5 Set Lis and Reading1 5

Study guide for OET © IRS Group 2018 1
2 Study guide for OET © IRS Group 2018

Study Guide
for OET
with 5 Practice test
Study guide for OET © IRS Group 2018 3

“Patients in their journey through the health care system are entitled to be
treated with respect and honesty, and to be involved wherever possible in
decisions about their treatment.”
(Kennedy, 2001)
Study Guide for

Occupational English Test 5
Practice test included
Milen Jacob
First Published: 2018 Copyright:

IRS Group Kottayam | Kochi |
Hyderabad
www.irsgroup.in

Occupational English Test
Test format
OET is an international English language test that assesses the language communication skills of
healthcare professionals who seek to register and practise in English-speaking countries such as Australia,
New Zealand, the UK and Ireland.
OET is a test developed for 12 healthcare professions: Nursing, Medicine, Pharmacy, Dentistry,
Physiotherapy, Radiography, Speech Pathology, Dietetics, Occupational Therapy, Optometry, Po- diatry,
and Veterinary Science
OET assesses all four language skills - listening, reading, writing and speaking - with an emphasis on
communication in a healthcare environment.
There is a separate sub-test for each skill area. The Listening and Reading sub-tests are designed to assess
the ability to understand spoken and written English in contexts related to general health and medicine.
The sub-tests for Listening and Reading are common to all professions.
The Writing and Speaking sub-tests are specific to each profession and are designed to assess the ability
to use English appropriately in a relevant professional context.
The four components of OET

Paper (duration) Content Shows candidates can:
Listening 3 tasks follow and understand a range of health related
(approx. 45 minutes) Common to all 12 professions spoken materials such as patient consultations and
lectures.
Reading (60 minutes) 3 tasks read and understand different types of text on
Common to all 12 professions health-related subjects.
Writing (45 minutes) 1 task write a letter in a clear and accurate way which is
Reading time: 5 minutes Specific to each profession relevant for the reader.
Writing time: 40 minutes
Speaking (20 2 tasks effectively communicate in a real-life context

minutes) Specific to each profession through the use of role-plays.
Listening
The listening sub-test is 45 minutes long.
The listening sub-sub-test is the first test on the test day and is for about 45 minutes. The
Listening sub-test consists of three parts, with 42 questions.
The listening sub-test is the same for all professions.
The topics are of generic medical interest, accessible to candidates across all professions.
Each part consists of a variety of recorded audio extracts, testing different listening skills. There will be
pauses throughout the test to allow candidates to read questions or write their answers.
Candidates will hear each recording once and are expected to write their answers while listening.
Part A - Consultation extracts

This part assesses candidates’ ability to understand, interpret and record detailed or specific information.
There would be an increased focus on patient centred language, and thus this part differs from a typical
structured consultation. You will listen to two recorded health professional-patient consultations and you
will complete the health professional’s notes using the information you hear. There will be 12 questions in
each consultation.
Duration :
15 minutes (for 2 consultations) structured note completion
Tasks Marks 24 :
:
Part B - Short workplace extracts

Part B consist of 6 short dialogues or monologues in work place settings that tests the candidate’s ability to
listen for gist, detail, and course of action.
Duration Tasks : 10 minutes (for all 6 questions)

Marks :
: three option multiple-choice questions
6
Part C - Presentation extracts

In part C, you will listen to two different extracts and you will answer six multiple-choice questions for
each extract. The extracts could be monologues or interviews with healthcare professional.
Duration Tasks : 15 minutes (for 2 extracts)

Marks : three option multiple-choice questions
:
12
Reading
The reading sub-test is for 60 minutes.
The Reading sub-test consists of three parts:
Part A – expeditious reading task Part B
– multiple-choice questions.
The topics are of generic medical interest and are therefore accessible to candidates across all professions.
Part A : Expeditious reading task

Part A assesses your ability to locate specific information from four short texts in a quick and efficient
manner. The four short texts relate to a single healthcare topic, and you must answer 20 questions in the
allocated time period.
Duration Tasks
: 15 minutes
Marks
: matching, sentence completion and short answer questions.
:
20
Part B and C: Careful reading tasks

Part B assesses your ability to identify the detail, gist or main point of six short texts sourced from the
healthcare workplace (100-150 words each). The texts might consist of extracts from policy documents,
hospital guidelines, manuals or internal communications, such as emails or memos. For each text, there is
one three-option multiple-choice question.
Part C assesses your ability to identify detailed meaning and opinion in two texts on topics of interest to
healthcare professionals (800 words each). For each text, you must answer eight four- option multiple
choice questions.
Duration : 45 minutes
Tasks
: multiple choice questions Part C: 4 option multiple choice questions
Part B: 3 option
22
Marks :
Practice test 1
Listening test
Extract 1: Questions 1 - 12
You hear a psychologist talking to a client called Candice May. For questions 13-24, complete the notes with a
word or short phrase.
You now have thirty seconds to look at the notes.
Patient :  Candice May
Reason for appointment :  tension due to relationship issues
 (1) in the workplace
 makes her (2)
Background to the condition:  experiencing difficulties for the last (3)
mother is sick for the last 3-4 months
 no treatment taken
Present condition :  (4) is bit of difficult
 doesn’t have (5)

to talk to
 prioriti
es dealing with issues with (6)
thinks she is putting a lot of pressure on him
Advice offered :  (7) on the relationship area
Further enquiries :  (8) of counselling sessions
 (9) involved for extra sessions
Session schedule :  can (10) as long as required
 difficult to provide set time
 (11) book a session for next week
 can focus on the (12)

of relationship
Extract 2: Questions 13-24
You hear a psychologist talking to a client called Jane Speirs. For questions 13-24, complete the notes with a
word or short phrase.
Patient :  Jane Speirs
Description of the condtion:  feeling (13)
 (14) in the muscles
 unable to play netball
Early symptoms :  started few weeks ago with a (15)

 (16)
head
 no treatment taken
 can’t do (17) really
Further details :  (18) fine
weight steady
no temperature with cold
 (19) regular
Diagnosis :  (20) around the body
 enlarged spleen
 suspected (21)
red throat
Management :  (22) to confirm diagnosis
 test for (23)
Advice given :  adequate rest
no specific remedies
body cures itself
 (24) diet and fluid intake
 follow up at the end of week
That is the end of Part A.

Part B
In this part of the test, you’ll hear six different extracts. In each extract, you’ll hear people talking in a
different healthcare setting.
For questions 25-30, choose the answer (A, B or C) which fits best according to what you hear. You’ll
have time to read each question before you listen. Complete your answers as you listen.
Now look at question 25.
25. You hear a health recommendation on free sugar reduction What
does the expert call for
A Reduction in determination of ill health

B Prevent the onset of the condition
C Eradication of non-communicable illness
26. You hear a health expert talk on pregnancy in women with epilepsy What
impact does seizure have on childbirth?
A Associated risks with delivery are unlikely

B Substantial risk of post partum bleeding
C Mother will remain seizure free for a year
27. You hear an advice on codeine use by an advanced practice pharmacist.
The speaker focuses on the biophysical model to
A explain the normal action of the drug

B reveal the addictive responses seen
C convey the working of analgesics
28. You hear a registered nurse talk on advantages of aged care channel How
does the channel benefit as a resource
A it aids in training and developing it

B helps in preparing new recruits it
C supplements other equipment
29. You hear a doctor discuss on carT-cell therapy The
new immunotherapy involves
A increasing the intensity of resistance

B altering cell structure of pathogens
C understanding the patient’s genetics
30. You hear a patient handover by two nurses
Detail observation of the patient outlines
A cessation of smoking two years ago constancy

B maintained in oxygen saturation daily
C independent performing of ADLs
That is the end of Part B. Now look at Part C.

Part C
In this part of the test, you’ll hear two different extracts. In each extract, you’ll hear health professionals talking about
aspects of their work.
For questions 31 to 42, choose the answer (A, B or C) which fits best according to what you hear.
Complete your answers as you listen.
Now look at extract one.
Extract 1: Questions 31 to 36
You hear a lecture on migraine by Dr Benjamin Durette. You

now have 90 seconds to read questions 37-42.
31. As per the doctor’s opinion, what may be the cause of migraine?
A Hormonal changes affecting the body Oedema of

B blood vessels inside the brain Aura that precedes
C the onset of headache
32. According to the doctor, why is aura benign?
A Since there is a difficulty in focussing eye sight Only

B rarer forms affect both sensation and speech The time
C duration during which the conditon lasts
33. What according to the doctor is visually the most widely relieving method?
A Effective sleep until the headache subsides Vomiting to

B reduce the chances of regurgitation Wait until the
C headache weans itself away
34. How can hormonal fluctuations be thought to be a trigger according?
A Lack of sleep even if the difference is marginal

B Around half of the women likely experience while menstruating The
C onset of the condition during sudden exercise.
35. Why does the speaker think ice treatment can reduce the impact?
A Blood vessels become swollen with blood and dilate It

B cools the blood vessels therapy resulting in relief It
C contracts the vessels and reduces the blood flow
36. According to the doctor, what can be administered to sporadic migraine?
A Relaxation techniques that include bio feedback. Prophylactic

B medication which is taken regularly
C Over the counter pain relievers like aspirin or ibuprufen
You hear a doctor talking about innovations in neuromuscular medicine. You
37. How did Dr Jeffry become a neuromuscular expert?
A The general neurology training that he started out with The

B fellowship he specialised in neuromuscular medicine His
C background in neurology and the fellowship combined
38. What best describes a typical day of the doctor?
A conducting a variety of procedures such as electromyography could

B be seeing a lot of patients or performing procedures seeing patients
C with rare conditions and serious prognosis
39. What was an exciting development regarding ALS?
A The discovery of genetic biomarkers that can be tested easily Ice

B bucket challenges helped raise funds required for research better
C understanding of its progresses in a particular patient
40. What should be a physician’s priority for an ALS patient
A Rely on treatments that really benefit patients overcome the disorder alleviate
B associated problems so that patients can lead normal lives help patients
C communicate better by helping them not to lose voices
41. What does Dr consider as one of the most under recognised problems with ALS
A How the disorder affects patient’s mental disposition The

B devastation that the diagnosis has on the patient The lack
C of social support that is required for patients
42. What can patients with diabetic neuropathy expect in the future
A Better pain medication to reduce the pain associated Exciting

B research on drugs that patients are familiar with Introduction of
C newer drugs with greater effectiveness
That is the end of Part C.
You now have two minutes to check your answers.
END OF THE LISTENING TEST.

Reading test
Variations in HIV testing: Texts
Text A
What is a
An ELISA or enzyme-linked immunosorbent assay, is a method used in the laboratory to aid in the diagnosis of a wide range of diseases. This test
This test relies on the interaction between components of the immune system called antigens and antibodies. Antibodies are proteins produced
What is the test used for?
ELISAs are used for numerous types of tests in the laboratory which can assist in the diagnosis of many different conditions.
It is most commonly requested if it is suspected you have been exposed to viruses such as HIV and Hepatitis B or C, or bacteria and parasitic infe
Other uses of the ELISA include:
• De
• D
• Meas
toid
Some kits are also available for the general public to use for ex
which is excreted in the urine of a pregnant woman.
Text B
ur healthcare worker should explain which test you will be given and how you will get your result. Normally, testing involves taking a small sample of blood from eithe
are taking. If you are taking a rapid test, you will be given your results within 20 minutes. Other types of tests will be sent to a laboratory and you may have to wait fo
Text C
es, are required to identify those most likely to benefit.

ms of PrEP. At a population level, given limited resources and a desire to achieve the maximum impact of PrEP, clinicians should use clinical criteria and recommend
case-by-case basis by clinicians when considering eligibility for PrEP and assessing HIV risk. Although this lacks a clear evidence base, the writing group has considered
Text D
Summary table of recommendations for PrEP
Recommend PrEP
(i) HIV-negative MSM and trans women who report condomless anal sex in the previous 6 months and ongoing
condomless anal sex.
(ii) HIV-negative individuals having condomless sex with partners who are HIV positive, unless the partner has been
on ART for at least 6 months and their plasma viral load is <200 copies/mL.
Consider PrEP on a case-by-case basis
PrEP may be offered on a case-by-case basis to HIV-negative individuals considered at increased risk of HIV acquisition
through a combination of factors that may include the following:
Population-level indicators Clinical indicators

• Heterosexual black African men and women • Rectal bacterial STI in the previous year
• Recent migrants to the UK • Bacterial STI or HCV in the previous year
• Transgender women • Post-exposure prophylaxis following sexual exposure
• People who inject drugs (PEPSE) in the previous year; particularly where
repeated courses have been used
• People who report sex work or transactional sex
Sexual behaviour/sexual-network indicators Drug use

• High-risk sexual behaviour: reporting condomless sex • Sharing injecting equipment
with partners of unknown HIV status, and particularly • Injecting in an unsafe setting
where this is condomless anal sex or with multiple
• No access to needle and syringe programmes or
partners
opioid substitution therapy
• Condomless sex with partners from a population group
or country with high HIV prevalence
Sexual health autonomy
• Condomless sex with sexual partners who may fit the
Other factors that may affect sexual health autonomy
criteria of ‘high risk of HIV’ detailed above
• Inability to negotiate and/or use condoms (or employ
• Engages in chemsex or group sex
other HIV prevention methods) with sexual partners
• Reports anticipated future high-risk sexual
• Coercive and/or violent power dynamics in relation-
behaviour
ships (e.g. intimate partner/domestic violence)
• Condomless vaginal sex should only considered high
• Precarious housing or homelessness, and/or other
risk where other contextual factors or vulner- abilities
factors that may affect material circumstances
are present
• Risk of sexual exploitation and trafficking
Part A
Time: 15 minutes
Look at the four texts, A-D, in the separate Text Booklet.
For each question, 1-20, look through the texts, A-D, to find the relevant information. Write
your answers on the spaces provided in this Question Paper.
Answer all the questions within the 15-minute time limit. Your answers should be correctly spelt.
Variations in HIV testing: Questions
Questions 1-7
For each of the questions 1-7, decide which text (A,B, C or D) the information comes from. You may use any letter
more than once.
1. Time taken to receive 4th generation antigen tests
2. Factors that are observed to affecting sexual autonomy
3. The differing conditions that are diagnosed with ELISA test
4. Talking to patients about pragmatic decisions on future
5. Antibodies are the substances produced for antigens
6. PrEP for partners from a high HIV risk population group
7. Health care worker should explain the test given
Questions 8 - 13
Answer each of the questions, 8 – 13, with a word or short phrase from one of the texts. Each answer may include
words, numbers or both. Your answers should be correctly spelled.
8. What does an ELISA test measure for in pregnancy?
9. How is acquisition considered for HIV negative individuals?
10. How long does it take to receive results of a rapid test?
11. What are the examples of autoimmune conditions detected by ELISA?

12. What kind of histories are required to identify those who need PrEP ?
13. How long will it take to detect HIV with self-testing kits?
Complete each of the sentences, 14 – 20, with a word or short phrase from one of the texts. Each answer may include
words, numbers or both. Your answers should be correctly spelled.
14. Particular are measured for diagnosis of an ELISA test.
15. People who engage in sex falls under population level indicators.
16. HIV tests involve taking sample from or the arm for detailed blood study.
17. for PrEP must be considered on the basis of vulnerability factors for HIV.
18. Interaction between components of is relied on for ELISA test results.
19. of self testing kits is satisfactory but requires further medical scrutiny.
20. Individuals who have with HIV positive partners must be recommended
PrEP.
Part B
In this part of the test, there are four short extracts relating to the work of health professionals. For questions
1-6, choose the answer (A, B or C) which you think fits best according to the text.
1. The changes in standards as per the revised protocol was necessitated due to
A more evidence of associated risks seen

B inconsistent responses to new findings
C protocols that prioritize peadiatricians only
Executive Summary
ns of a national expert group convened under the auspices of Children’s Healthcare Australasia (CHA), have led to variable practices across NSW Health ho
2. The guidelines on CDCT aims to enumerate the
A importance of eliciting personal preference morbidity

B rates noticed in clinical observations conservative
C estimates of procedural effectiveness
Updates on early lung cancer detection with Low-Dose Helical

Computed Tomography
Key Discussion Points for the Process of Shared Decision Making Related to Screening for Early Lung Cancer
Detection With Low-Dose Helical Computed Tomography
• Benefit: Screening with LDCT has been shown to substantially reduce the risk of dying from lung cancer
• Limitations: LDCT will not detect all lung cancers or all lung cancers early, and not all patients who have a
lung cancer detected by LDCT will avoid death from lung cancer
• Harms: There is a significant chance of a false-positive result, which will require additional periodic testing
and, in some instances, an invasive procedure to determine whether or not an abnormality is lung cancer or
some nonlung-related incidental finding; <1 in 1000 patients with a false-positive result experiences a major
complication resulting from a diagnostic workup; death within 60 d of a diagnostic evaluation has been
documented but is rare and most often occurs in patients with lung cancer
• Individuals who value the opportunity to reduce their risk of dying from lung cancer and who are willing to
accept the risks and costs associated with having an LDCT and the relatively high likelihood of the need for
further tests, even tests that have the rare but real risk of complications and death, may opt to be screened
with LDCT every year.
3. The evaluation and management exercise requires students to
A perform in the presence of a billing physician document

B services accorded in the medical record record significant
C decision making exercises involved
Evaluation and Management Documentation Provided by Students

ction for teaching physician billing. Students may document services in the medical record; however, the teaching physician must verify in the medical r
4. On suspecting a disorder it is important to
A convey the gist of the problem articulate

