Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles. Under the new definition of COPD, it is considered a disease process separate from COPD (GOLD, 2008).
Bronchiectasis is a condition where the bronchial tubes of your lungs are permanently damaged, widened, and thickened.


Bronchiectasis is an obstructive lung condition in which there is destruction and widening of the large airways and abnormal bronchial wall thickening as a result of a recurring cycle of infection and inflammation (Ten Hacken 2010). Bronchiectasis is usually localised to one lung segment or lobe but may spread over time to other parts of the same lung as a result of unresolved infections. Exacerbations are associated with infections.
A number of conditions lead to bronchiectasis, including structural lung conditions, CF and other conditions associated with abnormal mucocillary clearance; retained inhaled foreign objects, tumours and obstructive lung conditions including COPD; an abnormal immune response; infections including tuberculosis, pneumonia, measles and whooping cough; and inflammatory bowel disease.

Clinical manifestations

  • Difficult breathing (dyspnea) due to the mucous production and irritation within the airways.
  • Productive, foul-smelling odorous cough, due to thick, difficult-to-expel, tenacious mucous, often with bacterial colonization.
  • Cough may be worse when lying down.
  • Recurrent bronchial infections.
  • Hemoptysis (blood-tinged or bloody mucous).
  • Loss of weight because patients are not eating well, due to respiratory changes and foul-smelling mucous with cough. Increased respiratory effort requires more calories to meet normal requirements.
  • Crackles or rhonchi on inspiration due to mucous build-up.
  • Anemia of chronic disease.
  • Cyanosis.
  • Clubbing of the fingers.

Bronchiectasis may be caused by a variety of conditions including:

  • Airway obstruction: Obstructions in the bronchi distend the wall permanently and impair mucociliary action.
  • Pulmonary infection: Pulmonary infection and obstruction of the bronchus or complications of long-term pulmonary infections cause bronchiectasis.
  • Genetic disorders: Genetic disorders such as cystic fibrosis causes the sputum to thicken in consistency and would ultimately obstruct the bronchi.
  • Idiopathic causes: There are causes that are unknown to medicine that cause bronchiectasis.

Potential complications include:

  • Atelectasi: Collapse of the alveoli is a common complication.
  • Pneumonia: Infection is recurrent in patients with bronchiectasis.
  • Empyema: Overproduction of sputum causes the bronchi to be filled with pus.


  • Culture and sensitivity of sputum to identify bacteria and appropriate antibiotics.
  • Shadows in affected area of the lungs on the chest x-ray.
  • CT scan or high-resolution CT will show areas of bronchiectasis.
  • Decreased lung vital capacity on pulmonary function test.

Treatment is focused on getting enough oxygen to meet current needs of the patient, expel mucous, and treat infections.

  • Supplemental oxygen to help meet body’s needs.
  • Postural drainage to assist with drainage of secretions.
  • Chest PT to loosen secretions.
  • Remove excessive secretions during a bronchoscopy.
  • Administer bronchodilators to help keep airways open:
    • albuterol, levalbuterol
  • Administer antibiotics to treat infection:
    • selected based on the results of a culture and sensitivity study


  • Ineffective airway clearance
  • Imbalanced nutrition: less than what the body requires
  • Impaired gas exchange


  • Monitor respiratory rate, effort, breath sounds, skin color, and use of accessory muscles.
  • Perform chest percussion to help loosen secretions.
  • Explain to the patient:
    • That family member can perform chest PT.
    • How to do postural drainage.
    • How to administer oxygen.
    • How to properly administer medications.

See videos:

Bronchitis  Chronic Bronchitis

Abnormal breath sounds

Breath sounds are an important part of respiratory assessment and are usually assessed by the respiratory team.

Sound Characteristic Signs of
Wheezing Whistling sound, generally heard on


Asthma and airway obstruction
Stridor Snoring sound heard on inspiration Typical of obstruction, sputum plug or

foreign body, anaphylactic reaction

Crackles A crackling or popping sound Collapsed alveoli popping open on


Rhonchi Snoring or rattling sounds Fluid partly blocking the bronchi; generally

heard on expiration

Pleural friction A grating or rubbing sound heard on

inspiration and expiration

Indicative of pleural inflammation

General Respiratory Assessment


Focus Observe Normal adult values Abnormalities Indications
Respiration Quality, rate Rate: 12–18 per
Bradypnoea <10
breaths per minute
Head injury
Narcotic overdose
Tachypnoea Following exertion
Diabetic ketoacidosis
Pyrexia – rate of
breathing increases by
7 breaths per minute
for every 10°C rise in
the patient’s
Apnoea Respiratory arrest
Depth Shallow or deep Hyperventilation
Rhythm Regular rhythm Cluster breathing –
normal breathing
interspersed with
apnoeic pauses
Neurological disorders
Cheyne–Stokes –
the rate changes
with increasing
periods of apnoea
End of life
Effort Unable to complete a sentence
Use of accessory
Muscle retraction –intercostal and
suprasternal muscles
Nasal flaring
Airway inflammation/
Colour Skin colour –
check the
skin, nail beds, lips, tongue, ears and nose
Cyanosis – central or peripheral Central – hypoxaemia
Peripheral – perfusion
Chest Shape Barrel chest Emphysema
Pigeon chest Rickets
Movement Symmetrical Asymmetrical Pneumothorax – air
trapped in the pleura
Extreme atelectasis

