2 Merged

OET Materials
Pharmacy
@OETbyMazin
Scan Here
Prepared by
Dr Mazin A.M.Ali
Pediatric Registrar Our lady of
Lourdes Hospital
Book Contents MBBS University of Khartoum

Faculty of Medicine
OET Practice test 1 OET Sample test 1 Msc Degree in Molecular

Medicine and Bioinformatics
OET Practice test 2 OET Sample test 2
University of Khartoum Faculty
OET Practice test 3 OET Sample test 3
of Medicine
Oet online mock test speaking cards Institute of Endemic Diseases
writing case notes
OETbyMazin +353-87-350-8176
contents
Listening Speaking
OET Practice test 1 20 Writing Case Notes
OET Practice test 2

writting
OET Practice test 3
50 Writing Case Notes
OET Sample test 1
OET Sample test 2
OET Sample test 3
OET Online Mock test
Reading
OET Practice test 1
OET Practice test 2
OET Practice test 3
OET Sample test 1
OET Sample test 2
OET Sample test 3
OET Online Mock test

Listening
Sample Test 1
LISTENING SUB-TEST QUESTION PAPER

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
Passport Photo
OTHER NAMES: Your details and photo will be printed here.
PROFESSION:
VENUE:
TEST DATE:
CANDIDATE SIGNATURE:
TIME: APPROXIMATELY 40 MINUTES
INSTRUCTIONS TO CANDIDATES:
DO NOT open this question paper until you are told to do so.
One mark will be granted for each correct answer.
Answer ALL questions. Marks are NOT deducted for incorrect answers.
At the end of the test, you will have two minutes to check your answers.
At the end of the test, hand in this Question Paper.
DO NOT remove OET material from the test room.
HOW TO ANSWER THE QUESTIONS:

Part A: Write your answers on this Question Paper by filling in the blanks.
Example: Patient: Ray Sands

Part B & Part C: Mark your answers on this Question Paper by filling in the circle using a 2B pencil.
Example:
A
B
C
SAMPLE
www.occupationalenglishtest.org
© Cambridge Boxhill Language Assessment ABN 51 988 559 414
[CANDIDATE NO.] LISTENING QUESTION PAPER 01/12
NK
LA
B
SAMPLE

Occupational English Test
Listening Test
This test has three parts. In each part youll hear a number of different extracts. At the start of each extract,
youll hear this sound: --beep--
Youll have time to read the questions before you hear each extract and youll hear each extract ONCE ONLY.
Complete your answers as you listen.
At the end of the test you'll have two minutes to check your answers.
LE Part A
In this part of the test, youll hear two different extracts. In each extract, a health professional is talking
P
to a patient.
For questions 1-24, complete the notes with information you hear.
M
Now, look at the notes for extract one.
SA
SAMPLE

Extract 1: Questions 1-12
You hear a physiotherapist talking to a new patient called Ray Sands. For questions 1-12, complete the notes
with a word or short phrase.
You now have thirty seconds to look at the notes.
Patient Ray Sands
18 months ago back injury sustained (lifting (1) )
1 year ago sciatica developed
6 months ago clear of symptoms
Last month recurrence of symptoms
E
Patients description of symptoms
L
pain located in (2)
pain described as (3)
P
loss of mobility
problems sleeping
M
mentions inability to (4) as most frustrating aspect
(5) sensation (calves)
SA
Occupation
general numbness in affected area
(6) (involves travel/some manual work)
Initial treatment prescribed NSAIDs
application of (7) (provided some relief)
Referrals (8) EULHÀ\
sports injury specialist for manipulation and exercise programme
Further treatment epidural injections
(9)
electrical impulses
decided not to try (10)
patient attributes recovery to (11)
Previous diagnosis sciatica probably related to (12) SAMPLE

reports no history of pain in buttocks

You hear a consultant dermatologist talking to a patient called Jake Ventor. For questions 13-24, complete
the notes with a word or short phrase.
Patient Jake Ventor
Reason for referral skin lesion
Patients description of condition
on the (13) of his left hand
preceded by (14)
E
then (15) form and join up
surrounding erythema
History of condition
P L GP describes appearance of lesion as (16)
normally resolves within two weeks
¿UVWH[SHULHQFHGLQVZKHQOLYLQJLQ&KLQD
A M also had a lesion on his (17)

there
recurs regularly on different parts of his left hand

never recurred
S
not becoming more (18)
no apparent link to general state of health, (19)

or stress
Medical history (20) on lower back in 2006 no sign

of recurrence
reports no history of (21)
Information given advised that (22) was unlikely to be effective
told him to take care if the skin is (23)
Outcome says his quality of life isnt affected
a (24) will be arranged
That is the end of Part A. Now look at Part B.
SAMPLE

