Moodle edit

No-carbohydrate diet
Premise: High-carbohydrate diets, not fat, lead to weight gain. by replacing sugar, pasta,
potatoes, and bread with meat, vegetables and dairy products, you'll lose weight.
Verdict: Initial weight-loss is likely to be due to losing water rather than fat. it's difficult to eat
more meat without eating more fat, which is linked to heart disease and cancer. you might be
thinner, but your arteries won't be happy
Hay diet
Premise: It's not what you eat, it's what you eat it with. carbohydrates can't be digested in acid
conditions, so shouldn't be eaten with protein. Mixing acid and alkaline is strictly forbidden, so
fruit should never be allowed anywhere near a main meal.
Verdict: A mixture of foods is necessary for a healthy metabolisom-vitamin C, for instance, helps
the absorption of iron. Extremely fashionable but with debatable scientific basis.
F-plan diet
Premise: This is the original high-carbohydrate, low-fat plan, advocating lots of fruit and fibre.
the 80s favourite has been translated into sixteen languages, and claims to be the best-selling diet
ever.
Verdict: Common sense disguised as new scientific breakgthrough.
Grapefruit diet
premise: More energy is spent digesting grapefruit and other foods like celery than is contained
in the food itself. the more you eat, logically, the thinner you get.
Verdict: digesting food does burn calories, but in such tiny proportions, you would have to eat a
vast amount to notice any difference.
Cabbage soup diet
Premise: By eating nothing but soup made from cabbage and a few other vegetables you can lose
up to six kilos in a week
Verdict: Most of the weight loss is due to water loss, not fat, and the weight returns when you
move back on to solids. Unfortunately side effects have been reported.
System S diet
premise: The way to get thin is to eat sugar-coated cereals, biscuits, chocolate and sugary soft
drik-"not the villains they are made out to be." It's a 'myth' that sweets make you fat and rot your
teeth, so tuck into another bar of chocolate.

Verdict: Just ask a dentist.
Read the information about six diets in the article below and find out which diet...............
F- doesn't allow you to eat fruit with your meal
E- has unpleasant side effects
C- allows you to eat cream
B- says that sweets don't make you fat
A- is based on the idea that the more you eat, the thinner you get
D- has been translated into many different languages
 No-carbohydrate diet
 Grapefuit diet
 Hay diet
 F-plan diet
 System S diet
 Cabbage soup diet


OLDER DADS LINKED TO RISE IN GENETIC DISORDER
By Pallab Ghosh Science correspondent, BBC News
A genetic study has added to evidence that the increase in some mental and other disorders
may be due to men having children later in life. An Icelandic company found the number of
genetic mutations in children was directly related to the age of their father when they were
conceived. One prominent researcher suggested young men should consider freezing their sperm
if they wanted to have a family in later life. The research is published in Nature.
According to Dr Kari Stefansson, of Decode Genetics, who led the research, the results
show it is the age of men, rather than women, that is likely to have an effect on the health of the
child. "Society has been very focused on the age of the mother. But apart from [Down's
Syndrome] it seems that disorders such as schizophrenia and autism are influenced by the age of
the father and not the mother."
Male-driven
Dr Stefansson's team sequenced the DNA of 78 parents and their children. This revealed a

direct correlation between the number of mutations or slight alterations to the DNA, of the child
and the age of their father. The results indicate that a father aged 20 passes, on average,
approximately 25 mutations, while a 40-year-old father passes on about 65. The study suggests
that for every year a man delays fatherhood, they risk passing two more mutations on to their
child. What this means in terms of the impact on the health of the child is unclear. But it does
back studies that also show fathers are responsible for mutations and that these mutations increase
with age. And, for the first time, these results have been quantified and they show that 97% of all
mutations passed on to children are from older fathers. "No other factor is involved which for
those of us working in the field is very surprising," said Dr Stefansson. He added that the work
backed other studies that have found links between older fathers and some disorders. "The
average age of fathers has been steeply rising [in industrialised countries] since 1970. Over the
same period there has been an increase in autism and it is very likely that part of that rise is
accounted for by the increasing age of the father," he said.
Genetic 'diversity'
The findings should not alarm older fathers. The occurrence of many of these disorders in
the population is very low and so the possible doubling in risk by having a child later in life will
still be a very low risk. Nearly all children born to older fathers will be healthy. But across the
population the number of children born with disorders is likely to increase if this theory holds
true. Older fathers and therefore genetic mutations have been linked with neurological conditions
because the brain depends on more genes for its development and regulation. So mutations in
genes are more likely to show up as problems in the brain than in any other organ. But it is
unclear whether the age of fathers has an effect on any other organ or system. The research has
not yet been done. The reason that men rather than women drive the mutation rate is that women
are born with all their eggs whereas men produce new sperm throughout their adult life. It is
during sperm production that genetic errors creep in, especially as men get older. Writing a
commentary in the Journal Nature, Prof Alexey Kondrashov, of University of Michigan, said
young men might wish to consider freezing their sperm if future studies showed there were other
negative effects on a child's health. "Collecting the sperm of young adult men and cold storing it
for later use could be a wise individual decision. It might also be a valuable for public health, as
such action could reduce the deterioration of the gene pool of human populations," he said.

Dr Stefansson, however, told BBC News that from a long-term perspective the decision by
some men to have children later in life might well be speeding up the evolution of our species.
"The high rate of mutations is dangerous for the next generation but is generating diversity from
which nature can select and further refine this product we call man," he said. "So what is bad for


the next generation may be good for our species in general." However a spokesman for the
National Autistic Society said: "While there is evidence to suggest that genetic factors may play a
role in some forms of autism, there are many 'younger' fathers who have children with the
condition. "Far more investigation needs to be done into the connection between genetics and
autism before we can draw any reliable conclusions."
1. All cases of genetic mutation are affected
by the age of fathers in conceiving. (T/F)
2. Achizophrenia and autism are influenced
by the age of ............
A. Mother
B. Father
C. Both father and mother
3. How many people participated in the
research of Dr Stefansson's team?
A. 20
B. 78
C. 97
D. 25

4. According to the research, for one year's
delay, a man passes 1 mutation to his new
born child. (T/F)
5. Most children from older father
are ...............