Essay: Women empowerment

Quaid-e-Azam said in a speech in 1944, “No nation can rise to the height of glory unless your women are side by side with you; we are victims of evil customs. It is a crime against humanity that our women are shut up within the four walls of the houses as prisoners.”

Women empowerment refers broadly to the expansion of freedom of choice and action to shape one’s life. It implies control over resources and decisions. An empowered woman will be one who is self confident, who critically analyses her environment and who exercises control over decisions that affect her life. The idea of empowerment manifests itself at all levels of societal interaction. It is found in giving a voice to the weak and marginalized. It requires having an access to the needed tools and materials for the expansion of capacities. Women empowerment has five components: women sense of self worth; their right to have and determine choices; their right to have access to opportunities and resources; their right to have the power to control their own lives, both within and outside the home; and their ability to influence the direction of social change to create a more just social and economic order nationally and internationally.

National development must be balanced with the equal distribution of resources to both males and females as in Pakistan females are approximately 51 percent of the total population and without the active participation of females Pakistan cannot achieve the required level of growth rate. Since the creation of Pakistan in 1947 it inherited the menace of poverty and the burden of this poverty was put heavily on female population because of the reason that the majority of females are involved in agriculture work, performing tasks to maintain household , carrying water and collecting fuel wood but their work in productive activities is unrecognised and, therefore, the female participation represented in economic activities seems to be low.

o promote the gender equality and women empowerment; to highlight the importance of women representation and participation in decision making; and to motivate the women towards public and private sector employment, GRAP is organising awareness raising programmes like celebration of events, seminars, workshops and trainings at district and at provincial level that are being organised on regular basis through its three main units ie, Gender Mainstreaming Units(GMUs) at provincial level, Career Development Centers at University level and Gender Support Units(GSUs) at district level.

Moreover, for the promotion and protection of women rights, to restore the personal security and dignity of women and to give them protection at workplace, the Pakistan government has taken deliberate and conscious steps like reservation of 10 percent quota for females, on the political side, reservation of thirty three percent seats for women in all local bodies (more than 36000 women councilors), seventeen percent seats have been reserved for women in the constituent assembly, senate, provincial assembly and in national assembly, to tackle the issues of harassment and to eliminate the gender based violence.

No doubt Pakistan government has taken many measures to enhance the participation of women in economic sphere but instead of all this, there is dire need to upgrade the status of women in society and it is only possible through giving them protection legally and mentally. She should be given access and control over resources. An effective mechanism should be institutionalised to enable the women in decision making at all levels. Subject of gender studies should be introduced from secondary level in the course curriculum, provision of women friendly infrastructure and environment at workplace, research and documentation on the achievements of women and launching of awareness raising campaigns among citizens on gender and development.

Essay: Role of Nurse in improving hospitals’ quality and efficiency

The Health Care Industry is one of the most important industries if not the most important one. The Health Care industry consists of everything from the little pharmacy across the street, drugs processing plants all the way to the hospital where we immune our kids. The Health Care industry affects nearly every living person. Most people don’t realize how important this industry is and how it affects their everyday lives, not to mention how complicated it is. That is why it is so critical that products and services of this industry are at their highest quality and are free of harm to ensure that the consumer will not face any damaging consequences. Therefore, as any other industry, quality in the health care system has become the element in the world’s market competition and Total Quality Management (TQM) plays a big role in promising that result.

Nurses are directly involved in almost all aspects of hospital quality, including patient care, bedside and medication management, assistance with surgeries and other major operations, data collection/reporting, and more.

Furthermore, nurses are directly responsible for monitoring and assessing patients, and performing immediate interventions to reduce risk or prevent medical complications. Nurses also oversee other care providers, i.e. CNAs, LPNs, patient care technicians, caregivers, and more. An attending nurse even helps educate patients and family members regarding post hospital care, before discharge.

Demand for Hospital Quality Improvement:

The demand for quality improvement in hospitals is ever increasing due to federal government mandates, as well as local requirements, accreditation or regulatory boards, hospital organizations, medical societies, non-profit organizations (NGOs) and health insurance plans. Core qualities reported may vary in terms of target medical concern or hospital department, but in most cases, employee and patient feedback is included in the measurement.