Part B
In this part of the test, youll hear six different extracts. In each extract, youll hear people talking in a different
healthcare setting.
For questions 25-30, choose the answer (A, B or CZKLFK¿WVEHVWDFFRUGLQJWRZKDW\RXKHDU<RX¶OOKDYHWLPH

to read each question before you listen. Complete your answers as you listen.
Now look at question 25.
25. <RXKHDUDQXUVHEULH¿QJKHUFROOHDJXHDERXWDSDWLHQW
LE
What does she warn her colleague about?
The patient is allergic to some types of antibiotics.
P
B Care must to be taken to prevent the patient from falling.
C Oxygen may be needed if the patient becomes breathless.
26.
A M
You hear the manager of a care home for the elderly talking to the nursing staff.
S
He says that errors in dispensing medication to patients usually result from
A interruptions while calculating dosages.
B a failure to check for patients allergies.
C administering drugs late in the day.
27. <RXKHDUSDUWRIDPRUQLQJEULH¿QJRQDKRVSLWDOZDUG
What is the plan for the patient today?
A Her emotional state will be carefully observed.
B She will be transferred to a more specialised unit.
C A social worker will come to see what help she needs.
SAMPLE

28. You hear part of an ante-natal consultation at a GP practice.
What does the patient want to know about?
A the advisability of a home birth
B ways of avoiding post-natal depression
C what painkillers might be available during labour
29. You hear a trainee doctor telling his supervisor about a problem he had carrying out a procedure.
E
The trainee feels the cause of the problem was
C L
treatment administered previously.
P
the patients negative reaction.
inappropriate equipment.
30.
A M
You hear a doctor talking to a teenage boy who has a painful wrist.
The doctor wants to establish whether
C
S
a fracture may be misaligned.
the swelling may be due to a sprain.
there may be more than one bone affected.
That is the end of Part B. Now look at Part C.
SAMPLE

Part C
In this part of the test, youll hear two different extracts. In each extract, youll hear health professionals
talking about aspects of their work.
For questions 31-42, choose the answer (A, B or CZKLFK¿WVEHVWDFFRUGLQJWRZKDW\RXKHDU&RPSOHWH\RXU

answers as you listen.
Now look at extract one.
You hear an interview with a cardiologist called Dr Jack Robson, whos an expert on Chagas disease.
E
You now have 90 seconds to read questions 31-36.
31.
L
Why does Dr Robson regard Chagas as a neglected disease?
P
A because of the social groups it mainly affects
M
B because patients often dont realise theyre infected
C because its impact is severe in a relatively small number of cases
32.
SA
Dr Robson says that concerns over Chagas in the USA are the result of
A a rise in the number of people at risk of being infected with the disease.
B a greater awareness of how many people there have the disease.
C an increased prevalence of the insect which carries the disease.
33. A patient called Marisol recently asked Dr Robson to test her for Chagas because
A she was worried about the health of any children she might give birth to.
B she wanted to know whether it was safe for her to donate blood.
C she thought she had symptoms associated with the disease.
SAMPLE

34. What problem does Dr Robson identify in the case of a patient called Jennifer?
A an unwillingness to accept that she was ill
B an inability to tolerate the prescribed medicine
C a delay between the initial infection and treatment
35. What does Dr Robson say about his patient called Juan?
A The development of his illness was typical of people with Chagas.
E
B An incorrect initial diagnosis resulted in his condition worsening.
C The medication he took was largely ineffective.
36.
P L
'U5REVRQWKLQNVWKHVKRUWWHUPSULRULW\LQWKH¿JKWDJDLQVW&KDJDVLVWR
M
A increase efforts to eliminate the insects which carry the parasite.
B produce medication in a form that is suitable for children.
A
design and manufacture a viable vaccine.
S
Now look at extract two.
SAMPLE