A. often sick
B. healthy
C. suffer from genetic mutation.
6. Genetic mutation is link to .............
A. health problem
B. social factors
C. neurological conditions
D. work
7. It hasn't been proved the link between the
genetic factors and autism. (T/F)


GENETIC MUTATIONS
Although genetic mutations in bacteria and viruses can lead to epidemics, some epidemics
are caused by bacteria and viruses that have undergone no significant genetic change. In
analyzing the latter, scientists have discovered the importance of social and ecological factors to
epidemics. Poliomyelitis, for example, emerged as an epidemic in the United States in the
twentieth century; by then, modern sanitation was able to delay exposure to polio until
adolescence or adulthood, at which time polio infection produced paralysis. Previously, infection
had occurred during infancy, when it typically provided lifelong immunity without paralysis.
Thus, the hygiene that helped prevent typhoid epidemics indirectly fostered a paralytic polio
epidemic. Another example is Lyme disease, which is caused by bacteria that are transmitted by
deer ticks. It occurred only sporadically during the late nineteenth century but has recently
become prevalent in parts of the United States, largely due to an increase in the deer population
that occurred simultaneously with the growth of the suburbs and increased outdoor recreational
activities in the deer’s habitat. Similarly, an outbreak of dengue hemorrhagic fever became an
epidemic in Asia in the 1950’s because of ecological changes that caused Aedes aegypti, the
mosquito that transmits the dengue virus, to proliferate. The stage is now set in the United States
for a dengue epidemic because of the inadvertent introduction and wide dissemination of another
mosquito, Aedes albopictus.

1. The passage suggests that a lack of modern sanitation would make which of the following most
likely to occur?
a. An epidemic of paralytic polio among infants
b. An epidemic of typhoid
c. An outbreak of dengue hemorrhagic fever
d. An epidemic of paralytic polio among adolescents and adults
e. An outbreak of Lyme disease
2. According to the passage, the outbreak of dengue hemorrhagic fever in the 1950’s occurred for
which of the following reasons?
a. The mosquito Aedes aegypti was newly introduced into Asia.
b. More people began to visit and inhabit areas in which mosquitoes live and breed.
c. The mosquito Aedes albopictus became infected with the dengue virus.
d. Individuals who would normally acquire immunity to the dengue virus as infants were
not infected until later in life.
e. The mosquito Aedes aegypti became more numerous.
3. It can be inferred from the passage that Lyme disease has become prevalent in parts of the
United States because of which of the following?
a. The inadvertent introduction of Lyme disease bacteria to the United States
b. The spread of Lyme disease bacteria from infected humans to noninfected humans
c. An increase in the number of humans who encounter deer ticks
d. The inability of modern sanitation methods to eradicate Lyme disease bacteria
e. A genetic mutation in Lyme disease bacteria that makes them more virulent
4. Which of the following can most reasonably be concluded about the mosquito Aedes albopictus
on the basis of information given in the passage?
a. It is native to the United States.
b. It can proliferate only in Asia.
c. It replaced Aedes aegypti in Asia when ecological changes altered Aedes aegypti’s
habitat.
d. It transmits the dengue virus.

e. It caused an epidemic of dengue hemorrhagic fever in the 1950’s.
5. Which of the following best describes the organization of the passage?
a. A paradox is stated, discussed and left unresolved.
b. An argument is described and is then followed by three counterexamples that refute the
argument.
c. A theory is proposed and is then followed by descriptions of three experiments that
support the theory.
d. A generalization is stated and is then followed by three instances that support the
generalization.
e. Two opposing explanations are presented, argued, and reconciled.
6. Which of the following, if true, would most strengthen the author’s assertion about the cause of
the Lyme disease outbreak in the United States?
a. In recent years the suburbs have stopped growing.
b. Outdoor recreation enthusiasts routinely take measures to protect themselves against
Lyme disease.
c. Scientists have not yet developed a vaccine that can prevent Lyme disease.
d. Interest in outdoor recreation began to grow in the late nineteenth century.
e. The deer population was smaller in the late nineteenth century than in the midtwentieth century.


NUTRIENTS
A healthy diet is essential for maintaining a healthy body and a healthy lifestyle. Though
some doctors and healthy experts disagree on some components of a healthy diet, other parts are
almost universally recognized, for example, all agree that a healthy diet includes necessary
nutrients-ingredients that help keep bodies strong and healthy human bodies need more than 50
different kinds of nutrients, including vitamins, minerals, water, and fiber.
Vitamins are natural substances found in plants and animals ■ A ) A body cannot make its
own vitamins, so it must get them from food. Vitamins do not supply energy ■ B) however, they
are useful substances that the bode needs ■ C) Vitamin A, for example, helps eyes see better.