Magnet Recognition:

Among numerous programs demanding or requesting hospital quality improvement, the most relevant for nurses is the Magnet Recognition. It was developed by the American Nurses Credentialing Center (ANCC) – a subsidiary of the American Nurses Association – in order to recognize hospitals which provide nursing excellence. 

The Magnet Recognition program is based on an appraisal consisting of 14 characteristics. Foundationally, Magnet looks for a strong presence of nurses in the organizational committee structure of hospitals – including executive functions – empowering nurses in all levels to have a voice in hospital processes. While Magnet was originally focused on recognizing hospitals with higher nurse retention, there are researchers which have proven that Magnet-awarded medical institutions boast of lower mortality rates and higher hospital quality care in general.

Challenges Involved

Some of the usual hindrances involved revolve around nurses. Problems include inadequate staffing or uneven distribution of schedules, demanding responsibility which covers all aspects of patient care, ineffective nurse training, inefficient administrative tasks, and traditional nursing education, which often clashes with advancing nursing techniques.

Staffing and Patient Care Quality

In relation to staffing and scheduling, research from the Institute of Medicine (IOM) pointed out the direct connection between hospital care quality and nurse staffing. 

Staffing is directly related to hospital budget considerations as well as the demand of the local labor market for nurses. Quality of care, on the other hand, is dependent on various factors, such as a nurse’s experience, skills, and education. Another important aspect is the human factor. Fatigue and stress can lead to a decline in patient care quality due to errors in medication, treatment, usage of medical devices, data reporting, and more.

In conclusion, Healthcare organizations are required to focus on total quality improvement and providing acceptable, quality health services to patients at affordable price within reasonable price, within in a reasonable time. We have learned by past experiences as Nightingale’s efforts to improve the quality of medical care. The Health Care Industry is one of the most important industries if not the most important one.

Essay: Effective ways to change image of nurse

Throughout time the world’s image on Nursing has evolved rapidly. Nurses work in an extremely stressful environment and must carry out their duties in a professional manner to ensure proper procedures are followed throughout their routines. They also have a considerable amount of responsibility that comes with their career. For those reasons nurses must present themselves in a professional and structured manner at all times. The Image of Nursing describes how people in and out of the profession see nurses. Nurses must protect and continuously improve their image by fully applying themselves to their profession every day.

Generally only people who have had extended contact with nurses, in the healthcare setting or as family and friends, really understand what nursing entails. We need to do much more to get the correct image of the nurse out there – that of an educated and highly skilled independent professional practitioner, male or female, who is self-assured and confident.

  1. Have pride in your profession

When asked in a social setting what your job is don’t answer with “Oh, um, I’m just a nurse” as though you are ashamed. Hold your head high and reply with confidence something like: “I’m a nurse working at St. John’s hospital in the pediatric unit”. If relevant, add that you are a specialist, e.g. in critical care. This may be a good opening for further conversation.

Never criticize patients, co-workers, your employer or the profession in front of patients or in social settings. The place to vent about your horrible day is either at home with your family or alone with your nursing colleagues or best friend.

  1. Maintain a professional image

Look and act like a professional person 24/7 – wherever you are you serve as a role model of who and what a nurse is.

Professional appearance starts with good grooming and workwear appropriate for a professional person. Keep to the dress code of the institution where you are working. Cartoon characters on uniforms might have a place – but only on a pediatric ward.

Introduce yourself to patients and explain to them who you are, why you are there and what are going to do. Explaining procedures and medications, and the reasons for them, not only reassures the patient but also shows that you are knowledgeable and confident in what you are doing.

  1. Get the nursing story in the media

A study conducted by Woodhall on nurses in the media during 1997 was published under the title “Health Care’s invisible partner”. It was found that nurses were referred to in fewer than 4% of over 2000 health articles in newspapers from across the United States. The researcher came to the conclusion that this largest group of health care providers was virtually invisible to the public.

The main career motivator for most nurses is service, rather than money or power and prestige. This is why nurses shy away from and are unaware of the need for media to promote the profession. For the public to understand the major and indispensable role of nurses in healthcare, they need to be shown who she is and what she does.

  1. Become a community leader

Given their education, background and exposure to community issues nurses can serve effectively on various platforms and become leaders in their communities. Participation by nurses at this level shows them as concerned and knowledgeable citizens and enhances the public image of nursing. Participating in community activities also contribute to your own professional development.

