OET ONLINE TEST 6 script

Miss Wells  
Part A6.1
Twenty-two.

Doctor  Are you married?

Miss Wells    No, but I live with my partner. 

Doctor  Have you ever been pregnant?

Miss Wells   No.

Doctor  And when was your last cervical smear? 
 Ah…that would have been done when I went to see my GP. Probably three
Miss Wells   months ago now. It was all normal. 

Doctor  Okay, great. Now I gather you’ve had some pelvic pain recently.
 Yes, that’s right. It started in February of this year as sharp pain in the left
side of my stomach. It usually came on a few days before my period and then
seemed to settle down at the end of my period. After February the pain got
really bad and it wouldn’t go away, so I was admitted to hospital. The
Consultant there performed a laparoscopy and it revealed that on my left ovary
and behind my womb I hadendometriosis. After that, he suggested I should take
the pill without a break, but the pain didn’t get any better so he started me on
progesterone tablets, which made me feel horrible. I put on weight and felt
Miss Wells   bloated all the time. I also developed acne – I hadn’t had that since I was a
teenager – but the pain still didn’t get any better. So the Consultant
readmitted me in May of this year and performed another laparoscopy and
treated the endometriosis with a diathermy. After that, I was much better and
the pain almost completely went away. That was until August, when it
returned. It’s been slowly getting worse since then, and again, as in the
beginning, it’s in my stomach and hurts just before my periods, only now the
pain is there at all different times and it really hurts when I’m having
intercourse, especially in certain positions.

Doctor  Right, I see. And are your periods regular? 

 Yes, regular because I’m taking the pill again with a week’s break. The last
Miss Wells   one was about three weeks ago. 
 Doctor What about any other health concerns?  
 No, everything else is fine. I’ve never been a smoker, but I do like a drink at
weekends. Just one or two though, nothing crazy. My family are all well too.
Miss Wells   No serious illness in either my mum or dad, or in my older sister. Nothing else I
can think of really.

Doctor  Okay. And do you have any problems passing urine or with your bowel motions?
 
No, that’s all good too.
Miss Wells  
 
All right Miss Wells, I think it would be sensible to have a look at you and run
some tests. Then we can chat about how to take things forward. But from what
Doctor you’ve told me my initial suspicions are that the endometriosis might have
come back.
 
That’s what I was afraid of. Since I was first diagnosed I’ve been doing a lot of
reading, so I was really worried when the pain returned. I’d like to be able to
have children in the future and I’m worried it might be difficult with the
endometriosis. I really don’t want to be one of those women who ends up
Miss Wells   having problems getting pregnant. I’m also really sick and tired of the pain. It’s
beginning to feel like I’ll be stuck with it forever. I can tell it’s starting to
affect my mood. Just ask my boyfriend.

Part A6.2
Mrs Georges Hello Nurse. My husband seems quite settled now. I can answer those questions
if you like.

Nurse Yes, Mrs Georges, now’s a good time. Come in and have a seat. So how are you
feeling now that Mr Georges is here with us?  
Mrs Georges  
I know it was the right decision. Being the only carer for my husband has been
such hard work, and we did discuss everything fully with the social workers and
our doctor. But I do miss having him with me at home. It had to happen though.
 I’m completely worn-out.

Nurse Do you mind telling me more about your husband?

I do wish you could have seen him before all of this happened. He was so alert
Mrs Georges  and active – always helping people. He was in the navy when he was younger, so
he’d often spend months away at a time. I got quite used to being on my own
before he retired.

Nurse I hope you’ve got family nearby to help you out and keep you company.

Oh, I won’t be lonely. Our son lives just around the corner, and we have a
daughter who comes to visit as often as she can. She has a young family now
Mrs Georges though, so she’s quite busy. I really lost my husband when his mind started to
go.

Nurse When did you first notice something was wrong?