Vitamin B develops protein needed in muscle growth. Vitamin C helps support the healing
process for certain illnesses ■ D) Finally, vitamin D helps strengthen teeth and bones.
Minerals help balance bodily fluids, such as blood and water. They are also an important
part of the iron in blood. There are seven major minerals that bodies need in large amounts, and
ten minor, or trace, minerals, which bodies need in smaller amounts. Scientist are still studying
many minerals, such as nikel and cobalt, to try to understand exactly how they affect the human
body.
Some people do not include water as a nutrient, but it is vital for a healthy body to
function properly. Humans can live for several days without food, but only for two or three days
without water. People who play sports or exercise a lot often fail to drink enough water. This can
cause their muscles to become overly tired. If not enough water is taken in during very strenuous
exercise, death may in fact result.
Scientists have learned much about the importance of fiber in recent years. ■ A) They now
say that many people do not get enough fiber in their diets. ■ B) The average many people should
eat between 30 and 40 grams of fiber each day, twice as much as the average person currently
gets. Though fiber is not digested or absorbed, it helps rid the body of waste products. ■ C) fiber
helps control weight and maintain normal levels of important substances such as cholesterol and
blood sugar. ■ D) Fiber is found in whole-grain breads and cereals, as well as nuts, beans, fruits,
and vegetables. There are several different kinds of fiber, and the each help in different ways.
Two kinds of fiber, called pectins and gums, are needed to help control body fats, cholesterol, and
carbohydrates (a type of nutrient that produces energy). Apples, cranberries, and cherries are good
sources of pectin. Oatmeal and legumes are good sources of gums. In general, fresh fruits and raw
vegetables provide more fiber than peeled fruits and cooked vegetables. according to dieticians,
two servings of vegetables and two servings of whole grains ( like whole wheat bread) each day
will provide enough fiber for most adults
In summary, recommendations for a healthy diet include drinking lost of liquids while
eating fiber from a wide variety of foods. This way, the body will not be getting to much of one
kind of fiber and too little of another kind. If a person is not eating enough fiber now, it is best to
change one’s diet gradually. Above all, experts warn, do not depend on getting fiber from pills or
tablets. A whole bottle would need to be consumed to see any benefit.

1. The word “nutrients” in paragraph 1 is
closest in meaning to
a. useful substance in food
b. regular food
c. source of energy for the body
d. substances that help the body
control levels of cholestrerol

2. The word “major” in paragraph 3 could
best be replaced by which of the following?
a. general
b. main
c. general
d. powerful
3. The word “function” in paragraph 4 is
closest in meaning to


a. lie down
b. move
c. breath
d. operate
4. According to the passage, which of the
following is true of vitamins?
a. They are natural substances made
by our bodies
b. They taste bad
c. Americans do not get enough of
them
d. They do not supply energy to

our bodies
5. What is the main purpose of paragraph 5?
a. To describe the structure of fiber
b. To explain the history of fiber
c. To discuss the importance of
fiber
d. To tell how to eat enough fiber
6. Which of the sentences below best
expresses the essential information in the
highlighted sentence in the passage?
Incorrect choices change the meaning in
important ways or leave out essential
information.
a. (d) Though water is sometimes
not classified as a nutrient, it is
essential for good health.
b. Water is not always considered
nutritious; however,, it helps your
body work.
c. (b) Though nutrients are not found
in water, they are essential for good
health.

VITAMINS

d. (a) Water is not always considered
a nutrient; however, your body needs
nutrients.
7. Look at the four squares that indicate
where the following sentence could be added

in paragraph 2:
Scientists name vitamins according to letters
of the English alphabet.
Where would the sentence best fit? Choose
the square where the sentence should be
added to the passage.
a. Paragraph 2, line 4
b. Paragraph 2, line 3
c. Paragraph 2, line 2
d. Paragraph 2, line 1
8. Look at the four squares that indicate
where the following sentence could be added
in the paragraph 5:
Too much fiber, however, can interfere with
the body's ability to use essential nutrients.
Where would the sentence best fit? Choose
the square where the sentence should be
added to the passage.
a. Paragraph 5, line 2
b. Paragraph 5, line 5
c. Paragraph 5, line 4
d. Paragraph 5, line 1
9. All of the followingare good sources of
fiber EXCEPT
a. Chocolat cake
b. oatmeal
c. apple
d. pears

Vitamins, taken in tiny doses, are a major group of organic compounds that regulate the
mechanisms by which the body converts food into energy. They should not be confused with
minerals, which are inorganic in their makeup. Although in general the naming of vitamins
followed the alphabetical order of their identification, the nomenclature of individual substances
may appear to be somewhat random and disorganized. Among the 13 vitamins known today, five
are produced in the body. Because the body produces sufficient quantities of some but not all
vitamins, they must be supplemented in the daily diet. Although each vitamin has its specific
designation and cannot be replaced by another compound, a lack of vitamin can interfere with the
processing of another. When a lack of even one vitamin in a diet is continual, a vitamin deficiency
may result.
The best way for an individual to ensure a necessary supply of vitamins is to maintain a
balanced diet that includes a variety of foods and provides adequate quantities of all the
compounds. Some people take vitamin supplements, predominantly, in form of tablets. The
vitamins in such supplements are equivalent to those in food, but an adult who maintains a
balanced diet does not need a daily supplement. The ingestion of supplements is recommended
only to correct an existing deficiency due to unbalanced diet, to provide vitamins known to be
lacking in a restricted diet, or to act as a therapeutic measure in medical treatment. Specifically,
caution must be exercised with fat-soluble substances, such as vitamins A and D, because, taken
in gigantic doses, they may present a serious health hazard over a period of time.
1. In paragraph 1, the bold word “regulate” is
closest in meaning to
a. confine
b. refine
c. control
d. refresh
2. According to the passage, vitamins are
a. miscellaneous substances
b. food particles
c. essential nutrients
d. major food groups

3. In paragraph 1, the bold word
“nomenclature” is closest in meaning to
a. concentration
b. classification
c. clarification
d. conservation
4. How many vitamins much be derived
from nourishment?
a. 5
b. 8
c. 7
d. 13
5. The author implies that foods
a. supplement some but not all
necessary vitamins
b. supply some but not all necessary
vitamins

c. are equivalent in vitamin content
d. should be fortified with all
vitamins
6. The bold phrase “daily diet” is closest in
meaning to
a. nourishment intake
b. vitamin tablets
c. weight loss or gain
d. sufficient quantities
7. A continual lack of one vitamin in a
person’s diet is
a. contagious

b. desirable
c. preposterous
d. dangerous
8. With which of the following statements
would the author be most likely to agree?
a. Vitamins should come from
capsules in purified form.
b. Vitamins cannot be consistently
obtained from food.
c. An inclusive diet can provide all
necessary vitamins.
d. A varied diet needs to be
supplemented with vitamins.
9. It can be inferred from the passage that
vitamin supplements can be advisable


a. after correcting a dietary
deficiency
b. in most restricted diets
c. in special medical cases
d. before beginning a therapeutic
treatment
10. In paragraph 2, the bold phrase “act as”
is closest in meaning to
a. attest to the fact that
b. fight for
c. pretend to be
d. play the role of
11. The author of the passage implies that

a. vitamins can be taken in very small
doses
b. most vitamins are water-soluble
c. some vitamins are not fat-soluble
d. all vitamins are found in measured
doses
12. What does the passage mainly discuss?
a. Vitamin categorization and
medical application
b. Adopting vitamins to control
weight
c. The place of vitamins in nutrition
d. The individual’s diet for optimum
health