You hear an occupational therapist called Anna Matthews giving a presentation to a group of trainee doctors.
37. Anna says that the main focus of her work as an occupational therapist is
A designing activities to meet the changing needs of each patient.
B making sure she supports patients in reaching their goals.
C EHLQJÀH[LEOHHQRXJKWRGHDOZLWKSDWLHQWVRIDOODJHV
38.
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:KHQ$QQD¿UVWPHWWKHSDWLHQWFDOOHG7HGVKHZDV
P
A unable to identify completely with his attitude.
B optimistic that he would regain full mobility.
M
C mainly concerned about his state of mind.
39.
B
A
Because Ted seemed uninterested in treatment, Anna initially decided to focus on
S
what he could achieve most easily.
allowing him to try and help himself.
C making him come to terms with his injuries.
40. Anna feels that, in the long term, her therapy helped Ted because
A it led him to become less emotional.
B it made him appreciate the need for patience.
C it showed him there was something to work towards.
SAMPLE

41. Anna describes the day Ted had his plaster casts removed in order to
A demonstrate how slow any progress can seem to patients.
B illustrate the problems caused by raising a patients hopes.
C give advice on what to do when patients experience setbacks.
42. Anna suggests that when patients like Ted recover enough to go home, they are often
A too ambitious in what they try to achieve initially.
E
B able to build on the work of the occupational therapist.
C held back by the over-protective attitude of family members.
P L
That is the end of Part C.
You now have two minutes to check your answers.
M
THAT IS THE END OF THE LISTENING TEST
A
S
SAMPLE

N K
LA
B
SAMPLE

Sample Test 2
LISTENING SUB-TEST QUESTION PAPER

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
Passport Photo
PROFESSION:
VENUE:
TEST DATE:

Example: Patient: Ray Sands

Part B & Part C: Mark your answers on this Question Paper by filling in the circle using a 2B pencil.
Example:
A
B
C
SAMPLE
NK
LA
B
SAMPLE

Listening Test
Sample Test 2
This test has three parts. In each part youll hear a number of different extracts. At the start of each extract,
youll hear this sound: --beep--
Youll have time to read the questions before you hear each extract and youll hear each extract ONCE ONLY.
At the end of the test you'll have two minutes to check your answers.
LE
P
Part A
In this part of the test, youll hear two different extracts. In each extract, a health professional is talking
to a patient.
M
A
S
S A MP L E
SAMPLE

You hear a gastroenterologist talking to a patient called Andrew Taylor. For questions 1-12, complete the notes
with a word or short phrase.
Patient Andrew Taylor
Background has had (1) over long period
reports a frequent (2) sensation in the last year
most recently (3) has become a problem
word used to describe symptoms (4)
LE
pre-existing skin condition aggravated
frequent (5)
bowel condition
patient didnt initially link these to
MP
Effects of condition on everyday life
works as an (6)
situation at work means patient is (7)
A
complains of lack of (8)
S
has noticed an increase in insomnia
Diet FODLPVWREHFRQVXPLQJVXI¿FLHQW(9)
claims to keep hydrated
has experimented with excluding (10) from diet
very slight reduction in caffeine intake
has undergone (11) no indications of anything

problematic
Medication has taken an anti-spasmodic not very effective
now trying (12)
SAMPLE

You hear a hospital neurologist talking to a new patient called Kathy Tanner. For questions 13-24, complete
Patient Kathy Tanner
Background to condition
experienced discomfort and a (13) feeling in neck

whilst driving
osteopathy exacerbated problem
E
used (14) to relieve symptoms in neck
L
Further developments in condition and diagnosis
describes a pulling sensation (dragging her head to the right)
MP doctor recommended (15)
diagnosis of spasmodic torticollis (ST)
- condition described as (16)
A
- resulted in feelings of depression
S
Treatment history
(a) from home some months of (17)
visited two neurologists without success
prescribed (18) (anti-spasmodic)
joined an ST support group
bought (19) to provide extra support
(b) from university hospital

࠮ [YLH[TLU[\ZPUN(20) PUQLJ[PVUZ
ZPKLLɈLJ[ZPUJS\KLKKPɉJ\S[PLZ(21)
YLWVY[Z[YLH[TLU[HZPUJYLHZPUNS`PULɈLJ[P]L
࠮ Z\WWSLTLU[LKI`(22)
࠮ L_WLYPLUJLKJVUM\ZPVUHUK(23)
࠮ HUHSNLZPJYLSPLM!TVYWOPULZLSMHKTPUPZ[LYLK]PH
(24)
SAMPLE