B the symptoms with patient focus on
C associated illness outcomes
How to approach the consultation

ch through what is said and not said. Listen and understand the patient’s version of reality, however bizarre it may appear, in order to discover more abo
sis is suspected and do not too readily dismiss symptoms as the results of depression, anxiety, or substance misuse
—for example, by saying, “Of course there aren't devils under the bed.” It works better to say, “I understand that this is how it appears to you, but this i
ere when well. Remember hostility can be a symptom of the illness
arly a stage; instead, focus the discussion around the patient’s symptoms and experiences
e. For example, some patients prefer “a person who experiences schizophrenia” rather than “schizophrenic”
5. The statutory catalogue informs
A appropriate dispensation of information is legal

B judicious consideration is required for data sharing
C consent of the individual must be maintained
Restricted sharing of information

ate to share that information with other organisations so that they may make reasonable use of it. Such restricted sharing of information may include sh
do so. Permissible legal means will include cases when:
6. The health guide advices individuals to
A prepare for long term wellness plan

B entrust a confidant for future care use
C informed choices for later care
Advance Care Planning

ges to prepare for the future. Both healthy people and people with health conditions do advance care planning.
ou would and would not want to receive if you become very sick or injured and couldn’t speak for yourself in the future
f you’re unable to do so for yourself. This person is called a health care agent
es of health care you want to receive so they’ll respect and honor your values and health care goals
nce directive. This form guides your health care providers as to what types of health care you want. It also helps your loved ones understand your wishes
Part C
In this part of the test, there are two texts about different aspects of healthcare. For questions 7-22, choose the answer
(A, B, C or D) which you think fits best according to the text..
Text 1: Pancreatic cancer: gradual rise, increasing relevance
Pancreatic cancer is the 10th most frequently occurring cancer but the fifth most common cause of cancer death in
Australia, as is also seen in other developed regions of the world. A gradual increase in incidence has been observed
since the 1980s in almost all age groups in both sexes. Increases have been attributed only to trends in smoking,
which is considered causal, with local published data suggesting a lag of about 30 years between smoking trends and
incidence. However, being overweight and obesity may also have contributed, in part, to incidence trends.
In developed countries, only about 50%–70% of cases of pancreatic cancer are histologically confirmed based on
review of the primary tumour, because pancreatic biopsy procedures have been associated with significant risks and
are often avoided. But improvements in imaging modalities, particularly endoscopic ultrasound and pancreas-specific
computed tomography, and magnetic resonance imaging protocols, together with endoscopically guided biopsy
procedures, are likely to have led to some of the increase in incidence through improved detection.
In 2011, the latest year for which results are available, 5-year survival from pancreatic cancer was 5.2% in Australia
and 7.3% in the United States (among patients on selected Surveillance, Epidemiology and End Results Program
registers) with modest improvements observed over the past several decades. Five-year survival from pancreatic
cancer was about 3% in the mid1980s in both places. Between 1987 and 2007 in Australia there was only a 6% drop
in mortality from pancreatic cancer in both sexes (in those aged less than 75 years), compared with decreases in
mortality of 34% from lung cancer, 47% from bowel cancer and 28% from all cancers overall. Current projections
suggest that within 10 years, pancreatic cancer will be the second-highest cause of cancer death in the US as mortality
and survival from the other four leading causes of cancer death (lung, bowel, prostate, and breast cancers) improves. If
these trends are reflected in Australia, it would be anticipated that pancreatic cancer will become one of the leading
causes of cancer mortality there also.
Complete resection of the primary tumour currently offers the only hope of cure. Beyond the setting of high- risk
families, screening to identify precursor or early invasive lesions is not feasible for two main reasons. First,
endoscopic ultrasound is invasive and can only be used in specialised settings, so does not meet criteria for a
population screening test. Second, the positive predictive value of screening is limited by the low population
prevalence of pancreatic cancer. Attempts to categorise the population using known risk factors, including several
known single nucleotide polymorphisms, have not yet identified population subgroups at sufficiently high risk to
warrant screening.
An avenue to optimise outcomes for patients is to ensure that all receive high-quality care in the most appropriate
setting. There is evidence from the US that not all patients with potentially resectable tumours are offered surgery.
Detailed data are not currently available for Australia, but it appears that there is similar underutilisation of surgery
there. It is thus important that all patients without metastatic disease are reviewed by a multidisciplinary team in a
major centre to determine the resectability of their pancreatic tumours. In addition, it is of great consequence that
resections be performed in hospitals that carry out a large number of these procedures annually, as this has been
shown to improve survival.
In conclusion, while the rise in pancreatic cancer incidence is slow, as the population ages, more people will be
affected with this disease. The burden of pancreatic cancer relative to other cancer types is likely to increase. A
multilevel approach is needed to control pancreatic cancer, including reducing the prevalence of risk factors such as
smoking and obesity, identifying effective biomarker screening tools and populations in whom screening or early
detection might be feasible, discovering new treatment modalities and ensuring that all patients have access to
optimal care.
Text 1: Questions 7 - 14
7. Opinion gauged from paragraph one on the eighties is that
A a rise in pancreatic cancer has occurred in all age groups. the

B rate of pancreatic cancer has risen in most age groups. the rate
C of pancreatic cancer has swiftly risen in all groups. the rate of
D pancreatic cancer rose in almost all age groups.
8. For developing pancreatic cancer, it is suggested in paragraph 1 that ……
A smoking trends have been attributed as the key factor. smokers lag
B by thirty years behind the incidence and trends. smoking and
C obesity combined is the exclusive cause. smokers have to wait a
D timespan of 30 years to get cancer.
9. From paragraph 2, what is suggested on pancreatic biopsy procedures?
A historically risky, leading to a detection rate of 50 to 70%. often

B avoided which has led to a 50 to 70% confirmation rate. are
C usually avoided due to being too risky to ever undertake.
D have contributed to the microscopic amount of confirmation rates.
10. The improvements in technology as is mentioned in paragraph 2 ……
A have contributed little to detection rates of pancreatic cancer. have

B detected more incidences of pancreatic cancer.
C have led to the increase in early detection of most cancers. have
D detected the abrupt increase of pancreatic cancer.
11. The word modest in paragraph 3 could NOT be replaced by ……
A Minor
B Marked
C Meagre
D Moderate
12. The figures for pancreatic cancer from the passage indicate
A a considerable decline in mortality rates for between 87-07. improved

B mortality rates within the next 10 years
C it will become the leading cause of cancer mortality.
D a highly probable rise in mortality rates in the near future.
13. In paragraph 4, the word ‘categorise’ could be replaced by
A Justify
B Classify
C Rectify
D Objectify
14. The author’s use of language in paragraph 6, is best described as ……
A Dismissive
B Biased
C Objective
D Disapproving
Text 2: Role of oral health on overall well-being
The relationship between oral health and diabetes (Types 1 and 2) is well known and documented. In the last decade,
however, an increasing body of evidence has given support to the existence of an association between oral health
problems, specifically periodontal disease, and other systemic diseases, such as those of the cardiovascular system.
Adding further layers of complexity to the problem is the lack of awareness in much of the population of periodontal
disease, relative to their knowledge of more observable dental problems, as well as the decreasing accessibility and
affordability of dental treatment in Australia. While epidemiological studies have confirmed links between
periodontal disease and systemic diseases, from diabetes to autoimmune conditions, osteoporosis, heart attacks and
stroke, in the case of the last two the findings remain cautious and qualified regarding the mechanics or biological
rationale of the relationship.
Periodontal diseases, the most severe form of which is periodontitis, are inflammatory bacterial infections that attack
and destroy the attachment tissue and supporting bone of the jaw. Periodontitis occurs when gingivitis is untreated
or treatment is delayed. Bacteria in plaque that has spread below the gum line release toxins which irritate the gums.
These toxins stimulate a chronic inflammatory response in which the body, in essence, turns on itself, and the tissues
and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets
(spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more
gum tissue and bone are destroyed. Often, this destructive process only has very mild symptoms. Eventually,
however, teeth can become loose and may have to be removed.
The current interest in the relationship between periodontal disease and systemic disease may best be attributed to a
report by Kimmo Mattila and his colleagues. In 1989, in Finland, they conducted a case-control study on patients
who had experienced an acute myocardial infarction and compared them to control subjects selected from the
community. A dental examination was performed on all of the subjects studied, and a dental index was computed.
The dental index used was the sum of scores from the number of carious lesions, missing teeth, and periapical
lesions and probing depth measures to indicate periodontitis and the presence or absence of pericoronitis (a red
swelling of the soft tissues that surround the crown of a tooth which has partially grown in). The researchers
reported a highly significant association between poor dental health, as measured by the dental index, and acute
myocardial infarction. The association was independent of other risk factors for heart attack, such as age, total
cholesterol, high-density lipoprotein triglycerides, C peptide, hypertension, diabetes, and smoking.
Since then, researchers have sought to understand the association between oral health, specifically periodontal disease,
and cardiovascular disease (CVD) – the missing link explaining the abnormally high blood levels of some
inflammatory markers or endotoxins and the presence of periodontal pathogens in the atherosclerotic plaques of
patients with periodontal disease. Two biological mechanisms have been suggested. One is that periodontal bacteria
may enter the circulatory system and contribute directly to atheromatous and thrombotic processes. The other is that
systemic factors may alter the immunoflammatory process involved in both periodontal disease and CVD. It has
also been suggested that some of these illnesses may in turn increase the incidence and severity of periodontal
disease by modifying the body’s immune response to the bacteria involved, in a bi-directional relationship.
However, not only is ‘the jury out’ on the actual mechanism of the relationship, it also remains impossible to say
whether treating gum disease can reduce the risk of cardiovascular disease and improve health outcomes for those
who are already sufferers. Additional research is needed to evaluate disease pathogenesis. Should the contributing
mechanisms be identified, however, it will confirm the role of oral health in overall well-being, with some
implications of this being the desirability of closer ties between the medical and the dental professions, and improved
public health education, not to mention greater access to preventive and curative dental treatment. In time, periodontal
disease may be added to other preventable risk factors for CVD, such as smoking, high blood cholesterol, obesity
and diabetes.
15. According to paragraph 1, periodontal disease is unknown to many Australians because ……
A dental treatment is no longer affordable.

B the problem has a high degree of complexity.
C information on dental problems is inaccessible. it is
D not as prominent as other dental issues.
16. ‘Epidemiological’ in the first paragraph is used to denote
A causative
B scientific
C plagiarised
D controlled
17. According to paragraph three, the 1989 study in Finland ……
A prompted further interest in the link between oral health and systemic disease. did not
B take into account a number of important risk factors for heart attacks. concluded that
C people with oral health problems were likely to have heart attacks. was not considered
D significant when it was first reported but is very major now.
18. The relationship between dental hygeine and heart attacks as is expressed in paragraph three is
A inconclusive
B coincidental
C evident
D inconsequential
19. As per paragraph three, the dental index was primarily used to
A indicate whether periodontis was present assess the

B overall oral health of patients. establish whether
C pericoronitis was present. predict the onset of acute
D myocardial infarction.
20. According to paragraph four, the viewpoint expressed is that
A cardiovascular disease could actually exacerbate periodontal disease.

B periodontal disease could modify the body’s immune response.
C there is a bi-directional relationship between periodontal disease and bacteria. systemic
D factors may contribute directly to atheromatous processes.
21. If the processes by which gum disease affects CVD, there will be ……
A less need for doctors and dentists to work in conjunction.

B a reduced emphasis on other preventable risk factors for CVD. a
C concomitant link between smoking and periodontal disease. more
D support for dental care in the public health system.
22. The expression the jury (is) out in paragraph 5 means that a definitive conclusion is ……
A imminent.
B impossible. without
C any merit yet to be
D attained.
END OF READING TEST

THIS BOOKLET WILL BE COLLECTED
Practice test 2
Listening test
Extract 1. Questions 1 -12
You hear a doctor talking to Tom Levin, a patient with some concerns. For questions 1-12, complete the notes
with a word or a short phrase.
Patient :  Tom Levin
Developments before :  kept it under control from the gap year

admission  recurred towards the end of the (1)
period
 started to put a bit (2)
 to push
themselves, some people took (3)
 observed (4) building up
Effects of elevated mood :  felt that it was his (5)

 started to enjoy the opportunity
Client’s reasoning :  did not (6) to the best of his ability

and hence did not achieve the first
Further description :  felt like he was let off the (7)

substance abuse took a hold
 was before the (8) were
announced
 used a lot of
cocaine and (9)
Predominant thoughts :  wanted himself to be the person (10)

wanted to know
 thought he was
the man (11) the town
Defense Mechanism :  did not have to deal with the symptoms during the
university
 let it take (12) of him
You hear a pediatrician called Dr Thomas talking to the mother of a toddler called Ethan. For questions 13-
24, complete the notes with a word or short phrase.
Patient :  Ethan Lucas
Description of the condtion:  started on (13)

 red patches (14)
and on legs
 had (15)
 went (16)
Past visit :  blood tests done

 viral infection confirmed
 called the doctor because rashes turned
(17)
:  baby was very fuzzy
Possible severe condition :  patches could be fatal if (18)

found to be negative
Diagnosis : rash goes away and reappers when rubbed

 child is alert
 (19) ; an allergic reaction
 could be response to virus or (20)
 child not very ill
Medication suggested :  (21) or benadryl

 basic anti-allergy medicines
 prednizone may be prescribed if condition worsens
 makes children
(22) and irritable
Duration of illness :  could last for 7 to 10 days
Possible trigger factors :  (23) taken

 food
such as peanuts or (24)
 should stop food, if it triggers allergy
That is the end of Part A. Now look at Part B.
Part B
In this part of the test, you’ll hear six different extracts. In each extract, you’ll hear people talking in a different healthcare
setting.
For questions 25-30, choose the answer (A, B or C) which fits best according to what you hear. You’ll have time to
read each question before you listen. Complete your answers as you listen.
25. You hear a doctor explain gastroscopy to a patient.
What is the purpose of the doctor’s explanation?
A to make the patient sign the consent form before the procedure to
B reduce the patient’s fear of side effects before the procedure to explain
C possible side effects before signing the consent form
26. You hear a doctor checking a patient’s details with a colleague.
What aspect is the doctor focusing on?
A the patient’s detailed identity the

B patient’s drug administration the
C patient’s overall progress
27. You hear a dentist talking to a patient about implant surgery.
What has the patient misunderstood about the proposed treatment?
A which tooth would be replaced

B the extent of surgery required
C how much it would cost
28. Yo hear a sports nutritionist talk on challenges in routine work
What must they be wary of?
A adopting to opinion flouted by the sportsperson

B contradictory messages being circulated around
C struggles faced by athletes for optimum BMI
29. You hear a surgeon conducting a debriefing meeting with his team What
problem are they going to follow up immediately?
A procedures not running to schedule

B equipment not being readily available
C paperwork not being dealt with efficiently
30. You hear a nurse handing over to a colleague at the end of her shift.
What does the incoming nurse need to do for the patient?
A contact the doctor about his pain management

B arrange for him to be taken for physiotherapy set
C up some monitoring of his mental acuity

Part C
For questions 31 to 42, choose the answer (A, B or C) which fits best according to what you hear. Complete
your answers as you listen.
You hear an interview with Dr Larry Appel regarding low GI diet. You
31. What was the reason for the second study?
A to find the effect of salt on blood pressure

B to identify the effect of salt on blood pressure
C to scrutinise ethe effect of fruit and vegetable diet
32. What was the finding of the omnicarb study?
A low glycaemic index was helpful

B signals that are related to LDL no
C effects of low glycaemic index
33. What was gauged from the study on comparision of diets?
A low glycaemic index has no effect on risk factors insulin

B resistance showed a difference in control diet LDL
C cholesterol increased in a low - GI diet
34. What does the researcher think of the way ahead?
A study of confounding nutrients that travel together

B benefits could be attributed to other aspects finding
C that low glycaemic food are fibre rich
35. What does the doctor think is crucial for obesity?
A cutting back on episodes of calorie consumption

B inexpensive methods to keeping individuals engaged tools
C that assist people to keep track by monitoring
36. What in the speaker’s vies is the reason for chronic kidney disease?
A fluctuation in the body’s acid - base balance unchecked

B consumption of an adverse diet accumulated kidney
C damage due to ageing
Now look at extract two.