THE SUPRISING TRUTH ABOUT SALT
Even though doctors have been telling us for decades that it's one of the villains in our diet
and public health leaders have started a crusade to slash salt from the food supply, there seems to
be no definitive proof of stroke or heart disease prevention. Here, learn why.
By Rachael Moeller Gorman
A- Sonia Angell has a thing about salt. She thinks about it much of her day. When she
talks on the phone from her office in Lower Manhattan, she speaks with increasing passion about
the mineral — specifically, getting rid of it. "It's a nutrient that we are eating in excess," she says,
"to the point where it has become dangerous."
B- Dr. Angell is a general internist with a master's degree in public health, and she is in a
good position to act on her conviction: She runs the Cardiovascular Disease Prevention and
Control Program at the New York City Department of Health and Mental Hygiene (DOHMH),
the same place that caused a huge uproar a few years ago when it mandated that all city
restaurants get rid of artery-clogging trans fats. Initially spurred on by former DOHMH

Commissioner Thomas Frieden, now director of the Centers for Disease Control and Prevention,
she and the Department of Health have taken on salt because they and many others in the
scientific community hold that eating too much sodium chloride, or salt, causes heart attacks,
strokes, and deaths. So in 2008, the DOHMH spearheaded a collaboration called the National Salt
Reduction Initiative — a group of more than 45 cities, states, and powerful national and
international health organizations, including the American Heart Association, the American
Medical Association, and the World Hypertension League — to prevent disease and death by
gradually siphoning off a lot of salt from the country's food supply.
C- The big glitch in this impressive-sounding plan: Not everyone in the medical
community agrees that limiting salt nationwide will prevent these problems. "Is sodium important
to most people's health? Is this a battle worth fighting for most people? The answer is no," says
Norman Hollenberg, M.D., Ph.D., a kidney specialist and blood pressure researcher at Harvard
Medical School who has edited books like the Atlas of Hypertension. Many doctors, including
journal editors, cardiologists, and medical association presidents, say that while it makes sense for
some people with high blood pressure to lower their salt intake, current science doesn't show that
the rest of us will reap much, if any, benefit from this sweeping policy. In fact, these researchers
believe the initiative is being foisted on the American public without sufficient justification —
and could even be dangerous.


D- They say that curtailing salt in the food supply may wreak unforeseen harm, and point
out that no clinical trials in the general population have linked salt to heart disease or death. Past
public health recommendations, they note, have backfired because they were implemented before
proper studies were conducted (one example: switching from butter to trans-fat-loaded margarines
— which proved to be worse). Salt is a cheap, tasty additive and preservative. "There are reasons
food companies put it in their products. Now they have to find substitutes, and we don't know
what impact the substitutes will have," says Hillel Cohen, Dr.P.H., M.P.H., an epidemiologist at
the Albert Einstein College of Medicine in the Bronx who studies hypertension. "Wouldn't it be
nice to have some information before going ahead with a health policy that will affect millions of
Americans?"

1. The article is written by Sonia Angell.
(T/F)
2. Match the two halves.
Glitch (N) (Para.C)
Backfire (v) (para.D)
Reap (v) (para.C)
Foist (somebody/something on/upon
somebody) (para. C)
Curtail (v) (Para.D)
Siphon (v) (para.B)
 A small problem
 To force sb to accept sth
 To have opposite effect.
 To limit sth
 To divert
 To obtain
4. It is clear that salt can help heart disease
prevention.
5. What is NOT mentioned? Eating too much
salt can cause ….......
A. Diabetes
B. Stroke
C. Death
6. What is the purpose of National Salt
Reduction Initiative ?

A. To prevent death, diseases by
controlling the amount of salt in food
B. To use less salt in fast food
C. To prevent death and diseases

D. To stop using salt from food
supply
7. What is "These" (these problems) ( 2nd
line of para. C) referred to?
A. Food supplies
B. Death and diseases
C. Diabetes
8. Dr. Norman Hollenberg is a blood
pressure researcher at Oxford Medical
School. (T/F)
9. Not all people get benefits from the policy
of reducing salt from the country's food
supply. (T/F)
10. Gap- filling
Clinical trials in the general population have
linked salt to ……. (2 words) or ……. (1
word)

SCABIES
Scabies is known colloquially as the "seven year itch. It is a contagious skin infection that
occurs among humans and other animals. It is an ancient disease. Archaeological evidence from
Egypt and the Middle East suggests that scabies was present as early as 4494BC. It was named
"scabies" by Roman physician, Celsus who is credited with describing its characteristic features.
Scabies is caused by a tiny and not directly visible parasite- the Sarcoptes scabiei.
Sarcoptes is a genus of skin parasites, which are part of a larger family of mites collectively
known as "scab mites". These organisms have eight legs as adults and are placed in the same
phylogenetic class (Arachnida) as spiders and ticks.


