Contents
Skill area
Topic
Featured subjects
Page
Introduction ........................................................................................................................................................................................................ 4
About the Michigan ECPE: Overview − Results − ECPE writing criteria ........................................................................................................ 6
1 Perspectives on personality
Introduction
Vices versus virtues (and vice versa) A moral primer – Vices and virtues: A sketchy sampler
8
Writing (1)
Paragraph development
Supporting a topic sentence with generalizations and specific examples
10
Vocabulary (1)
It takes all kinds (Part I)
Using context clues – Personality portraits A-F – Time out for review
11
Grammar (1)
Adjectives: Frequently tested topics Order of adjectives: Mnemonics to the rescue – Adjectives that are not adjectives
Vocabulary (2)
It takes all kinds (Part II)
Personality portraits G-P – Time out for review
17
Cloze
A closer look
How to handle a cloze passage – Practice: Amelia Earheart: The lady vanishes
21
Grammar (2)
Predicate adjectives
Using adjectives after stative verbs (predicate adjectives)
24
Vocabulary (3)
It takes all kinds (Part III)
Personality portraits Q-Z – Time out for review
26
Reading
Skimming and scanning
The importance of skimming and scanning – Practice: Presidents at gunpoint
30
Writing (2)
The importance of clear structure
The “Tell Them” prototype – Topic: Early role models
32
Exam practice (1)
15
34
2 Flora and fauna
Introduction
Biodiversity
What on earth is ‘biodiversity’? – Home sweet home – Biodiversity under attack –
On the brink
38
Writing (1)
Paragraph development
Earth Day contest: wildlife threat (jumbled paragraph)
40
Vocabulary (1)
The plant kingdom (flora)
Our debt to plants – Plant points to ponder – Plants in action – Get the picture? –
Itchy eyes, sneezing, and the sex life of flowers – Time out for review
41
Grammar (1)
Verb alert! (Part 1)
Handling ECPE verb-tense questions – Back to basics: Commandments 1-5 –
From theory into practice
45
Vocabulary (2)
The animal kingdom (fauna)
What’s what and who’s who? – The phylum Chordata – Be fruitful and multiply – A guide
to -vores – A picture’s worth a thousand words – Beyond zoology – Time out for review
48
Cloze
Reference words
Tracking down reference words – Practice: Close encounters of the natural kind
53
Grammar (2)
Verb alert! (Part II)
Back to basics: Commandments 6-10 – From theory into practice
55
Vocabulary (3)
Animal language in action
Animal movements – Actions speak louder than words! – Animal idioms
58
Reading
Tracking down technical terms
Losing your fear of technical writing – Practice: Co-evolution
61
Writing (2)
The problem/solution essay
Topic: Wildlife at risk: analysis of local problem + steps to correct it
64
Exam practice (2)
66
3 Health and medicine
Introduction
First day of med school
We’ve come a long way, baby! – A sickness by any other name – What’s up, doc? –
Time out for review
70
Writing (1)
Paragraph development
Linking: The power of complex sentence structure
73
Vocabulary (1)
Anatomy 101
In the beginning – All systems go! – Other systems in brief
74
Grammar (1)
Clauses (Part 1)
Noun clauses – Relative clauses – From theory into practice
78
Cloze
Easily confused words and word
forms
Practice (1): Easily confused word forms (Passage: Epidemic in the Sudan) –
Practice (2): Easily confused words (Passage: Whooping cough)
81
Vocabulary (2)
In sickness and in health ... until
death do us part
Sicknesses and symptoms – Routine check-up (preposition and particle practice) –
Anatomical idioms
84
Grammar (2)
Clauses (Part II)
Adverbial clauses and related structures – Participle clauses – From theory into practice
87
Vocabulary (3)
Daunting developments
The conquest of disease – Diagnostic technology – Surgical advances –
Reproductive medicine – Time out for review
90
Reading
Visualizing metaphors
Practice (1): Drug abuse – Practice (2): Commando viruses to the rescue
93
Writing (2)
The “for and against” essay
Topic: Genetic engineering
96
Exam practice (3)
2
98
Contents
Skill area
Topic
Featured subjects
Page
4 Environmentalism 101
Introduction
In the beginning ...
The biosphere and the forces that have helped to shape it – In praise of erosion:
Waxing eloquent in Nevada’s Valley of Fire – Enter Homo sapiens ...
102
Writing (1)
Paragraph development
Writing introductions – Which is better: objective or imaginative?
107
Vocabulary (1)
Pandora’s box
Global warming – Declining air quality – Declining water quality – Time out for review
108
Grammar (1)
Emphatic structures: Inversion
Inversion with negative adverbials and so/such – Inversion in emphatic conditionals
– From theory into practice
112
Vocabulary (2)
Disasters wrought by nature
Kobe earthquake – Volcanoes, melting glaciers, and flooding in Iceland – Hurricanes
Andrew and Katrina – Time out for review
114
Cloze
Finding “missing links” in a writer’s train of thought – Practice (1): Establishing
relationships within short contexts – Practice (2): Finding missing links in a text
analyzing cause and effect
117
Linking words
Vocabulary (3)
Disasters wrought by man
Chernobyl – Mumbai’s urban nightmare – Sea of Japan oil spill – Time out for review
120
Grammar (2)
The subjunctive and other
message-intensifying phrases
The subjunctive mood – Common colloquial intensifiers
Reading
Coping with texts that describe a
process
How to handle process descriptions – Practice: What’s an El Niño?
Writing (2)
The opinion essay
Acknowledging the complexity of an issue – Topic: Pesticides
123
125
128
Exam practice (4)
130
5 Technological transitions
Introduction
Technology and innovation
What is technology? – What drives technology forward? – Ingenious 19th-century
innovations – Techno adjectives for a brave new world
Writing (1)
Paragraph development
The importance of mechanics
137
Vocabulary (1)
20th-century milestones
Mass production – Radar – Laser – Integrated circuits – Time out for review
138
Grammar
Gerunds and infinitives
Handling ECPE questions with gerunds and infinitives – From theory into practice
141
Vocabulary (2)
Techno buzz words
Interlocking revolutions – High-tech computer spin-offs – Time out for review
144
Cloze
Parallel structure
Dealing with cloze items testing parallel structure – Practice: Robo-revolution
147
Vocabulary (3)
Other hot techno themes
Food technology and the Green Revolution – Medicine and biotechnology –
Time out for review
150
Reading
Coping with typical ECPE techno
passages
Characteristics of typical ECPE techno passages and questions – Practice: Seeing is
believing (past ECPE techno extracts)
153
Writing (2)
Time management
Developing a time-management approach to ECPE writing – Topic: Automation
Exam practice (5)
134
156
158
Grammar reference .......................................................................................................................................................................................... 162
ECPE?
Follow m
e!
3
3
Health and medicine
Introduction
First day of med school
Α We’ve come a long way, baby! − The purpose of the text below is not only to introduce you to the early history of medicine,
but also to remind you that you can usually understand the gist (or general meaning) of what the writer is saying without
understanding every single word.
STEP 1: Skim through the text in the blue box. Then circle the choice that
best sums up the main idea:
a)Early humans were surprisingly bad at treating and
preventing illness.
b) Before the 5th century B.C., little was known about the real
nature of disease.
Medicine has come a long way since prehistoric times, when early humans attributed most diseases to the influence
of malevolent demons who entered the body of unsuspecting victims. Paleopathologists have found evidence
indicating that preventive medicine in those days involved the use of magic, dancing, and lucky charms to ward off
evil spirits. If demons did manage to enter the body, then efforts were made to render it uninhabitable by beating,
torturing, or starving the patient. Attempts were also made to expel demons by using potions that induced violent
vomiting or by drilling a hole in the skull from which a demon could be driven out. Not surprisingly, such therapies
had limited success, but to their credit our Neolithic ancestors were better at dealing with wounds and fractured
bones. Limited progress was made by the Egyptians and other Mesopotamian cultures, but the real breakthrough was
made by the Greek physician Hippocrates in the 5th century B.C. Challenging the idea that disease was punishment
sent from the gods, he is believed to have been the first to suggest a connection between disease and unsanitary
environmental conditions such as poor water and food quality.
STEP 2: Read through the text again, and scan for the answers to the questions below. As you read, circle any unfamiliar words,
but don’t worry about them yet. Focus only on finding the details you need to answer the questions.
1. In the view of our early ancestors, what was the cause of most diseases?
2. List 3 ways that the ancients tried to prevent illness and 5 methods of treatment.
Prevention:
Treatment:
3. What important contribution did Hippocrates make in the 5th century B.C.?
STEP 3: Now read the text again and find the words that correspond to the meanings below. (The meanings reflect the order in
which the words appear in the text. For verbs, use the base form.)
a. – say (sth) is caused by
g. – magical drinks or liquids
b. – evil, intending harm
h. – produce, cause, bring about
c. – keep away, turn aside
i. – broken
d. – make, cause to become
j. – important development
e. – not fit to live in
k. – doctor
f. – force to leave, drive out
l. – unclean and unhealthy
70
3
Health and medicine
B A sickness by any other name – Use the words in the box to fill in the blanks. Some are very close in meaning, but don’t
give up: items 1, 3, 6, and 7 contain clues that will help you start to work things out.
affliction
ailment
disability
disease
disorder
illness
impairment
1. The word
is an uncountable noun meaning “the condition of being ill (i.e., not in good health)”:
e.g., If your son shows signs of ~, take him to a doctor. Mental ~ is a taboo subject for many people. It can also be used
as a countable noun to refer to a period of ill health: e.g., He died after a prolonged ~.
2.
A(n)
is a specific illness such as influenza or chicken pox or a condition involving the improper
functioning of an organ or system: e.g., ~s like hepatitis and asthma, a heart/lung ~.
3.
The word
is used for an illness that is not very serious (e.g., the common cold); it derives from ail,
which means “to trouble in body or mind”: e.g., “What’s ~ing you?”
4. A(n)
is a disturbance of the normal workings of the body or mind: e.g., a rare nerve ~, an eating ~.
5.
The word
refers to an injury, illness, or condition that restricts the way a person lives: e.g.,
paralysis is a physical ~, dyslexia is a learning ~.
6.