You hear a gastroenterologist called Catherine Frenette talking about new treatment options for liver cancer.
You now have 90 seconds to read questions 37-42.
37. Why does the interviewer describe the numbers as shocking
A incidence has been hugely higher in the past decade unresectable

B liver cancer was detected in the past decade underlying liver
C conditions mutated into liver cancer
38. How does Dr Frenette see alcohol-induced cirrhosis leading to liver cancer
A reducing it should be a primary focus on the fight against liver cancer fatty
B liver developed from alcoholism is leading to more liver cancer unlike
C popular perception, alcoholism is not the leading trigger factor
39. Why are most liver cancers treated by liver doctors and not cancer doctors?
A there are not many treatment options available for liver cancers yet liver
B cancers typically have an underlying liver condition behind it the best
C treatment options are surgical including transplantations
40. Why is it harder to diagnose liver cancer unlike other cancers?
A the symptoms are all over the place and hence not possible to diagnose liver
B conditions reveal fewer symptoms until they have progressed much they
C symptoms for liver diseases and liver cancer are radically varied
41. How does the doctor regard liver function test?
A she considers it to be simple lab test that should be done more often she feels
B that test reports can sometimes be confusing and is unreliable
C she is critical about primary care doctors not conducting the test annually
42. Why does the doctor think that liver cancer doesn’t get the attention despite being a major concern?
A patients do not present due to the social stigma associated with liver problems liver
B cancer is ranked the fifth most common cause of cancer related deaths
C it is one of the few cancer deaths that is contrastingly increasing in frequency
THAT IS THE END OF THE LISTENING TEST

Reading test
Tuberculosis: Texts
Text A
Tuberculosis
Tuberculosis is an infectious disease caused in most cases by a micro-organism called Mycobacterium tuberculosis. The micro-organisms usually
Pulmonary tuberculosis is the most frequent form of the disease, usually comprising over 80% of cases. It is the form of tuberculosis that can be c
Extra-pulmonary tuberculosis is tuberculosis affecting organs other than the lungs, most frequently pleura, lymph nodes, spine and other bones an
Tuberculosis develops in the human body in two stages. The first stage occurs when an individual who is exposed to micro-organisms from an infec
Text B
Diagnosis of tuberculosis
The most frequent symptoms of pulmonary tuberculosis are:

• persistent cough for 2 weeks or more: every patient presenting with this symptom should be designated a
tuberculosis suspect;
• sputum production, which may be blood-stained (haemoptysis), shortness of breath and chest pain;
• loss of appetite and loss of weight, a general feeling of illness and tiredness, night sweats and fever. Any patient
presenting with any of these symptoms should be suspected of having tuberculosis. If the patient is, or was, in contact with
a patient with infectious tuberculosis, such a person is even more likely to be suffering from tuberculosis. © IRS Group
Symptoms of extra-pulmonary tuberculosis depend on the organ involved. Chest pain from tuberculosis pleu-
risy, enlarged lymph nodes and sharp angular deformity of the spine are some of the presenting symptoms or signs of
extra-pulmonary tuberculosis.
Symptoms of extra-pulmonary tuberculosis depend on the organ involved. Chest pain from tuberculosis pleu- risy, enlarged
lymph nodes and sharp angular deformity of the spine are some of the presenting symptoms or signs of extra-pulmonary
tuberculosis.
Tuberculosis cases are most likely to be found among:

• patients who present themselves on their own initiative at a health facility with symptoms suggesting
tuberculosis;
• those (especially children and young adults) living in the same household with smear-positive patients;
• those infected with HIV;
• those found to have an abnormality that has the appearance of tuberculosis when a chest radiograph has
been taken for clinical investigation of a sick patient.
Confirmation of the diagnosis:

There are several tests available to diagnosis TB. some of these are:
• Mantoux Test: This involves injecting a small amount of tuberculin into the skin in the lower part of the arm.
Then the person must return after 48 to 72 hours to have a trained health care worker look at their arm and
examine for hard area or swelling
• TB culture Test : Culture test involve studying bacteria by growing them on different substances. Bacte- ria
are usually contained in a sputum sample taken from suspected person.
• Chest X-ray: If a person has had bacteria which have caused inflammation in the lungs, an abnormal shadow
may be visible on an X-ray.
Text C
First line tuberculosis drugs and its dosage in adults
Drugs Daily dose Preparation Side effects

in mg/kg (range)
Isoniazid 4-6 Tablets(50,100,300 mg)

Aqueous IV/IM solution Burning sensation,
(100mg/ml) Vomiting,Jaundice,
Confusion
Rifampicin 8-12 Capsule(150,300mg) Aqueous Anorexia, Nausea,

IV solution Itching, Purpura,
shock
Pyrazinamide 20-23 Tablet(500 mg) Joint pain,

Jaundice,vomiting
Ethambutol 15-25 Tablet(100 and 400 mg) Visual Impairment
Streptomycin 12-18 IM Injection Dizziness
For drug-resistant TB, a combination of antibiotics called fluoroquinolones and injectable medications such as amikacin,
kanamycin or capreomycin are generally used for 20-30 months.
Text D
Tuberculosis: Lifestyle Management

• People with active TB disease should stay away from work and school until the doctor says it’s safe to return, in order to
avoid infecting others.
• Cover the mouth with a tissue when coughing and sneezing, then seal the tissue in a bag to throw it away.
• Make sure the patient’s room has adequate ventilation, so that the exhaled bacteria are carried away.
• People with active disease need to tell their doctor or health professionals about anyone they have had close contact
with, such as family, friends. © IRS Group
• Take all the medications on right time. If patient stop taking medications or skip some doses, the risk of
developing drug resistant TB is high.
Part A
Time: 15 minutes
For each question, 1-20, look through the texts, A-D, to find the relevant information. Write your
answers on the spaces provided in this Question Paper.
Tuberculosis: Questions
Questions 1-6
more than once.
In which text can you find information about

1. Measures to prevent the spread of disease
in household setting
2. Indicators of the disease
3. How tuberculosis advances in individals
4. Patients under risk
5. Investigations to be done
6. Tuberculosis treatment after exposure
7. Mode of transmission of tuberculosis
Questions 7-14
Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may include
words, numbers or both.
8. Which is the drug used for TB skin test?
9. What is the maximum dose of streptomycin per kilo of a patient’s weight?
10. Which bacteria causes tuberculosis?
11. How long does a patient have to take medication for drug-resistant TB?
12. Which type of tuberculosis spreads from infected person to others?

13. What needs to be ensured to remove breathe out bacteria from a room?
14. What threat follows the stoppage of TB medications?
Questions 15-20
Complete each of the sentences, 15-20, with a word or a short phrase from one of the texts. Each answer may include
15. The disease advances beyond the to affect various areas.
16. The signs of extra-pulmonary disease is based on the involved
17. Mantoux test checks for hard area and .
18. Inflammation of lungs as a result of presence of bacteria may be evident on .
19. is suspected on patients who visit the health sector on their own interest.
20. Four-drug regimen falls under tuberculosis drugs.
END OF PART A
THIS QUESTION PAPER WILL BE COLLECTED

Part B
1. The standard procedure for health surveillance must include
A tests that require biological monitoring

B formulation of tests for close scrutiny
C constant testing to check for irregularities
Health Surveillance
his could be a skin inspection ensuring no dermatitic changes have occurred as a result of exposure to an irritant, through to lung function tests and urin
2. The manual promotes ‘airborne precautions’ for the
A use of an elaborate plan to prevent any infection ease

B to monitor adherence of preventive methods
C strength of protection against communicable sickness
Airborne Precautions
that are spread by airborne droplets (= 5 microns) that remain infectious and suspended in air for long periods of time over long distances and can be w
2 air exchanges per hour; airborne infection isolation room (AIIR) preferred © IRS Group
tion
ersons must be worn prior to entering room and removed after leaving room
respiratory hygiene/cough etiquette
patients with vaccine-preventable airborne diseases

3. The extract ails to give information about
A work practices that reduce the risk of injuries

B the need to specify and follow regulations at work
C the importance of risk assessment and control measures
The six pack
ng and review systems. However, for the first time the idea of a ‘competent person’ is introduced. The em- ployer is required to appoint one or more co
4. The extract conveys the need to
A develop patient-centred healthcare service skills adopt

B approaches to achieve excellence in practice inculcate
C skills required by practice developers
Characteristics, Qualities and Skills

arer about the approaches taken to develop excellence in practice at different organizational levela and in addition, differentiate the skills and activities in
5. What does the regulation outline?
A prevention of similar injuries to employees ahead

B reporting of grievous injuries for acknowledgement
C analysis of the incident and its proper redressal
The reporting of injuries

s or dangerous occurrences that have stemmed from work activities. The enforcing authority must be notified immediately.
e information may suggest a pattern of disease or injury associated with a particular industry. Action can be taken to establish the cause of the risk and i
6. The extract on randomised control trials on HIV infers
A presence of foreskin is a major precipitating factor

B circumcision performed by certain devices are safe immune
C systems are weak in males are uncircumcised
Male circumcision and HIV infection

he epithelium of the inner foreskin and are close to the surface . The highly vascularized foreskin mucosa and the mucosa at the frenulum are prone to
Part C
Text 1: “Miracle” jab makes fat mice thin
After a four-week course of treatment with a protein called ob, the fat simply falls off, leaving vastly overweight
mice slim, active and sensible eaters. If the protein has the same effect on people, it could be the miracle cure
millions have been waiting for. That, at least, is the theory. But sceptics warn that too little is known about the way
the human version of the ob protein works to be sure that extra doses would help people to lose weight. But when
the results of the tests were leaked last week, Amgen, the Californian biotechnology company which owns the
exclusive rights to develop products based on the protein, saw an overnight jump in its share prices.
Last December, a team led by Jeffrey Friedman and his colleagues at the Howard Hughes Medical Institute at the
Rockefeller University, New York discovered a gene which they called ob. In mice, a defect in this gene makes
them grow hugely obese. Humans have an almost identical gene, suggesting that the product of the gene – the ob
protein – plays a part in appetite control. The ob protein is a hormone, which Friedman has dubbed leptin. In April,
Amgen, which is based in Thousand Oaks, California, paid the institute $20 million for exclusive rights to develop
products based on the discovery. Amgen will carry out safety tests on the protein in animals next year, and hopes to
begin clinical trials on people within a year.
The excitement began last week when the journal Science published the findings of three groups which have been
working on the protein. The results in obese mice with a defective gene that prevents them making the protein were
dramatic. Mary Ann Pelleymounter and her colleagues at Amgen gave obese mice shots of the protein every day for
a month. Those on the highest dose lost an average of 22 per cent of their weight. Before treatment, these mice
overate, had lower metabolic rates than normal, lower temperatures, and raised levels of insulin and glucose in their
blood” says Pelleymounter. “The protein brought all these back to normal levels,” she says.
More significantly, in terms of the potential for a human slimming drug, the treatment also worked on normal mice,
which lost what little spare fat they had. They lost between 3 and 5 per cent of their bodyweight, almost all of it in
the form of fat, according to Pelleymounter. This is important because no one has identified a mutation in the human
ob gene that might lead to obesity, suggesting that whatever the cause of obesity, the ob protein might still help
people lose weight. Friedman and his team carried out similar experiments. In just one month, their obese mice shed
around half their body fat. In the average obese mouse, fat makes up about 60 per cent of body weight. Treated mice
lost their appetite. Within a few days they were eating about 40 per cent as much as untreated animals. Their fat
practically melted away, falling to 28 per cent of their body weight after a month. In normal mice, treatment reduced
the amount of fat from an average of 12.22 per cent of body weight to a spare 0.67 per cent.
Friedman and Pelleymounter believe that the protein, which is produced by fat cells, regulates appetite. “We think it’s
something like a circulating hormone to tell the brain there are normal amounts of fat, or too much, in which case
the brain turns down your appetite,” says Pelleymounter. The experiments also show that treated mice have an
increased metabolic rate, suggesting that they burn fat more efficiently. Their appetites decrease – and they are less
sluggish, becoming as active as normal mice.
The third group of researchers from the Swiss pharmaceuticals company Hoffmann-La Roche, are more sceptical
about how significant the ob protein might be in treating obesity. From their studies, they conclude that the protein is
just one of many factors that control appetite and weight. “This is a very important signal, but it’s one of several,”
says Arthur Campfield, who led the team. Campfield doubts whether the ob protein alone will have much effect in
overweight humans. His team hopes to unravel the whole signalling system that regulates weight, and is particularly
keen to find the receptor in the brain that responds to the ob hormone. Hoffman-La Roche, excluded by the Amgen
licence deal from developing products based on the ob protein itself, hopes to develop pills that interfere with the
message pathways in appetite control.
Stephen Bloom, professor of endocrinology at London’s Hammersmith Hospital, agrees. “I think the work with ob is
a major advance, but we’ve not got the tablet yet. That will come when people have made a pill that stimulates the
ob receptor in the brain so it switches off appetite.” Even Pelleymounter at Amgen cautions against overoptimism at
this stage. “We don’t know whether it would be true that people would lose weight, but you can predict from mice
that it would have some positive effect,” she says. “However, I don’t think obese people should hold out for this.
They should carry on with their exercises and dieting.”
7. The first paragraph puts forward to the reader that
A a protein treatment has caused mice to lose weight dramatically a

B protein treatment for mice cannot be adapted for use in humans
C scientists agree that a new protein treatment makes people lose weight a
D scientific method of making obese people slim has been developed
8. According to Friedman and his colleagues, the ob protein
A may be transformed from mice to humans may

B be a factor in appetite control
C is produced by the ob hormone is
D mainly found in obese mice
9. What according to paragraph two does dubbed refer to
A written
B named
C defined
D proved
10. A study by Mary Ann Pellymounter and her colleagues found that
A the ob protein caused subjects in the study to decrease their metabolic rate the ob
B protein cased people to lose about twenty percent of their weight
C a deficiency in the ob protein had caused obesity in the subjects a
D defective ob gene resulted in the production of the ob protein
11. According to the Friedman and Pelleymounter studies, treatment with ob protein
A may be useful only for people with a defective ob gene may

B be useful for anyone who wants to lose weight
C is effective only on mice with a defective ob gene.
D will not be effective on people who want to lose weight
12. What does sluggish in paragraph five denote?
A strong
B lazy
C slow
D sick
13. The research from Hoffman-La Roche are less confident of the protein’s importance because
A it has not been trialled yet on human beings the

B trials done on mice were rather inconclusive it does
C not have a significant role in weight loss
D it is not the only factor involved in appetite control
14. In conclusion, the article suggests that
A a treatment for obesity in humans will be developed from the ob protein scientists
B will soon have more knowledge about the ob receptor in the brain the results of the
C study of mice will lead to weight loss pills for humans despite the results of the
D study of mice, the benefits for humans is unknown
Text 2: The search for cholesterol-free fats
Butter, as anyone who has not been living in a cave for the past ten years has probably heard, contains a lot of
saturated fat, which increases the levels of cholesterol in the blood. Margarine, on the other hand, is made from
vegetable oils, which contain cholesterol-lowering polyunsaturated fat. So switching to a diet with only vegetable
fats should lower cholesterol levels, right? ‘Wrong,’ says Margaret A Flynn, a nutritionist at the University of
Missouri. When she performed the experiment with a group of 71 faculty members – switching in both directions –
she found that ‘basically it made no difference whether they ate margarine or butter.’ The reason, according to a
growing group of nutritionists, could be partially hydrogenated fats. Recent studies suggest that such fats might
actually alter cholesterol levels in the blood in all the wrong ways, lowering the ‘good’ high-density lipoprotein and
increasing the ‘bad’ low-density lipoprotein.
Partially hydrogenated fats are made by reacting polyunsaturated oils with hydrogen. The addition of hydrogen turns
the oils solid, and some of their polyunsaturated fat is turned into trans monounsaturated fats. Monounsaturated fat
is generally perceived as good, but things are not so simple. ‘Trans monounsaturates act in the body like saturated
fats,’ says Fred A Kummerow, a food chemist at the University of Illinois at Urbana-Champaign. ‘Almost all
naturally occurring monounsaturated fat is of the cis variety, which is more like polyunsaturated fat.’ Flynn’s study
is not the first to raise questions about trans fatty acids. Ten years ago a Canadian government task force noted the
apparent cholesterol-raising effects of trans fats and requested margarine manufacturers to reduce the amounts – which
can easily be done by altering the conditions of the hydrogenation reaction.
Last August two Dutch researchers, Ronald P Mensink and Martijn B Katan, published a study in the New England
Journal of Medicine that showed eating a diet rich in trans fats increased low-density lipoprotein and decreased levels
of high-density lipoprotein. In an editorial accompanying the study, Scott M Grundy, a lipid researcher at the
University of Texas Southwestern Medical Center at Dallas, wrote that the ability of trans fatty acids to increase
low-density lipoprotein ‘in itself justifies their reduction in the diet.’ Grundy called for changes in labelling
regulations so that cholesterol-raising fatty acids, including trans monounsaturates, are grouped together. James I
Cleeman, co-ordinator of the National Cholesterol Education Program, disagrees. ‘To raise a red flag is
premature,’ he says. ‘Mensink’s audience is the research community – the public needs useable simplifications.’
Cleeman points out that the subjects in Mensink and Katan’s study ate relatively large amounts of trans fats. He
believes more typical consumption levels should be investigated before any change in recommendations is
warranted.
Furthermore, Cleeman notes that studies like Flynn’s are hard to interpret because subjects were allowed to eat as
they pleased. Flynn’s study, published this month in the Journal of the American College of Nutrition, found
considerable variability among subjects in their blood lipid profiles. ‘The only way to study the question properly is
in a metabolic ward,’ Cleeman says. ‘Trans fats are a wonderful example of an issue that’s not ready for prime
time.’ Edward A Emken, a specialist on trans fats at the Agricultural Research Service in Peoria, Illinois, also
downplays the concern but for different reasons. Although Mary G Enig, a nutritional researcher at the University of
Maryland, has estimated American adults consume 19 grams of trans fat per day, Emken thinks that figure is too
high. According to his calculations, eliminating trans fatty acids from the
diet will for most people make only a tiny change in lipoprotein levels. ‘If you’re hypercholesterolaemic, it could be
important, but if you’re not, then it is not going to affect risk at all,’ he concludes.
Emken, together with Lisa C Hudgins and Jules Hirsch, has performed a study to be published in the American
Journal of Clinical Nutrition that finds no association between levels of trans fats in fat tissue in humans and their
cholesterol profiles. To Emken, that suggests trans fats are not a major threat for most people. Nevertheless, trans fats
seem destined for more limelight. ‘How can one defend having cholesterol and saturated and unsaturated fats listed on
food labels but not allow public access to trans information when such fats behave like saturates?’ asks Bruce J
Holub, a biochemist at the University of Guelph in Ontario. ‘At the very least, one has to ask whether cholesterol-
free claims should be allowed on high-trans products.’
15. What is ‘wrong’ as made out from paragraph one?
A Switching to a diet with traditional vegetable fats

