OET Reading 43 Back Pain With Answers

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Write your answers on the spaces provided in this Question Paper.

Part A Text Booklet

Text A

Back pain is very common, affecting people of all ages. It usually feels like an ache, tension or stiffness in the back. It usually improves over a few days, but sometimes back pain can last for weeks or months. If no obvious reason is found for the back pain, this is known as non-specific back pain.

Acute back pain can happen if there has been a sudden movement, fall or injury. The pain can be due to a pulled muscle or ligament in the back. It could also be because a disc that sits between each of the spinal vertebrae suddenly bulges out. This is commonly known as a slipped disc and needs immediate medical assessment.

Persistent or chronic back pain is when some part of the back has become damaged and continues for 3 months or longer. People most at risk of chronic back pain include those who frequently lift heavy items, who are overweight or have arthritis.

Text B

Clinical assessment

• Gather previous history of back pain.
• Carry out these checks to see if the person has non-specific back pain.
• Locating pain areas along the spine.
• Assessing range of movement;

Possible causes or triggers

• Assessing the types of pain, such as burning or stabbing pain.
• Finding the triggers that worsen the pain.
• Finding what reduces the pain.

Investigations

• If the diagnosis is non-specific back pain, further investigations are unnecessary.
• For possible sciatica or slipped disc, an x-ray, magnetic resonance imaging (MRI) or a computed tomography (CT or CAT) scan may be required

Management of non- specific back pain

For acute pain:

• Advise the patient to keep moving such as walking, light exercise, swimming.
• The temptation is to rest but this lets muscles and tendons tighten up, causing more pain.
• Avoid lifting heavy items or excessive exercise until pain eases.
• Simple analgesia and/or anti- inflammatory medication.

For persistent back pain:

• Supervised exercise, with a physiotherapist or similar professional.
• Referral to pain management team.
• Referral to psychologist for cognitive behaviour therapy for guidance on changing poor behaviours and habits that contribute to back pain

Text C

Causes of non-specific back pain

Aging causes wear and tear on the spine. This means that people over age 30 or 40 are more at risk for back pain than younger individuals. An occupation that involves repetitive bending and lifting has a high incidence of back injury. Work that involves long hours of standing or sitting in a chair also puts the person at greater risk. Lack of regular exercise increases risks for occurrence of lower back pain, and increases the likely severity of the pain.

• Being overweight increases stress on the lower back, as well as other joints.
• Any type of prolonged poor posture will, over time, substantially increase the risk of developing back pain. Examples include slouching over a computer keyboard, driving hunched over the steering wheel, lifting improperly.
• Pregnant women are more likely to develop back pain due carrying excess body weight in the front, and the loosening of ligaments in the pelvic area as the body prepares for delivery.
• People who smoke are more likely to develop back pain than those who don’t smoke.

Self-care of non-specific back pain

Almost everyone suffers back pain at some stage but recovers quickly with little or no treatment.

The most effective treatments people can do themselves include: 

• learning more about back pain – what makes it better, what makes it worse?
• Exercising and staying active as much as possible.
• Managing stress.
• Managing weight – a healthy weight lessens the strain on the back.
• Avoiding sitting or standing in one position for a period of time.
• Quitting smoking – smoking increases your chances of developing back pain.
• Lifting and carrying safely.
• Relaxing / relaxation techniques to reduce stress levels and related muscle tension massage, heat or cold packs and gentle exercise

Text D

Specific conditions that cause back pain:

Sciatica is inflammation of the sciatic nerve, which runs from hips to feet. It may get better if treated in the same way as acute back pain.

A slipped disc is when the soft cushion of tissue between the bones in the spine pushes out and presses on nerves. It usually gets better slowly with rest, gentle exercise and painkillers but manual therapy or surgery is sometimes needed. A slipped disc can cause issues that need immediate medical attention. These include:

• Paraesthesia including tingling, pins and needles and numbness around the bottom or genitals.
• Not able to urinate, or loss of control of bladder and bowel.
• Loss of feeling in one or both legs.
• Pyrexia or feel hot and shivery.
• Having swelling in the back.
• Pain worsening at night.