When one’s speech, hearing, or sight has been damaged but not totally destroyed, the word
used: e.g., a speech ~. It derives from impair, meaning “to damage or weaken.”
is
7.
is a formal word meaning “something that causes great physical or mental suffering”: e.g., AIDS
is a terrible ~. It derives from the verb afflict, which is often used passively to mean “suffer from”: e.g., She is afflicted
with diabetes.
C What’s up, doc? – The meaning of most of the words in the green boxes below will already be familiar to you. Discuss them,
and then use them to complete the two texts.
diagnose
fatigue
fever
fracture
A doctor’s ability to (1)
(2)
rash
swelling
symptoms
tenderness
(or identify) a disease depends on an accurate recognition of its
(signs of illness). These may range from signals such as pain, (3)
(higher than normal body temperature), (4)
(extreme tiredness), or (5)
(soreness) of muscles or organs to visible signs such as a (6)
(red spots on the skin) or (7)
(enlargement). X-rays and routine lab tests may turn up a wide variety of other problems, such as a bone (8)
(break) or changes in the cells, nerves, or blood that can only be detected with the aid of a microscope.
alleviate
anesthetize
cure
inject
operate
prescribe
preserve
set
stitch
treat
New doctors must take the Hippocratic Oath, a promise that they will do their best to (9)
(reduce, lessen) suffering and (10)
(maintain) life. Doctors can (11)
(give medical care to) their patients in a variety of ways, but there is no guarantee that they will
(12)
everyone (bring about a full recovery). If the problem is minor, they can
(13)
(recommend the use of) medication or use a syringe to (14)
you with antibiotics. If you cut yourself deeply, they can (15)
your leg or arm is broken, they can (16)
(sew) up the wound. If
it (put it back in place) and immobilize it in a
plaster cast. If the problem is more serious, they may be forced to (17)
unconscious) and (18)
you (make you
(perform surgery).
71
3
Health and medicine
Time out for review
First day of med school
Α “Prosthetic” surgery (verbs ➝ nouns) – Change each verb to a noun by “adding on” one of the noun suffixes in the box
and making other spelling changes as necessary. Then use ten of the nouns to complete sentences 1-8.
-ability
-ation
-ing
-is
-ment
-sion
-tion
ail–
afflict –
preserve – expel – impair – diagnose – treat – starve
prescribe – swell – prevent–
–
disable
–
1. Both of his legs were crushed in the accident, leaving him with a permanent
2. Since the explosion, she’s suffered from a serious hearing
.
.
3. Look at your finger! It’s twice the size it usually is. What caused the
4. His refusal to study resulted in his
?
from medical school.
5.
In the United States, you can buy medicines for common
to get a
from your doctor.
s (e.g., colds or the flu) without having
6. My family doctor is fond of saying that
is by far the best
for disease.
7.
Doctors sometimes face a difficult moral dilemma. Which should be their higher priority: the alleviation of suffering or the
of life?
8.
The civil war in this poor African nation is a terrible
many villagers will die of
.
. If food supplies don’t reach the area soon,
B Medical mix and match – In part 1, pair up the adjectives and nouns to fill in the blanks with common adjective + noun
combinations. In part 2, pair up the verbs and nouns.
1.
Adjectives
fractured
learning
preventive
prolonged
routine
Nouns
bones
disability
examination
illness
medicine
a. There’s nothing wrong. She’s just seeing her physician for a
.
b. The writer died after years of suffering from a
.
c. Dyslexia is a common
.
d. X-ray technicians frequently deal with patients who have
e. The goal of
2.
.
is to avoid disease by promoting strategies for healthy living.
Verbs
alleviate
diagnose
induce
perform
take
Nouns
an oath
disease
pain
surgery
vomiting
a.
Modern imaging techniques such as CAT scans and MRIs enable doctors to
much more accurately than they could in the past.
b.New doctors must
in which they promise to do their best to
and suffering.
c.
If you suspect that someone has accidentally swallowed poison, call the Poison Center immediately. Do not
unless a qualified person tells you to do so.
d.
The Smiths were relieved when the surgeon told them it would not be necessary for him to
on their year-old infant.
72
Health and medicine
Writing (1)
3
Paragraph development
SKILLS FOCUS
Linking: The power of complex sentence structure
In addition to assessing your ability to organize and develop your ideas in a series of
well-structured paragraphs, ECPE examiners will also be looking for evidence of your
ability to use a range of complex sentence structures. This section will give you practice
in combining simple ideas into complex sentences. It will also remind you of some of the
structures you can use to make your writing richer and more varied.
How can I link thee?
Let me count the
ways ...
Warm-up − In pairs, combine each set of sentences into one sentence. Then compare answers with several other pairs. Discuss
the different solutions and decide whose is the most effective. What structures did you use to combine your ideas?
1.The first category includes certain diseases. Some of these are pneumonia, cholera, AIDS, and influenza. These are caused
by microscopic organisms. The microorganisms are known as germs.
The first category includes
2.Sometimes a disease can be “communicated” or passed from one person to another. This kind of disease is known as a
communicable disease.
When a disease
3.There is another word. It is commonly used to describe such diseases. The word is contagious. It means “catching” or “able
to be spread by direct or indirect contact.”
Another word
Α Try it! − On notebook paper, combine the simple sentences below into a paragraph with fewer, but more complex sentences.
When you finish, compare answers with several other students, and decide whose answer is most effective.
There is the second large category. It includes diseases. Some of these are cancer, diabetes,
cirrhosis, and heart disease. There are also others. They are not caused by living organisms.
They are known as non-infectious disease. They are now the leading cause of mortality (or
loss of life) in the industrialized world. Not all causes of these diseases are known.
Scientists have found out some things. Some can be traced to long-term exposure to harmful
substances. These substances are found in the workplace or environment. Here is an example.
Miners breathe in coal dust. They do this for many years. They may develop a disease. It is
called “black lung.” Other diseases may stem from another thing. It is known as “harmful
lifestyle.” The following is now widely accepted. Smoking, alcohol, overeating, lack of
exercise, and stress are harmful habits. They make people susceptible to a wide range of
chronic and potentially fatal disorders.
Asking for troubl
e ...
Analyze it! − Look at your work and see if you used any of the following. If not, what other structures did you use?
B compound sentence
impersonal passive
noun clause
pronoun reference
relative clause
reduced participle clause
prepositional phrase
73
3
Health and medicine
Vocabulary (1)
Anatomy 101
Warm-up – In pairs or small groups, discuss the questions, and then share your answers with the class.
1. How does human life begin and what happens as the single-celled life starts to develop in its mother’s body?
2. What do you know about DNA, genes, and chromosomes?
Α In the beginning – Read the two texts below. Then match the boldfaced words with their meanings.
1. Human life is the sum of many individual cells organized in specific ways. It begins with fertilization, when
the nucleus of a sperm cell combines with the nucleus of an ovum (or egg). The result is a zygote, a single
cell that contains hereditary (or genetic) material from both parents: 23 pairs of chromosomes, each of which
consists of a single, long, thin, twisting bit of DNA. DNA is an amazingly complex chain of chemicals that is
uniquely different in each and every living thing. This is because the genes that we inherit from our parents are
incorporated into the DNA molecule that makes up each chromosome. How the zygote develops is determined
by the unique combination of genes that are in its DNA. It’s as if the genes carry with them a detailed genetic
“blueprint” (or building plan) that controls what happens at every stage of the new organism’s development.
a. – deoxyribonucleic acid
f. – baby “starter” cell
b. – small unit of living matter
g. – conception, start of new life
c. – female reproductive cell
h. – central part of cell
d. – male reproductive cell
i. – inherited, passed on
e. – thin structures of DNA that
j. – subunits of DNA that contain
carry genetic information
inherited characteristics
2. A
bout thirty hours after conception, the single-celled zygote divides into two cells, which divide into four, then
eight, and so on until a hollow ball of cells called a blastula is formed. The blastula attaches itself to the wall of
the mother’s uterus, where it continues to develop: first into an embryo and later into a fetus, until it is born
as a human infant nine months later. Development within the uterus occurs in the amniotic sac, through which
the embryo receives nourishment from its mother’s body via the umbilical cord. The process is nothing short of
miraculous. Following the blueprint in the genes, the new cells are like “do it themselves” building blocks. By the
second week, they have already formed into groups and become specialized units known as tissues, from which
the skin, bones, nerves, muscles, blood, and other parts of the body will form. By the end of the first month, all
major organs have begun to develop. The eyes are visible, arms and legs have begun to bud, and the heart has
already begun to beat.
a. – baby – early prenatal1 phase
b. – baby – later prenatal phase
c. – baby – birth to two years
d. – food needed for growth
e. – specialized masses of cells
f. – organ in which baby develops
g. – sac in (f) where baby develops
h. – what “ties” baby to mother
1
74
– before birth
c.
mniotic sa
Fetus in a
l cord?
e umbilica
h
t
e
e
s
u
o
Can y
Health and medicine
3
B All systems go! – This section is designed to acquaint you with the major systems and organs of the body so they come as
no surprise if you encounter them on an exam.
Warm-up – Work in pairs or small groups, and then share your answers with the class.
1.Without looking at the texts in this section, make a list of the vital organs you know in English. What function does each
one perform?
2. Describe some of the systems that help the body function. Which do you find most fascinating?
As you work through the texts on pages 75-77, use a word from the box to fill in the name of each system. Then label the
diagrams with the boldfaced words. (You may want to write equivalents in your own language next to the English labels.)
circulatory
digestive
muscular
nervous
1. The
system provides the body
with support and protection of its vital organs
and the
system enables us to
move. The adult human skeleton is composed
of 206 bones that are bound together by tough
bands of tissue called ligaments. The places
where bones join together are known as joints.
Movement depends on the contraction (or
tightening) of the skeletal muscles, which are
attached to the bones by tendons. The bones
are filled with a fatty substance called bone
marrow, where red and white blood corpuscles
(cells) are produced.
respiratory
skeletal
b.
a.
e.
a.
2. The
system is a vast network
in which billions of neurons (or nerve cells)
in the brain communicate with millions more
in the rest of the body to transfer sensory
impressions, control muscle movement,
and regulate involuntary processes such as
heartbeat, breathing, digestion, and hormone
production. The system is divided into two
subsystems: the central nervous system
(consisting of the brain and spinal cord)
and the peripheral nervous system (which
extends throughout the body). The three
main areas of the brain are: the cerebrum
(or forebrain, which includes the cerebral
cortex or brain surface); the brain stem
(midbrain); and the cerebellum (hindbrain).
b.
d.
c.
f.