B Commonly held perception of polyunsaturated fat
C The method adopted by the experimental group
D available information regarding hydrogenated fats
16. M A Flynn’s finding is supported by the proposition that
A butter lowers high-density lipoprotein while margarine increases low-density lipoprotein butter
B contains just as much partially hydrogenated fat as margarine does
C trans monounsaturates behave similar to most naturally occurring monounsaturates trans
D monounsaturated fat increases the cholesterol level
17. The passage points out that
A eating butter is not as dangerous for cholesterol levels as was previously thought
B cholesterol levels in humans can be noticeably reduced by cutting out animal fats eating
C margarine is s healthier option than eating butter
D the benefits of using only vegetable fats in the human diet are arguable
18. In paragraph three, what is meant by ‘to raise a red flag’?
A to warn of dire consequences to

B criticize existing methods to
C express unfounded concern to
D ignore prevalent signs
19. James I Cleeman is stated to
A agree with Grundy’s recommendation for relabelling

B dispute Mensink and Katan’s research into the effects of eating trans fats want
C Mensink and Katan’s work discussed outside the research community want to wait
D any longer before warning the public
20. Cleeman is of the view that
A Flynn’s study is not very valuable because she is hard to understand

B trans fats should now be discussed and debated by interested members of the public Flynn’s
C study was not sufficiently rigorous
D Flynn’s subjects should have had more food of a more vaied nature
21. On American consumption of trans fats, Edward Emken
A believes that a reduction in this figure could be achieved quite easily is not
B very concerned about trans fat intake levels for most people does not think
C that they should consume so much in trans fats thinks that people should
D eliminate trans fats from their diets
22. The passage summarises that,
A Emken, in a study published has challenged other researchers’ claims

B the levels of trans fats tissue in humans and their cholesterol profiles are not connected the
C issue of trans fat is likely to receive more, rather than less, attention in future
D food products should be labelled with their trans information in addition to current information
END OF READING TEST

Practice test 3
Listening test
You hear Dr Daniel talking to Samara, a patient preparing for a surgery. For questions 1-12, complete the notes with
a word or a short phrase.
Patient :  Samara Cox
Reason for visit :  Pre-operative discussion
 Surgery :joint (1)
On the day of surgery :  Morning - patient taken to (2)
 Surgeons manipulate the patient
 patient taken to (3)
antibiotics administered
 patient set up for (4)

monitoring
 patient rolled up in (5)

position
Short-term restrictions :  limited activity allowed
 patient
should limit (6) standing or
walking to about 30 minutes
 avoid repetitive (7)
Long-term restrictions :  avoid things that are (8) to the back
avoid certain aerobic exercises
 should not do extreme yoga postures
Mobility issues :  surgery aims to limit (9)
 mobility will improve after surgery.
Pain management :  patient to start (10) start by afternoon
 pre-operative pain will be gone
:  post-operative pain remains and is more

(11) than pre-operative pain
 pain (12) less by next morning

You hear Dr Mark talking to a George Hill, a patient who has eye problems. For questions 13-24, complete the notes
Patient :  George Hill
Description of symptoms :  Redness in the (13) of the eye
On the day of surgery  (14) conjunctivitis
 More tears than usual
 Thic
k yellow discharge that (15) over
the eyelashes, especially after sleep
 Itchy and (16)
 Blurred vision, More sensitive to light
 Stuffy or runny nose
Causes  An allergic reaction to (17)
 A common cold
Diagnosis :  (18) done in the lab
Recommendations :  Through history collection
 Always keep the eyes clean
:  Wash or change the (19) every day

until the infection goes away
 Don’t touch or rub the infected eye
 Don’t wear and never share eye make up,
(20) or contact lenses
 Don’t put a (21)

over the eye as it may worsen the infection
Protect the eyes from dirt, especially from the

(22)
 Give adequate rest to the eyes
 Apply (23) eye drops
Stay away from work for a few days
 An (24) will help to clear

the symptoms within a few days
Part B
setting.
25. You hear an oncologist explain thyroid scan and uptake What
is the focus on the talk?
A help patients decide whether they should go for a thyroid scan or not explain the
B procedure in detail and preparation to be done in advance reassure that the scan is
C a safe procedure without major side effects
26. You hear a delivery on hospital discharge meeting
What role is most crucial for physiotherapists
A explaining how to undergo full rehabilitation

B examining the extent of mobility after surgery
C encouraging the patient to perform exercise daily
27. You hear a professional talking on a code blue system What
does he say is the distinctive feature of the system
A increased power output from the tool

B customisation to specific standards
C identification of the source of call.
28. You hear a brief on when to do direct speech therapy for preschool stuttering How
long must pass before a thorough diagnosis
A when the child is distressed about stuttering after

B 6 months from observation of disorder as
C precipitating factors increase in intensity
29. You hear an update on the change in criteria for glaucoma To
qualify for the conditon © IRS Group
A the patient must have more than 25mm of mercury it

B must be a co-morbidity of neuromuscular disease the
C level should fall within the adequate category
30. You hear a health policy statement on structured reporting in a cardiac cath lab What
aim does the speaker state
A accessing information to improve patient quality utlising

B consistent information for quality care compiling
C documents to improve routine work

Part C
You hear an associate professor Stacy Carter talking on overdiagnosis. You now
have 90 seconds to read questions 31-36.
31. Why is having a definition to overdiagnosis important?
A results in an absence of conviction when communicating lack

B of clarity affects policies and the general public lack of
C efficiency if several meanings do exist
32. What does she fear about too much medicine
A it results in difficulty to recuperate it

B is detrimental to overall health
C allocation must be based on need
33. What is the fundamental aspect of overdiagnosis?
A identifying areas of benefit from treatment

B trying to balance the effects of both locating
C the harm of too much medicine
34. Which perspective must be taken into account?
A Primarily from the patient chiefly

B based on a consensus of the
C clinicians treating it
35. How must the issue be addressed?
A by covering all basic social needs by

B recognising the motives behind it by
C identifying inherent social factors
36. The narrow sense meant by the speaker is
A having a set of special parameters

B rethinking the diagnostic categories
C bordering the definitive boundaries

You hear an interview with Tom Clarke, a science expert on break through in breast cancer research
37. What does Mr Clarke say about the new technology
A they are beneficial for personalised care of patients they

B are tailored to the requirements of the patient
C it redefines the spectrum of identifying varying diseases
38. What does the study prove, according ot the speaker?
A treatment course for a specific condition can be mentioned large

B studies are plausible for respective conditions
C breast cancer falls broadly into ten main genetic groups
39. What is the speaker’s view on breast cancer tumor types?
A present understanding of treatment is flawed certain

B conditions have positive outcomes
C it can ensure appropriate treatment
40. Why does the speaker advocate a ‘more tailored approach’?
A due to complexities in the treatment

B because of the many facets of illness
C since the condition is a sum total of disease
41. How do the advanced tests the doctors?
A increase the tools for diagnosis prevent

B the development of conditions ascertain
C the treatment type required
42. What does Mr Clarke ask to be wary of?
A the tests will take more time to be available the

B clinical study has been performed already newly
C diagnosed women can participate in it

Reading test
Deep Vein Thrombosis : Texts
Text A
Descriptors
Deep vein thrombosis occurs when a blood clot (thrombus) forms in one or more of the deep veins in the body, usually
in the legs. It can cause leg pain or swelling, but may occur without any symptoms. Deep vein thrombosis is a serious
condition because blood clots in the veins can break loose, travel through the bloodstream, and obstruct the lungs,
blocking blood flow. Although it usually affects the leg veins, DVT can occur in the upper extremities, cerebral
sinuses, hepatic, and retinal veins.
Common symptoms include pain, especially throbbing cramp like feeling, swelling and tenderness in one of your legs
(usually your calf), a heavy ache in the affected area, warm skin in the area of the clot, red skin, particularly at the back
of your leg below the knee.
Text B
Causes of Deep Vein Thrombosis

Anyone can develop DVT, but it becomes more common in those with age above 40. As well as age, there are
also a number of other risk factors, including:
• having a history of DVT or pulmonary embolism
• having a family history of blood clots
• being inactive for long periods – such as after an operation or during a long journey
• blood vessel damage – a damaged blood vessel wall can result in the formation of a blood clot
• having certain conditions or treatments that cause your blood to clot more easily than normal – such
as cancer (including chemotherapy and radiotherapy treatment), heart and lung disease, thrombo- philia and
Hughes syndrome
• being pregnant – your blood also clots more easily during pregnancy
• being overweight or obese
The combined contraceptive pill and hormone replacement therapy (HRT) both contain the female hormone
oestrogen, which causes the blood to clot more easily. If taking either of these, the risk of developing DVT is
slightly increased.
Text C
Nursing Intervention for Deep Vein Thrombosis:
Various nursing intervention for deep-vein thrombosis are in the following:

1. Assess for and reports sign and symptoms of Deep Vein Thrombosis.
2. Keep the affected leg elevated and comfortable position.
3. Keep the head up of bed.
4. Immobilize the patient and initiate bed rest to reduce risk of clot mobilization.
5. Administer anticoagulants as ordered to reduce the risk of additional clotting.
6. Carefully calculate heparin dose.
7. Use infusion pump to administer intravenous heparin.
8. Do not mix the heparinized solution with other medications.
9. Discourage positions that compromise blood flow.
10. Administer analgesics (Morphine) as ordered to manage pain.
11. Apply warm compress to affected leg using a 2-hour-on, 2-hour-off schedule around the clock.
12.Provide elastic compression stocking as it not only increase blood flow, but also reduce swelling and pain.
13. Administer oxygen as ordered in order to maintain tissue perfusion.
14. Check and monitor any sign of bleeding.
15. Check any sign of complication (Pulmonary embolism).
16. Obtain lab orders to monitor APTT, PT and INR.
17. Ensure intake of vitamin-k rich food including green, leafy vegetable.
18. Instruct patient to keep nasal mucosa hydrate and moist.
19.Ensure a minimum intravenous fluid intake of 2500ml per day for proper hydration unless contraindi- cated to
prevent increase blood viscosity.
20. Provide adequate knowledge to patient pertaining to warfarin therapy.
21. Check any sign of excessive bleeding complication of warfarin therapy.
22.Be aware of the signs of excessive bleeding, such as frequent and bilateral epitasis, hematuria (blood in the urine) and
deep tissue bruising (purpura).
23. Advise the patient to take care when brushing teeth in order to reduce risk of bleeding gums.
Text D
Pharmacological Therapy
ations are anticoagulant drugs. Anticoagulants interfere with some part of the body’s process that causes blood clots to form. This process is called the
Newer anticoagulants
Drug nameBrand nameOral pill or injectable solution
Apixaban Eliquis Oral
Dabigatran Pradaxa Oral
Dalteparin Fragmin Injectable
Edoxaban Savaysa Oral
Enoxaparin Lovenox Injectable
Fondaparinux Arixtra Injectable
Rivaroxaban Xarelto Oral
agulants used to help prevent and treat DVT are heparin and warfarin. If a patient takes either of these drugs, the healthcare provider will need to monitor the patien
END OF PART A
THIS TEXT BOOKLET WILL BE COLLECTED

Part A
Time: 15 minutes
For each question, 1-20, look through the texts, A-D, to find the relevant information. Write your
answers on the spaces provided in this Question Paper.
Deep Vein Thrombosis : Questions
Questions 1-7
more than once.

1. Warning signs of deep vein thrombosis
2. Hormone that increases the risk of DVT
3. Definition for clotting cascade
4. What does it feel when there is a blood clot
5. Care for DVT patients
6. Common drug regimen
7. Factors that increase the danger of DVT
Questions 8-14
Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may include words,
numbers or both.
8. What is the drug used for pain management?
9. What is the complication of warfarin therapy?
10. Which age group is at the risk of developing DVT more?
11. What does the DVT pain feel like?
12. Where does thrombus most commonly form?
13. Which category does heparin and warfarin belong to?
14. Which type of drugs are used to treat deep vein thrombosis?
Questions 15-20
15. Improving the flow of blodd and decreasing swelling and pain is the advantage of
.
16. The complication of DVT is
17. Blood clot obstructs the lungs and thereby block the .
18. The female hormone present in contraceptive pill and HRT is .
19. Injectable solution of dalteparin is available by the name .
20. Deep tissue bruising is termed as .
END OF PART A

Part B
1. What is the primary purpose of obtaining a patient’s consent for the review?
A to give patients the liberty to participate or withdraw from the service to

B enable the accredited pharmacist to access relevant information to ensure
C that the information is safeguarded with security measures
Patient’s rights, confidentiality and consent

the course of providing the HMR service, exchanged with other health professionals, discussed on the phone or in the pharmacy or stored as a result of
2. What does the guideline try to regulate
A the number of hours of work permissible uneven

B working hours for different professions intensity
C of the work done in stipulated time
Working time regulations

ver a 17-week- period. Besides working time limits, the regulations cover working at night, health assessments for night workers, time off, rest breaks at
3. The note emphasises the significance of the difference by
A indicating the contrasting purposes

B highlighting the informational value
C exhibiting the distinction in outcome
Aggregated versus disaggregated data

ated for different uses. Aggregated data are combined from many sources (for example, client records, registers and surveys) and summarized for a spec
4. The standard procedure for health surveillance must include
A tests that require biological monitoring

B formulation of tests for close scrutiny
C constant testing to check for irregularities
Health Surveillance
could be a skin inspection ensuring no dermatitic changes have occurred as a result of exposure to an irritant, through to lung function tests and urine, b
5. Needle stick injuries must be handled by
A following the laid out steps for complete care

B primarily completing any critical procedures
C exercising caution and refraining from routine
What to do if there is a needle-stick (sharps) injury
area of the needle-stick (sharps) injury with soap and plenty of water. No antiseptics or scrubbing brushes should be used. If the provider is in the middle
6. What does the circular convey?
A information on managing blood borne pathogens the

B policy implementation required for personnel
C preventative measures to reduce pathogenic risk
Managing Occupational Exposure To Blood Borne Pathogens,

Hepatitis And Hiv Through Post-Exposure Prophylaxis
Health care workers are at increased risk of accidental exposure to bloodborne pathogens—such as hepatitis B
and C viruses and HIV. A minimum approach to health and safety practices for health care providers and waste
workers includes the following:
• implementation of standardized management approaches
• compulsory vaccination for the hepatitis B virus for all health care workers, including cleaners and staff who
handle medical waste © IRS Group
• provision of sharps disposal boxes for safe disposal of used needles, syringes and other sharps • compliance
with hand hygiene standards
• availability of appropriate personal protective equipment—mask, face shield or goggles, rubber apron and utility
gloves (at the bare minimum, every health care worker handling waste should have a face shield and utility
gloves)
• appointment of a clinic staff member or designated staff to additional or dedicated responsibility for infection
control, including waste management
Immediately after any needle-stick (sharps) injury, the person injured should—as soon as it is safe to do so—
hand over his/her duties to another provider and wash the area with plenty of soap and water. Antisep- tics or
caustic agents, such as bleach, should not be used. Flush any exposed mucous membranes with plenty of water.
The clinic should have a system to quickly report any needle-stick (sharps) injuries to the nearest health facility
that provides post-exposure prophylaxis services so that this can be given to the injured health care worker
according to the national guidelines.
Part C
Text 1: Non-invasive prenatal testing: the new era in reproductive medicine
In some countries, it is routine practice to offer pregnant women screening for foetal chromosomal and structural
abnormalities, and, if serious anomalies are diagnosed, the option of terminating the pregnancy. Screening for
chromosomal abnormalities commenced in the 1960s and was initially restricted to women whose pregnancies were
considered to be of increased risk because of an obstetric history of aneuploidy or advanced maternal age. Over the
past five decades, prenatal chromosome screening (PCS) has been expanded to encompass the entire obstetric
population. However, the commonly used aneuploidy screening tests are plagued by high false-positive rates,
typically 4%–5%. Confirmation of an increased screening risk for aneuploidy involves diagnostic tests such as
amniocentesis or chorionic villus sampling, each associated with low but definite risks of pregnancy loss.
Many women are reluctant to proceed with a diagnostic test after a positive aneuploidy screening result, and the
ability to assess foetal genetic material without directly sampling the amniotic fluid or placenta has long been a goal
of prenatal diagnosis. The recent development of non-invasive prenatal testing (NIPT), a high-level screening test using
cell-free foetal DNA, offers the opportunity to markedly reduce the requirement for invasive testing while potentially
also increasing detection rates of chromosomal anomalies, in particular of trisomy
21. In addition, NIPT may be offered earlier in pregnancy than standard aneuploidy screening and diagnostic
techniques.
Although initially used in pregnancies at high risk for aneuploidy, recent data indicate that NIPT is also a robust
screening test in lower-risk pregnancies. NIPT is now the most sensitive and specific screening test for the common
trisomies, with detection rates greater than 99% for trisomy 21 and false-positive rates of less than 0.5%. The
performance characteristics for trisomies 13 and 18 and the sex chromosome anomalies are lower than for trisomy
21, although the sensitivity is still typically greater than 90%.
NIPT is not without its limitations. Failure to obtain a result occurs in routine clinical practice in about 3%–4% of
tests, usually due to a low cell-free foetal DNA fraction, which is detectable in the maternal bloodstream, typically
because the sample was collected too early in the pregnancy or because of maternal obesity. False- positive results
have been associated with confined placental mosaicism, the death of a co-twin, maternal malignancy and maternal
mosaicism. Detection rates appear to be lower and the chances of not obtaining a result are higher in twin than in
singleton pregnancies.
Ethical questions, ever present and never fully resolved when discussing prenatal testing, will come more sharply
into focus with the broader introduction of NIPT into obstetric practice. A woman and her partner have two options
after trisomy 21 has been diagnosed: continuation or termination of the pregnancy. The option of termination is
widely regarded in our society as part of the couple's reproductive health rights. If the diagnosis is made earlier, and
termination methods that are less stressful and safer for the woman and more acceptable to medical staff are
available, there could be greater pressure to undergo testing (and termination, when abnormalities are detected) than
is currently the case.
What message does this then send to people with trisomy 21 in our community and their families? The same
arguments would apply to other non-lethal chromosomal anomalies, such as Turner syndrome. Of even greater
consequence would be the ability to discover the sex of the foetus at an early stage. Sex-based termination,
widespread in some parts of Asia, is believed to be uncommon in developed countries, but this situation could
change were the sex known much earlier in pregnancy. The wider introduction of NIPT must be accompanied by
appropriate increases in the provision of genetic counselling services for women and of education for health care
providers.
7. Paragraph one indicates that termination of pregnancy is
A commonly practised in some countries a