  1. Speak up for you and your patient’s rights

How many times have we been advocating for safe nurse-to-patient ratios? Numerous studies (here, here, and here) have found out that understaffing causes increased risk not only for patients but also for nurses. These studies support the minimum staffing levels, but hospital administrators are reluctant to adopt them, of course, to save money. Press would usually attribute the overburdened state of hospitals to a national nursing shortage, but most everywhere there has been a surplus of educated nurses for years.

  1. Make a difference

Contribute to the future of your profession – what you as a nurse do or say does make a difference. Be proud to be a nurse, always look and act professionally, help to inform the public about nurses and nursing an example within your community.


Promoting and sustaining positive nursing image is very crucial in nursing profession to keep nurses to be motivated to work and retain in the profession to be more professional and be a role model and mentor nurses everywhere you go to promote nursing image either in personal life or professional workplace. It is also very inspiring to correct public media’s misconception of nursing image by writing to them to keep inform and upgrade them regarding positive image in nursing to recruit more staff to join nursing and retain in nursing and to enhance job satisfaction, job performance. By actively involved in professional organization to talk to policy maker, writer to media or newspaper to keep them well-informed of nurses’ achievement and to get recognition from public.

Essay Health Insurance Pros And Cons

At present, the health care dilemma has become a bone of contention with the public as to whether or not this health coverage is to be supplied by the government. People often possess different perspectives and referred to pros and cons on both sides of the spectrum. While some believes a universal healthcare system will set a foundation for lower quality of service, increasing governmental finance deficit, and being burdened by high tax for tax-payer, others do not hold the same thought. A universal healthcare system brings enormous advantages rather than disadvantages, such as all-inclusive population coverage, convenient accessibility, low time cost, and affordable medical cost, all of which not only provide minimum insurance.

As the increasing of the patients, they still needed working capital to support their expenditure. The most sources of money were from found-raising and receiving the donation from tycoons or philanthropists. Fortunately, this model of operation for health institutions struck the balance between income and expense barely. However, the situation went worse and worse because of the increasing of tax from the government and raising of resource abuse from immoral patients. As a result, the health institutions were compelled not to provide shelter for the low-income people and underprivileged. In addition, they changed their mind on their operation and decided to charge their patients in order to restrain the immoral phenomenon. The notion of Health insurance also budded in this time. The accident insurance, another name with which we are more familiar is Disability insurance, was provided by the Franklin Health Assurance Company of Massachusetts. The purpose of the plan was to compensate the salary those who got hurt and couldn’t work in a rail or steamboat accident. However, patients still paid the healthcare fee when they went to the hospital.

During the Great Depression, hundreds of thousands of middle-class people lost their bread-and-butter. The tough circumstance brought a series of sequential problems, such as poor quality of life, public disorder, and especially unsatisfying demand of medical services. It is a stimulus for employer-sponsored organization to assist low-income family to cover their expenses at health institutions. It is a kind of health insurance. Simultaneously, government drafted out a plan to resolve social problems. President Franklin Delano Roosevelt prepared to pass the Social Security Act (SSA). Originally, he considered the concept of all-inclusive healthcare system in this provision.

Pros/Advantages of health insurance

Of course, the most obvious advantage is that health insurance can provide coverage for some of your healthcare expenses. Doctor’s visits, trips to the emergency room and specialist treatments may be paid for (either in part or in whole) by this type of insurance. With health insurance, large hospital bills associated with surgery or other major treatments may also be covered depending on your specific policy.

And a PPO health insurance plan may also allow you to choose your own doctor, although you may pay more if he or she is not included in the network maintained by your health insurance carrier.

Private coverage also usually comes with more choices than those offered by public plans such as Medicare. This could allow you to choose the options that you are most likely to need and omit those that you don’t. The experiences that come with private health insurance might include shorter wait times, greater individualized attention and more sophisticated facilities. Public facilities can be overcrowded at times and may provide a lower level of care in many cases.

Cons/Disadvantages of health insurance

As you might expect, the greatest disadvantage of private health insurance can be the cost. This is especially true if you are in poor health and do not have access to group coverage of any kind. Many individual policies can cost several hundred dollars a month, and family coverage can be even higher. And even the more comprehensive policies come with deductibles and copays that insureds must meet before their coverage kicks in.

Most health insurance policies don’t offer coverage for all types of diseases and conditions. Those who need care that falls into one of the gaps that are written into these policies are on their own when it comes to paying for certain medical services. Furthermore, the cost of healthcare has risen much faster than the general rate of inflation, and this trend shows no sign of slowing.

Sex education: These 4 facts about virginity will bust all myths

By: Aishwarya Chopra

There have been a lot of misconceived myths about virginity, which are accepted as the truth. It is time to bust these myths and know the real facts.

Untouched by the world of sexual experiences, there exists a unicorn land where virgin women tightly-hold onto their hymen as a mark of their character. Right? Wrong.