75
3
Health and medicine
3. The
(or cardiovascular)
system serves a dual purpose: first, to circulate oxygen-rich,
nutrient-laden blood to all parts of the body and, second,
to carry carbon dioxide (CO2) and other waste away from
the cells. The system includes: the heart, a four-chambered
muscular organ that pumps blood through the system; the
lungs, or breathing organs, which filter CO2 from the blood
and replace it with oxygen; and a complex network of blood
vessels through which the blood flows. The latter consists
of arteries, which carry oxygen-rich blood away from the
left side of the heart; veins, which carry oxygen-poor blood
back to the right side of the heart, where it is sent to the
lungs for oxygenation; and tiny, hair-like capillaries that
connect the arteries and veins.
➝
➝
a.
b.
c.
d.
4. T
he
system is responsible for breathing. Air is sucked into the nose and
mouth and down through the trachea (or windpipe), which divides into two long, hollow tubes called bronchi
(plural of bronchus), which extend into the lungs. Inside each lung, the bronchus branches out into smaller
and smaller tubes called bronchioles, which end in small air balloons known as alveoli (plural of alveolus).
These are surrounded by tiny blood vessels known as capillaries, through which oxygen enters the blood and
carbon dioxide is removed. Inhalation (breathing in) and exhalation (breathing out) are controlled by the
diaphragm, a large muscle under the lungs.
a.
b.
a.
c.
b.
c.
d.
d.
e.
e.
f.
f.
g.
g.
76
Health and medicine
3
5. The
system breaks food down so it can be absorbed by the body’s tissues. The
process begins in the mouth, where food mixes with saliva from the salivary glands and is broken up by the
teeth and tongue. After it is swallowed, the food travels down the esophagus to the stomach, where it is acted
on by gastric acid. It then passes into the small intestine, where much of it is absorbed into the blood. Other
organs help out by producing chemicals called enzymes that flow into the small intestine: the liver (a large
organ on the right side of the abdominal cavity that produces bile, which breaks down fats); the gall bladder
(a small sac under the liver, which stores bile until it is needed); and the pancreas, which produces fluids
that break down protein, fat, and starches. Unabsorbed food passes into the large intestine, where water and
minerals are absorbed into the blood. The remaining solid waste exits the body through the rectum.
a.
b.
c.
d.
e.
f.
C Other systems in brief – Match the words in the box with the descriptions
endocrine system
immune system
reproductive system
urinary system
a. –helps the body defend itself against antigens (disease-causing germs). Includes
various white blood cells, such as phagocytes and macrophages (which surround
lymphocytes, which make antibodies).
b. –relieves the body of liquid waste known as urine via the bean-shaped filters called
kidneys and the bladder (a muscular organ that stores urine until it is ready to be
expelled).
c. –secretes hormones into the blood by means of chemical-producing sacs called
glands. Included are the pancreas and glands such as the pituitary, thyroid, and
adrenals.
d. –enables the body to produce new life (see page 74 for more information).
77
3
Health and medicine
Grammar (1)
Clauses (Part I)
Α Noun clauses – A noun clause always acts as part of a main clause. It functions in one of these ways:
How a patient will react is of great concern to the doctor.
as subject as complement The real test is whether or not he’ll listen to the doctor.
It seems/appears (that) the patient will live.
as object of a verb I believe (that) he’s putting his health at risk.
We just don’t understand why people continue to smoke.
as object of a preposition She’s afraid of what the doctor is going to say.
after opinion adjectives
I’m sure (that) the doctor will be here soon.
He’s afraid (that) his injuries are serious.
in reported speech
He said (that) he would have to operate.
She asked me where the pain was.
Links
Notes
that, how, however, if/whether/whether or not, what, when, where, which,
who, why, whatever, whenever, whichever, whoever
1.Subject noun clauses are singular and require a verb in the third-person singular. Exception: sentences with compound subjects (see examples on blackboard).
2.Many of the linking words used with noun clauses are question words, but the structure remains:
link + subject + verb. In other words, there is no need for inversion.
was
1.What I asked him were confidential. ^
are
Where I went and what I did is not your concern.
^
s
2.I don’t understand why does he
keep on doing that.
^
How will a patient react is of great concern to a doctor.
I’m worried about what will she do when she finds out.
Practice 1 – Underline the errors and make corrections on the right, as needed.
1. Did she say was he in which hospital?
2. I wonder does he know a good pediatrician?
3. Who told you that were they seriously mistaken?
4. What does he say and what does he do are two different things!
5. I’d like to know what doctor did you see. 6. It’s unclear how long has he been ill. Practice 2 – Underline the noun clause in each sentence. Then choose the correct linking word.
1. I promise to do exactly
2.
the doctor says. the doctor suggests is all right with me. 3. Can they explain
the patient died so suddenly? that – what – whatever – how
That – When – Whatever – How
whether – what – that – why
4.
she’s still alive is something of a miracle. That – However – If – That which
5.
you begin treatment is up to you. Is next week OK?
However – Whatever – That – When
6. It’s not clear
78
they are going to operate or not.
when – whether – where – that
Health and medicine
3
B Relative clauses – A relative clause describes a noun or pronoun, and is positioned directly after the word it describes. It
may also serve as the object of a prepositional phrase that relates back to a noun or pronoun. A relative clause is linked to
the word it modifies by means of a relative pronoun or a relative adverb (see “Links” below). There are two main types:
•The defining relative clause provides information that is essential to the meaning of the noun or pronoun it modifies. It
is never set off with commas. For example:
Dr. Smith was the surgeon who/that performed the heart transplant.
The doctor whom/who/that you recommended is excellent.
She saved a patient whose kidneys were failing.
That’s the hospital where I was born / in which I was born / (that/which) I was born in.
•The non-defining relative clause provides information that is extra and not essential to the meaning of the word it
modifies. It is always separated from the main clause by commas. For example:
The AIDS epidemic, which once affected mainly gay people, has spread to heterosexuals.
Mary, whose sister is a cardiologist, has decided to specialize in orthopedics.
The two men, both of whom are gynecologists, are close friends.
Links
Notes
Relative pronouns For people: who, that, whom, whose
For things/animals: which, that, whose
Relative adverbs when, where, why
1.
That can be used instead of who, whom, or which, but it is never used after commas or prepositions.
2.
Whom (for people) and which (for things) must be used after a preposition.
3.When a relative pronoun acts as the subject of a relative clause, the clause cannot have a second subject.
who
1. Ann Lee, that lives on my block, is a nurse.
^
whom
2. She’s the doctor on who I depend.
^
3.
ItwasDr.Smithwhoheperformedtheoperation.
He’s afflicted with a disease that it has no cure.
Practice – Underline the word or phrase that best completes each sentence.
1. The patient
was waiting for a heart transplant. 2. The disease,
once in decline, is now back in full force. 3. That’s Dr. Green,
in charge of the Emergency Room. 4. She’s a doctor
5. The pills
you can put your complete trust. prescribed for me have terrible side-effects. died – which died – that he died – who died
that was – which it was – which was – it was
whose – whose wife is – his wife is – who he is
that – whom – in whom – in who
who were – she – whom she – which
6. The woman
you are speaking is a pediatrician.
that – who – to who – about whom
7. The disease
suffers from is incurable.
from which he – which he – that he is – that
8. Psoriasis is a skin disease
is unknown. 9. Ten cases were reported, seven
10.
He’s the patient
were fatal. Dr. Casey operated. its cause – the cause – whose cause – which
whose – in whom – which – of which
on whom – that – on which – whose
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C FROM THEORY INTO PRACTICE – Now let’s look beyond the basics and see how noun clauses and relative clauses might
be tested on the exam. For items 1-12, circle the correct choice (a-d).
Noun clauses – Expect a range of questions testing topics such as: appropriate tense in a that clause (especially after
modals or wishes); word order with noun clauses introduced by interrogative words; clauses with if/whether and equivalent
structures; and noun clauses as subjects in long complex sentences. Also expect questions to contain wrong choices based
on alternative structures (e.g., with gerunds or infinitives).
1. He ought to admit
the window.
a. he broke
c. he break
b. that he breaks
d. him breaking
2. The report showed
to smoke.
a. how is it risky
c. that it is how risky
b. how risky it is d. that how it is risky
3. “Did the physical therapist give you exercises for your back?”
“Not yet, but she told me
.”
a. not what to do c. that I shouldn’t do
b.
not what I should do
d. what I shouldn’t do.
4.
a vacation this year depends on how much money I save.
a. If I don’t take
c. Whether or not I take
b. Should I not taked.
To take
5. We couldn’t decide
to the party or stay home.
a. whether we should go
c. whether we go
b. if we went
d. between going
6. You should call him
you want to or not.
a. even if
c.either
b.whether
d. in case
Relative clauses – Common question types range from simple items that test a missing relative pronoun or adverb with or without
a preposition (e.g., who, to whom, whose, in which, where) to more complex items that test both structural and lexical issues.
7. Ann Baxter is the name of the doctor
son I live next door to.
a. that her
c. to whose
b. whose d.
whom her
8. “Can you apply for the nursing program at any time?”
“No, there’s a special date
your application must be submitted.”
a. when byc. in that
b. at which
d. by which
9. I’ve read a lot of articles lately, the most interesting
a. of which
c. of that
b.that
d.it
was about new cancer treatments.
10. Bob just graduated medical school,
no one else in our family has ever done.
a. that c.which
b. who d. from which
11. The hospital has hired ten new lab technicians,
just finished college.
a. who most had
c. the most of them had
b. most of whom have
d. that most have
12. One issue that
is the reappearance of diseases like malaria and smallpox.
a. it is concerning us
c. concerns us
b. is concerned about
d. it is of concern to us
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Health and medicine
Cloze
3
Easily confused words and word forms
ECPE multiple-choice cloze questions often ask you to distinguish among words and word forms that are easily confused with
each other. For example:
•At sentence level, you may be asked to choose among different forms of the same word (e.g., cure – curative – curable
– incurable or decimated – decimate – decimation – decimating) or words that are similar in meaning but collocate with
different prepositions and/or verb structures (e.g., afflicted with vs. suffer from or capable of doing vs. able to do).