B possibility in some countries
C routine practice in most countries often
D carried out for serious anomalies
8. Prenatal chromosome screening has
A confirmed an increase in screening risk

B resulted in significant loss of fetal life
C been observed to be used in all pregnancies commonly
D shown an increased sign of abortion
9. Paragraph two concludes that NIPT may
A slightly lessen the requirement for invasive testing

B marginally increase requirement for invasive testing
C dramatically decrease the need for invasive testing
D significantly increase the need for invasive testing
10. Paragraph three suggests that for lower-risk aneuploidy detection
A NIPT is proving reliable for finding strong and durable lower-risk rates
B NIPT is considered to be a strong and reliable screening process NIPT is
C considered a significantly reliable robotic testing format NIPT mainly
D finds aneuploidy in lower-risk screening processes
11. In paragraph four, it is assumed that carrying twins
A may lead to false-positive results, as can maternal mosaicism

B is included in the list of concerns involving false-positive readings
C gives a substantial drop in NIPT data of singleton pregnancies
D proves a greater risk in acquiring unreliable detection rates from NIPT
12. The phrase ‘will come more sharply into focus,’ in paragraph 5 means ethical questions
A will be visually clear and free from debate for all people.
B will become a topic of greater discussion and debate among people. will
C become a topic of much hostile criticism among the community.
D will rise quickly into focus and force complacency among the community
13. Which of the following best describes the author’s use of the term non-lethal in paragraph six?
A unimpressive
B dangerous
C unintentional
D nonnoxious
14. The final paragraph professes
A NIPT will cause sex-based termination to increase in developed countries.

B Counselling and education must be given prior to introducing NIPT.
C Sex-based termination is an obsolete problem throughout Asia. Education and
D counselling services should coincide with introducing NIPT
Text 2: Caring means Curing
In the paediatric intensive care unit at the University of California San Francisco (UCSF) Medical centre, four nurses
are clustered around the bed of an unconscious 7-year-old Cambodian boy who was hit by a truck several days
earlier. A plastic respirator tube snakes out of his mouth, and other tubes and wires connect him to IV drips,
evacuation bags, and a series of monitors that provide second-by-second displays of his heart and respiratory rhythms.
His right leg, bent at the knee, is held up in traction. His face is so swollen that visitors find it too grueling to stare
for too long. He is sedated to shield him from what would be excruciating agony and to stave off any further threat of
injury.
Janet Craig, a nurse educator based in the paediatric intensive care unit is comforting the boy’s family as they keep
an anxious bedside vigil. As they talk, a sudden commotion diverts Craig’s attention. She rushes towards the room
of another patient, hastily explaining that this 17-year-old girl has been a frequent visitor to the ICU. She was born
with a congenital heart defect that has required a number of surgeries, and recently she may have suffered a heart
attack. Five days earlier surgeons had implanted a permanent pacemaker, but also decided that a heart transplant
would be necessary if she were to survive over the long term.
In such an hour of intense activity, and in the time she spends each day attending to complex cases such as those in
the ICU, Janet Craig, an intensive care nurse for over 14 years, tries her utmost to embody the very heart of the
nursing profession – that unique relationship between caring and curing. In hospitals and communities throughout the
world, nursing staff are treating not only the patient’s complex physical needs but their interlinked emotional needs as
well. While doctors focus on limb, heart, or lung, nurses carry out the medical regimens that physicians prescribe, as
well as monitoring intricate human needs.
Nurses take care of patients 24 hours a day, 7 days a week. If a patient with a broken leg complains of chest pain, it
is the nurse’s duty to inform the physician of a suspected pulmonary embolism. If a patient with metastatic breast
cancer comes in for chemotherapy and complains of dizziness, shivering, and simply not feeling like herself, the
nurse will alert the oncologist to the possibility that the cancer may have travelled to the brain. In addition to
following the physicians’ treatment plan, nurses establish treatment plans of their own. They assess patients’ basic
needs and do for them what they cannot do alone; they help educate people about how to cope with a disease or the
aftermath of surgery; they become deeply involved – as patient advocates – in helping patients and families make
informed decisions about major surgery and termination of life-support systems. All of these responsibilities should
make nurses major participants in the evolving debate about national health care. Yet to most of the public and
policy-makers, they remain almost invisible.
Real health care involves far more than paying physicians to intervene when disease is well established or financing
dazzling research into potential ‘cures.’ It involves education in disease prevention and health maintenance from
childhood through old age, as well as providing skilled nursing care in hospitals when patients are acutely ill. A
truly humane system would not push futile treatment on patients with terminal diseases, but would permit them to
die in comfort and with dignity. A genuinely economical health-care system would finance a cohesive network of
long-term care to be provided outside of big hospitals in the home and the community.
To create a new health-care system, nurses need to be far more assertive in promoting their profession and its
achievements. They also need advocates and allies – among patients, families, politicians and businessmen
– who understand that high-quality health care is dependent not only on technology, surgery and the promise of cure
but also on the efforts of those nurses providing the care necessary for cure to be possible at all.
15. In paragraph one, what is meant by the use of the word ‘clustered’?
A Anxious
B Silent
C Motionless
D Gathered
16. the use of sedatives as mentioned in paragraph one are
A given needlessly for the particular situation to

B immobilise him and numb the pain
C to prevent the respiratory tube from moving not
D needed as he is unconscious
17. The objective of nurse educator is to
A keep a bedside vigil with the patient’s relatives maintain

B a level of support befitting the situation take charge of
C the emergency situation taking place remedy the
D immediate danger to the 17-year-old-girl
18. In paragraph three, the author’s view is that
A doctors should solely treat the physical needs of the patient nurses only
B focus on the emotional and human needs of patients. nurses undergo a
C grueling regimen of physical prescriptions. doctors tend to deal with the
D physical aspects of the patient.
19. According to paragraph four, current debates on health care have
A completely excluded nurses and their insight into the health industry. left
B policy-makers and the public no alternative but to exclude nurse evolved
C without proper input from nurses
D remained nearly invisible to policy-makers and the public
20. As per paragraph five, complete healthcare involves
A disease prevention and humane system

B providing funds for probable cure permitting
C people to die with dignity health education
D and skilled care
21. The opinion put forth by the final paragraph is that
A Confident nurses are unnecessary for a positive view of their profession. Nurses
B need politicians support for new technological advancements. The promise of
C cure does not guarantee successful surgeries.
D Nursing as a whole is as imperative as other dependent factors.
22. Which word can be best described for the term “futile” in paragraph five?
A expensive
B flashy
C needless
D unprofitable
END OF READING TEST

Practice test 4
Listening test
You hear a nurse talking to Elizabeth, a patient who requires follow-up care. For
questions 1-12, complete the notes with a word or a short phrase.
Patient :  Elizabeth Campbell

Reason for the visit :  referral to (1) health nurse
 pain in the back
 experienced
discomfort and (2) in the back
 used pain relief oinments to relive the symptoms.
Treatment history :  pain started one and a half years ago
 was (3) a pain killer.
 hospitalised © IRS Group for 2 days.
12 months ago :  underwent blood tests and (4) test.
6 months ago  (5) was found.
 surgery to remove a
(6) of the bone
Recent pain control  (7) 3 times a day
 alternative modalities of pain relief
 smokes (8) (dope)
Mental status :  seems (9) and anxious because of tumour
 considered (10)
because of bouts of depression
Assessment & follow-up :  arrange for (11)
 alternative therapies -
accupressure, accupuncture and (12)
 see a specialist
You hear Dr Juvenita talking to a Griffith Alexander, a patient with back problems. For questions 13-24, complete the notes
Patient :  Griffith Alexander
Patient’s condition :  back spasm
Presenting symptoms  (13) , not sleeping well
 exhausted with discomfort
Treatment options :  (14) for the back pain spasm, medication

for pain.
 exercises and heating pad © IRS Group
back pain gets better with the (15)
Patient’s request :  needs an (16) since he is concerned
might have a (17) or slipped disc

that requires attention
Explanation given :  has (18) that reveals other than a back

spasm
 No red flags to be concerned about
(19) treatment is enough for most patients
Patient’s concern :  been over a week, will be (20) ,

disabled for life
 will be informed if something is wrong
(21) from the machine may ease the

condition
Advice offered :  MRI is an (22) study, not a treatment

mode
 MRIs may cause harm if its unrequired
 most
patients get better within (23)
with the prescribed treatment
Patient’s response :  consider an MRI if other (24) present

Part B
setting.
25. You hear a nurse manager instructing a batch on clinical formalities.
What is the instructor trying to convey?
A standard procedure for medication administration

B methods to improve clinical skill and performance
C checklists prepared for a physician’s appointment
26. You hear an extract of a nurse talking about ‘confidence in profession’.
What does the seminar emphasise
A acknowledge the mistake that was committed composed and

B calm admittance of any errors understanding that the
C situation can be overcome
27. You hear a doctor talking about aboriginal mental health
Why did the psychologist say culture bound prevention does not exist?
A because it is not researched thoroughly yet

B since it has not been exposed to it earlier due to
C the lack of evidence to support it
28. You hear a pharmacist telling a patient about some medication.
Why does she give a verbal explanation of the side effects?
A to highlight their severity

B to ensure the patient understands
C to allow the patient to raise any concerns
29. You hear two nurses discussing about a patient during handover What
was administered to him?
A Stiches on the right shoulder

B morphine and antibiotic drip
C dosage to prevent blood clot
30. You hear a mental health specialist talking about therapeutic interventions
Treatment mode that worked best was by
A assisting the patient overcome sheer solitude understanding

B the person’s cognitive complexities empowering the patient
C by active listening

Part C
In this part of the test, you’ll hear two different extracts. In each extract, you’ll hear health professionals talking
about aspects of their work.
You hear a presentation on treating scoliosis by a physiotherapist called John Booker. You now
have 90 seconds to read questions 31-36.
31. What general point does John make about physiotherapy
A It allows patients to opt for a less invasive form of treatment.

B It tends to be used in conjunction with other forms of treatment.
C It places more emphasis on prevention than other forms of treatment.
32. John suggests that before treating a patient with scoliosis, the physiotherapist needs
A to develop a treatment plan based on a description of the symptoms. to

B establish whether the cause of the condition has been identified. to
C determine which of the two main types is being presented.
33. John feels that once scoliosis is confirmed, the priority for the multi-disciplinary team should
be
A to determine the severity of the condition.

B to agree how exercises will complement medication.
C to ensure that the patients’ pain is being well managed.
34. The second phase in John’s preferred treatment plan for scoliosis focuses on
A using new techniques on various joints in the body. regaining full

B movement in the affected part of the spine.
C ensuring the patient has realistic aims regarding the likely outcome.
35. John believes that success in the final phase of treatment depends on
A handing long-term responsibility over to the patient. ongoing co-

B operation between physiotherapist and patient.
C practical assistance supplied by practitioners in other professions.
36. John suggests that patients with mild to moderate scoliosis often
A find the demands of physiotherapy too challenging. express

B doubts about the effectiveness of physiotherapy. lack the
C motivation to gain any benefit from physiotherapy.

You hear an interview with Dr Michael Greger, an expert on vegan diet. You
37. What is the biggest progress to vegan diet as per the doctor.
A clinics operating on plant-based diet surge in

B plant-based nutrition movement Palpable
C changes in health sector
38. Why does the doctor think a change is inevitable?
A majority of the illnesses are largely preventable there

B is a degree of control on human longevity risk factors
C to health have been precipitating
39. The doctor believes sufficient randomised control trials are in existance because
A it does not have the backing of corporate budget many

B people are dying due to preventable illnesses
C it was published in a medical journal two decades ago
40. Why does the expert feel the need to publish resources
A doctors had monopoly over health industry

B access to information by the masses
C to address immediate health concerns
41. Doctor Michael thinks of a conflict of interest in USDA because
A they refrain from taking measures that are unviable the

B message is to eat more fruits and vegetables medical
C professionals must frame dietary guidelines
42. What is the primary barrier faced by doctors?
A big pharma companies sponsor mainstream medical associations they are

B not paid enough to communicate with patients
C the defeciency of knowledge from medical schools

Reading test
Schizophrenia: Texts
Text A
Assess Symptoms and Establish a Diagnosis.

Establish an accurate diagnosis, considering other psychotic disorders in the differential diagnosis because of the major implications for short- and
Reevaluate the patient’s diagnosis and update the treatment plan as new information about the patient and his or her symptoms becomes availab
Identify the targets of each treatment, use outcome measures that gauge the effect of treatment, and have realistic expectations about the degre
Consider the use of objective, quantitative rating scales to monitor clinical status (e.g., Abnormal Involuntary Movement Scale [AIMS], Structured C
Text B
Assistance in Organising Confusing Experiences

ABC model
The ABC model, which was originally developed by Ellis and Harper,12 can be used to give the patient a way
of organizing confusing experiences. It involves slowly and thoroughly moving the patient through the various
steps using Socratic questioning to clarify the links between the emotional distress the patient is experiencing
and the beliefs he holds (Table). It includes the following steps:
• Based on a scale of 0 to 10, the patient rates the intensity of distress.
• The consequence (C) is assessed and divided into emotional and behavioral Cs.
• The patient gives his own explanation as to what activating events (As) seemed to cause C; and the
therapist ensures that the factual events are not “contaminated” by judgments and interpretations.
• The therapist provides feedback to the patient to acknowledge the A-C connection.
• The therapist assesses the patient's belief, evaluations, and images and communicates to the patient
that a personal meaning is lacking in the A-C model; simple examples can be provided to facilitate
understanding.
• The patient's own belief (B), which is actually the cause of C, is then discussed; often, this can be
rationalized, and a B such as “nobody will like me if I tell them about my voices” can be disputed and changed
to “I can't demand that everyone likes me. Some people will and some won't...Maybe some friends might find
it interesting.” This may lead to a change in C, ie, less sadness and isolation.
Text C
Text D
Goals of Treatment
• Minimize stress on the patient and provide support to minimize the likelihood of relapse.
• Enhance the patient’s adaptation to life in the community.
• Facilitate continued reduction in symptoms and consolidation of remission, and promote the process of
recovery.
If the patient has achieved an adequate therapeutic response with minimal side effects, monitor response to the
same medication and dose for the next 6 months.
Assess adverse side effects continuing from the acute phase, and adjust pharmacotherapy accordingly to
minimize them.
Continue with supportive psychotherapeutic interventions.
Begin education for the patient (and continue education for family members) about the course and outcome of
the illness and emphasize the importance of treatment adherence.
To avoid gaps in service delivery, arrange for linkage of services between hospital and community treatment
before the patient is discharged from the hospital.
For hospitalized patients, it is frequently beneficial to arrange an appointment with an outpatient psychia- trist
and, for patients who will reside in a community residence, to arrange a visit before discharge.
After discharge, help patients adjust to life in the community through realistic goal setting without undue
pressure to perform at high levels vocationally and socially.
Part A
Time: 15 minutes
Schizophrenia: Questions
Questions 1-7
more than once. © IRS Group

1. Facilitating continued deduction in symptoms
2. The various steps using socratic questioning
3. Gauging the effect of treatment to establish diagnosis
4. The rating scales used to monitor clinical status
5. Administration routes © IRS Group for giving drugs
6. Advantages of haloperidol medication for treatment
7. Division into emotional and behavioural Cs
Questions 8-14
8. What must be arranged for, to avoid gaps between hospital and community
9. What was the ABC model developed to © IRS Group assist
10. What does the therapist provide to acknowledge the A-C connection?
11. What can be used to gauge the effect of treatment?
12. What must be done if the patient appears problematically symptomatic?
13. How long will a sublingual administration of asenapine take to peak plasma concentration?
14. Which drugs are examples of slow acting orally disintegrating tablets?
Questions 15-20
15. A disadvantage of inhaled medication is that it requires .
16. route of administration of midazolam ensures rapid absorption.
17. It is advised to the patient’s diagnosis and update the treatment plan.
18. The ABC Model helps to clarify from the beliefs the patient holds.
19. Assitance in understanding © IRS Group can be facilitated by providing .
20. After discharge, patients must be allowed to perform without .