It’s time to shun the wrong perception that songs, movies and gossip sessions on ‘virginity-par-charcha‘ have fed us. Let’s talks virginity myths and facts in this chapter of sex education 101:

1. Your “cherry” can’t be popped! 
We all seem to have false ideas about what the hymen ( a.k.a cherry ) is. It is often assumed that the hymen is a thin membrane that goes over the vagina. After penetrative sex, this hymen is broken, which results in bleeding. Its ‘absence’ is seen to signify a lack of virginity.

All of this is FALSE! The hymen doesn’t completely cover the vagina. This thin elastic membrane sits either outside the vagina or just inside of it. So the first time you experience sexual intercourse, you aren’t popping anything but just stretching the membrane a little bit.

So, always remember ladies: the hymen isn’t a sign of your virginity. It is significantly elastic and can be penetrated without breaking–but fragile enough to be affected by intense physical activity too.

2. Stop believing in absurd virginity tests!
The hymen doesn’t disappear forever after your first sexual intercourse. In fact, it stays in the body forever. Yet, many cultures have ritualized displaying bloody sheets after a married couple gets intimate for the first time to show that the young woman was a virgin.

Yet, what really is the connection between losing one’s virginity and bleeding? According to medical professionals, many women do not experience tearing or bleeding of the hymen the first time they have sex. This myth has a negative impact on women soon to experience sex.

The fear of pain or the anticipation of bleeding makes it harder for the muscles around the opening of the vagina to be relaxed. The feelings attached to the probable pain of penetration spread through the myth are the real culprits rather than the experience itself.

3. A visit to the gynaecologist won’t affect your virginity
Going for your first gynaecologist exam often brings anxiety, yet there is also a misconception that surrounds it. Similar to tampons, gynaecological exams are there to ensure reproductive health.

Gentle inspection of the external genitals is recommended by the Ministry of Health and Family Welfare as a routine part of health care for kids and teens.

In a Pap smear test, an exam used to detect precancerous cells from the cervix, an instrument called a speculum is used to spread the walls of the stretchy hymen and vagina. However, the speculum‘s movement is wrongly considered to be an equivalent to sexual penetration–which often discourages women from taking the Pap test, leaving the potential diseases go unnoticed.

4. Your sexual partner can’t tell whether you’re a virgin or a not with certainty
If an experienced gynaecologist can’t tell if a woman has had intercourse by examining her hymen, then how on earth can your partner? On the other hand, to practice healthy sexual health it is essential to build relationships of trust with your partner. Being open with them about your sexual history can build deeper connections and keep you both healthy and happy.

Our ‘Lashman rekha’ of virginity is based on elastic scrunchies aka hymen that are built and evolve into different anatomic variations with different experiences. The intent in talking about virginity myths and facts is to shift the focus of the collective from just the status of the hymen to the entire knowledge of intimate health.