•At discourse level, you may be asked to choose among words with closely related meanings (e.g., treatment – remedy
– cure or rise – arise – arouse) or words that sound or look somewhat alike but have different meanings (e.g., infect – infest
– invest). You may also have to discriminate among phrasal verbs or collocations to see which best fits the context.
You can maximize your chances of answering such questions correctly by following a few simple rules.
SKILLS FOCUS
Tackling easily confused words and word forms
Always take the time to analyze the choices and the context surrounding each blank to determine whether you are being tested at
the sentence level or discourse level.
At sentence level:
w
Always check to see what part of speech is missing. This is particularly important if you are asked to choose between
different forms of the same word. Eliminate any choices that are obviously wrong. Then study the context carefully to make
sure the meaning of the form you choose is logical and appropriate.
w
Note whether or not a preposition follows the blank. If it does, then make sure your choice agrees with it. Test-makers
frequently test collocations (or set phrases) with this type of question.
At discourse level:
w
Try to predict the meaning of the missing item. You can do this by studying the surrounding context.
w
Use the context and what you know to rule out any obviously wrong choices. Of course, there’s no “better medicine”
than knowing what all the choices mean. But if you do come across unknown phrasal verbs or other lexical items in the
choices, then there is nothing wrong with narrowing down the choices based on knowledge that you do have and then
making an educated guess. Each choice you can rule out improves your chance of answering correctly by 25%!
Part of speech?
Don’t panic!
Preposition after the blank?
Obviously wrong choices?
Which one?
Which choices can be ruled out?
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Health and medicine
Α CLOZE PRACTICE (1): Easily confused word forms
STEP 1: Skim the text without looking at choices 1-5. Then answer the following questions.
1. What problem do villagers in southern Sudan face?
2. How does the current situation compare to the situation during the 1980s?
STEP 2: Now work through the text. Use hints 1-5 to help you narrow down your answers.
Droves of villagers throughout Western Equatorial Southern
Sudan are being screened and entered into treatment for sleeping
sickness by doctors and nurses from the International Medical
Corps. An estimated 12,000 people in the Tambura region are
__(1)__ with sleeping sickness, and hundreds of thousands more
are at extreme risk of contracting the potentially __(2)__ parasitic
disease from infected tsetse flies. Since October 1997, treatment
and __(3)__ efforts have been focused on the town of Ezo in
southern Sudan, the presumed epicenter of this recent __(4)__ of
sleeping sickness. The disease has remained uncontrolled since
1989 when civil war in Sudan forced the __(5)__ of a Belgian
healthcare team who had been working for almost ten years to
eradicate it.
1.a. suffering c.afflicted
b. suffered d.afflicting
2.a. fatality
c.deathly
b.
fatalistic
d.deadly
3.a. eradicated
c.eradicable
b.
eradicate
d.eradication
4.a. resurgence
c.stimulated
b.
resurgent
d.stimulation
5.a. withdrew
c.withdrawn
b.
withdrawal
d.withdraw
Hints
1. Note the with after the blank and the fact that you’re being asked to choose between the -ed and -ing forms of two different
verbs. Also note the are before the blank. Now ask:
• Which two choices collocate with from and can thus be ruled out?
• Which of the others fits the context: the active -ing form or the passive -ed form?
2. Careful! An adjective is needed to complete the phrase potentially ... parasitic disease, but two of the choices look like
adverbs as they end in -ly. Before you panic, remember that some adjectives do end in -ly (daily, monthly, etc.). Consider the
following:
• Which is clearly a noun and should be ruled out?
• Which means “pessimistic” and should be ruled out?
• Which means “fatal, likely to cause death” and thus fits the context?
3. Logically you’re looking for an adjective (or perhaps a noun that acts as an adjective) to collocate with the word efforts.
That rules out the verb eradicate (meaning “totally destroy, put an end to”). Try writing definitions for the phrases below, and
choose the one that logically suits the context.
• eradicated efforts –
• eradicable efforts –
• eradication efforts –
4. Review your answers to the questions in Step 1. Then consider the following:
• What part of speech is needed to complete the prepositional phrase before the blank?
• Which two choices can you rule out?
• Which of the others implies a sudden strong reappearance of an old problem?
5. What part of speech is needed in the blank?
Which three choices can automatically be eliminated?
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Health and medicine
3
B CLOZE PRACTICE (2): Easily confused words
This exercise contains discourse-level questions that test vocabulary. Finding the right answers depends not only on your
ability to discriminate among the meanings of the four choices but also on your ability to understand the text well enough to
determine the meaning that is required in each blank.
STEP 1: Skim the text without looking at choices 1-6. Then answer the following questions.
1. Why is it that whooping cough is not the “killer childhood disease” that it once was?
2. Why does it now affect so many adults?
STEP 2: Now work through the text. Before choosing an answer, match each choice to its meaning in the hints below. Then
check the surrounding sentences carefully, and choose the word that best fits the context.
If you have a cough that just won’t go __(1)__ , it could be
pertussis, more commonly known as whooping cough. According to
a recent medical report, one quarter of adults who see their doctor
for __(2)__ cough actually have this bacterial __(3)__ . Once a
killer childhood disease, whooping cough has been in decline for
years due to widespread vaccination of children. But the immunity
can wear __(4)__ in time, and the number of reported adult cases
has been on the __(5)__ recently. In an otherwise healthy adult,
symptoms include coughing, low-grade fever, and runny nose. The
bacterial infection can be treated with antibiotics, which renders it
less contagious and therefore less of a threat to __(6)__ infants.
1.a. back
b. away
c.down
d.off
2.a.resistant
b.defiant
c.consistent
d.persistent
3.a.infestation
b.inflammation
c.infection
d.infraction
4.a.out
b.off
c.away
d.down
5.a.wane
b.verge
c.rise
d.move
6.a.unvaccinated
b.irresistible
c.resisting
d.inoculated
Hints
1. go
–decrease
4. wear
– become weak, thin, useless
go
– return
wear
– become thin/hard to see
go
– leave
wear
– become weak, tired, strained
go
–explode
wear
– become ineffective, disappear
2. – rebellious
5. on the
–about to experience/happen
– unchanging, steady
on the
– in motion
– continuing, chronic
on the
– increasing
– (things) unaffected
on the
– decreasing
3. – redness, soreness
6.
– charming, attractive
– disease, illness
– not immunized
– breaking of a rule/law
– opposing, fighting back
–invasion of insects or
animals
–immunized (protected against
illness)
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Health and medicine
Vocabulary (2)
In sickness and in health … until death do us part
Α Sicknesses and symptoms – Hippocrates would have recognized some of the ailments in the box from his knowledge of
Greek. Which ones are you familiar with? Share your knowledge with your classmates.
arteriosclerosis
epilepsy
hemophilia
sinusitis
sleeping sickness
stroke
Now skim each text and fill in the missing disease. Then read each one a second time and match the boldfaced words with their
meanings. (Note: Unless noted, the boldfaced words are nouns.)
1. (or “brain attack”) is America’s third leading cause of death (after heart disease and
cancer) and the leading cause of adult disability. More than 500,000 Americans are afflicted and nearly 150,000
die each year. Despite this grim toll, however, it ranks low in the public’s awareness. Many lives might be
saved if more people recognized the following warning signs: difficulty speaking or understanding even simple
sentences; sudden weakness, numbness, or paralysis of the face, arm, or leg; sudden dimness or loss of vision,
particularly in one eye; a sudden, severe headache; and temporary dizziness or loss of balance or coordination,
especially if occurring along with one of the other warning signs.
a.
– light-headed, spinning feeling
d.
– loss of physical feeling
b.
– ability to control arms/legs
e.
– number killed or injured
c.
– lack of brightness
f.
– (pp) made to suffer
2.
is a chronic brain disorder characterized by repeated seizures (or convulsions). The
seizures can occur as a result of underlying brain damage or a structural brain lesion or as part of a systemic
medical illness; in some cases they appear to have no organic cause. Seizures differ with the type of condition
and may consist of loss of consciousness, jerking of parts of the body, emotional explosions, and/or periods
of mental confusion. In individuals suffering from the disease, the brain waves, which are manifestations of
electrical activity in the cerebral cortex, have an abnormal rhythm produced by excessive nerve-cell discharges.
a. – wound, injury
d.
– sudden attacks (of this disease)
b. – sudden, quick moving
e. – clear indications
c. – emissions, things sent out
f. – state of being aware
3. , officially called African trypanosomiasis, has again become one of Africa’s biggest public
health scourges. It begins with the tsetse, a fly with a nasty taste for blood. If your fly is carrying the trypanosome
parasite, its bite can transmit the disease. If left untreated, it can put you on course for a slow, agonizing, and
certain death. An unpleasant, flulike feeling sets in as you fight a foe that multiplies and tricks your immune
system by changing its outer coat. Sooner or later, parasites inflame your brain, causing weird changes in your
behavior, personality, and sleep patterns. You sink into a zombielike apathy and eventually lapse into a coma that
ends in death. The World Health Organization estimates that each year 250,000 to 300,000 are left to suffer and die
because their illness has gone undiagnosed and untreated.
a. – enemy
e. – (adj) causing great suffering
b. – state of deep unconsciousness
f. – (v) pass along to sb/sth
c. – things that causes great suffering
g. – (v) pass/fall (into a worse state)
d.
– state of total indifference
h. – (v) cause swelling, pain, redness
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3
4. (or inflammation and congestion of the cavities of the cranium around the eyes) may follow
a cold or occur independently but be misdiagnosed as a lingering cold. As with ear infections, several strains of
bacteria that cause this condition have developed resistance to older antibiotics, resulting in chronic and recurrent
infections. Fever, chills, thick nasal discharge, and pain around the eyes are the hallmarks.
a.
– skull, head bone
e.
– empty spaces in something solid
b.
– painful redness and swelling
f.
– kinds, types, breeds
c.
– distinctive characteristics
g.
– (adj) slow to leave; drawn-out
d.
– state of being blocked/full
h.
– (adj) repeated, reappearing
5. is a hereditary blood disease
characterized by the inability of the blood to clot. This
leads to massive bleeding, even from minor injuries.