Spinal stenosis is a narrowing of the spaces between vertebrae. This can cause pressure on the spinal nerves. Osteoarthritis is wear-and-tear of the vertebrae, causing pain and reduced range of movement.

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. Reasons for the development of back pain with no obvious cause.
2. Issues that may need the person to see a doctor urgently.
3. Self-help strategies for people with back pain.
4. The tests people may have to find the cause of their back pain.
5. What back pain feels like.
6. Why pregnancy increases the chances of a woman suffering from back pain.
7. The link between spinal stenosis and back pain.

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.

1. What type of back pain can be eased with gentle exercise?
2. How long has a person been experiencing back pain if it is considered to be persistent?
3. What sort of pain might a person be suffering from if they are referred to a pain management team?
4. People over what age are at higher risk of back pain?
5. What condition might a person have if they are experiencing pins and needles around their bottom?
6. Which nerve carries information from the pelvic area to the toes?
7. Being overweight can cause back pain and place stress on what parts of the body?

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, numbers or both.

1. Over time _____________ posture will raise the risk of a person developing back pain.
2. Massage and ____________ packs can ease acute back pain.
3. If a person has back pain for no detectable reason it is called __________________ back pain.
4. A person with acute back pain should keep moving and include light exercise such as ____________________.
5. Surgery or _____________________ is often needed if someone has a slipped disc.
6. An x-ray, _____________________ or a computed tomography (CT or CAT) scan are some of the options available to diagnose a back problem.

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Part B | 6 Extracts | 6 Questions

1. What does the following article say about the application of eye-drops?

1. There is more than one way to apply eyedrops.
2. The dropper tip should be wiped clean after each use.
3. Your eye should be closed for 2-3 minutes before applying eye drops.

General Guidelines for Eyedrop Application

These guidelines give general advice on how to use most eye drops. However, you may be given specific instructions which may vary from the advice below. After thoroughly washing your hands, sit or stand in front of a mirror. Bend your head backwards and gently pull your lower eyelid down. Hold the dropper above one eye. Squeeze one drop into the pocket formed by gently pulling down the lower eyelid. Try not to touch your eye, eyelashes, or anything else with the dropper tip in order to keep it clean. Let go of the eyelid and do not keep the eye closed for not as long as possible (2-3 minutes at least) after application of the eye drop, with your head tilted down towards the floor. Wipe away any liquid that falls on to your cheek with a tissue.

2. Which of the following statements is not mentioned?

1. Value for money is an important factor in cochlear implantation acquisition.
2. Both adults and children could be possible candidates for cochlear implantation.
3. Simultaneous bilateral cochlear implantation necessitates the use of identical devices.

Cochlear Implantation Recommendations

This technology appraisal examined the currently available devices for cochlear implantation. Unilateral cochlear implantation is recommended as an option for people with severe to profound deafness who do not receive adequate (sufficient) benefit from acoustic hearing aids. If different cochlear implant systems are considered to be equally appropriate, the least costly should be used. Assessment of cost should take into account acquisition costs, long-term reliability and the support package offered. Simultaneous bilateral cochlear implantation is recommended as an option for children and for adults who are blind or who have other disabilities that increase their reliance on auditory stimuli as a primary sensory mechanism for spatial awareness. Patients should have severe to profound deafness with limited or no adequate benefit from acoustic hearing aids.

3. What can you infer about Dr. Bhatt’s opinion?

1. He is doubtful that a proper diagnosis can be made.
2. He thinks this type of technology is likely to become widespread.
3. He is a proponent of the medical uses of wearable technology.