Pregnant female mites tunnel into the stratums corneum of a host's skin and deposit eggs

in the burrows. The eggs hatch into larvae in 3-10 days. These young mites move about the skin
an moult, into a "nymphal” stage before maturing as adults, which live 3-4 weeks within the host's
skin. Males roam on top of the skin, occasionally burrowing into it.
The movement of mites within and on the surface of the skin causes intense allergic
itching. The burrow tracks are often linear, to the point that a neat line of four or more closelyplaced and equally developed mosquito-like bites is almost diagnostic of the disease. In the
classic scenario, the itch is made more severe by warmth and is usually experienced as being
worse at night, possibly because there are fewer distractions.
A rash soon appears after the itching starts. It is typically a blotchy, lumpy red rash that
can appear anywhere on the body. The rash is often most obvious on the inside of the thighs, parts
of the abdomen and buttocks, armpits and around the nipples in women. As a symptom, it is less
common in elderly. The infection in animals is called scarcoptic mange.
the disease may be transmitted from objects but is most often spread by direct skin-to-skin
contact, with a higher risk of infection if contact is prolonged. Infections require four to six weeks
to become symptomatic. Re-infection, however, may manifest symptoms within as little as 24
hours. Because the symptoms are allergic, their delay in onset is often mirrored by a significant
delay in relief after the parasites have been eradicated.
Crusted scabies, formerly known as Norwegian scabies, is a more severe form of the
infection. However, most people who develop scabies do not contract this form of the disease.
Crusted scabies occurs when there is a hyper-infestation of scabies mites. This means that there
are thousands or millions of mites causing excessive flaking of the skin. Because there are so
many mites, and because the skin is in the process of flaking off, it is highly contagious. The rash
crusts and resembles psoriasis. It can be very extensive and may, if severe, lead to serious
secondary bacterial skin infections. Crusted scabies mainly occurs in people who are immunocompromised. This includes people with HIV/AIDS: those undergoing chemotherapy and frail
people who are ill with other conditions. Other people at risk are those who are malnourished,
have learning difficulties (meaning that they cannot comprehend or respond to the itch), or have
nerve problems (meaning that they cannot feel the itch).
In crusted scabies, the mites can survive for up to a week. In a hospital scenario, even
minimally exposed people, such as cleaners and laundry personnel, are at risk from the parasite.
In an institution where an outbreak of crusted scabies occurs, treatment with an insecticide is
needed. However, a healthy person with a normal immune system would develop "normal"

scabies if infected with the scabies mite following contact with someone who had crusted scabies.
Scabies tends to be diagnosed clinically on the basis of typical symptoms. Often, a doctor
will find one or more mite burrows on the skin to confirm the diagnosis. It is, however,
sometimes difficult to tell the difference between the rash caused by scabies and some other skin
conditions. Therefore, if there is any doubt about the diagnosis, a scraping of skin is sometimes
sent to the laboratory for examination under microscope.
Scabies can be effectively treated with a number of medications. Permethrin cream is the
most effective, but is expensive compared to other treatments. Crotamitan is less effective, but
also nontoxic and soothing, while Ivermectin may be used orally and topically. Treatment with
Lindane preparations, however, has fallen out of favour due to high toxicity and parasite
resistance.
1. Scabies is
A. More than a thousand years old
B. A disease of the Celsus

C. A disease which can last for seven
years
D. Caught from animals


2.What is the closest meaning of the word
“parasite”?
A. A skin disease caused by mites
B. An organism which lives in or on
another one
C. “many legs”
D. A place on the skin where disease
occurs
3. What is the direct cause of Scabies?
A. Females mites depositing eggs in the

epidermis
B. 3-4 weeks of exposure to the sun
C. Male mites moving over the skin
D. Young mites moulting skin
4. What are the physical effects of having
mites under the skin?
A. The constant need to scratch
B. Circles of bites appear on the skin
C. Distractions, especially in hot
weather
D. The skin feels very warm, especially
at night
5. The rash associated with scabies is
A. Found at any location on the body
B. Found on the back of the body
C. Known as sarcoptic mange
D. Only found on women
6. How does the disease spread?
A. Following treatment with a number
of medications
B. By actions such as hand holding
C. By 24hours’ exposure to the sun
D. Mostly by individuals touching
objects

7. What happens in the case of crusted
scabies?
A. It may result in psoriasis and other
diseases
B. It is a result of a massive presence of

parasite
C. It is more common than regular
scabies
D. The patient’s immune system suffers
8. Crusted scabies is serious because
A. It affects healthy people who come
into contact with those with the
condition
B. All hospitals have these parasites
C. It affects people with a poor immune
system
D. It means a person cannot have
chemotherapy
9. Why is scabies sometimes difficult to
diagnose?
A. Many burrows are present, which
makes diagnosis problematic
B. The skin rash is not always visible
C. The patient may have damaged the skin
and made it worse
D. It cannot always be distinguished from
other skin problems
10. In the penultimate paragraph, what does the
word “scraping” mean?
A. Small piece
B. Microscope
C. Photograph
D. Blood sample

WHEN A STROKE IS SILENT

A stroke is a loss of blood flow in the brain. There are two kinds of stroke. One is an
ischemic stroke. It happens when a blood vessel in the brain gets blocked. The other kind is called
a hemorrhagic, or bleeding stroke. This happens when a blood vessel breaks. Strokes can cause
death or disability. Bleeding strokes are more likely to kill than ischemic strokes. But ischemic
strokes are more common -- and doctors can treat them with a drug that breaks up blood clots. If
you think someone is having a stroke, you should seek help immediately. Experts at the United
States National Institutes of Health say the treatment has to begin within three hours. But they say
people need to get to the hospital within one hour so that doctors have time to examine them.
Usually the warning signs appear suddenly. These include trouble walking, weakness especially
on one side of the body, difficulty seeing and difficulty speaking. Yet a recent study showed that
seemingly healthy middle-aged people can suffer a stroke without immediately knowing it. The
study involved about two thousand people. They were the children of men and women who took


part in a major research project in Massachusetts called the Framingham Heart Study. The
average age in the new study was sixty-two. The people were examined every four to eight years.
They were given M.R.I., magnetic resonance imaging, tests to inspect for damaged brain tissue
and signs of stroke. The imaging showed that nearly eleven percent of those with no reported
stroke had suffered a silent cerebral infarction, or silent stroke. Silent strokes are brain injuries
likely caused by a blockage that limits blood supply to the brain.
1.One of stroke causes is the blockage of a blood vessel in the brain
2. Death or disability can be caused by strokes. 
3. Ischemic strokes are more serious than bleeding strokes. 
4. Doctors can treat hemorrhagic strokes with a drug that breaks up blood clots.
5. Stroke sufferers need to go to the hospital in day for being examined.
6. The treatment for those who have a stroke has to begin within three hours. 
7.Most cases, the warning signs occur unexpectedly.
8. Poor vision is warned as one of the signs of a stroke.
9. Healthy middle-aged people can suffer a stroke without immediately knowing it. 
10. The people in the study were examined every four years.