 ++++++++++++++++ (Script missing)
At first he knew something was wrong. He was frustrated and would fly off the
handle with me and I’d snap back at him. I suppose I didn’t realise he couldn’t
Mrs Georges
help it. I feel teary now just talking about it. After 40 years of marriage we
knew what the other was thinking most of the time, but now we can’t
understand one another at all.

Nurse I’m sorry Mrs Georges.

In the beginning, when I really started to suspect something wasn’t right, one of
Mrs Georges the main things he’d do was ask me the same question again and again. I’d say
to him, “Bob, you’re driving me mad,” and he’d just smile and the next minute
he’d do it again. But he hardly speaks at all now.

Nurse How is he with everyday tasks?

Mrs Georges
Oh, he has a lot of trouble with dressing. I have to help him. It’s as if he’s
completely forgotten what it is he has to do. Getting him to have a shave is
another issue. He just won’t do it and he pushes me away if I try to help. I hate
 to see him looking so untidy. He was always so particular about the way he
looked. Maybe you’ll have better luck with him than I’ve had.

 
Nurse Perhaps.

 
Oh and in the last few months he’s started to wander off during the day. That’s
been a real problem. He could be out the front door and down the street before
I even knew what was happening. I was sure one day he was going to get hit by a
car. And then he stopped knowing the difference between day and night and
Mrs Georges would get up out of bed at all hours. That really frightened me. I used to wonder
what would happen if he turned on the gas for the oven – he was always playing
with the controls for it during the day. I’d lay there in bed in the dark listening
to hear if he was going to get up, and when I did finally fall asleep, any little
noise would wake me. That’s what finally convinced me to bring him here.
 

Part B6

You hear two doctors discussing a patient.

 
Dr Jones speaks to Dr Khan because he wants to
 
Select one:
A. confirm his own diagnosis.
B. hear Dr Khan’s diagnosis. 
C. send the patient for tests.

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Transcript
Dr Jones  Dr Khan, have you got a moment? I wanted to talk to you about Polly Peptide.
Dr Khan Sure Dr Jones.
Polly is a 6-year-old girl with a medical history of asthma and eczema who was admitted
yesterday for an asthma exacerbation. She presented with shortness of breath and cough after
visiting with her grandparents, who are smokers. She responded well to albuterol and
Dr Jones
prednisolone in the emergency department, but was admitted due to persistent hypoxia in room
air. She was also given a recent dose of acetaminophen because of fever. Her current
temperature is 39.7 degrees Celsius.
Dr Khan  How is she on auscultation?
There are significant audible expiratory wheezes throughout the left lung and in the right upper
Dr
regions. Her breathing sounds are diminished and there is an absence of wheezes toward the
Jones  
right base.  
Dr Khan Possible bacterial pneumonia?
 That’s what I was thinking. I’m sending her for a full range of tests to confirm. Thanks Dr
Dr Jones
Khan.
The correct answer is: confirm his own diagnosis.
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You hear a dietician talking to a patient.

What is she doing?

Select one:
A. Showing the patient alternative diet plans that eliminate fat.
B. Explaining why the doctor wants the patient to eat a low-fat diet.
C. Empathising with the patient about the challenges of reducing fat. 
Feedback
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Transcript

Dietician  There are reasons the doctor talked to you about being on a diet low in fat.
Patient I know, but I like salami, cheese, fries. A meal is not a meal without bread and butter.
I can understand that it’s hard for you. I myself have had to eliminate nearly all the fat from my
Dietician
own diet, and it is difficult to give up the things we like so much.
 What foods have you had to give up?
Patient
Ice-cream was my favourite. I used to have a bowl of that almost every night. But there have
been others – butter, sausages. No one’s saying you can’t eat fatty food occasionally, but you
Dietician 
really do need to try and reduce your overall fat intake if you want to start to feel better. Here,
let’s look at a possible meal plan to give you a better idea of what I’m talking about.
The correct answer is: Empathising with the patient about the challenges of reducing fat.
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You hear a professor of emergency medicine giving a presentation to a group of trainee doctors.  
 