Apple Watch Detects Irregular Heart Beat in Large U.S. Study

Dr. Deepak Bhatt, one of the study’s lead investigators, said “the physician can use the information from the study, combine it with their assessment … and then guide clinical decisions around what to do with an alert.” The study found that 57 percent of participants who received an alert on their watch sought medical attention. For Apple, the data provides firepower as it pushes into healthcare. Its new ‘Series 4 Watch’ has the ability to take an electrocardiogram to detect heart problems and requires clearance from the U.S. Food and Drug Administration. Dr. Bhatt called it an important study as use of this type of wearable technology is only going to become more prevalent.

4. In this article, what does the word ‘advocates’ indicate?

1. Sometimes, workplace violence results in legal procedures.
2. Healthcare workers may need to support themselves as well as their patients.
3. Violent patients should be admonished

Violence in the Workplace: A Growing Problem

Workplace violence in any form comes at a high cost to the individual and institutions. It has lasting effects on our healthcare system and deeply impacts clinicians on a personal and professional level. Workplace violence can have a wide range of impacts, including effects on self-esteem, relationships with co-workers, recruitment and retention. The psychological trauma often makes individuals fearful of returning to work. As healthcare professionals, we must be advocates for not only our patients, but also for ourselves. A safe work environment is built upon a foundation of trust and respect for all. No case should go unreported and zero tolerance should be implemented to ensure that we can protect ourselves as well as deliver safe patient care.

5. What does this article tell the reader about drawing blood?

1. The procedure of pulling blood back gives rise to more than one sensation.
2. The catheter should be removed before taking blood samples.
3. Aspiration should be avoided in CVAD procedures

Is it safe to reinfuse blood drawn from a CVAD via a syringe when checking line patency or drawing blood?

Before withdrawing a blood aspirate from a central venous access device (CVAD), ask yourself, why am I taking this blood aspirate? Are you taking the blood aspirate to assess for device patency prior to hooking up to an intravenous infusion or do you require a blood sample for laboratory analysis? If you are simply checking CVAD patency, you only need to pull blood back into the catheter until you see the liquid gold; it never needs to come as far as the catheter hub and needleless connector. The ease of aspiration can still be assessed with this small aspiration technique as you get a different feel when you are aspirating air (more resistance is felt) as opposed to the free-flowing feeling of aspirating liquid.

6. What advice is given in this article about participating in a clinical trial?

1. You should inform a family member of your intentions.
2. You should give consent to possible side-effects.
3. You should know about the reason for the trial.

What Should I Consider Before Participating in a Clinical Trial?

Before participating, you must be provided with an “informed consent” document explaining the risks and potential benefits of the trial. Be sure to read over this information carefully. It is important to fully understand the purpose of the trial and what to expect. You will want to find out if the treatment will interact with any of your current medication or affect any other medical conditions you may have. You should be informed about what tests or procedures, such as biopsies or blood draws, will be performed, and you should consider your comfort level with what will be done. Also, think about whether you are prepared for any anticipated side effects, pain, or discomfort that may be involved.

End of Part B | Next: Part C

Reading Part C, Text 1

The ongoing measles outbreaks across the United States and Europe prove definitively that our personal choices affect everybody around us. Although you have a right to your own body, your choice to wilfully be sick ends where another’s right to be healthy begins. For that reason, people who “opt out” of vaccines should be opted out of American society. This is America, the Land of the Free. That freedom, however, doesn’t mean “I can do whatever I want, whenever I want.” When we choose to live in a society, there are certain obligations—both moral and legal—to which we are bound. You cannot inflict harm or infringe on the rights and liberties of those around you.

Those obligations extend even to your constitutional rights. Although we have a First Amendment, you are not allowed to play music as loudly as you want in your apartment. Your neighbours have a legal right to peace and quiet. Even though we have a Second Amendment, you are not allowed to shoot a gun for sport in the middle of a city or town. Stray bullets are not only scary, they’re hazardous, and often inadvertently kill people. Finally, your moral and legal obligations to the safety of others can even curtail combinations of your rights. Even though consuming alcohol and driving are both legal activities, they are not legal when performed together. Nearly 11,000 people die every year because people choose to exercise their “rights” inappropriately.

