to the risks of regurgitation and respiratory aspiration. It is crucial to differentiate between gastric and respiratory placement on initial insertion to prevent potentially fatal pulmonary complications. Insertion and care of an NG tube should therefore only be carried out by a registered doctor or nurse who has undergone theoretical and practical training and is deemed competent or is supervised by someone competent. Assistant practitioners and other unregistered staff must never insert NG tubes or be involved in the initial confirmation of safe NG tube position.

13. What must all staff involved in the transfusion process do?

'Right Patient, Right Blood' Assessments.

The administration of blood can have significant morbidity and mortality. Following the introduction of the 'Right Patient, Right Blood' safety policy, all staff involved in the transfusion process must be competency assessed. To ensure the safe administration of blood components to the intended patient, all staff must be aware of their responsibilities in line with professional standards.
Staff must ensure that if they take any part in the transfusion process, their competency assessment is updated every three years. All staff are responsible for ensuring that they attend the mandatory training identified for their roles. Relevant training courses are clearly identified in Appendix 1 of the Mandatory Training Matrix.

14. The guidelines establish that the healthcare professional should:

Extract from ‘Chaperones: Guidelines for Good Practice’

A patient may specifically request a chaperone or in certain circumstances may nominate one, but it will not always be the case that a chaperone is required.
It is often a question of using professional judgement to assess an individual situation. If a chaperone is offered and declined, this must be clearly documented in the patient’s record, along with any relevant discussion.
The chaperone should only be present for the physical examination and should be in a position to see what the healthcare professional undertaking the examination/investigation is doing.
The healthcare professional should wait until the chaperone has left the room/cubicle before discussion takes place on any aspect of the patient’s care, unless the patient
specifically requests the chaperone to remain.

15. The guidelines require those undertaking a clinical medication review to

Annual medication review

To give all patients an annual medication review is an ideal to strive for. In the meantime there is an argument for targeting all clinical medication reviews to those patients likely to benefit most. Our guidelines state that ‘at least a level 2 medication review will occur’, i.e. the minimum standard is a treatment review of medicines with the full notes but not necessarily with the patient present. However, the guidelines go on to say that ‘all patients should have the chance to raise questions and highlight problems about their medicines’ and that ‘any changes resulting from the review are agreed with the patient’.

It also states that GP practices are expected to:
• minimise waste in prescribing and avoid ineffective treatments.
• engage effectively in the prevention of ill health.
• avoid the need for costly treatments by proactively managing patients to recovery through the whole care pathway.