The disease is caused by an insufficiency or absence
of certain blood proteins that aid in blood clotting. The
bleeding may occur as excessive bruising or persistent
bleeding after a simple cut. Hemorrhaging into joints
and muscles can be disabling. Before the advent of
modern therapy, the chance of surviving to adulthood
was poor.
a. – bleeding in large amounts
b. – blackish-blue marks on skin
c. – arrival of sth important
d.
– (v) thicken, form lumps
e. – (adj) inherited
f. – (adj) continuing non-stop
6.
The major form of heart disease in the West is atherosclerosis, in which fatty deposits called plaque (made up of
cholesterol and fats) build up on the inner walls of the coronary arteries. Atherosclerosis is actually a form of
, or “hardening of the arteries.” In atherosclerosis, narrowing of the arteries gradually
restricts the blood flow to the heart. Symptoms may include shortness of breath and a tight pain in the chest
called angina pectoris. The plaque may become thick enough to totally obstruct the artery, causing a sudden
decrease in the heart’s oxygen supply. Obstruction can occur when a piece of plaque breaks away and lodges
further along in the artery. This is the major cause of heart attack, which is often fatal. Survivors must undergo
extensive rehabilitation, and there is always the risk of a recurrence.
a. – repetition, happening again
e. – (v) limits, confines
b. – layers of built-up matter
f. – (v) becomes stuck
c. – recovery process
g. – (v) block, impede
d.
– blockage
h.
– (v) experience, be put through
Symptoms synonymous – Each group contains three words that have something in common and a fourth that is unrelated.
Underline the “odd one out,” and be ready to explain what the other three have in common.
1. lingering temporary chronic persistent
2. resistance protection immunity susceptibility
3. seizure wound injury lesion
4. scourge rehabilitation suffering affliction
5. symptom manifestation diagnosis hallmark
6. restriction recurrence obstruction blockage
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Health and medicine
B Routine check-up (preposition and particle practice) – The paragraphs below contain useful health phrases. Use the
words in each box to fill in the blanks. Some may be used more than once.
1. down
in
over
to
under
up
If you’re healthy, you can say you’re
good health or
good shape/condition. If you’re feeling ill,
you can say you’re feeling
the weather, run
, or not quite
par. In
extreme cases, you may feel like death warmed
(or warmed
, in British English).
2.
above
down
from
in
of
out
If you think you’re coming
wrong
over
to
up
with
something, you’d better have a check-
you. Chances are you’re only suffering
but most doctors will want to look you
you are
under
a common cold or a touch
the flu,
carefully. They’ll ask you if your temperature is
pain. They may also ask if you are short
Then they’ll subject you
to see what’s
breath or if you are
normal or if
stress at work.
a physical exam. Before prescribing anything, they’ll ask if you are allergic
any medications.
3.
at
for
from
in
of
on
to
under
If doctors suspect something serious, they may refer you
a specialist, who may want to operate
you. In this case you’ll need to be scheduled
surgery and admitted
a hospital. Before the
operation, you will be put
anesthesia. If all goes well, you will be discharged
the hospital
a matter
days and back
your feet
no time
all.
4.
against
from
in
to
up
Children are vaccinated early
life to build
their resistance (or immunity)
diseases. Elderly people who have weak immune systems and are susceptible
to get an annual flu shot to protect themselves
5.
at
for
of
respiratory infections may want
) infection.
to
A great number of ailments are attributed
cancer
(or
certain
smoking. Smokers run the risk
the lungs. Passive smokers are also
risk
developing heart disease and
these diseases.
C Anatomical idioms – Complete the sentences with words from the box. When you finish, go back and underline the idioms
and discuss what each means. Do any have equivalents in your own language?
chest
ears
elbow
1. She finds it hard to
finger
heads
lungs
thumbs
.
4. You’ll feel better if you get your problems off your
.
5. Upon seeing the mouse, she screamed at the top of her
6. Tell me the good news. I’m all
.
!
7. Michael is always dropping things. He’s all
.
8. The spoiled girl has her parents wrapped around her little
86
shoulder
are better than one.
3. If you need to, you can always cry on my
10. Good journalists know how to
stomach
movies that have a lot of violence.
2. Perhaps I can help. Two
9. The eager photographer had to
nose
.
his way through the crowd.
out a good story.
All but two of the body parts in the box
are shown in the picture. Which are not?
Health and medicine
Grammar (2)
3
Clauses (Part II)
Α Adverbial clauses and related structures – Adverbial clauses and related structures (e.g., prepositional phrases and
infinitives of purpose) can be used to express a wide range of functions, such as time or place, reason or purpose, and so on
(see chart below). When tackling a grammar or cloze item that involves one of these structures, it’s important that you focus
on the incomplete clause or phrase and try to work out what its role is. For example:
•
Does it express an action that happens before or after an action in the main clause?
•
Does it present information that contrasts with the main idea?
•
Does it explain why something happens in the main clause?
Recognizing the function and, in turn, knowing what linking words can be used to introduce this function will help you
choose the option that best fits the meaning of the gapped sentence.
Here is a summary of the main functions and their links. (For examples of sentences in which these links are used, see Grammar
Reference, page 171.)
Function
Question prompt and common links
Time
When? – before, after, as, as long as, as soon as, by, by the time, the minute, the moment, once, since,
till, until, when, whenever, while
Place
Where? – where, wherever
Reason
Why? – as, since, because, for, now that, because/due to/owing to the fact that
Related structures: because of/due to/owing to + noun/-ing
Purpose
For what purpose? – in case + present/past; so that + can/will or could/would; for fear (that)/lest +
might/should
Related structures: to/in order (not) to/so as (not) to + base form; in case of + noun; with a view to/
with the aim of + -ing; for + -ing, for fear of sth /-ing sth, to prevent sb from + -ing, to avoid + -ing
Result
So/Such … that what happens? – that (after so/such), so
Concession
and Contrast
Although what contrasting condition exists? – although, even though, though,
in spite of/despite the fact that, while, whereas, however/no matter how … ,
whatever/no matter what … , adj/adv + though/as + subject + verb
Related structures: in spite of/despite + noun/-ing, regardless of
Manner
How? In what way? – as, as if, as though, in that
Practice – Underline the adverbial clause in each item, decide its function, and underline the best answer. Function
1. The baby was born
2. they got to the clinic. whenever – until – before – while
However – Wherever – When – Though
she is overweight. because – despite – in case – that
his excessive smoking. in case of – due to – for fear of – despite
in case of – despite – as – to avoid
though – although – if – as though
Whenever – However – Though – As
so as to – with a view to – to – for
in that – despite – due to – for fear that
Once – Before – Since – Now that
doctors go, people ask them for advice. 3. Ann eats so much
4. He coughs a lot
5. She gave me her number
6. She looks
7. she is going to faint.
ill he was, he insisted on going to work.
8. She studied hard
becoming a doctor.
9. He put off seeing the doctor
10.
an emergency. he was ill!
he begins treatment, he’ll feel much better.
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B Participle clauses – Participle clauses are formed with present (or -ing) participles and past participles. They are reduced
forms of relative and adverbial clauses.
Study the examples, and discuss the differences you see between each full and reduced form.
1. PARTICIPLE CLAUSES that are reduced forms of RELATIVE CLAUSES
•
•
Relative clause (active voice)
Reduced form (with -ing participle)
Ed is on the train that is arriving now.
→
Ed is on the train arriving now.
Anyone who attended the class was bored.
→Anyone attending the class was bored.
Eve, who lives in a village now, is very happy. →
Living in a village now, Eve is very happy.
Relative clause (passive voice) Reduced form (with past participle)
Al’s wearing a tie which was bought by Sue. →
Al’s wearing a tie bought by Sue.
Ed, who was born on July 4th, is a real patriot.
→
Born on July 4th, Ed is a real patriot.
2. PARTICIPLE CLAUSES that are reduced forms of ADVERBIAL CLAUSES
•
lauses with while and active clauses
C
with because, as, since
Reduced form (with -ing participle)
They discussed work while they had lunch. While having lunch, they discussed work.
Because/Since I felt ill, I stayed home. →
Feeling ill, I stayed home.
As/Since I’m not rich, I can’t buy a Porsche.
→
Not being rich, I can’t buy a Porsche.
Note 1
To reduce a clause whose subject is different from the subject of the main clause, we must place the subject before
the participle.
Since it was dark, they walked quickly.
Note 2
•
→
It being dark, they walked quickly.
→
To emphasize that the action in a reduced clause occurs before the action in the main clause, we use the perfect
form of the participle: i.e., having + past participle:
He felt better as he had seen her.
→
Passive clauses with because, as, since
Having seen her, he felt better.
Reduced form (with past participle)
Because/Since he was fed up, he quit his job.
→
Fed up, he quit his job.
As he was exhausted, he went straight to sleep.
→
Exhausted, he went straight to sleep.
Practice: Anatomy of a not-so-broken heart – Complete the story with the present (-ing) or past participle form of the verbs in
parentheses. Pay special attention to the time markers in bold (see Note 2 above).
(1)
(determine) to work things out, the quarreling couple had agreed to meet. Now, (2)
(sit) in his home, they chatted quietly. When the mood seemed right, he pulled her close … and that’s when everything
changed! Without warning, she pulled away, (3)
(slap) him hard. (4)
(discover)
the day before that he had another girlfriend, she knew that her love for him had died. (5)
(stun), he
watched her slam the door and walk out of his life forever. On the street below, it now (6)
3 a.m., our heroine failed to find a taxi, so she set out on foot. (7)
contemplated her stupidity. After all, (8)
have known better. (9)
disgust: “Women (10)
88
(be)
(trudge) through the darkness, she
(end) her last relationship in the same way, she should
(arrive) home after a two-hour trek, she grabbed her diary and wrote in
(decide) to break off a relationship should do so early in the evening.”
Health and medicine
3
C FROM THEORY INTO PRACTICE – Now let’s look beyond the basics and see how adverbial clauses and participle clauses
might be tested on the exam. For items 1-12, circle the correct choice (a-d).
Adverbial clauses – Question types range from items that ask you to fill in the correct link to more complex items that test
both structural topics (e.g., word order, tense, related structures) as well as lexical issues. Answers often contain lowerfrequency linking words (e.g., once instead of as soon as, or since instead of because), while wrong choices are often
structurally possible but illogical in context.