The exact same reasoning applies to vaccination. There is no moral difference between a drunk driver and a wilfully unvaccinated person. Both are selfishly, recklessly and knowingly putting the lives of everyone they encounter at risk. Their behaviour endangers the health, safety and livelihood of the innocent bystanders who happen to have the misfortune of being in their path. 

The reasons are simple and straightforward. Vaccines aren’t perfect (e.g., they can wear off over time) and not everyone can be vaccinated. There is one and only one legitimate reason to skip a vaccine: being immune-compromised. Some individuals, because of genetic deficiencies or diseases like cancer, cannot receive vaccines. Other people are too young. Vaccines such as MMR (measles, mumps, rubella) cannot be administered before 12 months of age. These vulnerable people rely on the responsible actions of everyone else in society to protect them, a concept known as “herd immunity.”

For their sake, we have a moral—and there should also be a legal—obligation to protect them. Everyone who can be vaccinated must be vaccinated in order to prevent the spread of disease. This is a protection we demand even for our animals: kennels will turn your pet away if they aren’t properly vaccinated and on an accepted flea treatment. There are rules we all have to play by and responsibilities we have to live up to if we want to live in a society together.

If this isn’t enough to convince a person to become fully vaccinated, then perhaps there is a solution that maintains everybody’s freedom: Anti-vaxxers (as people who object to vaccinations call themselves) can opt out of American society. No public or private school, workplace or other institution should allow a non-exempt, unvaccinated person through their doors. A basic concern for the health and safety of others is the price it costs to participate. Is that too harsh? We don’t think so. If a person wants to blast their music loudly, shoot guns aimlessly, and drink and drive, they should be allowed to do exactly as they please: so long as it’s on their own property, sufficiently isolated from everyone else. Similarly, if you don’t want to be vaccinated, perhaps that should be allowed too, so long as you agree to permanently live out in the middle of nowhere.

It is inexcusable that society has reached this point. Many of the deadliest diseases known to mankind are due to bacteria and viruses, and dozens of them are now entirely preventable thanks to the sciences of microbiology and immunology. People falsely believe that diseases like measles have “gone away,” but they have not. They’re always there, waiting to strike as soon as our collective guard goes down. Not so long ago, smallpox ran the risk of obliterating entire cities, while polio paralyzed large fractions of a generation. We have forgotten this morbid history because public health has been a victim of its own success.

But misinformation abounds. The internet, both a blessing and a curse, has allowed devilish lies, propaganda and a discredited fraud masquerading as science to infect the minds of millions of people. Unfortunately, there’s no vaccine that can inoculate someone against a counterfactual, unscientific mindset. There are, however, vaccines that can prevent dozens of harmful diseases. Those who refuse, and recklessly endanger others, should be put in quarantine.

Questions 7-14

7. In the first paragraph, what does the writer infer about freedom?

1. freedom has its limits.
2. moral and legal freedom is undesirable.
3. an individual’s freedom is more important than other’s rights and liberties.
4. you cannot ‘opt out’ of the question of freedom in modern society.

8. In paragraph two, which of the following are not true?

1. the people who live near you have a right to a certain degree of calm.
2. the First Amendment limits your activity in some ways.
3. the Second Amendment does not permit unlimited use of guns.
4. moral and legal obligations extend to other amendments.

9. The example of a drunk driver is given to:

1. show that there can be terrible consequences of selfish behaviour.
2. demonstrate that acting freely can lead to accidents.
3. emphasise the link between decisions and risk.
4. some people are innocent of wilful misdemeanours.

10. In paragraph four, which of the following would not be exceptions to the idea that everyone should be vaccinated?

1. people with pre-existing conditions which mean that vaccines would be ineffective.
2. people for whom the effects of vaccines do not wear off over time.
3. very young children.
4. anyone who has a severe problem with their immune system.