OBSESSIVE-COMPULSIVE DISORDER (OCD) SYMPTOMS
OCD symptoms generally begin between the age of 10 and 24 and continue indefinitely
until a person seeks treatment. A child's upbringing does not seem to be part of the cause of the
disorder, though stress can make the symptoms stronger. The underlying causes of OCD have
been researched greatly and point to a number of different genetic factors. While studies show
that OCD and its related anxiety disorders are often passed down through families, the specific
symptoms for each family member are rarely the same. For example, a mother who is obsessed
with order may have a son who can't stop thinking about a single word or number.
Research on OCD sufferers has found certain physiological trends. In particular, many
studies show an overactivity of blood circulation in certain areas of the brain. As a result of this
increase in blood flow, the sero-toninergic system, which regulates emotions, is unable to
function effectively. Studies have also shown that OCD sufferers have less serotonin than the
average person. This type of abnormality is also observed in Tourette syndrome and Attention
Deficit Hyperactive Disorder. People who developed tics as children are found to be more
susceptible to OCD as well. Many reports of OCD point to infections that can trigger the disorder, namely streptococcal infections. It is believed that a case of childhood strep throat can elicit
a response from the immune system that produces certain neuropsychiatric disorders, such as
OCD.
Because OCD sufferers tend to be so secretive about their symptoms, they often put off
treatment for many years. The average OCD sufferer waits about 17 years before receiving
medical attention. As with many anxiety disorders, early diagnosis and proper medication can
lessen many of the symptoms and allow people to live fairly normal lives. Most treatment plans
for OCD involve a combination of medication and psy-chotherapy. Both cognitive and behavioral
therapies are used to teach patients about their disorder and work through the anxiety. Serotonin
reuptake inhibitors are prescribed to increase the brain's concentration of serotonin. This
medication successfully reduces the symptoms in many OCD sufferers in a short amount of time.
For cases when OCD is linked to streptococcal infection, antibiotic therapy is sometimes all that
is needed.
1.OCD often results from the way a child is raised.

2.Stress can have an effect on OCD.
3.OCD sufferers are deficient in serotonin.
4.Obsessive-compulsive disorder usually begins after the age of 17.
5.Many OCD patients prefer psychotherapy to medication.
6.OCD is very difficult to treat.
7.Many OCD sufferers keep their problem a secret.
8.Antibiotics can be used to treat OCD.

YOUR OWN MEDICINE
Too much self-help can be bad for your health
“ONE of the first duties of the physician is to educate the masses not to take medicine,”
observed William Osler, one of the giants of 19th-century medicine. It is a lesson that I, as a pillpopping member of the public, have learned the hard way. Several years ago, I was given a
prescription for an acne medication which worked wonders for my complexion—so much so that
when the prescription ran out, I kept refilling it myself, thanks to a friendly neighbourhood
pharmacist.
I pride myself on being a fully empowered health-care consumer, being well-informed
(keeping up with medical developments is, after all, my job), with a doctorate in immunology,
and with enough money and determination to take treatment of minor complaints into my own
hands. In this case, I was also extremely foolish.
After a few months on the medication, I started to experience dizzy spells. I dismissed
them as overwork, and continued to take the pills. About a year later, those spells became a curse.
I awoke one day to find the world spinning around me. For a week, I lay in a darkened room with
my eyes tightly shut. Every time I opened them, I would start to vomit. Doctors have a word for
this living hell—auditory nerve damage. Thankfully, I recovered, but not without losing my
balance for several weeks and becoming permanently deaf in one ear. There is no proof that my
illness was caused by do-it-yourself doctoring. But once I stopped taking the pills, the dizziness
and other side-effects ceased.
An experience like that would give anyone a healthy appreciation of the limits to self-help.
But these days people are being encouraged—indeed, expected—to take personal control of their
own bodies. This is sound advice when it comes to staying healthy: sticking to a sensible diet,

taking regular exercise, consuming alcohol in moderation, and refraining from smoking. But I
wonder about the wisdom of such an approach when it comes to making people better as opposed
to merely keeping them well. On the road to recovery, who should be in the driver's seat—doctor
or patient?
Certainly, there are powerful forces—social, political and legal as well as economic—that
are jostling doctors out of taking full charge of their patient's health. For one thing, professional
paternalism is no longer fashionable in western society. Today, your banker, lawyer and, above
all, your physician is supposed to be an adviser, not an unquestioned authority who singlemindedly determines the course of action necessary. Malpractice litigation, especially in America,
has pushed the medical profession into shifting much of the responsibility for taking decisions on
to the patients themselves. For another thing, easy access to medical information on the internet
and elsewhere is giving patients an illusion of expert knowledge with which to challenge—and,
increasingly, dictate—their doctors' decisions.
Pharmaceutical companies have been quick to take advantage of this trend. When a blitz
of television commercials encourages viewers to “ask your doctor” about the latest wonder drug,
chances are your doctor will prescribe it for you. As one American expert on medical ethics has


noted, in many branches of medicine, the doctor has become simply a waiter, and the patient a
customer ordering from a menu of treatments.
There is a fundamental inequality in the doctor-patient relationship that no amount of
education and empowerment can resolve
Meanwhile, as governments and employers struggle to pay for expensive new medicines,
they are trying to move more of the cost of treatment, and therefore more of the responsibility, on
to patients—rolling back support in the process to where it was before the rise of state-sponsored
medicine. In America, the rise of co-payments and medical-savings accounts are signs of these
“new old times”. Drugmakers have also caught on to this economic trend, switching many of their
products from being available only on prescription—where doctors and penny-pinching insurance
firms control access—to becoming available as over-the-counter remedies that consumers choose
and pay for themselves.
The drive to turn patients into self-reliant health-care consumers needs to be watched