Part B
1. The extract from the circular is intended to
A. give information on compiling private prescriptions

B. remind the staff of particulars to be included
C. instruct the doctors of methods to standardise procedures
Record keeping
A record must be kept of every DCA EPP prescription only medicine (POM) supplied. Record to be kept in a bound book or electronically.
Particulars to be recorded:
Date of supply
Name, © IRS Group
quantity and pharmaceutical form and strength of the medicine
Date on the prescription
Name and address of the prescriber
Name and address of the patient
Entry must be made on the day of supply, or if that is not reasonably practical, on the next following day.
The record must be retained for a period of 2 years from the date of last entry in the book/electronic register.
Prescription token must be referenced accordingly and filed in a chronological order, and retained for a period of 2 years from the date of supply.
2. The report on homeless patients suggests that issues can be addressed by
A. assuring help required from a GP or dentist

B. registering the identity of those uncovered
C. adhering to the laid down structure of identification
The issues of looking after homeless patients in General Practice
alth and Social Care Act introduced statutory duties on the health department to “have regard to the need to reduce inequalities” in access to and outco
3. What does this advisory intend to convey?
A. The requirement for monitor of malnourished patients.

B. Primary route for providing external nutritional support
C. Identification and management of malnourished patients.
Step to contain malnourishment
unction or clinical outcome. It is vital to identify patients at risk of malnutrition as nutritional support is advantageous in malnourished patients. A nutri-
4. The directive on discharge plan outlines the
A. Approach to be considered on the length of the stay

B. Need for the patients choice in the duration of stay
C. Use of systems to estimate the course of admission
Discharge or transfer protocols update
cting a patient’s length of stay can be undertaken in two ways. It can be based on actual performance in the ward or unit, or on benchmarking informati
5. In the prospectus for infection prevention, what are control professionals required to do?
A. Prepare an exhaustive analysis and control an outbreak

B. Chart a course to apply policies that cuts an infection
C. Implement practices that are best suited for individuals
Infection prevention and control professional
actices or those mandated by regulatory and licensing agencies; application of epidemiologic principles to improve patient outcomes; participa- tion in p
6. In view of the circular published, what is the hospital trying to address
A. services required by the midwives for intensive care

B. support required for full term pregnant mothers
C. objectives that are vital for quality maternal care
Commitment and Support by Governing Body
nagement System in Zamboanga City Medical Center starting October 13, 2018. We also hereby authorize the Zamboanga City Medical Center Materna
Text 1: The Chemistry and Physics Behind the Perfect Cup of Coffee
We humans seem to like drinks that contain coffee constituents (organic acids, Maillard products, esters and
heterocycles, to name a few) at 1.2 to 1.5 percent by mass (as in filter coffee), and also favor drinks containing 8 to 10
percent by mass (as in espresso). Concentrations outside of these ranges are challenging to execute. There are a
limited number of technologies that achieve 8 to 10 percent concentrations, the espresso machine being the most
familiar.
There are many ways, though, to achieve a drink containing 1.2 to 1.5 percent coffee. A pour-over, Turkish, Arabic,
Aeropress, French press, siphon or batch brew (that is, regular drip) apparatus – each produces coffee that tastes
good around these concentrations. These brew methods also boast an advantage over their espresso counterpart: They
are cheap. An espresso machine can produce a beverage of this concentration: the Americano, which is just an
espresso shot diluted with water to the concentration of filter coffee. There are two families of brewing device within
the low-concentration methods – those that fully immerse the coffee in the brew water and those that flow the water
through the coffee bed.
From a physical perspective, the major difference is that the temperature of the coffee particulates is higher in the full
immersion system. The slowest part of coffee extraction is not the rate at which compounds dissolve from the
particulate surface. Rather, it’s the speed at which coffee flavor moves through the solid particle to the water-coffee
interface, and this speed is increased with temperature.
A higher particulate temperature means that more of the tasty compounds trapped within the coffee particulates will be
extracted. But higher temperature also lets more of the unwanted compounds dissolve in the water, too. The
Specialty Coffee Association presents a flavor wheel to help us talk about these flavors – from green/ vegetative or
papery/musty through to brown sugar or dried fruit. © IRS Group
The water-to-coffee ratio matters, too, in the brew time. Simply grinding more fine to increase extraction invariably
changes the brew time, as the water seeps more slowly through finer grounds. One can increase the water-to-coffee
ratio by using less coffee, but as the mass of coffee is reduced, the brew time also decreases. Optimization of filter
coffee brewing is hence multidimensional and trickier than full immersion methods.
Every coffee enthusiast will rightly tell you that blade grinders are disfavored because they produce a seemingly
random particle size distribution; there can be both powder and essentially whole coffee beans coexisting. The
alternative, a burr grinder, features two pieces of metal with teeth that cut the coffee into progressively smaller
pieces. They allow ground particulates through an aperture only once they are small enough.
There is contention over how to optimize grind settings when using a burr grinder, though. One school of thought
supports grinding the coffee as fine as possible to maximize the surface area, which lets you extract the most delicious
flavors in higher concentrations. The rival school advocates grinding as coarse as possible to minimize the
production of fine particles that impart negative flavors. Perhaps the most useful advice here is to determine what
you like best based on your taste preference.
Finally, the freshness of the coffee itself is crucial. Roasted coffee contains a significant amount of CO2 and other
volatiles trapped within the solid coffee matrix: Over time these gaseous organic molecules will escape the bean.
Fewer volatiles mean a less flavorful cup of coffee. Most cafes will not serve coffee more than four weeks out from
the roast date, emphasizing the importance of using freshly roasted beans.
7. The favorable concentration of drinks by mass in espresso include
A 3 percent by mass 8
B percent by mass 12
C percent by mass
D 1.3 percent by mass
8. What can be the advantage of other brew methods over espresso
A They produce a favorable concentration The

B methods are cheaper
C The other brew methods produce tastier coffee The
D other methods are advantageous
9. What can be the meaning of "counterpart"
A Neighbor
B Enemy
C Coequal
D Sibling
10. Higher temperature can help easy extraction even though
A More tastier compounds get trapped

B Unwanted compounds gets dissolved in the water The
C brewing gets trickier
D The speed gets increased with temperature
11. What can be true with respect to optimization of filter coffee brewing
A Water-coffee ration can be less of importance

B Full immersion methods gets less trickier and multidimensional Simple
C grinding does not changes brew time
D The relevance of optimization is null
12. A burr grinder features
A Seemingly random particle size distribution

B Coexistence of powder and whole coffee beans
C A progressive grinding of coffee into smaller pieces Blade
D grinders are © IRS Group completely disfavored
13. What can be “contention”
A Approval
B Disagreement
C Harmony Plea
D
14. Less flavorful cup of coffee can be due to
A The gaseous organic molecules that escape the bean over time The
B volatiles that get trapped into the beans over time
C The freshly roasted beans have significant amount of CO2
D Cafes serve coffee that can be containing more volatiles
Text 2: Difficult-to-treat depression
Depression remains a leading cause of distress and disability worldwide. In one country’s survey of health and
wellbeing in 1997, 7.2% of people surveyed had experienced a mood (affective) disorder in the previous 12 months.
Those affected reported a mean of 11.7 disability days (when they were “completely unable to carry out or had to cut
down on their usual activities owing to their health”) in the previous 4 weeks. There was also evidence of substantial
under treatment: amazingly 35% of people with a mental health problem had a mental health consultation during the
previous 12 months. Of those with a mental health problem, 27% (i.e., three- quarters of those seeking help) saw a
general practitioner (GP). In the 2007–08 follow-up survey, not much had changed: 12-month prevalence rates were
4.1% for depression, 1.3% for dysthymia and 1.8% for bipolar disorder. These disorders were associated with
significant disability, role impairment, and mental health and substance use co-morbidity. Again, there was evidence
of substantial unmet need, and again GPs were the health professionals most likely to be providing care.
While general practitioners (GPs) have many skills in the assessment and treatment of depression, they are often faced
with people with depression who simply do not get better, despite the use of proven therapies, be they psychological
or pharmacological. This supplement aims to address some of the issues that GPs face in this context. GPs are well
placed in one regard, as they often have a longitudinal knowledge of the patient, understand his or her circumstances,
stressors and supports, and can marshal this knowledge into a coherent and comprehensive management plan. Of
course, GPs should not soldier on alone if they feel the patient is not getting better.
In trying to understand what happens when GPs feel “stuck” while treating someone with depression, a qualitative
study was undertaken that aimed to gauge the response of GPs to the term “difficult-to-treat depression”. It was
found that, while there was confusion around the exact meaning of the term, GPs could relate to it as broadly
encompassing a range of individuals and presentations. Thus, the term has face validity, if not specificity. More
specific terms such as “treatment-resistant depression” are generally reserved for a subgroup of people with
difficult-to-treat depression that has failed to respond to treatment, with particular management implications.
One scenario in which depression can be difficult to treat is in the context of physical illness. Depression is often
expressed via physical symptoms, but the obverse is that people with chronic physical ailments are at high risk of
depression. Pain syndromes are particularly tricky, as complaints of pain require the clinician to accept them as
“legitimate”, even if there is no obvious physical cause. The use of analgesics can create its own problems, including
dependence. Patients with comorbid chronic pain and depression require careful and sensitive management and a
long-term commitment from the GP to ensure consistency of care and support.
It is often difficult to tackle the topic of depression co-occurring with borderline personality disorder (BPD). People
with BPD have, as part of the core disorder, a perturbation of affect associated with marked variability of mood. This
can be very difficult for the patient to deal with, and can feed self-injurious and other harmful behaviour. Use of
mentalisation-based techniques is gaining support, and psychological treatments such as dialectical behaviour
therapy form the cornerstone of care. Use of medications tends to be secondary, and prescription needs to be
judicious and carefully targeted at particular symptoms. GPs can play a very important role in helping people with
BPD, but should not “go it alone”, instead ensuring sufficient support for themselves as well as the patient.
Another particularly problematic and well known form of depression is that which occurs in the context of bipolar
disorder. Firm data on how best to manage bipolar depression is surprisingly lacking. It is clear that treatments
such as unopposed antidepressants can make matters a lot worse, with the potential for induction of mania and mood
cycle acceleration. However, certain medications (notably, some mood stabilisers and atypical antipsychotics) can
alleviate much of the suffering associated with bipolar depression. Specialist psychiatric input is often required to
achieve the best pharmacological approach. For people with bipolar disorder, psychological techniques and long-
term planning can help prevent relapse. Family education and support is also an important consideration.
15. Paragraph one aims to convey that
A each surveyed participant in 1997 reported 11.7 disability days.

B those with an affective disorder performed their typical duties as normal. a
C large proportion of mental health consultations were provided by a GP. 35%
D having a mental health consultation is a great improvement.
16. What is signified from the statistics of 2007-2008?
A Comparable findings for the several mental illnesses mentioned. The

B rate of depression had fallen considerably.
C Disability days had declined from the 1997 statistics. The
D level of treatment provided had improved somewhat.
17. What information is expressed in paragraph two?
A GPs are in an advantageous position GPs

B should not force a pointless plan
C GPs must address the issues when faced GPs
D are likely to have required skills
18. According to paragraph 3, the term ‘difficult-to-treat depression’ has
A relatability to its broader meaning

B an unidentifiable and misunderstood meaning full
C value and is specific in its meaning
D full value but is not specific in its meaning
19. Paragraph 4 implies that physical ailments are a difficult area because
A clinicians do not generally believe all apparent physical symptoms clinicians

B must decipher what is valid and what is improbable clinicians observe the
C patient for any legitimacy of mental problems
D clinicians only recognise legitimate complaints of comorbid chronic pain
20. According to paragraph 5, people with BPD s
A have a stable mood making it difficult to diagnose. have

B mood fluctuations which are key to the disorder. have
C rapid mood swings which are clearly identifiable. have
D limited support from the health service.
21. In paragraph 6, the author’s use of ‘surprisingly lacking’ is
A to portray a tone of doubt that it is truly lacking.

B because of the scarcity of bipolar disorder in modern times. due
C to the established prevalence of bipolar disorder.
D to enable readers to understand and feel the author’s skepticism.
22. Reducing symptoms associated with BPD is achieved by
A psychological techniques and long term planning

B treatments requiring unopposed antidepressant use
C medications including use of atypical antipsychotics
D therapies like family education and support groups
END OF READING TEST

Practice test 5
Listening test
You hear a doctor talking to a patient called Graham, a patient with breathing difficulty. For
questions 1-12, complete the notes with a word or short phrase.
Patient :  Graham
Reason for presenting :  trouble with (1)
Description of symptoms :  experiences wheezing and breathlessness
 (2) a lot (3 weeks)
 white (3) - thought it was a cold
 (4) getting worse as weeks progressed
very worried when he is (5) able to

take breath.
 (6) are more frequent now
 worse at night and in the morning
 (7) did not go for work yesterday
 chest tightness without pressing pain
Precipitating factors :  no known (8) to dust
 no known use of drugs
Further factors :  work has been intense
(9) has made him anxious
Points to consider :  (10) had anything like this before
 has no other known medical conditions
 first time being (11)
sister and mother has (12)

You hear a doctor talking to a client called Barbara Roberts, a patient with psychosomatic disorder. For
questions 13-24, complete the notes with a word or short phrase. © IRS Group
Patient :  Barbara Roberts
Age :  58 years
Difficulties experienced :  terrible trouble with the stomach
 (13) nearly all the time
 often times, feels (14)
 swings between (15) and constipation
 cramping feeling (16)
 passes very smelly wind
Onset of the condition :  about (17) ago
Previous treatment and :  started with (18)
investigation  took other medications including (19)
 gastroscopy was performed
 (20) also administered
Assessment of :  feels (21) pain, can’t be all in the head
insight  thought it was an infection that had not cleared
 sometimes wonders if its an (22)
Treatment options :  try to bring back few (23)
 (24) between the tablets that are

helping and ones that aren’t
 wait for 2-3 months for results to show
 keep an eye on the symptoms

Part B
setting.
For questions 25-30, choose the answer (A, B or C) which fits best according to what you hear. You’ll have time
to read each question before you listen. Complete your answers as you listen.
25. You hear a nurse manager speak to his team.
What needs to be focused on
A effectively pacing the week ahead

B attending to the patient regularly ensuring
C the completion of procedures
26. You hear a doctor discussing with a patient the complications of a surgical procedure The
risks associated with the procedure are
A benign and can be corrected

B uncommon and problem free
C varied but usually infrequent
27. You hear the head of a unit discussing patient details
Observation made on the patient is
A satisfactory according to the results

B encouraging for further treatment stable
C as per ongoing treatment
28. You hear a nurse brief about behavioural nursing
What is the purpose of the extract
A to identify shortcomings in children to

B share school nursing experience to
C highlight a shortage of expertise
29. You hear a scientist deliver a talk on physical activities for children What
does he advocate
A repetitive activities for specific areas

B minimise overuse of certain parts must
C play in a variety of sports
30. You hear a talk by a nurse anasthetist
How do the mannequins respond to procedure
A by alerting the nurses if vitals fluctuate

B by being versatile to the presenting process by
C mimicking the changes in ill patients

Part C
You hear a talk on suicide prevention by a social researcher Mary Todd. You
31. Mary describes the purpose of secondary suicide prevention is as
A reduce the number of new cases bring

B down the attempts in an area minimise
C the attempts by the suicidal
32. Secondary suicide prevention is understated because
A it is only starting to be applied in practice suicide

B is difficult to predict due to complexity recent
C events lead to increased suicide
33. Mary talks on the importance of suicide assessment because
A psychiatric illness is a major contributing factor it

B enables in the identification of the risk factors
C it helps develop diagnosis and treatment methods
34. What must be done for subjective rating of severity of depression
A physicians should not hesitate to ask on suicidal ideation clinicians

B need to overcome obstacles in providing care additional information
C should be incorporated into assessment
35. Mary feels that suicide rates may be reduced by interventions like
A legal restrictions that reduce access to harmless substances psychological

B follow up and other methods including telephonic therapies that address
C repetition of suicide thoughts and behaviours
36. What is the increasing concern with digital media covering suicide
A there are still many gaps in the research

B it glamorises suicide among the vulnerable
C it provides accessible information for an attempt

You hear an interview with Samantha Solon, a lead scientist on diet that boosts the ‘miracle hormone’
37. Samantha feels that prospects for are high because?
A it has been proven effective for longevity the

B effects of administration are long term varied
C indicators of health can be influenced
38. What does the study of diet in mice identify
A an influence on metabolic rate

B effective way for increasing the hormone the
C animals showed an increase in weight
39. Samantha opines the influence of protein is
A minimal without high carbohydrate in

B tandem with the carbohydrates optimal
C with high carbohydrate
40. According to the expert, evidence from paradoxical conditions are
A that reduced protein intake is crucial teased

B apart for clarity on findings studied for
C influence of insulin variation
41. What can be done to harness the potential of the hormone?
A modify the diet and nutritional guidelines

B administration by means of chronic injection develop
C a mimetics for increased effectiveness
42. What can be said with certainty as per the expert
A everyone is in a race for an answer

B the dynamics can not be explained now no
C one knows the mechanism of action

Reading test
Inguinal Hernia : Texts
Text A
Inguinal Hernia
An inguinal hernia is a protrusion of the intestine or bladder through the inguinal canal, often into the groin or scrotum. It is a very common problem
The cause of inguinal hernias depends on the type of inguinal hernia. The causes can range from mere birth defects to the inclusion of external forc
Text B
t versus direct inguinal hernias
uinal hernia develop over time due to straining and is caused by weakness in abdominal muscles whereas indirect hernia is caused by a defect in the ab
Text C
How are inguinal hernias treated?