11. In paragraph five, what does the writer infer about vaccinations?

1. The need for vaccinations is growing as some animals can spread disease.
2. The society that administers vaccines should be more powerful.
3. There should be a law (or laws) to enforce vaccination for vaccinatable people.
4. Fleas can carry diseases that can harm humans.

12. What alternative does the writer propose in the sixth paragraph?

1. More education should be given to encourage vaccination.
2. People who refuse to be vaccinated should live in secluded locations.
3. Some institutions could be established for unvaccinated people.
4. Harsh laws should be passed to enforce vaccination.

13. In the seventh paragraph, the writer’s opinion could be summarized as:

1. the sciences of microbiology and immunology are extremely important.
2. collective vaccination is a sign of a well-adjusted society.
3. the present situation cannot be justified.
4. thanks to vaccinations, there are more successes than victims.

14. What can the reader infer about the writer’s opinion in the last paragraph?

1. There are advantages and disadvantages in using the internet.
2. Internet usage can masquerade as propaganda.
3. Counterfactual mindsets ought to be inoculated against.
4. quarantine is the only remedy for certain types of diseases.

Part C, Text 2

Although sports injuries to the knee, ankle, and shoulder have been well documented, injuries to the pelvis, hip, and thigh get little attention because of their low prevalence. Unfortunately, severe consequences may result if these injuries are improperly managed.

Femoral neck stress fractures were mainly seen in military recruits due to a triad of activity that is new, strenuous, and highly repetitive. However, as a result of self-imposed fitness regimens of recreational athletes, over the last 20 years the number of these injuries has been increasing in non-military populations. In contrast, contact sports such as football, rugby, and soccer are usually the cause of most fractures of the hip. Stress fractures occur in normal bone undergoing repeated submaximal stress. As the bone attempts to remodel, osteoclastic activity occurs at a greater rate than osteoblastic activity. When these cumulative forces exceed the structural strength of bone, stress fractures occur. Stress fractures occur mainly at the femoral neck and are classified as either tension (at the superior aspect of the femoral neck) or compression (at the inferior aspect of the femoral neck).

Hip fractures are classified as intracapsular, which includes femoral head and neck fractures, or extracapsular, which includes trochanteric, intertrochanteric, and subtrochanteric fractures. The location of the fracture and the amount of angulation and comminution play integral roles in the overall morbidity of the patient, as does the pre-existing physical condition of the individual. Fractures of the proximal femur are extremely rare in young athletes and are usually caused by high-energy motor vehicle accidents or significant trauma during athletic activity. Other causes may be an underlying disease process such as Gaucher disease, fibrous dysplasia, or bone cysts.

Identification and initiation of treatment is imperative in attempts to avoid complications, such as avascular necrosis (AVN). AVN is more common in patients in the paediatric and adolescent age groups. This outcome is due to the precarious nature of the blood supply to the subchondral region of the femoral head, which does not stabilize until years after skeletal maturity, after which collateral flow develops.

The blood supply to the femoral head has been studied extensively and has been found to change substantially during development. Until the cartilaginous growth plate forms a barrier at age 4 years, the major blood supply comes from the medial and lateral circumflex arteries (metaphyseal arteries), which arise from the deep femoral artery. After age 4 years, the posterosuperior and posteroinferior arterial branches of the medial femoral circumflex bypass the growth plate and form the main blood supply to the femoral head. During adolescence, the growth plate fuses and the metaphyseal vessels again become significant, traveling along the femoral neck. Fractures in this area can disrupt this delicate blood supply, leading to AVN, the most severe complication of this fracture.

An estimated 340,000 hip fractures occur each year. Estimates indicate that in 2040, approximately 500,000 hip fractures will occur. Nine of 10 hip fractures occur in patients aged 65 years and older, and 3 of 4 occur in women. White females have been reported to be twice as likely to fracture their hips than black and Hispanic females. This frequency has been associated with a metropolitan setting, increased caffeine use, alcohol use, sedentary lifestyle, psychotropic drug use, and senile dementia.