1.
he cancelled tomorrow’s meeting, let’s meet to discuss sales.
a.Since
c. Once
b.After
d.When
2. We can leave
a.until
b. since you finish packing.
c.afterwards
d.once
3.
I planted a hedge, people could see into my yard.
a.Whenever
c.Until
b.Since
d.Because
4.
the doctor’s optimism, the patient did not recover.
a. Although c.Regardless
b.Despite
d. On the contrary
5. Eve ran
she could to help the old man.
a. so fast that
c. faster so
b. as fast as
d. faster than
6. The nurses are on strike because of
happy with pay cuts.
a. they weren’t c. they hadn’t been
b. not to be d. their not being
Participle clauses – Items testing participle clauses seem to be on the rise in recent years. Always start by analyzing what is
in the question stem. Then try to predict the full form of what is missing. If choices start with both past and present participles,
use what you know about participle reductions to help you narrow down the choices.
7.
from working six hours straight, she finally took a break.
a. She was tired
c. Tired
b. Had she been tired
d.Tiring
8. The people
a.waited
b.waiting
for the bus looked tired and upset.
c. are waiting
d. have been waiting
9. The conclusion
a. is presented
b. is presenting
in the article is that the drug is harmful.
c.presenting
d. presented
10. happy in his new job, John missed his old colleagues.
a. Although c.Despite
b.Usually
d.Even
11. “Did the aide give Mr. Smith his medicine?”
“No,
told it was necessary, she didn’t.”
a. not having been
c. had she not been told
b. she hadn’t been
d. her not being
12. She works long hours,
a. making
b. makes it
difficult to see her friends.
c.makes
d. making it
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Vocabulary (3)
Daunting developments
Α The conquest of disease – Read the following text, taking note of the boldfaced words. When you finish, check the accuracy
of statements 1-7. If a statement is true, write T. If it is false, correct it.
Thanks to stunning advances in preventive medicine and technology, the 20th century saw a major increase
in life expectancy (how long an average person lives) and a great decline in infant mortality (i.e., a statistic
that compares the number of babies who die to the number of babies born). Scientists managed to eradicate
(totally destroy or put an end to) diseases like smallpox and the bubonic plague, which could once decimate
(or destroy a large part of) major segments of the population. A major factor has been improved sanitation –
i.e., providing safe water supplies, regulated food sources, and adequate rubbish-disposal and sewage systems
(or underground networks that remove human and industrial waste). A major role has also been played by
advances in immunology (the study of how the body protects itself against disease) and the introduction of mass
immunization, whereby large groups (e.g., school-age children) are vaccinated (or inoculated) with substances
that protect them against various infectious diseases. Finally, vast improvements in hospitals, health clinics, and
health-insurance plans guarantee that basic health care is now available to many more people than ever before. In
the 21st century, scientists will continue to combat old foes like cancer (a disease marked by abnormal cell growth)
and new diseases like AIDS. They will also have to cope with a resurgence (i.e., a reappearance or renewed wave)
of old diseases as microorganisms evolve and develop resistance (immunity) to 20th-century antibiotics.
1. Diseases like smallpox have been immunized in the 20th century.
2. Sanitation is the study of how the body protects itself from disease.
3. Immunity to disease is the same thing as resurgence.
4. Life expectancy has fallen off dramatically in the past century. 5. AIDS is a disease that is characterized by unusual cell growth. 6. Sewage systems contribute to a safer, more sanitary environment. 7. We decimate or eradicate children to build up their resistance to disease. Diagnostic technology – You should be able to unlock the meaning of most of the words in the box by searching out their
Β Greek and Latin roots. Underline the roots that you recognize. After discussing the possible meanings with your classmates,
use the words to complete the text.
Nouns
angiogram
biopsy
electrocardiogram
electroencephalogram
Adjectives
benign
malignant
sophisticated
ultrasound
tumor
Technology now allows us to diagnose a wide array of diseases with great precision. If a patient has a(n)
(i.e., an abnormal growth), a(n) (2)
(1)
can be performed in which tissue is removed and analyzed under a microscope to determine if it is
(harmless) or (4)
(cancerous).
(3)
(a test that records the
Heart disease may be detected by a(n) (5)
electrical impulses of the heart). If doctors suspect blocked blood vessels, they may send you for a(n)
(an X-ray taken after injecting dye into blood vessels around the
(6)
technology, which uses sound
heart). Another exciting advance is (7)
waves to project images on a video screen. Neurological diagnosis has greatly been aided by the
, which traces electrical activity in the brain. Even more
(8)
(complex, advanced) are techniques such as Computerized Axial
(9)
Tomography (CAT scans) and Nuclear Magnetic Resonance Imaging (NMRI).
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Health and medicine
3
C Surgical advances – You can get a feel for some of the boxed words (a) by looking for clues in the roots and (b) by looking
for words that remind you of words in your own language. Share your observations with your classmate, and then use the
words to complete the text.
bloodless
microsurgical
bypasses
prosthetic devices
cataracts
severed
incision
transplant
Astounding advances have also been made in surgical procedures. Surgeons
can now reattach (1)
(completely cut off) limbs
with the aid of (2)
techniques that allow them
to repair nerves and blood vessels with high-powered microscopes. In
addition, people who have lost arms or legs can be surgically fitted with
battery-powered artificial limbs called (3)
.
Heart surgeons can not only repair leaky heart valves, but they can also
construct (4)
(or “detours”) around narrowed
segments of arteries or veins. Great strides have also been made in
(5)
medicine, where an organ (e.g., a heart,
liver, or kidney) is taken from one person and placed into another. Finally,
thanks to advances in laser technology, high-tech (6)
surgical techniques are now being used to repair bone and joint
damage, remove (7)
from the eyes, and treat
hard-to-reach brain tumors without surgeons having to make even the
tiniest (8)
(surgical cut).
D Reproductive medicine – When it comes to having babies, women now have a wide range of options that were not available
fifty years ago. Explore the roots and possible meaning of the words in the box, and then use the words to complete the text.
amniocentesis
artificial insemination
conceiving
The development of (1)
congenital
fertility
oral contraceptives
(or birth-control pills) in 1960 now seems “old hat” compared
to other developments that have occurred in reproductive medicine. Thanks to (2)
(analysis of the fluid in the amniotic sac) and other forms of prenatal testing, doctors are now able to diagnose
a wide array of illnesses in unborn children that are either inherited or (3)
from faulty fetal development). Women who have trouble (4)
may be helped by drugs that increase their (5)
life). They may also try (6)
(resulting
(becoming pregnant)
(ability to produce
, where
ova are fertilized by sperm outside the body under laboratory
conditions. With gene therapy, cloning, and other feats of genetic
engineering now coming into their own, who knows what
advances will be made over the next few decades?
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Health and medicine
Time out for review
Anatomy – Symptoms – Developments
Α Disease control center – The goal of this exercise is to remind you that medical terminology in many languages draws
heavily on Greek. Use your knowledge of your own language to help you match the diseases in the box with their descriptions.
Exam tip
“It’s all Greek
to me!”
When you come across technical vocabulary, remember to slow down and
look for clues within the words that will help you unlock their meanings.
anemia
cirrhosis
arteriosclerosis
diabetes
asthma
hemophilia
arthritis
leukemia
bronchitis
pneumonia
1.
– a condition in which there are too few red blood cells in the blood
2.
– type of cancer marked by the overproduction of white blood cells
3.
– hardening of the arteries, often caused by old age and/or a high cholesterol count
4.
– the bleeder’s disease: people who have this bleed extensively, even from a small cut,
because their blood clots more slowly than normal
5.
–respiratory disease often brought on by allergies (e.g., to dust, pollen, and animal fur);
symptoms include a tightness in the chest, shortness of breath, and wheezing
6.
–infection and inflammation of the inner lining of the airways in the lungs, characterized by a
bad cough
7.
– infection and inflammation of one or both lungs
8.
– liver disease in which healthy cells are replaced with thick scar tissue
9. 10.
–disorder of the metabolism, characterized by underproduction of insulin, which results in
undesirably high levels of sugar in the blood
– condition causing pain, stiffness, and swelling of the knee, wrist, and/or other joints of the body
B Word forms – Fill in the blanks with nouns derived from the boldfaced words in the definitions on the right.
1. the state of being mortal
_________
2. the substance that people are vaccinated with
_______
3. a place through which sewage is channeled _____
4. the act of eradicating (or putting an end to) something
___________
5. the act of conceiving something (e.g., a baby or an idea)
__________
6. the act of avoiding or protecting against conceiving _____________
7. another word for a prosthetic device
__________
8. another word for a malignant tumor
__________
9. what you have if you are immune to something
________
10. what you have if you are resistant to something
__________
11. the study of genes and inherited characteristics ________
12.the passing on of hereditary (i.e., inherited) traits from 92
________
one generation to the next
Health and medicine
Reading
3
Visualizing metaphors
In Unit 2 we saw how writers help their readers follow them by defining technical terms the first time they are
used. Another technique they use is to describe an object or process with figurative language – that is, with
metaphors or comparisons that create a lasting image in the reader’s mind. Think back, for example, to the
first time you learned about the human body in science class. Your teacher probably introduced you to some
parts of the body by comparing them to machines or building materials.
Α Warm-up – See if you can match the words in the box to the devices, systems, or other objects to which
they are commonly compared.
brain
cell
DNA
heart
nervous system
urinary system
a.
– computer CPU
d.
– building block
b.
– electrical wiring
e.
– plumbing/drainage system
c.
–pump
f.
– genetic blueprint
Writers often use metaphors to help them explain complex subjects. When you encounter one, do your best to visualize the
image the writer describes. The more clearly you can “see” it in your mind, the easier it will be to understand and remember.
B READING PRACTICE (1): Drug abuse – The passage below contains two metaphors related to drug abuse. Skim the text,
find the metaphors, and discuss why he prefers one to the other. Then answer the questions below.
No magic bullet can eradicate drug abuse overnight, but treatment does bring sustained reduction in drug use.
The metaphor of a “war on drugs” is misleading, however. It implies a lightning, overwhelming attack. We defeat
an enemy. But who is the enemy in this case? It’s our own children. It’s our fellow employees. The metaphor
starts to break down. The United States does not wage war on its own citizens. The chronically addicted must be
helped, not defeated.