Repair of an inguinal hernia via surgery is the only treatment for inguinal hernias and can prevent incarceration
and strangulation. The two main types of surgery for hernias are
• Open hernia repair. During an open hernia repair, a health care provider usually gives a patient local
anesthesia in the abdomen with sedation; however, some patients may have
o sedation with a spinal block, in which a health care provider injects anesthetics around the nerves in
the spine, making the body numb from the waist down
o general anesthesia
• The surgeon makes a cut in the groin, moves the hernia back into the abdomen, and reinforces the
abdominal wall with stitches (herniorrhaphy). Usually the surgeon also reinforces the weak area in
abdominal wall with a synthetic mesh or “screen” to provide additional support (hernioplasty). This
procedure requires a single incision except in cases where hernias are on both sides.
• Laparoscopic hernia repair. A surgeon performs laparoscopic hernia repair with the patient under
general anesthesia. The surgeon makes several small, half-inch incisions in the lower abdomen and inserts
a laparoscope—a thin tube with a tiny video camera attached. The camera sends a magnified image from
inside the body to a video monitor, giving the surgeon a close-up view of the hernia and surrounding
tissue. While watching the monitor, the surgeon repairs the hernia using synthetic mesh or “screen.”
People who undergo laparoscopic hernia repair generally experience a shorter recovery time than those who
have an open hernia repair.Surgery to repair an inguinal hernia is quite safe, and complications are
uncommon. However, the health care provider should assess for any of the following symptoms
• redness around or drainage from the incision
• fever
• bleeding from the incision
• pain that is not relieved by medication or pain that suddenly worsens

Text D
Nursing Interventions
Place the patient in the Trendelenburg’s position to reduce pressure on the hernia site.
Apply truss only after the hernia has been reduced. For best results, apply it in the morning before the patient gets out of bed.
Assess the skin daily and apply powder to prevent irritation.
• Watch for and immediately report signs of incarceration and strangulation.
Closely monitor vital

• signs and provide routine preoperative preparation. Administer IV fluids and analgesics for pain as ordered.
Control fever with• acetaminophen.
•
inal hernia may be able•to prevent symptoms by eating high-fiber foods.This may help prevent the constipation and straining that cause some of the pain
rventions:
• Provide routine postoperative care.
Do not allow•the patient to cough.

Encourage deep
• breathing and frequent turning.
Apply ice bags
• to the scrotum to reduce swelling and relieve pain; elevating the scrotum on rolled towels may also help to alleviate swelling.
• Administer analgesic as prescribed.
• In males, a jock strap or suspensory bandage may be used to provide support.
END OF PART A
THIS TEXT BOOKLET WILL BE COLLECTED
Part A
Time: 15 minutes
Inguinal Hernia : Questions
Questions 1-6
more than once.

1. Rationale for inguinal hernia
2. What happens during surgery
3. Care before and after surgery
4. Potential complications post operatively
5. Forms of inguinal hernia
6. Recovering from inguinal hernia repair
Questions 7-14
7. Which is the site of incision for open hernia repair?
8. What medication is used to control fever caused by hernia?
9. Which group is at the risk of developing direct inguinal hernia?
10. Which device is used to view the internal body in laparoscopic surgery?
11. What is the type of hernia repair surgery where a mesh patch is sewn over the weakened region?
12. Which surgery needs less recovery time?

13. Who is more prone to develop inguinal hernias?
14. Which position is recommended to relieve crushing on the point of hernia?
Questions 15-20
15. The food that is rich in aids in hindering symptoms.
16. Inorder to numb the lower part of the body a drug is injected in the spine over the
17. The deformityin indirect inguinal hernia is not as it is in the back of fibers of
the external oblique muscle.
18. The associated with inguinal hernia is typically exacerbated by common

activities.
19. Open surgery usually requires one large incision instead of several small incisions as in
surgery for hernia repair.
20. In direct inguinal hernia defect in the abdominal wall is felt on top of the
END OF PART A

Part B
1. Priority during physical examination must be given to
A informed consent of the patient

B appropriate length of the test
C full comfort experienced by them
Sexual boundaries in the doctor-patient relationship
in the patient’s consent before conducting a physical examination. You must also obtain the patient’s consent prior to the start of the consultation if an
and that they can ask you to stop the examination at any time.
heir clothes, you should provide an appropriate place to undress. This is an area where the patient can undress in private, out of view of anyone else, inclu
ary lengths of time. For example, the patient only needs to uncover the part of the body that is being examined, and should be allowed to cover it again
2. The advice below can best be applied to a healthcare setting by
A the inclusion of nurses in governance structures

B providing relevant information to patients in their native language
C redesigning projects according to advisory group recommendations
Working with patients and consumers
Partnerships with consumers can come in many forms. Some examples include:
working with consumers to check that the health information is easy to understand
using communication strategies and decision support tools that tailor messages to the consumer
including consumers in governance structures to ensure organisational policies and processes meet the needs of consumers
involving consumers in critical friends groups to provide advice on safety and quality projects
establishing consumer advisory groups to inform design or redesign projects.
3. The notice is giving information about
A differential management of infants using glucose How

B to check an infant’s blood glucose level
C The ideal glucose concentration in infants with clinical signs
Management of documented hypoglycemia in breastfeeding

infants
A. Infants with no clinical signs
1. Continue breastfeeding (approximately every 1 to 2 hours) or feed 3 to 10 mL/kg of expressed breast milk or
substitute nutrition.
2. Recheck blood glucose concentration before subsequent feedings until the value is acceptable and stable.
3. Avoid forced feedings.
4. If glucose remains low despite feedings, begin intravenous glucose therapy.
5. Breastfeeding may continue during IV glucose therapy.
6. Carefully document response to treatment.
B. Infants with clinical signs or plasma glucose levels 20 to 25 mg/dL (1.1 to 1.4 mmol/L)
1. Initiate intravenous 10% glucose solution.
2. Do not rely on oral or intragastric feeding to correct extreme or symptomatic hypoglycemia.
3. The glucose concentration in symptomatic infants should be maintained 45 mg/dL (2.5 mmol/L).
4. Adjust intravenous rate by blood glucose concentration.
5. Encourage frequent breastfeeding.
6. Monitor glucose concentrations before feedings as the IV is weaned until values stabilize off intravenous
fluids.
7. Carefully document response to treatmenti

4. The information sheet recommends
A regular auditing to ensure pain management program efficacy indicators to

B use in pain management program audits
C at least 50% change as being clinically important
Audit of pain management programs: Methods
It is recommended to conduct an audit of 20 or more sequential patients undertaking a pain management
program. Data collection should include simple demographic and program data as well as data (pre and post
program with a minimum three month interval between data sets) regarding changes in:
• Healthcare utilisation.
• Depression/anxiety/stress.
• Pain self efficacy.
• Pain catastrophising.
Percentage change in individual patients has been suggested (rather than average percentage change across the
population audited) as average percentage change is very sensitive to outliers and small audits may therefore
be significantly influenced by average percentage change.
The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommends
considering clinical important change (as distinct from statistically significant change) on the following basis:
• Minimal benefit 10-20 per cent change.
• Moderately important benefit at least 30 per cent change.
• Substantially important benefit at least 50 per cent change.
5. The purpose of the guideline is to
A prevent medicare claims being paid for public patients

B specify when services can be billed to Medicare ensure
C healthcare professionals don’t falsify claims
Guideline for substantiating claims for diagnostic imaging and

pathology services rendered to emergency department patients
of public hospitals
Public hospitals are funded under an arrangement with the Australian Government to provide free public
hospital services to eligible patients. This includes diagnostic imaging and pathology services provided to
public hospital emergency department patients. A patient who presents to a public hospital emergency
department should be treated as a public patient. If that patient is subsequently admitted they may elect to be
treated as a private patient for those admitted services. For a Medicare claim to be paid for a patient in a
public hospital, the patient must be admitted as a private patient at the time the service was rendered. Where a
service for a patient in a public hospital has been billed to Medicare, the hospital or rendering practitioner may
be asked to substantiate these claims.
Documents you may use include:
• the form which the patient (or next of kin, carer or guardian) - has signed indicating that the
patient has elected to be admitted as a private patient, and
• patient records - that show the patient was admitted as a private patient at the time the service was
rendered
6. Healthy ageing according to the information guide is
A functional ability that enables well being holistic

B health which is shaped by environment wholesome
C potential of an individual to exist
What is Healthy Ageing?
ents and opportunities that enable people to be and do what they value throughout their lives. Everybody can experience Healthy Ageing. Being free of di
Part C
In this part of the test, there will be a text about different aspects of healthcare. For questions 7-22, choose the answer
(A, B, C or D) which you think fits best according to the text.
Text 1: Seasonal Influenza Vaccination and the H1N1 Virus
As the novel pandemic influenza A (H1N1) virus spread around the world in late spring 2009 with a well- matched
pandemic vaccine not immediately available, the question of partial protection afforded by seasonal influenza vaccine
arose. Coverage of the seasonal influenza vaccine had reached 30%– 40% in the general population in 2008–09 in the US
and Canada, following recent expansion of vaccine recommendations.
The spring 2009 pandemic wave was the perfect opportunity to address the association between seasonal trivalent
inactivated influenza vaccine (TIV) and risk of pandemic illness. In an issue of PLoS Medicine, Danuta Skowronski
and colleagues report the unexpected results of a series of Canadian epidemiological studies suggesting a
counterproductive effect of the vaccine. The findings are based on Canada's unique near- real-time sentinel system for
monitoring influenza vaccine effectiveness. Patients with influenza-like illness who presented to a network of
participating physicians were tested for influenza virus by RT-PCR, and information on demographics, clinical
outcomes, and vaccine status was collected. In this sentinel system, vaccine effectiveness may be measured by
comparing vaccination status among influenza-positive “case” patients with influenza- negative “control” patients.
This approach has produced accurate measures of vaccine effectiveness for TIV in the past, with estimates of
protection in healthy adults higher when the vaccine is well- matched with circulating influenza strains and lower for
mismatched seasons. The sentinel system was expanded to continue during April to July 2009, as the H1N1 virus
defied influenza seasonality and rapidly became dominant over seasonal influenza viruses in Canada.
The Canadian sentinel study showed that receipt of TIV in the previous season (autumn 2008) appeared to increase
the risk of H1N1 illness by 1.03- to 2.74-fold, even after adjustment for the comorbidities of age and geography. The
investigators were prudent and conducted multiple sensitivity analyses to attempt to explain their perplexing
findings. Importantly, TIV remained protective against seasonal influenza viruses circulating in April through May
2009, with an effectiveness estimated at 56%, suggesting that the system had not suddenly become flawed. TIV
appeared as a risk factor in people under 50, but not in seniors—although senior estimates were imprecise due to
lower rates of pandemic illness in that age group. Interestingly, if vaccine were truly a risk factor in younger adults,
seniors may have fared better because their immune response to vaccination is less rigorous.
The Canadian authors provided a full description of their study population and carefully compared vaccine coverage
and prevalence of comorbidities in controls with national or province-level age-specific estimates— the best one can
do short of a randomized study. In parallel, profound bias in observational studies of vaccine effectiveness does exist,
as was amply documented in several cohort studies overestimating the mortality benefits of seasonal influenza
vaccination in seniors.
Given the uncertainty associated with observational studies, we believe it would be premature to conclude that TIV
increased the risk of 2009 pandemic illness, especially in light of six other contemporaneous observational studies in
civilian populations that have produced highly conflicting results. We note the large spread of vaccine effectiveness
estimates in those studies; indeed, four of the studies set in the US and Australia did not show any association
whereas two Mexican studies suggested a protective effect of 35%– 73%.
The alleged association between seasonal vaccination and 2009 H1N1 illness remains an open question, given the
conflicting evidence from available research. Canadian health authorities debated whether to postpone seasonal
vaccination in the autumn of 2009 until after a second pandemic wave had occurred, but decided to follow normal
vaccine recommendations instead because of concern about a resurgence of seasonal influenza viruses during the
2009–10 season. This illustrates the difficulty of making policy decisions in the midst of a public health crisis, when
officials must rely on limited and possibly biased evidence from observational data, even in the best possible
scenario of a well-established sentinel monitoring system already in place.
What happens next? Given the timeliness of the Canadian sentinel system, data on the association between seasonal
TIV and risk of H1N1 illness during the autumn 2009 pandemic wave will become available very soon, and will be
crucial in confirming or refuting the earlier Canadian results. In addition, evidence may be gained from disease
patterns during the autumn 2009 pandemic wave in other countries and from immunological studies characterizing the
baseline immunological status of vaccinated and unvaccinated populations. Overall, this perplexing experience in
Canada teaches us how to best react to disparate and conflicting studies and can aid in preparing for the next public
health crisis.
7. The question of partial protection against H1N1 arose
A before spring 2009

B during Spring 2009
C after spring 2009
D during 2008-09
8. According to Danuta Skowronski
A the inactivated influenza vaccine may not be having the desired effects.
B Canada’s near-real-time sentinel system is unique.
C the epidemiological studies were counterproductive
D the inactivated influenza vaccine has proven to be ineffective.
9. The vaccine achieved higher rates of protection in healthy adults when
A it was supported by physicians.

B the sentinel system was expanded. used
C in the right season.
D it was matched with other current strains.
10. Which one of the following is closest in meaning to the word prudent in paragraph 3?
A anxious
B cautious
C busy
D confused
11. The Canadian sentinel study demonstrated that…..
A age and geography had no effect on the vaccine’s effectiveness. vaccinations

B on senior citizens is less effective than on younger people. the vaccination
C was no longer effective.
D the risk of H1N1 seemed higher among people who received the TIV vaccination.
12. Which of the following sentences best summarises the writers’ opinion regarding the uncertainty
associated with observational studies?
A More studies are needed to determine whether TIV increased the risk of the 2009 pandemic. It is
B early to tell whether the risk of catching the 2009 pandemic illness increased due to TIV. Studies
C show that there is no association between TIV and increased risk of 2009 pandemic. Civilian
D populations are less at risk of catching the 2009 pandemic illness.
13. Which one of the following is closest in meaning to the word alleged in paragraph 6?
A reported
B likely
C suspected
D possible
14. Canadian health authorities did not postpone the Autumn 2009 seasonal vaccination because…
A of a fear seasonal influenza viruses would reappear in the 2009-10 season.

B there was too much conflicting evidence regarding the effectiveness of the vaccine. the
C sentinel monitoring system was well established.
D observational data may have been biased.
Text 2: Addiction to prescription
Addiction to prescription pain killers is soaring, with the number of Victorians being treated in hospital emergency
departments more than doubling in the past five years. Health experts say the crisis is partly driven by suburban
white-collar patients who get hooked after being prescribed opiate-based pills such as morphine and oxycodone for
chronic pain.
With an ageing population fuelling a jump in conditions such as arthritis, they fear addiction to pain killers will rise
further. Since 1991, there has been a 40-fold rise in morphine tablet use in Australia, while use of oxycodone has
quadrupled.
Medical professionals are now so concerned about pain killers abuse that 70 leading GPs, physiotherapists, chiropractors,
and pain-management specialists convened a national pain summit in Melbourne last week. The experts backed by
the college of anaesthetists, the college of General Practitioners and the college of Physicians, will present Prime
Minister Kevin Rudd with a plan to tackle the crisis before the end of the year. The clinical director of alcohol and
drug services at Southern and Eastern Health, Dr Matthew Frein, will tell the annexe Australian drugs conference in
Melbourne this week that the number of pain killer addicts going to the Monash Medical Centre and Dandenong
Hospital Emergency Departments jumped from about 150 in 2005 to 300 so far this year. In the same period, there
has been a corresponding drop in hospital visits heroin abuse.
This shift, which Dr. Frein believes is mirrored at hospitals across Victoria, is partly due to former heroin users
switching to cheaper prescription drugs and has been compounded by a short age of heroin and underfunding of
methadone programmes.
The problem was also being fuelled by people being prescribed pain medication after orthopaedic surgery or major
injuries. When the drugs failed to work, the dosage was increased. “That can often become a battle against pain that
the doctor and patient can never win,” he said. “The jury’s not out on whether this is a major problem for drug
treatment services – the jury’s back in. This is becoming the bread and butter of what we do”. Dr. Frein said he
believed Australia could go the same way as the United States where abuse of prescription pain killers is soaring.
Richard Smith from addiction, the Raymond Hader Clinic, said Australians were already the highest per capita users
of analgesics (paracetamol and aspirin) in the world. He said pill- popping had been “normalised” by Hollywood’s
widespread use of prescription medication. Singer Michael Jackson was believed to be addicted to pain killers at the
time of his death, and actor Heath Ledger died from an accidental overdose of prescription drugs including
oxycontin. Dr. Smith said: “we recently saw a woman with two young kids. She had a back injury and was advised
to have operations, putting in braces... She ended up with serious pain from the operations and was getting some
serious medication. The withdrawal symptoms are the same as heroin if not worse”. Dr. Frein said addicted patients
often “Doctor-shopped” to get a new prescription or told their GP they had lost the first one. When refused, they
often went to an emergency department.
Morphine and oxycodone are scheduled 8 substances, requiring a permit before being prescribed. Strict criteria
should be met before a prescription is offered to minimise the risk of dependency, but there are concerns that busy
GPs are overprescribing instead of offering alternatives such as psychological therapy and relaxation techniques. Dr
Penelope Briscoe of the Australian and New Zealand college of anaesthetists said medication reduced pain by only
about 30% and failed to work for 2 out of 3 patients.
John Ryan, chief of harm-reduction group annexe warned: “One of the complications of pharmaceutical use is half
life. It means people can take a drug and think they’ve cleared it from their system because they don’t feel any
effects but its still there and it puts them at risk of overdose”.
15. The author states that
A People treated in hospital EDs has risen dramatically in the past five years The
B number of EDs in Victoria have more than doubled in the past five years The
C number of prescription painkillers has doubled in the past five years.
D Victorians requiring hospitalisation for addiction has risen by more than 100% in the past five
years
16. According to this journalist
A Medical experts will be reporting to an Australian Drugs Conference later in October, 2009 Health
B (including pain) specialists arranged an Australia-wide seminar in Melbourne Medical experts and
C others will present a plan to solve the crisis by the end of 2009.
D A Clinical Director asserts that the number of addicts has doubled during the past year.
17. The idea expressed by Bread and butter in paragraph five is
A doctors pay too much attention to pain