The presentation is about
 
Select one:
A. why European wasps are a problem. 
B. what European wasps like to eat.
C. how European wasps sting.

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Transcript

European wasps feed on meat and meat products, such as dog food and barbecue scraps. They
also like to scavenge sweet food and drinks and steal honey from beehives. Their stings are not
barbed like bee strings. This means a single wasp can sting repeatedly. The toxins in the sting
will cause a powerful reaction, and in some people an allergic reaction.Because they are
Professor
attracted to food, many wasp stings are in or around the mouth. These are the most dangerous
places for a sting, as swelling can result. Minor reactions include painful swellings on the lips,
while in severe cases there can be blockage of the trachea due to swelling and in the most severe
cases this can lead to death.
The correct answer is: why European wasps are a problem.
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You hear a GP talking to a regular patient who has been having kidney problems.
 
What does the GP suggest?
 
Select one:
A. That the patient’s lifestyle will change forever.
B. That there is more than one way to treat the patient. 
C. That the patient needs dialysis for the rest of their life.

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Transcript

 Hello, Mr. Hartley. Come and sit down. I gather you’ve been having more trouble since I last
GP saw you?

Mr
Yes, that’s right. I’ve kept vomiting and feeling dreadful. I can’t keep on like this.
Hartley
Mmm. It looks as though the next the step will be to get you to hospital to start further treatment.
GP
I think you’re going to need peritoneal dialysis treatment.
Mr  What's that doctor?
Hartley
It means putting a tube into the abdomen and then washing fluid in and out to keep the toxic
substances in the blood down. It’s not uncomfortable and you’ll be taught to do it yourself for
GP  
when you get home. With this method of dialysis you can walk about and live a reasonably
normal life.  
Mr
Will I have to use this for the rest of my life?
Hartley
Well, we will also take a specimen of your blood and put you in the computer for a kidney
transplant. If a suitable kidney becomes available, you may be able to undergo a kidney
GP
transplant operation. So you see, there are several ways of helping you. We’ll just have to see
how you get on
The correct answer is: That there is more than one way to treat the patient.
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Question text
You hear a physiotherapist in a hospital talking with John, a new patient.
 
The physiotherapist is
 
Select one:
A. providing sports recovery options.
B. explaining why warm showers are beneficial.
C. giving instructions to assist with recovery from an injury. 

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Transcript

Now that we’ve established that you’re not going to be playing sport, here’s what you’re
Physiotherapist
going to need to do for the next two to four weeks. 
John Ok.
 First of all, you’re going to have to wear a neck brace. You can get one in the shop on
Physiotherapist
the ground floor.
John  Do I wear that at night, like when I’m sleeping?
One thing that will help with the pain is using an icepack for 10 to 20 minutes, followed
Physiotherapist  
by a warm shower.
John Ok, um…I’ll still probably be working a bit…we don’t have a shower there.
 If you’re at work, you can just use a warm cloth instead. Another really good thing to do
Physiotherapist 
is neck and back stretches. We can go through those now if you like.
John Ok, great.
The correct answer is: giving instructions to assist with recovery from an injury.
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You hear a specialist physician and a nurse discussing a patient’s treatment.

The nurse is unable to help the physician because

Select one:
A. she isn't senior enough
B. she isn't familiar with the patient. 
C. she doesn't understand the treatment options.

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Transcript

Ah, nurse, hello. I’m wondering if you can help me. I’ve just been going over the charts for Mr
Physician Chui in bed 34 and I’m wondering why I wasn’t told that his blood pressure medications were
being held over the past few days
Hi Dr Greizman, right, I’m not sure. I didn’t even know that had happened. Let me look into it
Nurse
and get back to you.
There’s no need for that. I’ve been sitting here for 20 minutes looking at the blood pressures
Physician
and medications that have been given to the patient and it simply doesn’t make any sense.
 Well, I really don’t know, Dr Greizman. I’ve literally taken care of this patient for 4 hours. I
Nurse can discuss it with the nursing director though if you like

Physician    No, that isn’t necessary. Thank you nurse.

