OET Listening 8 C1

Part C

In this part of the test, there are two texts about different aspects of healthcare. For questions 7-22, choose the answer (A, B, C or D) which you think fits best according to the text. Write your answers on the separate Answer Sheet.

Paget’s Disease

Paget’s disease of the bone is an unusual, chronic bone condition that occurs in only about 1% of people in the United States and slightly more often in men than in women (3 to 2). Individuals with Paget’s disease experience rapid bone repair, which causes a variety of symptoms from softer bones to enlarged bone growth, typically in the pelvis, lower back (spine), hips, thighs, head (skull) and arms. Medical therapies have proven effective in reducing the frequency of pain, fractures and arthritis that may be caused by this condition. Paget’s disease typically occurs in the older population and usually only in a few of their bones. Bones become large and soft, leading to problems such as bending, breaking, pinched nerves, arthritis and reduced hearing. Effective and safe treatment methods can help most people with Paget’s disease.

Normally, as people age, their bones rebuild at a slower rate. For those with Paget’s disease, however, this process of rebuilding bones takes place at a faster rate. As a result, the rebuilt bone has an abnormal structure. The involved bone can be soft, leading to weakness and bending of the pelvis, lower back (spine), hips, thighs, head and arms. Or, the rebuilt bone can enlarge, making it more susceptible to arthritis, hearing loss, fractures and discomfort. Given that this takes place in those over the age of 40, the symptoms are often mistaken for changes associated with ageing.

The cause of Paget’s disease is unknown. It does appear to be, at least partially, hereditary, perhaps when activated by exposure to a virus. Indicative of the hereditary consideration: Paget’s disease occurs more commonly in European populations and their descendants. In 30% of cases, disease incidents often involve more than one member of a family. Paget’s is rarely discovered in individuals before they reach the age of 40, and the number of people identified increases in each progressive age group. Typically, it is the appearance of the bones on an X-ray that prompts the physician to make the diagnosis. Blood tests taken most often will indicate an increase in serum alkaline phosphatase (SAP), which is reflective of the rapid new bone turnover. Urine test results will also indicate the speed at which this rebuilding is taking place. Physicians usually obtain a non-invasive bone scan to determine the extent of bone involvement. Only if cancer is suspected will it be necessary to do a bone biopsy to examine it under a microscope.

Treatment approaches can focus on providing physical assistance, including the addition of wedges in the shoe, canes as walking aids and the administration of physical therapy (this is considered to be the best). Medication that help reduce the pain associated with Paget’s include acetaminophen (e.g. Tylenol) and anti-inflammatory drugs such as ibuprofen and naproxen. In addition, a group of medication called bisphosphonates reduce the pain and help the body regulate the bone-building process to stimulate more normal bone growth. Your physician may prescribe an oral medication such as Alendronate (Fosamax) or etidronate (Didronel) to be taken orally every day for 6 months; Tiludronate (Skelid) to be taken orally every day for 3 months, Risedronate (Actonel) to be taken orally every day for 2 months. All oral medication should be taken with a large glass of water (6-8 oz) upon rising in the morning. Patients should remain upright for the next 30 minutes and not eat until that time has passed. Any of these treatments can be repeated if necessary. Side effects of these medicines may involve heartburn and sometimes an increase in bone pain for a short period of time.

There are also injectable medication that can be given to a patient for Paget’s which include Pamidronate (Aredia), which is injected into the vein once a month or once every few months. The injection takes a few hours. Unusually, there is inflammation of the eye or loss of bone around the teeth (osteonecrosis); Zoledronate (Reclast), which is injected in the vein once a year. The injection takes less than 30 minutes; Calcitonin, a hormone that is injected under the skin several times a week. Surgery for arthritis caused by Paget’s disease is effective in reducing pain and improving function. Medical treatment is not expected to correct some of the changes of the Paget’s disease that have already occurred, such as hearing loss, deformity or osteoarthritis.

In a new study, published on December 20, 2023, in Annals of the Rheumatic Diseases, researchers recruited participants through family members already diagnosed with PDB who received treatment at outpatient clinics. Over 1400 individuals with PDB underwent genetic testing for pathogenic SQSTM1 variants. If they tested positive, their first-degree relatives — primarily children — were offered the same genetic test. In total, 350 relatives tested positive for these pathogenic SQSTM1 variants, and of these individuals, 222 agreed to participate in the trial.

At the beginning of the study, all participants received a radionuclide bone scan to screen for bone lesions. They also underwent testing for the bone resorption marker type I collagen C-terminal telopeptides (CTX) and the bone formation marker procollagen type I amino-terminal propertied (P1NP). Participants were then randomized to receive either a single intravenous infusion of 5 mg of zoledronic acid (ZA) or placebo treatment. Researchers followed up with participants annually for a median of 84 months (7 years), and then baseline assessments were repeated. A total of 90 individuals in the ZA treatment group and 90 individuals in the placebo group completed the trial.

Participants were, on average, 50 years old at the beginning of the study. In the ZA group, nine individuals had lesions detected in bone scans at baseline, compared with just one at the study’s end. In the placebo group, 12 individuals had detectable lesions at baseline, compared with 11 individuals at the study’s end. While the proportion of individuals with lesions was similar between the two groups, there were about twice as many lesions overall in the placebo group, compared with the ZA group (29 vs 15), which researchers said was by chance. All but two lesions disappeared in the ZA group, compared with 26 lesions remaining in the placebo group (P < .0001).

Text 1: Questions 7-14

7. Paget’s disease:

1. Affects more women than men.
2. Affects 3 men in 4.
3. Affects 3 women in 4.
4. Affects a higher number of men than women.

8. Paget’s disease can lead to:

1. Bone disorder.
2. Softening of bones.
3. Arthritis in its final stage.
4. None of the above.

9. Paget’s disease is a condition in which:

1. Bones become large and soft.
2. Rebuilding of bones is stopped.
3. Pelvis bends at a faster rate.
4. Rebuilding of bone is accelerated.

10. Reformation of the bones can lead to:

1. Lower back pain, loss of hearing and discomfort.
2. Arthritis, loss of hearing and softening of bone tissues.
3. Fractures and discomfort only.
4. All of the above.

11. Which of the following statements is right as per the given information in the passage?

1. If one member of the family is affected with Paget’s disease then other members will also be affected.
2. If one member of the family is known to have Paget’s disease then others can also be affected.
3. Paget’s disease is highly hereditary.
4. Paget’s disease is both heritable and inheritable.

12. Pick the correct statement as per the given information in the passage:

1. Those who reach the age of 40 shall undergo blood tests and urine tests for the identification of Paget’s disease.
2. Physicians should always advise the patients to go for a non-invasive bone scan.
3. Increase is indicative of the development of the bone at a rapid speed.
4. It is necessary to do a biopsy of the bone to understand the nature of the disease.

13. What is right about oral medication?

1. May increase bone pain.
2. Should be taken only during the morning.
3. May disturb physiological function.
4. All of the above.

14. Which of the following statements is incorrect as per the given information in the passage?

1. Paget’s disease is a condition which can lead to arthritis.
2. Surgery can get rid of Paget’s disease.
3. Surgery of arthritis which occurred due to Paget’s disease can only reduce the pain associated with it.
4. Medical treatment will not correct a loss in hearing or deformity or osteoarthritis which resulted from it.