A more appropriate conceptual framework for the drug problem is the metaphor of cancer. Dealing with cancer is
a long-term proposition. It requires the mobilization of support mechanisms – human, medical, educational, and
societal, among others. To confront cancer, we must check its spread, deal with its consequences, and improve
the prognosis. Resistance to the spread of both cancer and drug addiction is necessary, but so is patience,
compassion, and the will to carry on. Pain must be managed while the root cause is attacked. The road to
recovery is long and complex.
1. The writer implies that the metaphor “war on drugs” is inadequate because …
a. we have not yet found an appropriate weapon to fight the problem.
b. treatment has proved to be ineffective in reducing drug abuse.
c. countries should not declare war on their own citizens.
d. drug abuse cannot be dealt with quickly and forcefully.
2. The writer prefers the cancer metaphor because …
a. it gives us hope that a cure may be found for the illness in the near future.
b. it suggests that the problem must be tackled on many fronts over a long time.
c. it makes us realize that drug addiction is a terminal illness.
d. it motivates us to use extreme measures to prevent its spread.
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C READING PRACTICE (2): Commando viruses to the rescue
STEP 1: Skimming for gist – The first two paragraphs of the reading passage opposite are based on an elaborate, extended
metaphor. Skim the text, and then answer the questions below.
1. Which phrase best sums up what the entire passage is about?
a. agents of destruction b. genetic diseases
c. viruses and gene therapy
d. war on DNA
2. Which character most closely reflects the author’s image of a virus?
a.
Harry Potter
b. Rambo c. Alexander the Great
d. Hippocrates
3. What kind of language is used to describe viruses in the first two paragraphs?
STEP 2: Vocabulary retrieval – Go through the text again and find words that correspond to the meanings below. (The words
are in the order that they appear in the text).
Paragraph 1
1.
– cruel, without mercy
4.
– take for military use
2.
– (phr) create disorder/chaos
5.
– (phr) create disorder/chaos
3.
– enter secretly
6.
– small, hard growth of skin
1.
– (army) persuade to join
3.
– move quietly, secretly
2.
– (army) signed up, made to join
4.
– use, employ, put into action
1.
– complicated, detailed
3.
– be caused by
2.
– (phr) progress despite difficulty
4.
– troublesome and dangerous
Paragraph 2
Paragraph 3
STEP 3: Anatomy of a metaphor – In the left column, put a “V” next to the roles the author ascribes to viruses and an “S” next to
those he ascribes to scientists. Then match phrases (a–g) with the roles. The first has been done as an example.
1.
Roles V
Rambo-like soldiers who kill in cold blood, without mercy 2.
Soldiers trained to commit sabotage and create chaos
3.
Soldiers who take civilian property for military use
4.
Generals planning a battle
5.
Spy-like troops who secretly invade enemy territory
6.
Hands-on weapon experts
7.
Military personnel trained to attract new soldiers Phrases
c
Phrases
a. recruiting the virus to fight the good fight – viruses are being enlisted
Think about it
b. infiltrate cells – slip behind enemy lines
Does the image of geneticallyaltered Rambo viruses being
sent into battle help you
understand what gene therapy
is all about? Would the text
be as effective without the
metaphor?
c.ruthless, machinelike – commandos in a microscopic battleground – special-forces
lifestyle
d. deploy new weapons against disease
e. commandeer genetic machinery for their own use
f.research has targeted these tiny agents of destruction – a new strategy is emerging
g.inflicting mayhem – wreak havoc from within – tiny agents of destruction
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Health and medicine
3
STEP 4: Now answer the questions below the passage. Remember to underline the key words in each question and mark the
place in the text where you think each answer is found.
Ruthless, machine-like, alive only when inflicting mayhem, viruses are commandos in a microscopic battleground. They
infiltrate cells, commandeer genetic machinery for their own use, and wreak havoc from within. They bring ills as minor
as warts, as major as AIDS. No wonder so much medical research has targeted these tiny agents of destruction.
Now, in an ironic twist, medicine is recruiting the virus, and its special-forces lifestyle, to fight the good fight against our
worst diseases. Cancer, AIDS, inherited ailments such as cystic fibrosis – full-frontal attacks with drug treatment have 5
done little to stop these killers. So a new strategy is emerging: viruses are being enlisted to slip behind enemy lines and
deploy new weapons against disease. Because the weapons are genes, the strategy is known as gene therapy.
Through an elaborate biochemical process, genes direct the construction of proteins that keep things running smoothly in
a cell. When disease strikes and things stop running smoothly, it’s often because one or more genes have become faulty
in some way. Researchers have made headway in identifying the faults responsible for many genetic diseases, such as 10
cystic fibrosis and hemophilia, as well as acquired diseases such as cancer. Much of this progress stems from the new
recombinant-DNA technology, with which biologists can pick apart and rearrange genes. Now the same technology is
allowing genetic engineers to assemble made-to-order viruses, which are essentially genes wrapped in a shell. Normally,
viruses replicate* and cause damage by forcing their own genes into a cell’s DNA. By replacing these rogue viral genes,
researchers can use the virus to introduce genes of their own choosing into diseased cells. Gene therapists thus correct 15
the mistakes produced by a faulty gene, treating illness at its root cause.
* replicate – (biology) divide into smaller molecules which are exact copies of the original
1. Which statement best sums up the main idea of the passage?
a. Viruses are lethal enemies that must be wiped out at all costs.
b. Scientists are learning to use viruses in the fight against certain diseases.
c. Gene therapy is the latest weapon in the war against killer viruses.
d. Stronger drugs are our only hope against waging war on disease.
2.
Why were viruses the target of so much medical research in the past?
a. because of their size
b. because of their ability to fight cancer, AIDS, and cystic fibrosis
c. because of their resistance to drug.
d. because of the wide range of medical problems they cause
3.
How do scientists use viruses to fight certain diseases?
a. by wrapping their genes in a special shell
b. by replacing their defective genes
c. by changing their genetic make-up and inserting them into diseased cells
d. by ordering them to destroy faulty genes
4.
Recombinant-DNA technology allows genetic engineers to
a. replicate viruses.
b. identify faulty viruses that cause disease.
c. increase protein construction in faulty genes.
d. take genes apart and reorganize them.
5.
What is not true about gene therapy?
a. It is more successful than drug therapy in fighting certain diseases.
b. It involves changing the genetic make-up of a virus.
c. Its goal is to correct defective genes within a virus.
d. It utilizes viruses to combat disease.
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Writing (2)
The “for and against” essay
Another common writing task that you might encounter on the ECPE asks you to discuss opposing opinions about a controversial
issue or to analyze the advantages and disadvantages of a subject.
A Analyze the task – Read the task carefully, and answer the questions that follow.
Genetic engineering allows scientists to modify the characteristics of living things by altering their DNA. Recent
advances in areas like gene therapy, cloning, and agriculture have raised tough questions about how genetic
engineering should be used. On the one hand, the technology shows great promise; on the other, there are moral
issues and real dangers to consider. Examine both sides of the issue, and finish by saying what you think might be
done to resolve the conflict.
1. Underline what the task asks you to do. How many parts are there?
2.
On the exam you have only 30 minutes to compose your answer. With this in mind, which part should you plan to
develop in more depth in the main body?
How many paragraphs do you think you would you
need for this?
3.Which part would be suitable for discussing in the conclusion?
to develop this part in more detail in the main body?
If you had time, would it be wrong
B Analyze the model – Now study the model on the opposite page, and do the tasks below.
1. Check (✓) the statement that is true about the introduction.
The writer shows us both sides of the issue, and clearly suggests that she is in favor of one of the sides.
The writer captures her reader’s interest by setting up a dramatic contrast between the opposing sides of the
issue, and suggests that she will discuss both sides in a balanced way.
2.The writer supports her topic sentence in paragraph 2 with examples drawn from two main areas. Underline the phrases
that she uses that clearly signal this to the reader. How many examples does she give under each area?
3.How many arguments does the writer present against genetic engineering? What are they? Put a circle around the three
words that the writer uses to signal the start of each argument. She uses two similar series of subjects earlier in the essay.
Can you find them?
4. In which paragraph does the writer first state her opinion?
have waited till the conclusion?
Do you think this is too early, or should she
5. Is the conclusion effective? Why or why not?
6.Imagine that other students in the class were opposed to genetic engineering. Would they have used the same paragraph
plan, or do you think they would have altered it slightly? What other changes, if any, would you expect to find?
C Try it! – Choose one of the topics below, and use the paragraph plan opposite to write your response (250-300 words).
1.Given the threat of “mad cow” disease, avian flu, and other problems related to eating meat (e.g., cloning or injecting
farm animals with hormones), more and more people are becoming vegetarians. Discuss the advantages and
disadvantages of being a vegetarian, and conclude by giving your opinion.
2.Whether or not to legalize “medically assisted suicide” − that is, the practice of doctors assisting terminally ill patients to
end their lives − is a highly controversial subject. Discuss the arguments for and against, and conclude by giving your
opinion on the matter.
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Health and medicine
For some people, genetic engineering conjures up a world free from hunger and
disease. For others, it evokes visions of mad scientists commanding armies of
evil clones. While few would deny that genetic engineering has already yielded
enormous benefits, it is hard to ignore the concerns that many people have.
In my opinion, genetic engineering has had and will continue to have great
social benefits. In medicine, for example, it has already resulted in our ability
to manufacture unlimited quantities of products like insulin and human
growth hormone. Progress has also been made in identifying and correcting
genetic faults that result in diseases like hemophilia and cystic fibrosis. More
controversial, but potentially just as beneficial, are areas that are still in their
infancy. One is cloning healthy cells to replace diseased or damaged cells.
Another is cloning human cells into organs for transplant. Breakthroughs have
also occurred in agriculture. Cloning is now used to produce healthier, more
productive herds of farm animals, and genetic engineering has also been used to
develop higher-yielding, more nutritious crop strains with greater resistance to
pests, drought, and disease.
But for all the potential benefits, genetic engineering has many detractors.
Some believe that genetic engineering is immoral and unnatural because it is
wrong to tamper with nature. Others argue that it might someday be used
for destructive purposes like biological warfare or for cloning human bodies
solely to harvest organs for wealthy transplant patients. Still
others
feel that genetically modified crops may have
disastrous effects on the environment and on
the humans that consume them.