The correct answer is: she isn't familiar with the patient.

Part C6.1
What does Dr Dugan suggest defines a patient’s health literacy?
Select one:
A. how frequently they use available health services.
B. how well they communicate with health professionals.
C. how clearly they understand health-related information. 

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 *Question 1
Hello there. My name is Carly Dugan. I’m an emergency medicine physician and researcher. I’d
like to talk to you today about the importance of consumer engagement in health, an area which
has been widely acknowledged in recent years as playing a crucial role in achieving the best
possible health outcomes for patients.
As health professionals, our clients or patients come to us with various levels of education or
Carly literacy, and they may prefer to speak a different language, and these issues can become
Dugan barriers for them to understand health information.This, essentially, is the issue of health
literacy,  which is defined as the capacity to obtain, process and understand basic health
information and services; make appropriate health care decisions or act on health information;
and the ability to access or navigate the health care system, which we all know is extremely
complicated.  Any client who does not read or write well, has trouble understanding verbal or
written communication about health, speaks a different language, or has trouble understanding
or using numbers could have trouble with these areas.
The correct answer is: how clearly they understand health-related information.

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As a result of her own research, and other studies, Dr Dugan believes
Select one:
A. most patients don't listen carefully enough to health professionals.
B. patient health outcomes rely heavily on a person's health literacy. 
C. governments aren't doing enough to assist with health literacy.

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  *Question 2
Studies show that patients immediately forget 40-80% of medical information provided to them
by health care providers, and my own research clearly indicates that health literacy is a strong
predictor of health status. Patients with low health literacy have more difficulty recalling health
information, and inadequate health literacy can lead to numerous negative effects on an
individual’s health and well-being, including poor self-care, increased utilisation of health
Carly services, worse outcomes, and decreased likelihood of receiving preventive care and services.
Dugan Poor communication by health professionals with patients also contributes to unnecessary
readmissions. In response to surveys that have indicated high rates of poor health literacy,
governments and national agencies in countries as diverse as the US, China, Australia and some
European nations have now gone on to develop national strategies and targets to improve health
literacy in their populations. 
 
The correct answer is: patient health outcomes rely heavily on a person's health literacy.

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Dr Dugan says most health professionals have at one time
Select one:
A. had complaints made about their poor communication.
B. incorrectly assumed their instructions were understood. 
C. forgotten how to speak to patients in their own language.

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Transcript

 *Question 3
Health information can be confusing even for those with advanced literacy skills. It’s easy for
those of us working in health care to forget that we speak our own language that patients can’t
Carly
always easily understand. Most of us can recall times when we believed that we had shared
Dugan
information with a patient and family member or caregiver and believed they understood our
instructions, only to later discover confusion or misunderstanding. Communication breakdowns
in the chain of care are also a leading factor in preventable disability and death. 
The correct answer is: incorrectly assumed their instructions were understood.
Question 4
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Why does Dr Dugan share the examples about previous patients?
Select one:
A. to show how she teaches health literacy.
B. to illustrate findings from recent research studies.
C. to demonstrate the importance of clear communication. 

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 *Question 4
I teach a session on health literacy at a local college, and share examples from my own time in
practice. One example I share with my students is a study in which researchers asked patients
what they knew about diuretics, better known to some of you as fluid pills. Fifty-two percent of
Carly
the respondents researchers interviewed believed that fluid pills caused fluid retention instead of
Dugan
alleviating it. Another example I use is the story of a patient who was informed that she had
Grave’s disease, and burst into tears because she thought the doctor was telling her she was
about to die. This kind of confusion is understandable, but may also be avoidable if we take
some extra care with our communication with patients and family caregivers.
The correct answer is: to demonstrate the importance of clear communication.