Part B
In this part of the test, youll hear six different extracts. In each extract, youll hear people talking in a different
healthcare setting.
For questions 25-30, choose the answer (A, B or CZKLFK¿WVEHVWDFFRUGLQJWRZKDW\RXKHDU<RX¶OOKDYHWLPHWR

read each question before you listen. Complete your answers as you listen.
25. <RXKHDUDQRSWRPHWULVWWDONLQJWRDSDWLHQWZKR¶VWU\LQJFRQWDFWOHQVHVIRUWKH¿UVWWLPH
LE
What is the patient concerned about?
his blurred vision
P
B soreness in his eyes
C how to remove the lenses
26.
A M
You hear a nurse asking a colleague for help with a patient.
S
Why does the nurse need help?
A The patients condition has deteriorated.
B The patient is worried about a procedure.
C The patient is reporting increased pain levels.
27. You hear a senior nurse talking about a new initiative that has been introduced on her ward.
What problem was it intended to solve?
A patients confusion over information given by the doctor
B relatives not being able to discuss issues with the doctor
C patients not discussing all their concerns when meeting the doctor
SAMPLE

28. You hear two radiologists talking about the type of scan to be given to a patient.
They agree to choose the method which will
A allow them to see the whole of the appendix.
B probably give the most accurate results.
C have the fewest risks for the patient.
29. <RXKHDUSDUWRIDVXUJLFDOWHDP¶VEULH¿QJ
E
The male surgeon suggests that the patient could
C L
require specialist equipment during surgery.
P
EHQH¿WIURPDVSHFL¿FDQDHVWKHWLFSURFHGXUH
be at risk of complications from another health issue.
30.
A M
You hear a senior research associate talking about a proposal to introduce inter-professional, primary
healthcare teams.
What hasnt been established about the teams yet?
C
S
the best way for collaboration to take place
WKH¿QDQFLDOLPSDFWWKDWWKH\DUHOLNHO\WRKDYH
the aspects of medical care they are best suited to
SAMPLE

Part C
In this part of the test, youll hear two different extracts. In each extract, youll hear health professionals

You hear a presentation by a specialist cancer nurse called Sandra Morton, whos talking about her work with
prostate cancer patients, including a man called Harry.
31. What does Sandra Morton see as the main aim in her work?
A to inform patients about the different treatments on offer
B to publicise the availability of tests for the condition
C to raise awareness of the symptoms of the illness
32. When Harry was offered a routine health check at his local surgery, he initially
A resisted the idea due to his wifes experience.
B IHOWWKDWKHZDVWRR¿WDQGZHOOWREHLQQHHGRILW
C only agreed to attend because his doctor advised him to.
33. During Harrys investigations for prostate cancer at a hospital clinic, he
A felt part of the examination procedure was unpleasant.
B found it hard to cope with the wait for some results.
C was given false hope by a preliminary blood test.
SAMPLE

34. What was Harrys response to being diagnosed with prostate cancer?
A He found himself reacting in a way he hadnt anticipated.
B He was unconvinced by the prognosis he was given.
C He immediately researched treatment options online.
35. What typical patient response to the illness does Sandra mention?
A an unwillingness to commence appropriate medication
B a failure to seek advice regarding different treatment options
C a reluctance to talk about the embarrassing aspects of treatment
36. Sandra believes that community follow-up clinics are important because they
A offer patients more personal aftercare.
B are proven to be less traumatic for patients.
C provide rapid treatment for patients developing new symptoms.
SAMPLE

You hear a neurologist called Dr Frank Madison giving a presentation about the overuse of painkillers.
37. In Dr Madisons experience, patients who become addicted to painkillers
A are more likely to move on to hard drugs.
B come from a wide variety of backgrounds.
C usually have existing psychological problems.
38. Dr Madison thinks some GPs over-prescribe opioid painkillers because these
A have a long-standing record of success.
B enable them to deal with patients more quickly.
C represent a relatively inexpensive form of treatment.
39. Dr Madison regrets that management of acute pain
A is often misunderstood by the general public.
B receives inadequate attention in medical training.
C fails to distinguish between different possible triggers.
40. Dr Madisons main concern about painkillers being readily available is that
A patients may build up a resistance to them.
B they may be taken in dangerous amounts by patients.
C they may interact adversely with patients other medication.
SAMPLE