carefully—for the simple reason that shopping for medical treatment will never be the same as
shopping for a flat-screen TV. There is a fundamental inequality in the doctor-patient relationship
that no amount of education and empowerment can resolve. You wouldn't try to buy a new car
with a complicated lease agreement when feeling like death. Likewise, a sick patient visiting a
healthy care-giver, will inevitably be entering into a one-sided relationship.
This is not to say that public education in health matters should be discouraged. Nor does
it mean that people should be dissuaded from doing all they can to look after themselves. As the
history of AIDS has shown, informed patients can be a powerful force for change when it comes
to improving medical practices. But this needs to be part of a partnership between doctors and
patients, not a substitute for it.
A. Choose at least one answer:
1. According to Shereen El Feki, which of the following benefits when patients become more
responsible for their healthcare?
Choose three answers from A-F
a. Television companies
b. Insurance companies
c. Lawyers
d. Doctors
e. Drug company
f. Governments
2. According to the writer, responsibility for healthcare is being transferred to patients because of
a. Legal action against patients
b. The high cost of healthcare
c. Changes in public attitude
d. The availability of non-prescription medicines
e. The availability of information
f. Advances in healthcare
B. Yes/No/Not Given
Do the following questions agree with the views of the writer?
Yes if the statement agrees with the views of the writer

No If the statement contradicts the views of the writer
Not Given If it is impossible to say what the writer thinks about this
3. The writer suffered from a skin complaint


4. The writer is certain that the medication was responsible for her
5.The writer eats sensibly and takes regular exercise
6.People should be encouraged to take responsibility for maintaining their health.
7.Patients expect their doctor to take responsibility for making them well
8. Doctors are making more use of the Internet than in the past
9. Patients have more influence over their doctors’ decisions than in the past
10. A relationship between a doctor and a patient is always unbalanced

CASE STUDY
Case Study 1: Esophageal Spasm B.R., a 53-year-old woman, consulted with her primary
physician because of occasional episodes of dysphagia with moderate to severe tight, gripping
pain in her midthorax. She reported that the onset was sudden after ingestion of certain foods or
beverages, beginning retrosternally and radiating to the cervical and dorsal regions. The pain was
not relieved by assuming a supine position or holding her breath. B.R. also stated that she felt like
her heart was racing and that she might be having a heart attack. She denied any dyspepsia,
vomiting, or dyspnea. Her doctor suspected acute esophageal spasm or possibly a
paraesophageal), hiatal hernia and referred B.R. to a gastroenterologist for a gastroscopy and
esophageal manometry study (pressure measurement). She also underwent a barium swallow
study under fluoroscopic imaging.
Case Study 2: HIV Infection and Tuberculosis T.H., a 48-year-old man, was an admitted
intravenous (IV) drug user and occasionally abused alcohol. Over 4 weeks, he had experienced
fever, night sweats, malaise, a cough, and a 10-1b. weight loss. He was also concerned about
several discolored lesions that had erupted weeks before on his aims and legs. T.H. made an
appointment with a physician assistant (PA) at the neighborhood clinic. On examination, the PA
noted bilateral anterior cervical and axillary lymphadenopathy and pyrexia. T.H.'s temperature

was 39°C. The PA sent T.H. to the hospital for further studies. T.H.'s chest radiograph (x-ray
image) showed paratracheal adenopathy and bilateral interstitial infiltrates, suspicious of
tuberculosis (TB). His blood study results were positive for human immunodeficiency virus
(HIV) and showed a low lymphocyte count. Sputum and bronchoscopic lavage (washing) fluid
were positive for an acid-fast bacillus (AFB), and a PPD (purified protein derivative) skin test
result was also positive. Based on these findings, T.H. was diagnosed with HIV, TB, and Kaposi
sarcoma related to past IV drug abuse.
Case Study 3: Endocarditis D.A., a 37-year-old alcoholic man, sought treatment after
experiencing several days of high fever and generalized weakness on return from his vacation.
D.A.'s family doctor suspected cardiac involvement because of D.A.'s history of rheumatic fever.
The doctor was concerned because D.A.'s brother had died of acute malignant hyperpyrexia
during surgery at the age of 12. D.A. was referred to a cardiologist, who scheduled an
electrocardiogram (ECG) and a transesophageal echocardiogram (M),,, D.A. was admitted to the
hospital with subacute bacterial endocarditis (SBE) and placed on highdose, IV antibiotics and
bed rest. He had also developed a heart murmur, 'which was diagnosed as idiopathic hypertrophic,
subaortic stenosis (IHSS).
1. The cervical region is the region of the:
A. heart
B. uterus
C. leg
D. head

E. neck
2. A word that has the same meaning as
dorsal is:
A. anterior
B. caudal


C. inferior

D. superior
E. posterior
3. In referring to tissues, the term interstitial
means:
A. under cells
B. around cells
C. through cells
D. within cells
E. between cells
4. The term axillary refers to the:
A. abdomen
B. wrist
C. armpit
D. bladder
E. groin
5. The term pyrexia refers to a :
A. spasm
B. fever
C. stone
D. tumor
E. poison
6. Dyspepsia refers to indigestion.
Dysphagia and dyspnea refer to difficulty
with ___ and___.
swallowing and urinating

A.
B.
C.
D.

sleeping and breathingCase
swallowing and breathing
breathing and coughing
walking and chewing gum

7. Paraesophageal and paratracheal refer to
____ the esophagus and trachea.
A. under
B. superior to
C. in between
D. near or beside
E. within
8. The endocardium is the lining of the
inside of the heart. Endocarditis refers to a
____of the lining of the heart.
A. narrowing
B. thinning
C. overgrowth of tissue
D. inflammation
E. cancerous growth
9. D.A.’s heart murmur was caused by a
stenosis, or _____ of the aortic valve of his
heart.
A. thinning
B. cancerous growth
C. overgrowth of tissue
D. narrowing
E. inflammation
10. The term for a condition or disease of

unknown etiology is:
A. chronic
B. acute
C. hypertrophic
D. idiopathic
E. stenosis