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The paediatrician example about the "teach-back" method demonstrates
Select one:
A. how easy it is to overlook whether or not a patient has understood instructions.
B. what patients do and do not understand about health literacy.
C. the best way to confirm what a patient understands. 

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Transcript

 *Question 5
Regardless of a patient's health literacy level, it is important that as health care professionals we
ensure that patients understand the information they have been given. The “teach-back” method
is one way of checking understanding by asking patients to state in their own words what they
need to know or do about their health. It is a way to confirm that we have explained things in a
Carly
manner our patients understand. A pediatrician I recently did some work with told me: "I
Dugan
decided to do teach-back on five patients. With one mother and her child, I concluded the visit by
saying 'so tell me what you are going to do when you get home.' She could not tell me what
instructions I had just given her. I explained the instructions again and then she was able to
teach them back to me. I had no idea she did not understand the first time. I was so wrapped up
in delivering the message that I did not even realise it wasn't being received".
The correct answer is: how easy it is to overlook whether or not a patient has understood
instructions.

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What does Dr Dugan make about improving patient safety and care?
Select one:
A. It is essential to have reliable health care for all patients.
B. Focusing on acute care settings is the most important aspect.
C. Delivery of information beyond the traditional care settings is vital. 

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Carly  *Question 6
 Research clearly shows that consultations that include checking patients’ recall and
understanding do not take any longer than consultations that don’t, and that they help prevent
future unnecessary health service use. It is therefore essential that as we continue to work on
Dugan improving the safety and reliability of care, we consider deficiencies that contribute to patient
harm beyond the obvious focus on acute care and ambulatory settings, to include how we
communicate with patients about their treatment plans and their health. Ensuring that we are
communicating clearly and delivering information at the appropriate literacy level will be an
important step.
The correct answer is: Delivery of information beyond the traditional care settings is vital.
Finish review

Part C6.2
Dr Marshall believes that the low-fat era is coming to an end because
Select one:
A. the US Dietary Guidelines have changed towards fat.
B. 35 years ago the US Dietary Guidelines were very different. 
C. fat and cholesterol are no longer linked in the US Dietary Guidelines.

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Transcript

My guest today is Dr Naveed Pettis, associate dean of medical education at the University of
Interviewe Massachusetts Medical School. In light of a new report that’s recently been published on the
subject, we’re talking today about saturated fat. So, Dr Pettis, can you tell us what the
r
difference is in how many experts view fat now versus 30 years ago?
 
Dr  
Marshall *Question 1
The low-fat era is finally starting to come to an end. The 2015 U.S. Dietary Guidelines did, for
the most part, exonerate fat and cholesterol with no restrictions on total fat or cholesterol in
the diet — after 35 years of previous guidelines advising a low-fat and low-cholesterol diet. I
think there is still a lot of misinformation floating around about saturated fat. Not all saturated
 fats are bad, and they’ve somehow been grouped together and labelled as harmful. So, we still
have some work to do there.
 
The correct answer is: the US Dietary Guidelines have changed towards fat.

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Dr Marshall suggests that LDL particles
Select one:
A. are more dangerous when they’re smaller. 
B. have nothing to do with saturated fat.
C. pose no risk to a person’s health.

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Interviewe
r Can you talk a little more about the relationship between saturated fat and cholesterol levels? 
 
*Question 2
We spent most of the last generation looking at total cholesterol and LDL as if to suggest that
those two values give you an accurate reflection of what we know to be a much more complex
Dr and nuanced issue with lipids. But, when you give people fat from a quality source and lower
Marshall their carbohydrates, generally you see their triglycerides come down. That’s a good thing. You
see their good cholesterol, the HDL, go up. That’s a really good thing. What you see in the
majority of people when you give them more saturated fat is a shift from the small dense LDL
particles — these are the more risky, inflammatory, atherogenic types of LDL — to larger,
more buoyant LDL particles which are less inflammatory.  Many physicians still aren’t aware
of this. 
The correct answer is: are more dangerous when they’re smaller.