B judgement on the procedure is reserved such
C means of treatment are unrestrained
D consequences of administration are numerous
18. What does Doctor-shopped in the fifth paragraph refer to
A visiting many doctors for prescriptions

B bargaining with medics for relievers using
C the same prescription over again choosing
D the professional on pills given
19. According to Richard Smith:
A Australians are the biggest users of analgesics in the world Australians

B were following in the footsteps of Hollywood celebrities People with back
C injuries get relief from strong pain killers Paracetamol and aspirin were
D popular forms of painkillers in the U.S.
20. The article refers to addicted patients
A who should be asking for other alternatives rather than a prescription for painkillers using
B a variety of strategies to get prescriptions filled.
C going from one doctor to another to get a prescription filled.
D pressuring overworked GP’s to write out another prescription.
21. Reported statistics shows that
A 30% of patients received pain relief from painkillers

B In two thirds of patients, painkillers had better effect than nothing at all.
C Patients using painkillers reported a 30% reduction in pain
D Painkillers were successful in 66% of patients.
22. The paragraph that starts with “This shift, which Dr Frei believes’ which refers to
A Painkiller addicts now attend Dandenong Hospital rather than Monash Medical The
B overall increase in addict numbers with previous figures
C As painkiller addict numbers have risen, there’s been a decrease in heroin abusers As
D painkiller addict numbers have risen, there’s been a decrease in heroin users
END OF READING TEST

ANSWER KEY
LISTENING SUB-TEST 1-5

READING SUB-TEST 1-5
LISTENING SUB-TEST 1
PART A: QUESTIONS 1 - 12
1 pressure
2 upset
3 3 months / three months
4 communication
5 anyone
6 partner
7 focus
8 number
9 money
10 continue
11 will
12 topic
13 tired
14 aches and pains
15 cold
16 blocked up
17 anything
18 appetite
19 bowel habits
20 scattered glands
21 glandular fever
22 blood tests
23 anemia
24 keep up
PART B: QUESTIONS 25 - 30
25 A reduction in determination of ill health

26 A associated risks with delivery are unlikely
27 C convey the working of analgesics
28 B it helps in preparing new recruits
29 B altering cell structure of pathogens
30 C daily independent performing of ADLs
PART C: QUESTIONS 31 - 36
31 A Hormonal changes affecting the body

32 B Only rarer forms affect both sensation and speech
33 A Effective sleep until the headache subsides
34 B Around half of the women likely experience while menstruating
35 C It contracts the vessels and reduces the blood flow
36 C Over the counter pain relievers like aspirin or ibuprufen
37 C His background in neurology and the fellowship combined

38 B could be seeing a lot of patients or performing procedures
39 A The discovery of genetic biomarkers that can be tested easily
40 B alleviate associated problems so that patients can lead normal lives
41 C The lack of social support that is required for patients
42 C Introduction of newer drugs with greater effectiveness
READING SUB-TEST 1
1 B
2 D
3 A
4 C
5 A
6 D
7 B
8 HCG / Human Chorionic Gonadotropin
9 combination of factors
10 20 minutes / twenty minutes
11 lupus and rheumatoid arthritis
12 sexual and drug taking (history)
13 3 months / three months (after exposure)
14 protein
15 transactional
16 finger
17 eligibility
18 immune system
19 reliability
20 condomless sex
1 B inconsistent responses to new findings

2 C conservative estimates of procedural effectiveness
3 A perform in the presence of a billing physician
4 B articulate the symptoms with patient
5 A appropriate dispensation of information is legal
6 C use informed choices for later care
7 B the rate of pancreatic cancer has risen in most age groups.

8 A smoking trends have been attributed as the key factor.
9 B often avoided which has led to a 50 to 70% confirmation rate.
10 B have detected more incidences of pancreatic cancer.
11 B Marked
12 D a highly probable rise in mortality rates in the near future.
13 B Classify
14 C Objective
15 D it is not as prominent as other dental issues

16 A causative
17 A prompted further interest in the link between oral health and systemic disease
18 C evident
19 B assess the overall oral health of patients
20 A cardiovascular disease could actually exacerbate periodontal disease
21 D more support for dental care in the public health system.
22 D yet to be attained
1 university
2 more
3 ritalin
4 momentum
5 time
6 perform
7 leash
8 exam results
9 MDMA
10 everyone
11 about
12 hold
13 Tuesday
14 (right) across (his) belly
15 runny nose
16 camping
17 purple / purplish
18 meningococcus
19 hives
20 immune response
21 claritin
22 grumpy
23 medication
24 eggs / strawberries / shell fish
25 C to explain possible side effects before signing the consent form

26 B the patient’s drug administration
27 B the extent of surgery required
28 B contradictory messages being circulated around
29 A procedures not running to schedule
30 C set up some monitoring of his mental acuity
31 A to find the effect of salt on blood pressure

32 C no effects of low glycaemic index
33 C LDL cholesterol increased in a low - GI diet
34 B benefits could be attributed to other aspects
35 B inexpensive methods to keeping individuals engaged
36 B unchecked consumption of an adverse diet
37 A incidence has been hugely higher in the past decade

38 C unlike popular perception, alcoholism is not the leading trigger factor
39 B liver cancers typically have an underlying liver condition behind it
40 B liver conditions reveal fewer symptoms until they have progressed much
41 A she considers it to be simple lab test that should be done more often
42 A patients do not present due to the social stigma associated with liver problems
READING SUB-TEST 2
1 D
2 B
3 A
4 B
5 B
6 C
7 A
8 tuberculin
9 18 mg
10 myobacterium tuberculosis
11 20 - 30 months
12 pulmonary tuberculosis
13 (adequate) ventilation
14 drug resistant TB
15 lungs
16 organ
17 swelling
18 X ray
19 tuberculosis
20 first line
1 B formulation of tests for close scrutiny

2 B ease to monitor adherence of preventive methods
3 B the need to specify and follow regulations at work
4 C inculcate skills required by practice developers
5 A prevention of similar injuries to employees ahead
6 A presence of foreskin is a major precipitating factor
7 A a protein treatment has caused mice to lose weight dramatically

8 B may be a factor in appetite control
9 B named
10 C a deficiency in the ob protein had caused obesity in the subjects
11 B may be useful for anyone who wants to lose weight
12 C slow
13 D it is not the only factor involved in appetite control
14 D despite the results of the study of mice, the benefits for humans is unknown
15 B Commonly held perception of polyunsaturated fat

16 D trans monounsaturated fat increases the cholesterol level
17 D the benefits of using only vegetable fats in the human diet are arguable
18 C to express unfounded concern
19 A agree with Grundy’s recommendation for relabelling
20 C Flynn’s study was not sufficiently rigorous
21 B is not very concerned about trans fat intake levels for most people
22 C the issue of trans fat is likely to receive more, rather than less, attention in future
1 fixation
2 pre-operative area
3 surgery site
4 neuromuscular
5 prone
6 prolonged
7 bending over
8 jarring
9 micro motion
10 physical therapy
11 tolerable
12 markedly
13 white
14 swollen
15 crusts
16 burning eyes
17 pollen
18 eye examination
19 pillow case
20 eye drops
21 patch
22 irritants
23 over the counter
24 antihistamine
25 B explain the procedure in detail and preparation to be done in advance

26 B examining the extent of mobility after surgery
27 B customisation to specific standards
28 B after 6 months from observation of disorder
29 C the level should fall within the adequate category
30 B utlising consistent information for quality care
31 C lack of efficiency if several meanings do exist

32 A it results in difficulty to recuperate
33 C locating the harm of too much medicine
34 B chiefly based on a consensus
35 C by identifying inherent social factors
36 A having a set of special parameters
37 B they are tailored to the requirements of the patient

38 A treatment course for a specific condition can be mentioned
39 C it can ensure appropriate treatment
40 C since the condition is a sum total of disease
41 C ascertain the treatment type required
42 A the tests will take more time to be available
READING SUB-TEST 3
1 A
2 B
3 D
4 A
5 C
6 D
7 B
8 morphine
9 bleeping
10 above 40
11 throbbing cramp
12 leg
13 older anticoagulants
14 anticoagulants
15 stockings
16 pulmonary embolism
17 blood flow
18 oestrogen
19 lovenox
20 purpura
1 B to enable the accredited pharmacist to access relevant information

2 A the number of hours of work permissible
3 A indicating the contrasting purposes
4 B formulation of tests for close scrutiny
5 A following the laid out steps for complete care
6 C preventative measures to reduce pathogenic risk
7 B a possibility in some countries

8 C been observed to be used in all pregnancies
9 C dramatically decrease the need for invasive testing
10 B NIPT is considered to be a strong and reliable screening process
11 D proves a greater risk in acquiring unreliable detection rates from NIPT
12 B will become a topic of greater discussion and debate among people.
13 D nonnoxious
14 D Education and counselling services should coincide with introducing NIPT
15 D Gathered
16 B to immobilise him and numb the pain
17 B maintain a level of support befitting the situation
18 D doctors tend to deal with the physical aspects of the patient.
19 C evolved without proper input from nurses
20 D health education and skilled care
21 D Nursing as a whole is as imperative as other dependent factors.
22 D unprofitable
1 district
2 stiff feeling
3 prescribed
4 barium meal
5 tumour
6 small part
7 pethadine
8 marijuana
9 depressed
10 suicide
11 counselling (session)
12 yoga
13 unbearable pain
14 something
15 treatment
16 MRI
17 pinched nerve
18 nothing
19 conservative
20 unable to work
21 magnetism
22 imaging
23 4 - 6 weeks
24 symptoms
25 A standard procedure for medication administration

26 C understanding that the situation can be overcome
27 B since it has not been exposed to it earlier
28 B to ensure the patient understands
29 C dosage to prevent blood clot
30 B understanding the person’s cognitive complexities
31 B It tends to be used in conjunction with other forms of treatment.

32 B to establish whether the cause of the condition has been identified.
33 C to ensure that the patients’ pain is being well managed.
34 B regaining full movement in the affected part of the spine.
35 A handing long-term responsibility over to the patient.
36 B express doubts about the effectiveness of physiotherapy.
37 C Palpable changes in health sector

38 C risk factors to health have been precipitating
39 C it was published in a medical journal two decades ago
40 C to address immediate health concerns
41 A they refrain from taking measures that are unviable
42 C the defecienty of knowledge from medical schools
READING SUB-TEST 4
1 D
2 B
3 A
4 A
5 C
6 C
7 B
8 linkage of services
9 organising confusing experiences
10 feedback
11 outcome measures
12 evaluate frequently
13 0.5 to 1.5 hours
14 olanzapine, resperidone, aripoprazole
15 patient cooperation
16 itranasal
17 reevaluate
18 emotional distress
19 simple examples
20 undue pressure
1 A give information on compiling private prescriptions

2 C adhering to the laid down structure of identification
3 C Identification and management of malnourished patients.
4 A Approach to be considered on the length of the stay
5 A Prepare an exhaustive analysis and control an outbreak
6 C objectives that are vital for quality maternal care
7 B 8 percent by mass
8 B The methods are cheaper
9 C Coequal
10 B Unwanted compounds gets dissolved in the water
11 B Full immersion methods gets less trickier and multidimensional
12 C A progressive grinding of coffee into smaller pieces
13 B Disagreement
14 A The gaseous organic molecules that escape the bean over time
15 C a large proportion of mental health consultations were provided by a GP.

16 A Comparable findings for the several mental illnesses mentioned.
17 A GPs are in an advantageous position
18 A relatability to its broader meaning
19 B clinicians must decipher what is valid and what is improbable
20 B have mood fluctuations which are key to the disorder.
21 C due to the established prevalence of bipolar disorder.
22 C medications including use of atypical antipsychotics
1 breathing
2 coughing
3 phlegm
4 started
5 not
6 attacks
7 nearly
8 allergy
9 mortgage
10 never
11 ill
12 eczema
13 (terrible) discomfort
14 bloated
15 diarrhoea
16 sometimes
17 4 years / four years
18 muscle relaxants
19 imodium
20 barium enema
21 real
22 ulcer
23 reassurable things
24 decide
25 C ensuring the completion of procedures

26 C varied but usually infrequent
27 C stable as per ongoing treatment
28 C to highlight a shortage of expertise
29 C must play in a variety of sports
30 B by being versatile to the presenting process
31 C minimise the attempts by the suicidal

32 A it is only starting to be applied in practice
33 B it enables in the identification of the risk factors
34 A physicians should not hesitate to ask on suicidal ideation
35 C therapies that address repetition of suicide thoughts and behaviours
36 C it provides accessible information for an attempt
37 C varied indicators of health can be influenced

38 B effective way for increasing the hormone
39 C optimal with high carbohydrate
40 B teased apart for clarity on findings
41 A modify the diet and nutritional guidelines
42 C no one knows the mechanism of action
READING SUB-TEST 5
1 A
2 C
3 D
4 C
5 B
6 D
7 the groin
8 acetaminophen
9 old age
10 laproscope
11 open hernia repair
12 laproscopic
13 men
14 Trendelenberg’s
15 fibre
16 nerves
17 palpable
18 symptoms
19 laproscopy
20 pubic tubercle
1 A informed consent of the patient

2 B providing relevant information to patients in their native language
3 A differential management of infants using glucose
4 B indicators to use in pain management program audits
5 A prevent medicare claims being paid for public patients
6 A functional ability that enables well being
7 B during Spring 2009

8 A the inactivated influenza vaccine may not be having the desired effects
9 D it was matched with other current strains.
10 B cautious
11 D the risk of H1N1 seemed higher among people who received the TIV vaccination
12 B It is early to tell whether the risk of catching the 2009 pandemic illness increased due to
TIV.
13 C suspected
14 A of a fear seasonal influenza viruses would reappear in the 2009-10 season.
15 D Victorians requiring hospitalisation for addiction has risen by more than 100% in
the past five years
16 B Health (including pain) specialists arranged an Australia-wide seminar in Melbourne
17 C such means of treatment are unrestrained
18 D choosing the professional on pills given
19 A Australians are the biggest users of analgesics in the world
20 C going from one doctor to another to get a prescription filled.
21 C Patients using painkillers reported a 30% reduction in pain
22 C As painkiller addict numbers have risen, there’s been a decrease in heroin abusers

5 Set Lis and Reading1 5

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

5 Set Lis and Reading1 5

Uploaded by

Copyright:

Available Formats

Study guide for OET © IRS Group 2018 1

2 Study guide for OET © IRS Group 2018

Study guide for OET © IRS Group 2018 3

Study Guide for

First Published: 2018 Copyright:

4 Study guide for OET © IRS Group 2018

The four components of OET

Speaking (20 2 tasks effectively communicate in a real-life context

Part A - Consultation extracts

Part B - Short workplace extracts

Duration Tasks : 10 minutes (for all 6 questions)

Part C - Presentation extracts

Duration Tasks : 15 minutes (for 2 extracts)

Part A : Expeditious reading task

Part B and C: Careful reading tasks

Patient :  Candice May

Reason for appointment :  tension due to relationship issues

 (1) in the workplace

 makes her (2)

Background to the condition:  experiencing difficulties for the last (3)

mother is sick for the last 3-4 months

Present condition :  (4) is bit of difficult

 doesn’t have (5)

thinks she is putting a lot of pressure on him

Advice offered :  (7) on the relationship area

Further enquiries :  (8) of counselling sessions

 (9) involved for extra sessions

Session schedule :  can (10) as long as required

 difficult to provide set time

 (11) book a session for next week

 can focus on the (12)

Patient :  Jane Speirs

Description of the condtion:  feeling (13)

 (14) in the muscles

 unable to play netball

Early symptoms :  started few weeks ago with a (15)

 can’t do (17) really

Further details :  (18) fine

no temperature with cold

 test for (23)

Advice given :  adequate rest

no specific remedies

body cures itself

 (24) diet and fluid intake

 follow up at the end of week

That is the end of Part A.

Now look at question 25.

25. You hear a health recommendation on free sugar reduction What

does the expert call for

A Reduction in determination of ill health

C Eradication of non-communicable illness

impact does seizure have on childbirth?

A Associated risks with delivery are unlikely

27. You hear an advice on codeine use by an advanced practice pharmacist.

The speaker focuses on the biophysical model to

A explain the normal action of the drug

does the channel benefit as a resource

A it aids in training and developing it

29. You hear a doctor discuss on carT-cell therapy The

new immunotherapy involves

A increasing the intensity of resistance

30. You hear a patient handover by two nurses

Detail observation of the patient outlines

A cessation of smoking two years ago constancy