41. Dr Madison refers to the case of an osteoarthritic patient called Ann to highlight
A the unsuitability of opioids for patients with particular conditions.
B the effect on patients working lives of dependence on painkillers.
C the extreme fear patients may have of living without pain medication.
42. Anns GP initially failed to identify her dependence because
A she managed to conceal its physical effects from him.
B he was unaware that she had another source of drugs.
C he lacked experience in dealing with problems like hers.
SAMPLE

Sample Test
LISTENING SUB-TEST – QUESTION PAPER

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
MIDDLE NAMES: Passport Photo
PROFESSION: Candidate details and photo will be printed here.
E
VENUE:
TEST DATE:
CANDIDATE DECLARATION
P L
By signing this, you agree not to disclose or use in any way (other than to take the test) or assist any other person to disclose or use any OET
test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice
or information, you may be disqualified and your results may not be issued at the sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
M
malpractice, their personal details and details of the investigation may be passed to a third party where required.
A
INSTRUCTIONS TO CANDIDATES S
You must not remove OET material from the test room.
HOW TO ANSWER THE QUESTIONS
Part A: Write your answers on this Question Paper by filling in the blanks. Example: Patient: Ray Sands
Part B & Part C: Mark your answers on this Question Paper by filling in the circle using a 2B pencil. Example: A
B
C
SAMPLE
© Cambridge Boxhill Language Assessment – ABN 51 988 559 414
NK
LA
B
SAMPLE

Listening Test
This test has three parts. In each part you’ll hear a number of different extracts. At the start of each extract,
you’ll hear this sound: --beep--
You’ll have time to read the questions before you hear each extract and you’ll hear each extract ONCE ONLY.
At the end of the test you’ll have two minutes to check your answers.
LE Part A
P
In this part of the test, you’ll hear two different extracts. In each extract, a health professional is talking
to a patient.
For questions 1-24, complete the notes with information WKDWyou hear.
M
S A
SAMPLE

You hear a rheumatologist talking to a patient called Harry Davies, who suffers from gout and is attending for
a medication review. For questions 1-12, complete the notes with a word or short phraseWKDW\RXKHDU.
Patient Harry Davies
Medical History • suffers from gout
KDGKLV¿UVWVHULRXVDWWDFNZKLOHRQKROLGD\±SDLQLQKLV
E
(1) accompanied by swelling
• initially thought it was either:
-
(2)
P L
possibly related to medication taken for (3)
control
M
• describes the pain as (4)‘ ’
A
• was unable to (5)
• says the clinic initially suspected (6) before
S
diagnosing gout
• reports previously feeling similar pain after (7) –

but less intense, self-resolving
Treatment received • (8) – not effective
• Colchicine – caused (9)
• (10) – caused nausea (may have overdosed)
• (11) – quite effective
• Allopurinol – caused (12)
SAMPLE

You hear a doctor in an emergency department talking to a patient called Gail Kennedy. For questions
13-24, complete the notes with a word or short phraseWKDW\RXKHDU.
Patient History Gail Kennedy
Two weeks ago • returned from South America
DW¿UVWDVVXPHGVKHKDGH[WUHPH(13)
V\PSWRPVLQWHQVL¿HGRYHUWLPH
E
• suspected (14) and so contacted GP
L
• GP suspected malaria (despite commencement of
P
(15) two weeks prior to holiday)
• *3SUHVFULEHG$UWHVXQDWHSOXV0HÀRTXLQHWKUHHGD\FRXUVH
Following days
Yesterday
• (16)
(
A M
• persistent vomiting and (17)
heavily.
S
Observations • no evidence of (18)
• no SOB or wheezing
• patient describes heart as (19)
• reports irritation and dryness in her (20)

from examination
• reports no (21)
• loss of appetite
Additional information
• prior to holiday had vaccinations for both typhoid and
(22)
• had (23) during holiday – self medicated
• underwent (24) in 2011
That is the end of Part A. Now look at Part B. SAMPLE

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 CZKLFK¿WVEHVWDFFRUGLQJWRZKDW\RXKHDU<RX¶OOKDYHWLPH

to read each question before you listen. Complete your answers as you listen.
Now look at question 25. A