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Question text
What are Dr Marshall's views on saturated fats?
Select one:
A. Refined carbohydrates are more dangerous than saturated fat.
B. Not all saturated fats are the same as others. 
C. Vegetable oil should replace saturated fat.

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Interviewe
r What are your views on saturated fat and its place in the diet? 
 
*Question 3
Quality becomes paramount here. The saturated fat in a fast-food bacon cheeseburger will
have an entirely different effect than saturated fat in coconut oil. I absolutely love healthy
saturated fats like coconut oil and grass-fed butter, and I think they have a place in our diets.
Dr Healthy saturated fats can actually help you burn fat, they make your brain work better and
Marshall faster, they make your skin glow, and they can help optimise your cholesterol profiles. It is
very important that you only include saturated fat in the context of a diet that’s very low in
refined carbs and sugar and includes omega-3 fats. The entire LDL-lowering hypothesis is
being questioned by recent studies that have found that those who had the LDL lowered the
most by vegetable oil had the greatest risk of heart attack or death.
 
The correct answer is: Not all saturated fats are the same as others.

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Why doesn't Dr Marshall believe people should stop worrying about cholesterol?
Select one:
A. Biological solutions haven’t been able to solve the problem. 
B. People continue to eat too many foods high in fat and sugar.
C. More research is required to understand how fat enters the blood.

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Interviewe
r Are you saying we should embrace saturated fat and stop worrying about cholesterol?
 
*Question 4
No, I’m actually not suggesting that. The saturated fat in your diet has very little correlation to
Dr the saturated fat in your blood, but we do know that higher saturated fats in your blood are
Marshall linked to heart disease.  The question is how do you get high saturated fat in your blood?  Logic
would dictate that it is by eating butter. But biology is not so straightforward. It is by eating
sugar and refined carbs. Low-fat, high-carb diets trigger synthesis of the type of blood-
saturated fats that are linked to heart disease.   
The correct answer is: More research is required to understand how fat enters the blood.

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Dr Marshall says there is no agreement over nutritional science because
Select one:
A. there are too many opinions when it comes to a person’s diet.
B. there are a lot of different ways to interpret the information. 
C. there isn’t enough money to fund high quality research.

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Interviewe
r Why is nutritional science often so contradictory and confusing?
 
*Question 5
There is contradictory information because the research is hard to read and, of course, if a
Dr study is being performed or funded by someone who has a strong opinion, the outcome is more
Marshall likely to favour that opinion. A lot of experts are also looking at outdated research. These are
studies in which people who are eating fat are eating bad fats, inflammatory fats, and junk
foods. Well, of course, you would think that the fat is bad for you if you’re looking at a study
like that. So, it often comes back to an individual’s understanding of the research.
The correct answer is: there are a lot of different ways to interpret the information.

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In Dr Marshall's opinion, many organisations and experts need to 
Select one:
A. become more open-minded about embracing current studies.
B. encourage more people to eat a diet high in vegetables.
C. stop saying that eating saturated fat is bad. 

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Transcript

Interviewe  
r Why do a lot of organisations and experts still push a no-fat or low-fat message?
Dr  
Marshall *Question 6
 
I think that is such an important question. I’ve been in practice almost 30 years, and I have
had very academic roots all along. And there is this incredible delay. The structures and
organisations and associations that we look to for guidance and advice are not nimble at all.
They bring inherent bias. These are good people, but there’s an inherent bias that these
 structures tend to embrace. We all know that there are researchers who will lose grant support
overnight if they suddenly change from saying “fat is bad”. They’ll struggle to maintain their
academic integrity based on the culture they’re in. In all of this debate over fat and saturated
fat in particular, I still recommend filling your plate with at least 75 percent phytonutrient-
rich, colourful, non-starchy veggies. Plant foods, by volume, should take up the majority of
your plate.

The correct answer is: become more open-minded about embracing current studies.