LYME DISEASE
When Allan Little began to feel ill, he knew almost immediately what it was - Lyme
Disease. But getting a medical diagnosis, and treatment, took a lot longer. I'd been going for years
to the same little town in New England and Lyme Disease is everywhere there. You can't walk
more than a few hundred metres in the countryside without coming across a public health notice
warning you not to get bitten by a deer tick.
So the intense headache, the aching limbs, the burning joints, the ferocious fever and night
sweats that hit me in a matter of hours, a few days after I'd got back to London, were all
consistent with what I'd read about the condition. I went to a London GP, who wasn't convinced.
She took a blood sample and advised me to go home, rest, and take paracetamol. The next day,
the blood test came back. It was negative for Lyme. My condition grew worse. I could hardly
stand up. I called another doctor, who came to my house. He was also sceptical. He took another
blood test. This too came back negative. But he gave me a prescription for powerful painkillers
which made me feel well enough to get on a train to Edinburgh, my home town.
Within three hours of arriving at Waverley Station I was an in-patient in the Infectious
Diseases Department of the city's Western General Hospital: diagnosis, Acute Lyme Disease. By
now I had found the tick bite and the distinctive livid red rash, about six inches in diameter. (To
be fair to those London GPs, I hadn't noticed it when I'd consulted them.)


"It's attacked your liver," the Edinburgh Consultant said. "You have three distinct kinds of
liver inflammation". I made a lame sick-bed joke: "You're sure that's not like Lager-and-Lime
Disease then?" She laughed politely and reassured me that that would look quite different. Why

then had both blood tests come back negative? Dr Roger Evans of Raigmore Hospital in Inverness
is one of the UK's leading Lyme Disease researchers. "In early Lyme Disease," he told me, "the
test is not reliable because no antibodies have been produced. In the first few weeks of infection,
you could test negative, but still have Lyme Disease."
This is a problem for GPs, especially in urban centres where Lyme Disease is unfamiliar.
Lyme is not a viral infection. It's bacterial. GPs will not prescribe antibiotics if they think you're
showing symptoms of a viral infection - and it does look and feel like a bad case of flu, or chronic
fatigue syndrome, neither of which can, or should, be treated with antibiotics. "In the early weeks
of infection, when the blood test is not reliable," says Evans, "the GP needs to assess the patient
clinically, looking for other symptoms that identify Lyme Disease." In other words, symptoms
that distinguish it from flu.
If you have been bitten:
 Remove the tick as soon as possible - the safest way is to use a pair of fine-tipped
tweezers, or a tick removal tool
 Grasp the tick as close to the skin as possible, pull upwards slowly and firmly, as
mouthparts left in the skin can cause a local infection
 Once removed, apply antiseptic to the bite area, or wash with soap and water and keep an
eye on it for several weeks for any changes
 Contact your GP if you begin to feel unwell and remember to tell them you were bitten by
a tick or have recently spent time outdoors
Catching it early is vital. Angela Howard fell ill with Lyme Disease in the 1990s. She had
never heard of it. Her doctor, she says, told her to go home and see whether her symptoms
persisted. It was only when a visiting American friend saw the distinctive rash - concentric red
rings around the place where the tick bite had occurred that she realised she might have Lyme
Disease. She says her doctor was still reluctant to diagnose Lyme. "Doctors say you can only get
this abroad - that it comes from overseas. But I hadn't been abroad. I'd been picnicking in
Wiltshire." She was not treated early and her symptoms have persisted for years.
There is an accumulation of anecdotal evidence that Lyme Disease often goes
undiagnosed. One problem is that no-one knows how prevalent it now is. It is not a notifiable
disease in the National Health Service - doctors are not required to inform a central database

when they diagnose it. So there is no reliable evidence of how widespread it is, or where in the
country you are most likely to get it. Roger Evans at Raigmore Hospital wants to remedy that.
"We're using Scotland as a pilot study," he said. "We're trying to create maps of areas
where there's a risk of tick exposure. We're using satellite data from the European Space Agency
to create an app that will give information, but which will also be interactive, so that users can put
in information about where they've been bitten and whether the Lyme Disease rash has appeared."
Why has Lyme, which 30 years ago seemed largely limited to a small area of New England Lyme is the town in Connecticut where it was first identified - now so prevalent across the
continental USA and in Europe? One theory is climate change: that small gradations in climate
can create new habitats for micro-organisms, or keep them alive and active for longer.
I was struck, at the time of my own treatment, that awareness was far greater in Scotland
than in England and Wales. And awareness of the condition is vital to catching it early. For when
you catch it early, treatment is easy and in most cases successful. It floors you though. It took me
four or five months to get my strength and stamina back. It is a debilitating and dangerous illness
and there is no doubt that it is getting more common. You can get it in the Scottish Highlands, in
Devon and Cornwall, in Richmond Park in London and probably in your own back garden anywhere where there are small furry animals on whose skins a deer tick can live. If you get it,
you can get treatment. But take it from me: it really helps if you know what it is you've got.
1. Alan had no doubt about his illness from the beginning.
2.Both blood tests were negative for Lyme Disease.


3. Alan didn’t become a Waverley Station patient for more than 3 hours.
4.Blood tests were inaccurate because they were taken unprofessionally.
5. Lyme Disease is very unfamiliar in the UK.
Complete the sentences below. Write NO MORE THAN TWO WORDS from the passage for
each answer.
6.Angela’s friend recognized the Lyme Disease as soon as she saw the ________ rash.
7.One problem is, it’s unknown how ___________ Lyme Disease is nowadays.
8. Roger Evans says that they try to create maps of Scotland where there’s a risk of
____________.
9 .The one possible reason for Lyme Disease to move all over the world is ______________.

10. You can catch the disease even in your own back __________.