English MCQs for Jobs/ B.Sc Nursing Entry Test

  1. While Pakistan has earned record revenue this year, __________ well behind in exports? it still lags
  2. Anna and Tania went shopping, but __________ couldn‘t find anything __________ liked? they, they
  3. Nuclear energy is __________ dangerous to be used widely? too
  4. I have money, I __________ it tomorrow? will purchase
  5. Cannon had __________ unique qualities _________ it was used widely in ancient times? such, that
  6. She succeeded by __________ hard? working
  7. Galilei made her children __________ chores on Sunday? do some
  8. I enjoy __________ tennis? playing
  9. Most of the guests arrived __________ buses? in
  10. The departmental store is open __________ eight to seven? from
  11. On leaving the shopping plaza, Kate was robbed __________ purse? of her
  12. If I had money, I __________ it now? would purchase
  13. The man __________ you met is an anchorperson? whom
  14. The woman __________ is standing by the table works in electronic media? who
  15. He is looking for accommodation __________ in flat or shared house? either
  16. You can go neither by train __________ by bus? nor
  17. Before designing a public park, the architect must __________ the public? consider
  18. When she was younger, she __________ five kilometers a day? walked
  19. The house is large __________ is quite old-fashioned? but
  20. We need to find __________ method to solve this problem? another
  21. The students in our school are __________ in other schools? smarter than those
  22. The number of web entrepreneurs __________ increasing every year? is
  23. Write down __________ your name and roll number? both
  24. Compressed Natural Gas (CNG) burns less efficiently than gasoline __________? burns
  25. Oxygen can be mixed with __________ gasses such as Hydrogen, Nitrogen and Chlorine? other
  26. The man __________ wallet was stolen called the police? whose
  27. The market is nearer to them than __________? us
  28. He takes his turn, and she takes __________? hers
  29. If I had had money, I __________ it yesterday? would have purchased
  30. Umma, accompanied by her brother, __________ at the party? was
  31. White ball __________ for the first time in the 1992 Cricket World Cup? was used
  32. The new information on dengue virus caused panic in the public and government
    __________? alike
  33. I cannot come to see you _________ tomorrow? until
  34. He has been living in Switzerland _________ two years? for
  35. She is standing __________ her boyfriend? by
  36. He paid the dining bill __________ a credit card? with
  37. He did not give up __________? hoping
  38. __________ the bad weather, the outdoor party was rescheduled? Because
  39. of__________ loosing the first match, our team has won the world cup? Despite
  40. Everyone at the party __________ amazed by his performance? was
  41. She __________ for the upcoming tennis tournament? is training
  42. I __________ Afghanistan next year? am going to
  43. There are some vacant rooms __________ in flats and shared houses? both
  44. The sun rises __________ the east? in
  45. Nitrogen gas is in abundance __________ the Earth? on
  46. I was watching a TV program, when he __________ in? walked
  47. We are planning __________ out to dinner tonight? to take our guests
  48. She took lessons __________ how to swim? to learn
  49. The class teacher __________ Anna move to another chair? let
  50. He devotes much of his time __________ for the future? to planning
  51. For good health, she __________ bed earlier? should go to
  52. If you have time, you __________ the nature museum? should visit
  53. It is our problem, not __________?  theirs
  54. The number of guests at the party __________ amazing? was
  55. __________ 600 and 800 B.C, Olympics were held in Athens, Greece? Between
  56. She __________ the driving test to get a license? has to pass
  57. As there were no buses, she __________ home last night? had to walk
  58. __________ these books belong to? Who do
  59. I cannot concentrate, here is too much __________? detraction
  60. It is expected that the assembly will _________ these treaties? ratify
  61. He came in Karachi __________ August 14, 2010? on
  62. Bilal is not receiving the call. He is __________ at work? still
  63. Bilal is getting __________ the car? out of
  64. Saad is travelling __________ the school? towards
  65. They went __________ the rain? despite
  66. I was surprised by the large __________ people who came? number of
  67. Synonym of Bonhomie_____________? Affability
  68. He was abstained_______ salted food by the doctor? From
  69. Well, this is very interesting but I am very_____ ?Busy
  70. You _____very clearSound
  71. I am just____ out my new mobileTrying
  72. Drugs addicts in Pakistan are___ in special centers set up by the Government? Consulted
  73. Can you help____ up the mess? clear
  74. The deadline was nearby, so Mrs. Jamal had her student _____their essays? completed
  75. Javed, two of______ brothers attend primary school? wishes to be a school
  76. teacher after his graduation from the University? whose
  77. She lived_____ juice for ten days to slim down for the fashion show? off
  78. My husband asked him if he’d ever been convicted_____ a crimes? of
  79. The department head insisted that he____ absolute authority to regulate office
    work? would be given
  80. She has been supporting her family______ her husband’s death? since
  81. There is something wonderful_____ him? about
  82. Could I have a____ of chocolate? bar
  83. Four independent______ testified to seeing him at the scene of the crime? witnesses
  84. May I give you______ advice? some
  85. There______ any message from my teacher since she moved to London? hasn’t been
  86. If everything goes according to_______ , work will be complete in December.? schedule
  87. Please_____ two color passport photographs to the application form? attach
  88. He shows great ability____ Mathematics? in
  89. The sparrows took no____ the bread? notice of