B
Fill the circle in completely. Example: C
25. You hear a patient talking to a dental receptionist.
How does he feel?
LE
ZRUULHGWKDWKHPD\KDYHGDPDJHGD¿OOLQJ
P
B disappointed that he can’t be seen immediately
C nervous about being treated by a different dentist
26.
A M
You hear part of a presentation to nursing staff about an extension to visiting hours.
S
What is the speaker doing?
A GHWDLOLQJWKHEHQH¿WVRIWKHSODQQHGFKDQJH
B reassuring them that their workload won’t increase
C explaining steps they should take to avoid problems
27. You hear a surgeon discussing a patient with a nurse in the recovery ward.
What is the surgeon concerned about?
A incomplete results from lab tests
B possible post-operative side effects
C the patient’s level of consciousness
SAMPLE

28. <RXKHDUDFKLURSUDFWRUEULH¿QJDFROOHDJXHDERXWDSDWLHQWFDOOHG5\DQ
What is the overall aim of the treatment plan?
A improving pain relief
B restoring feelings in his arm
C treating the side-effects of an operation
29. You hear a surgeon talking to a group of medical students about patient risk in emergency surgery.
E
The surgeon is emphasising the fact that
P L
prompt preparation is the most effective way to minimise patient risk.
certain types of surgery carry more risk for patients than others.
patients at high risk require extra recovery time after surgery.
30.
A M
You hear a surgeon talking to a patient who’s just had a knee operation.
The man’s comments reveal that he’s
C
S
determined to start doing sport as quickly as possible.
impressed by how little time he spent in the hospital.
surprised that he’ll be relatively pain-free so soon.
SAMPLE

Part C
In this part of the test, you’ll hear two different

fe extracts. In each extract, you’ll hear health professionals

A
Now look at extract one. B
You hear an interview with Dr Helen Sands, about her work with patients who are learning to cope with amputation.
E
31.
P L
How did the young patient called David react to the amputation of his leg?
He felt he was now excluded from normal life.
M
B He compared it to the experience of a relative dying.
C He resented his inability to take part in physical activities.
32.
B
S A
What does Dr Sands suggest about pain in a missing or ‘phantom’ limb?
Under-reporting by patients makes it hard to know how frequent it is.
The discomfort can generally be traced to a physical cause.
C The problem affects far fewer patients than in the past.
33. Some patients feel that their missing limb is still attached but
A would cause pain if they used it.
B LV¿[HGLQDVWUDQJHSRVLWLRQ
C has increased in size.
SAMPLE

34. Dr Sands’ current treatment trial includes people who have
A reacted badly to previous treatments.
B failed to respond to any form of medication.
C reported pain levels that impact on their daily lives.
35. In Dr Sands’ current trial, patients are
A helped to come to terms with the loss of a limb emotionally.
E
B shown how to manage a computer-operated prosthetic limb.
C made to move a simulation of the missing limb in their minds.
36.
P L
Dr Sands feels one advantage of the trial group’s treatment is that
M
A its effects are long-lasting.
B it can be used by patients after discharge.
S
Now look at extract two. A
it helps certain patients to become almost pain-free.
SAMPLE

You hear a dermatologist called Dr Jake Cooper talking about a skin condition called Hidradenitis Suppurativa (HS).
37. When describing the condition known as HS, Dr Cooper suggests that it
A is fairly common so should be more accurately diagnosed.
B would be better understood if it presented more uniformly.
C may be incorrectly treated due to misinformation from patients.
38.
LE
Dr Cooper explains that one cause of HS may be blocked hair follicles resulting from
P
A shaving of the affected area.
B the overuse of deodorants.
M
C the effects of smoking.
39.
B
S A
When describing the case of a patient called Sophie, Dr Cooper suggests that
HS has a tendency to get progressively worse.
diagnosis of HS may require a full patient history.
C a multiple treatment approach is often required for HS.
40. Dr Cooper says that those treating patients with HS should be aware that the condition
A may recur after disappearing for many years.
B may be triggered by an episode of depression.
C PD\EHFRPHLQFUHDVLQJO\GLI¿FXOWWRWUHDWRYHUWLPH
SAMPLE

41. When discussing a patient called Emily, Dr Cooper suggests that her mother’s attitude
A UHÀHFWHGDODFNRIV\PSDWK\DQGXQGHUVWDQGLQJ
B OHGWRDGHOD\LQFRQ¿UPLQJWKHFRUUHFWGLDJQRVLV
C may have contributed to the severity of the symptoms.
42. When discussing the treatment of HS sufferers, Dr Cooper recommends they should
A eat healthy foods such as brown bread.
E
B restrict their intake of dairy products.
C avoid all types of alcoholic drinks.
P L
M
A
S
SAMPLE

NK
LA
B
SAMPLE

Mock test
LISTENING SUB-TEST ± QUESTION PAPER
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
OTHER NAMES: Passport Photo
PROFESSION:
VENUE:
TEST DATE:
CANDIDATE SIGNATURE
DO NOT remove the OET material from the test room.

