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TIME: 15 MINUTES
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OET Reading mock sample test – Part A
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1. Question
20 point(s)Malaria in Pregnancy: Texts
Text A
Malaria occurs mainly in the tropical areas of Africa, Asia and Latin America. Malaria is a parasitic disease spread by the bite of the female Anopheles mosquito, which results in infection of the red blood cell. Five main species of the malaria parasite infect humans: Plasmodium falciparum (the severest form), Plasmodium vivax, Plasmodium ovale, Plasmodium malarie, Plasmodium knowlesi.
Australia was declared malaria-free by the World Health Organization in 1981, and since then, only a small number of cases of locally acquired malaria have been reported from North Queensland. Severe malaria may lead to foetal loss and high maternal mortality due to hypoglycaemia and acute respiratory distress syndrome (ARDS). All forms of malaria in pregnancy may adversely affect the mother and foetus. The main complications are: miscarriage, stillbirth, preterm birth, low infant birth weight, severe maternal and neonatal anaemia.
Pregnant women should be advised to avoid travel to malaria-endemic areas. For pregnant women who cannot avoid travelling, the medical officer should consult with an Infectious Diseases specialist or experienced Travel Medicine doctor to determine the appropriate chemoprophylaxis agent
Text B
Clinical symptoms of malaria:
- Fever, Malaise, Headache
- Abdominal discomfort, Muscle and joint aches
- Chills, sweats, rigours
- May present as a respiratory or gastrointestinal illness.
Incubation period:
– 95% of malaria cases develop symptoms within one month
– Incubation period depends on the species:- ⁃ P. falciparum 9 – 14 days
- ⁃ P. vivax and P.ovale 12 – 18 days
- ⁃ P. malariae 18 – 40 days
- ⁃ P. knowlesi 9 – 12 days
Malaria should be considered in pregnant women with a fever who have travelled to malaria-endemic areas
Text C
Laboratory diagnosis for malaria
Both thick and thin blood smears should be prepared. They should be stained with a Romanowsky stain so as to maximise the occurrence of diagnostic criteria such as stippling on the infected red blood cell.
Blood specimens can be taken directly onto a slide from a finger or an earlobe, or by venepuncture into a tube containing an anticoagulant such as heparin or EDTA. From infants, the blood is best obtained from the heel.
If blood in anticoagulant is being used, the smears should be made as soon as possible after collection because the parasite morphology deteriorates markedly with time. Blood specimens older than 12 hours should be rejected and a new specimen collected.
In a febrile patient, three negative malaria smears 12 to 24 hours apart rules out the diagnosis of malaria
Rapid diagnostic tests (RDTs) for malaria antigens should also be requested.
Other tests should include complete blood count, urea, creatinine, electrolytes, liver function tests, serum glucose, venous pH, serum lactate and coagulation studies.
Text D
Severe malaria in pregnancy Uncomplicated malaria in
pregnancyFirst trimester Artesunate 2.4 mg/ kg IV on admission and repeat
at 12 hours and 24 hours, then once daily until
oral therapy is tolerated
OR
(if parenteral artesunate is not immediately
available)
Quinine dihydrochloride 20 mg/kg IV over 4 hours
as a loading dose, then 10 mg/kg IV over 4 hours
(starting 4 hours after loading dose is completed),
8-hourly until oral therapy is toleratedQuinine sulphate 600 mg
(adult under 50 kg: 450 mg)
orally, 8-hourly for 7 days,
PLUS
clindamycin 300 mg orally, 8-
hourly for 7 daysSecond
and third
trimesterIV artesunate as above IV quinine should be avoided as it is associated
with recurrent hypoglycaemiaArtemether + lumefantrine
tablets 20 + 20mg
4 tablets per dose orally with
fatty food or full-fat milk (to
ensure adequate absorption
of lumefantine) at 0, 8, 24,
36, 48 and 60 hours, making
a total adult dose of 24
tablets in 6 dosesOET Reading Part A
Malaria in Pregnancy: Questions.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 fi nd 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 only be taken from texts A-D and must be correctly spelt.Questions 1-6
For each question, 1-6, 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. how to collect samples for analysis?
2. regions of the world where malaria is endemic ?
3. how long it may take for an infected patient to feel unwell?
4. treatment for pregnant malaria patients?
5. who to contact for advice on preventative medication?
6. how malaria enters the body?
Questions 7-14
Answer each of the questions, 7-14, with a word or short phrase from one of the texts.
Each answer may include words, number of the both. Your answers should be correctly spelled.7 How long does a blood sample remain usable for diagnostic purposes?
8 What is the ideal part of a newborn baby’s body for collecting a blood specimen?
9 What method of taking blood should be used if the sample is to go into a tube with EDTA?
10 What should be added to the blood films to aid diagnosis?
11 Which medication is contraindicated during the later stages of pregnancy?
12 Which species of malaria parasite may have an incubation period of over a month
13 Among the complications resulting from malaria in pregnancy, which condition may affect both mother and infant?
14 Which is the most dangerous species of malaria parasite for humans?
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, number or both.
Your answers should be correctly spelled once.15. If a pregnant woman who has been to a tropical region of Africa presents with a , she should be tested for malaria
16. Malaria patients may have symptoms of illnesses affecting their breathing or functions. .
17. Malaria antigens in a patient’s blood can be detected by means of a
18. When considering malaria, tests should be carried out to determine how well the
patient’s is working.19. In severe cases of malaria in pregnancy, the woman may die as a result of low blood sugar and
20. Patients should receive their third dose of artesunate hours after admission
END OF PART A THIS TEXT BOOKLET WILL BE COLLECTED
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