  90. The powers of the party are__ in several places in the Constitution? enumerated
  91. The teacher found many mistakes in my composition, when she went___ it? through
  92. The President’s speech was so_____ that many people were persuaded to
    accept the need for change? eloquent
  93. The fireman managed to put____ the fire? out
  94. A system is_____ if it is easy for citizens to access and understand? transparent
  95. Did the boys turn____ for football practice? up
  96. Health______ labels have adorned cigarette packages since 1966 in USA? warning
  97. Some animals have unique_____ that allow them to survive in extreme weather
    conditions? characteristic
  98. What was the main______ behind London bombings? motive
  99. There was an_____ response for the marathon? overwhelming
  100. I would really______ if you could help me out? appreciate
  101. A speed limit is the______ legal speed that you can travel on the road? maximum
  102. Ali must have the______ to stick to his diet, if he wants to lose weight? determination
  103. Although he had no_____ injuries, doctors found that he was suffering from
    internal bleeding? external
  104. _______weight gain or weight loss is not good for your body? Excessive
  105. Water is made up of two____ , namely oxygen and hydrogen? Elements
  106. and Mrs. Khan go for a______ walk just before dinner? brisk
  107. A Computer is hard to repair as there may be hundreds of different_____ ? components
  108. We shall go for a picnic if the weather______ good? is
  109. In the test, we will_______ your work and then give you detailed feedback? assess
  110. The smoke went_______ the chimney? up
  111. She has only_____ friends? a few
  112. He wore multiple bracelets on_____ hand? each
  113. I______ to the Islamabad with some friends last night? went
  114. Army_____ troubled places as curfew remained in force? patrolling
  115. _____you hear the President’s speech? Did
  116. How much longer_____ this book? will you be needing
  117. He decided to______ his degree examination in order to get a higher score? rewrite
  118. The news was____ good to be true? too
  119. The speaker did not properly space out his speech, but went on_____ one point
    only? stressing
  120. How did these things come______? about
  121. Macbeth’s desire_____ power brought about his downfall? for
  122. The worker used_____ to patch up the hole in the wall? cement
  123. The agenda for the meeting is____ the notice? enclosed with
  124. I am exhausted, let’s_____ a day? call it
  125. It’s difficult_________ reconcile such different points of view? to
  126. Many people reported_________ a noise in the night? to have heard
  127. The color of the walls in my room has faded_____? away
  128. The flight stewardess the passenger_____________? how to fasten the seat belt
  129. _______a single word he says? don’t believe
  130. She made her stepson her______ to her large fortune? heir
  131. The girl ran______ the field when she saw her father after long time? across
  132. The Paralympics is a competition for the______? disabled
  133. He has___________ his mind to Join Pak Army? made up
  134. The farmers___________ their farms, if they had known that a thunderstorm was
    approaching? would have left
  135. I promise________ to you in all circumstances? stand with
  136. The problem___________ a lot of thought? calls for
  137. Do you prefer_________ or traditional art forms? contemporary
  138. It is already 8 o’clock. Can you________ time to catch the bus? make it in
  139. _________she is clever, she often makes mistakes? Although
  140. It is certain that human beings_______ latent power of which they are only vaguely aware? possess
  141. _________your instruction, we have closed your bank account? In accordance with
  142. He tends to________ any suggestion I make in meetings? cooperate
  143. My younger sister constantly misbehaves and is always causing_________? mischief
  144. If you had followed the rules, you_______ disqualified? would not have been
  145. The_______ were arrested for illegally hunting the bears? poachers
  146. _______you leave now, you will be late? Unless
  147. The man________ down the road is my brother? hurrying
  148. John said he________ to play at home? would prefer
  149. The housewife________ the cakes burning, and ran to switch off the oven? smelt
  150. If we go to the park___________, you like to come too? would
  151. When will you hand ________your assignment? in
  152. I am very much_________ to meet you? delighted
  153. If I had helped him, he________ drowned? would not have
  154. He has many friends, but______ are good ones? few
  155. ______ the rain forests is very important, if we do not want the flora and fauna
    found there to become extinct? Preserving
  156. That was______ movie I have ever seen? the worst
  157. I assume________ with me? that everyone agrees
  158. There is quite tenuous evidence________ it? for
  159. The company let me_____ time off work? take
  160. ________you wake me up so early on a Sunday? could
  161. Do not stay in the grasslands after dark, as some animals become______ when
    they see humans? aggressive
  162. My father was angry______ my failure? At
  163. She remained a______ all her life? spinster
  164. My brother is devoted_________ religion? to
  165. The lion sprang______ the buffaloes? upon
  166. The song in the play cannot be deleted as it is_____ to the story? integral
  167. After_______ smoking, they let the cigarette fall on the wood floor? finishing
  168. There is something wonderful_____ him? about
  169. He_______ in Pakistan? lives
  170. The building is not safe and must be______ down? pulled
  171. He is blind_____ one eye? of
  172. I shall look_____ the matter? into
  173. I am very much_______ to meet you? delighted
  174. All of us are devoted____ one another? to
  175. The man_________ down the road is my brother? hurrying
  176. It is already 5 o’clock. Can you_________ time to catch the bus? make it in
  177. It is certain that human beings__ latent power of which they are only vaguely aware? possess