There are no easy answers, but if
society is to make the most of genetic
engineering, then measures must
be taken to ensure that scientists
carry out their work responsibly. I
feel strongly that research should
not be banned, as that would mean
sacrificing the benefits. What I think
we need is carefully thought-out
legislation that regulates research so
it proceeds under strict supervision
with clear ethical guidelines.
Task tip
3
INTRODUCTION: Tell them what
you’re going to tell them
wRestate the topic, suggesting both
sides of the issue.
MAIN BODY: Tell them
Paragraph 2: Arguments “for”
wClear topic sentence introducing
benefits
wFirst argument, supported by
examples and/or reasons
w2nd argument, supported by
examples and/or reasons
Paragraph 3: Arguments “against”
wClear statement transitioning
from benefits into disadvantages/
problems
wArguments against, supported by
examples and/ or reasons.
CONCLUSION: Tell them what you’ve
told them and suggest solution
wAcknowledge the complexity of
the topic by suggesting that both
viewpoints are valid.
wState your viewpoint and suggest
what could be done to resolve the
issue.
• Follow the paragraph plan above.
• Use clear topic sentences in the main body, supported by examples and/or reasons.
• Use linking words, transitions, and other sign posts that help your reader track your main ideas.
• Where possible, combine ideas into compound and complex sentences for richness and variety.
•Remember to present both sides of the issue in the main body, and clearly state your opinion in the
conclusion.
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3
Exam practice
Grammar
1. Whether or not the boss gets angry will depend on
the idea to him.
a. how do we present
b. how to present
c. however we present
d. how we present
6. “I’m so cold, I’m shaking like a leaf!”
“
is a hot bath and a nice cup of cocoa.”
a. That you need
b. Whatever you need
c. What you need
d. Supposing you need
2. “I’m thinking of joining a gym.”
“
you do, you’ll be an old man!”
a.If
b. By the time
c. In case
d.Until
7. , I decided to go to the party and not miss
out on the fun.
a. As tired I was
b. Despite I was
c. Although tired
d. So tired I was
3. It’s odd how different the twins are.
hard, the other is extremely lazy.
a.As
b.While
c.However
d.Since
one works
8. “Which Joan are you talking about?”
“You know, the one . . . in the choir.”
a. that she is
b.who’s
c. of whom is
d. which is
4. I’m so relieved.
my exams are over, I can finally
relax again.
a. Now that
b. As soon as
c. As a result of
d. Due to
9. The doctor told me to call her
discuss the results of my tests.
a. so that
b. in order to
c. in case
d.because
5.
so
0. 1
hard I try, I can’t figure out how to open this
bottle of medicine.
a.Whereas
b.How
c. In spite of
d. No matter how
to Mary, I have no idea why she left the party
early.
a. Had I not spoken
b. I didn’t speak
c. Not having spoken
d. I’m not speaking
we could
After you finish
Here is a list of some of the grammar topics you’ve seen in Unit 3.
a. linking words (time)
f. noun clause as subject
b. linking words (contrast)
g. word order in noun clauses
c. linking words (manner)
h. relative clause: structure
d. linking words (reason)
i.
participle clause (reduced adverbial)
e. linking words (purpose)
j.
clause of concession (full vs. reduced)
Look at items 1-10 again. Write the letter of the grammar point that each item tests.
1.
2.
3.
4.
5.
6.
7.
8.
If you missed any of the items, go back to Grammar (1) and (2) and review the relevant topics.
98
9.
10.
Exam practice
3
Cloze
When a new microbe emerges from the jungle or a resurgent
11. a. has c. that
b. had d. having
12. a.travelers
c.one
b.germ
d.bacteria
13. a.from
c.across
b.as
d.out
14. a.in
c.which
b.because
d.that
News of resurgent microbes comes __(13)__ an unexpected
15. a.infectious
c.infecting
surprise to ordinary Americans, who share the widespread belief
d.infection
__(14)__ medical science and modern sanitation have conquered
16. a.beliefs
c.innovations
__(15)__ disease. Smallpox was vanquished; tuberculosis nearly
d.germs
bacteria emerges from a Third World slum, humans provide a
perfect system for its spread. A drug-resistant strain of plague
__(11)__ emerged in Madagascar in 1997 could make it from the
African island to the United States in a day and a half, hitching
a ride on some unwitting traveler. Other __(12)__ might hop a
ride on coconut milk from Thailand, melons from Mexico, or
raspberries from Guatemala.
so, and, as sanitation, the spread of vaccinations, antibiotics,
and other __(16)__ swept the developing world, every trend
pointed towards continued __(17)__ on almost every front.
Health officials confidently talked about an “epidemiological
transition” as improving public health shifted concerns __(18)__
chronic diseases, such as cancer. That was before AIDS made its
__(19)__ , before new resistant strains of tuberculosis followed
b.infected
b.news
17. a.succession
c.problems
d.progress
b. defeat 18. a.that
c.by
d.for
b.toward
19. a.appearance
c.way
d.escape
b.discovery
suit, and before malaria made its great leap forward __(20)__
20. a.to
c.will
become the world’s most widespread mosquito-borne disease.
d.has
b.and
After you finish
Here is a list of topics that are tested in items 11-20:
a. train of thought: which noun?
b. complex sentence structure: what’s missing?
c. structure/meaning (singular vs. plural noun in context)
d. vocabulary: easily confused word forms
e. vocabulary: common collocations
Look at items 11-20 again. Write the letter of the topic that each item tests. (Several are used more than once.)
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Now compare answers with a partner. If any of your answers are different, to reach agreement.
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3
Exam practice
Vocabulary
21. Advances in medicine have brought about a
dramatic increase in life
.
a. mortality
b. fatality
c. anticipation
d. expectancy
26. It took more than a month for the surgical incision
to
completely.
a. clot
b. cure
c. treat
d. heal
22. The doctor assured the parents that their son’s
for recovery was extremely good.
a. diagnosis
b. prognosis
c. prescription
d. symptom
27.He is currently
treatment for a rare and debilitating
tropical disease.
a.combatting
b.resisting
c.expelling
d.undergoing
23. A well-balanced diet promotes good health and
disease.
a. immunization against
b. susceptibility to
c. resistance to
d. recurrence of
28. Everyone was relieved when the doctor reported that he
had managed to
the malignant tumor.
a.fracture
b.diagnose
c.remove
d.transmit
24. It will be many years before AIDS is finally
a. deployed
b. immunized
c. eradicated
d. infiltrated
25. His hearing has been seriously
explosion last year.
a. impaired
b. afflicted
c. obstructed
d. decimated
.
since the
29. The doctor
the patient’s heart condition to smoking
and excessive drinking.
a.attributed
b.alleviated
c.prescribed
d.diagnosed
30.The
of lasers and computer technology has
revolutionized modern medicine.
a.eradication
b.breakthrough
c.advent
d.resurgence
After you finish
Look at items 21-30 again. Find the choices that are synonyms of the following:
21. − death caused by war, etc.
26.
− thicken, form lumps
22. − sign of illness
27.
− experiencing, having
23. − protection against
28.
− break/cause to break
24. − used, sent into action29.
− reduced, lessened
25. − blocked
− complete destruction
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30.
Exam practice
3
Reading
Many diseases once easily treatable with antibiotics − tuberculosis, for example − have turned into killers again.
The reason for this is that bacteria have evolved. They not only resist penicillin and other treatments, but they
actually thrive in, and in some cases even require, the presence of antibiotics. Many researchers are concerned that
the development of new antibiotics may not keep up with the appearance of resistant bacterial strains. In the wake
of such alarming developments, researchers have discovered a new class of chemical compounds that could serve 5
as powerful antibiotics and perhaps even anticancer agents.
The new compounds come from Xenorhabdus, bacteria that live inside certain species of soil-dwelling microscopic
worms called nematodes. These bacteria cannot survive in the soil and can reproduce only inside insects. They are
thus content to reside harmlessly inside the nematode until the worm encounters their breeding ground. When that
happens, the nematode burrows into the hapless insect and releases a packet of bacteria. The bacteria start feeding 10
on the insect and reproduce furiously. In turn, the nematode starts feeding on the multiplying bacteria, and then
the nematode starts reproducing, so everybody benefits except the insect, which eventually dies and bursts open.
What intrigued researchers was that the bacteria, during their feeding frenzy, produce chemicals that kill competing
bacteria. They began studying the chemicals while investigating the antibiotic effect of dumping millions of
nematodes into soil to control insect crop pests. Their efforts have isolated several unique compounds from 15
Xenorhabdus. One, which they call nematophin, is a powerful antifungal and antibacterial agent. Another, named
xenorxide, attacks human lung, breast, prostate, and colon cancer cells, while leaving healthy cells alone, at least
in a petri dish. One major advantage of these new chemicals is that even low doses are highly effective against
bacteria now immune to the penicillin family of antibiotics. In lab tests the chemicals don’t appear to be toxic in
mice or rats. As yet, little is known about why these compounds work so well. Experts say it will be at least six to 20
eight years before the drugs have any human application.
31. Why have scientists recently become so interested in Xenorhabdus bacteria?
a. Because they have amazing reproductive properties.
b. Because, unlike other forms of bacteria, they cannot survive in soil.
c. Because they can control certain types of crop pests.
d. Because they may be effective in fighting penicillin-resistant bacteria.
32. What is true about tuberculosis?
a. Scientists are still looking for a way to cure the disease.
b. Treatments that worked in the past are no longer effective.
c. It thrives in the presence of penicillin and other antibiotics.
d. It is spread by bacteria that live in microscopic worms.
33. According to the passage, what is true about Xenorhabdus bacteria?
a. They reproduce wildly when they enter nematodes.
b. They are resistant to penicillin and other treatments.
c. They live in a symbiotic relationship with nematodes.
d. They will only feed on dead insect matter.
34. Laboratory tests have indicated that, unlike nematophin, xenorxide ...
a. may be useful in the fight against certain forms of cancer.
b. have already proven to be safe for human application.
c. may be useful in fighting diseases that now resist penicillin.
d. can be successfully manufactured in a petri dish.
35. The writer implies that researchers ...
a. must constantly search for new means of combating resistant bacteria.
b. may never understand why nematophin and xenorxide are so effective.
c. are ready to begin testing the new compounds in human beings.
d. will never solve the problems posed by the evolution of bacteria.
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