Patients with hip fractures may present in a variety of ways, ranging from an 80-year-old woman reporting hip pain after a trivial fall to a 30-year-old man in haemorrhagic shock after a high-speed motor vehicle accident. Stress fractures usually manifest more insidiously, with an otherwise healthy person reporting pain related to activity and not healing with the conservative treatments suggested by their primary care doctor. Although the classic presentation of a hip fracture is an elderly patient who is in extreme pain, a young, healthy athlete usually has the same presentation. The affected leg is externally rotated and may be shortened. The extremity shortening occurs because the muscles acting on the hip joint depend on the continuity of the femur to act, and when this continuity is disrupted, the result is a shorter-appearing leg. Assessing peripheral pulses and checking Doppler pressures to assure vascular patency is very important.

The patient with a stress fracture may present more subtly, reporting pain in the anterior groin or thigh. This pain increases with activity and can persist for hours afterward. The pain can progress to a point of consistency, even without activity. This pain generally expresses itself in the groin; however, it can also be referred to the knee. An antalgic gait pattern is often present. Signs and symptoms usually involve a diffuse or localized aching pain in the anterior groin or thigh region during weight-bearing activities that is relieved with rest. Night pain is also common. A study by Brännström et al that included 408,000 older adults reported an association between antidepressant medication and hip fracture before and after the initiation of therapy. Further investigations are needed to study this association.

Questions 15-22

15. What do we learn about sports injuries in the first paragraph?

1. Some sports injuries have severe consequences for subsequent sporting careers.
2. Improper injury management has been well-documented.\
3. Low frequency pelvis, hip, and thigh injuries are more difficult to treat.
4. There is more information available for some types of injuries than for others.

16. When do stress fractures happen?

1. They happen in specific situations.
2. They often occur when athletes leave military service.
3. They often happen following abnormal osteoclastic activity.
4. When bones cannot remodel to deal with contact sports injuries.

17. According to the third paragraph, which of the following statements is not true?

1. The exact position of the fracture is relevant for subsequent treatment.
2. A patient’s state of health can play a role in the severity and complexity of fractures.
3. High-energy athletic accidents can exacerbate hip fractures.
4. The angle of any distortion is an important factor.

18. Why is AVN more common in younger patients?

1. Because treatment initiation usually takes longer in young patients.
2. Because blood supply does not become stable until later in life.
3. Because skeletal maturity can hinder blood flow.
4. Because collateral flow is infrequent during adolescence.

19. In the fifth paragraph, which of the following statements about blood supply to the femoral head is not mentioned?

1. There have been a large number of studies into this topic.
2. A significant development in this area occurs during adolescence.
3. There is a significant change in infants aged four years old.
4. Metaphyseal vessels are significant only for infants aged less than four.

20. What do the statistics in the sixth paragraph reveal?

1. A disproportionally high number of elderly women are affected by hip fractures.
2. The number of hip fractures rises by over 340,000 each year.
3. The rise in hip fractures affects all ethnic groups equally.
4. Hip fractures can be set more quickly in metropolitan hospitals.

21. What do we learn about hip fractures in the seventh paragraph?

1. Stress fractures are more difficult to detect than ordinary fractures.
2. 30-year-old patients have a better likelihood of recovery than patients over 80.
3. Primary care doctors may suggest painkillers rather than treatment for a fracture.
4. In some patients, contorted leg muscles may make stress fracture diagnosis more difficult.

22. Which of the following is not mentioned in the last paragraph?

1. The location of a pain is an important factor in correct diagnosis.
2. Nocturnal pain can be symptomatic of a stress fracture.
3. Pain duration should be taken into account.
4. Antidepressant medication can relieve some symptoms of stress fractures.

End of Back Pain.