  178. If we go to the park__________ you like to come too? would
  179. Some people_______ to the officer against him about his misdeeds? complained
  180. The police forces have launched an operation to__ out the kidnapped person? trace
  181. If she is not interested, we will___________ the proposal? abandon
  182. There is something wonderful________ him? about
  183. The President’s speech was so______ that many people were persuaded to
    accept the need for change? eloquent
  184. A speed limit is the legal speed_____ that you can travel on the road? maximum
  185. In the test, we will_____ your work and then give you detailed feedback? assess
  186. The speaker did not properly space out his speech, but went on___ one point only? stressing
  187. Its difficult_______ reconcile such different points of view? to
  188. I promise to_________ you in all circumstances? stand with
  189. Asmah __________ a book yesterday? read
  190. It was raining yesterday, so we __________ out? did not go
  191. I __________ what was happening? couldn‘t understand
  192. If you work hard, you __________ good marks? will get
  193. If you __________ hard, you would not have failed in the exams? had worked
  194. If the camera was working, we __________ a movie? .could make
  195. Emma is getting __________ the car? out of
  196. Near the London eye, there is a bridge __________ the Thames River? .over
  197. Asmat is falling __________ the horse? off
  198. She is looking for a job in __________ electronic or print media? either
  199. They could save money if they bought __________ furniture? economical
  200. I ___an old friend in Empress Market this morning? came across
  201. Nothing must be allowed to_____ our search for the truth? interfered with
  202. Our plan_____ to succeed? bid fair
  203. Complete the following sentence: No sooner did the thief see the policeman____? then  he ran away
  204. What is Synonyms of word Nightmare? Incubus
  205. Pick the correct response from following sentence “In the beginning he worked
    honestly but later he turned_________ to be a cheat? Out
  206. As he was not prepared for making a speech he broke_______ in the middle? off
  207. Complete the following sentence: The doctor advised the patient________? not to neglect his health
  208. I dont agree with you; I think_________? it is rather a good film
  209. I enquired of him________? if he wanted to join the course
  210. He exclaimed with shock________? that it was a very tragic accident
  211. What is antonyms of word Restoration______? Depredation
  212. What is synonyms of word Pedigree_________? Lineage
  213. Because of oil crisis, the prices of commodities are looking_______? up
  214. Synonym of “Mano a Mano? Hand to hand
  215. I am astonished______ his behavior? With
  216. “Profligate” Antonym______? Thrifty
  217. “Reading” quickly and well requires practice. The “Reading” word is a/an _______? Gerund
  218. What does the word ‘CASCADE’ means? Waterfall
  219. Adnan is “very different about” passing the Civil Services Examination this year? Lacking self-confidence about
  220. It was he who put “a spoke in my wheel? thwarted in the execution of the plan
  221. Plough a lonely furrow means_____? do without the help of others
  222. He is “out and out” a reactionary? thoroughly
  223. Synonym of Shelve_______? postpone
  224. The decision did not appear to “hold out” bright prospects? offer
  225. Stew in ones own juice means________? Suffer for his own act
  226. Play to the gallery means_________? attempt to appeal to popular taste
  227. He is using “backstairs influence” to sort out his matter? Secret and unfair influence
  228. He was undecided. He “let the grass grow under his feet? loitered around
  229. This matter has been “hanging fire” for the last many days. It should be sorted out? going on slowly
  230. I ___an old friend in Empress Market this morning? came across
  231. Nothing must be allowed to_____ our search for the truth? interfered with
  232. Our plan_____ to succeed? bid fair
  233. Complete the following sentence: No sooner did the thief see the policeman____? then  he ran away
  234. What is Synonyms of word Nightmare? Incubus
  235. Pick the correct response from following sentence “In the beginning he worked
    honestly but later he turned_________ to be a cheat? Out
  236. As he was not prepared for making a speech he broke_______ in the middle? off
  237. Complete the following sentence: The doctor advised the patient________? not to neglect his health
  238. I dont agree with you; I think_________? it is rather a good film
  239. I enquired of him________? if he wanted to join the course
  240. He exclaimed with shock________? that it was a very tragic accident
  241. What is antonyms of word Restoration______? Depredation
  242. What is synonyms of word Pedigree_________? Lineage
  243. Because of oil crisis, the prices of commodities are looking_______? up
  244. Synonym of “Mano a Mano? Hand to hand
  245. I am astonished______ his behavior? With
  246. “Profligate” Antonym______? Thrifty
  247. “Reading” quickly and well requires practice. The “Reading” word is a/an _______? Gerund
  248. What does the word ‘CASCADE’ means? Waterfall
  249. Adnan is “very different about” passing the Civil Services Examination this year? Lacking self-confidence about
  250. It was he who put “a spoke in my wheel? thwarted in the execution of the plan
  251. Plough a lonely furrow means_____? do without the help of others
  252. He is “out and out” a reactionary? thoroughly
  253. Synonym of Shelve_______? postpone
  254. The decision did not appear to “hold out” bright prospects? offer
  255. Stew in ones own juice means________? Suffer for his own act
  256. Play to the gallery means_________? attempt to appeal to popular taste
  257. He is using “backstairs influence” to sort out his matter? Secret and unfair influence
  258. He was undecided. He “let the grass grow under his feet? loitered around
  259. This matter has been “hanging fire” for the last many days. It should be sorted out? going on slowl