Example: Patient: Ray Sands .
Part B & Part C: mark your answers on the Question Paper by filling in the circle using a 2B pencil.
Example:
A
A
B
C
© Cambridge Boxhill Language Assessment ± ABN 51 988 559 414

Listening Test
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Part A
,QWKLVSDUWRIWKHWHVW\RX¶OOKHDUWZR different extracts. In each extract, a health professional is talking to a

patient.

You hear a consultant rheumatologist talking to a patient called Suzanne Hinds. For questions
1-12, complete the notes with a word or short phrase.
You now have 30 seconds to look at the notes.
Patient Suzanne Hinds
Symptoms Mouth:
x chapped lips
x painful (1)
x increased number of (2)
x dryness
x tongue appears (3)
Eyes:
x eyelids described as (4) on waking
x frequent irritation
x itchiness made worse by (5)
x self-treating with (6)
x recurring (7)
x increased sensitivity to light
x vision described as cloudy
Throat:
x patient says it sometimes feels (8)
x regular difficulty in (9)
x some swelling
Background details x works as a tour guide
x moderate smoker for 15 years
x family history of (10)
Recommended tests x saliva flow rate test
x (11) biopsy
x (12) test - possibly

You hear a gastroenterologist talking to a patient called Toby Smithers. For questions 13-24, complete
Patient Toby Smithers
Background x initial stomach upset
x main symptom (13)
Original presenting factors
x feeling (14) immediately after meals
x extremely (15) (especially at night)
x no history of (16)
*3¶VLQLWLDOGLDJQRVLV x main symptoms similar to those associated with
(17)
*3¶VLQWHULPtreatment plan
x advised to keep (18) intake high
x suggested separating eating and drinking by 30 mins
x suggested a (19) µ ¶ regime for meals
Tests x both (20) clear
x (21) performed
x (22) confirmed and treated
x eradication confirmed by (23)
Current situation x original presenting factor persists
x works as a (24)

Part B
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healthcare setting.
For questions 25-30, choose the answer (A, B or C) which fits best according to what you hear. <RX¶OOKDYH
time to read each question before you listen. Complete your answers as you listen.
25. You hear a consultant talking to a woman whose father has just been admitted to hospital.
What does she want to know about his condition?
A how serious it is
B KRZPXFKSDLQLW¶VFDXVLQJ
C how long before there will be a diagnosis
26. <RXKHDUDWUDLQHHQXUVHUHFHLYLQJIHHGEDFNIURPKHUWXWRUDERXWWKHZDUGURXQGVKH¶VMXVW
completed.
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A eliciting information from the patient
B keeping the patient better informed
C updating patient notes more fully
27. You hear a hospital nurse briefing a colleague about a patient with Chronic Obstructive
Pulmonary Disease, or COPD.
What does he want his colleague to do?
A encourage greater mobility
B organise a visit by a dietitian
C consult with the medical team

28. You hear two hospital managers talking about a training session for people who do
voluntary work with patients.
What do the managers think about the course?
A Too few people attended to make it worthwhile.
B The content may need revising for future sessions.
C 7KHIHHGEDFNIURPSDUWLFLSDQWVZDVQ¶WHQFRXUDJLQJ
29. <RXKHDUDSKDUPDFLVWWDONLQJWRDGRFWRUDERXWDSDWLHQW¶VPHGLFDWLRQ
What is the pharmacist doing?
A reporting side effects
B checking the dosage
C recommending an alternative
30. You hear a surgeon talking to a member of his team as they are finishing a surgical
procedure.
The surgeon says their next priority should be
A to complete a routine administrative task.
B to report a faulty piece of equipment.
C to locate an appropriate bed.

Part C
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For questions 31-42, choose the answer (A, B or C) which fits best according to what you hear. Complete
your answers as you listen.

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31. Dr Dean says that patients with tennis elbow
A may be unaware that they have the condition at first.
B tend to come from a remarkably narrow range of occupations.
C can easily avoid the condition by adopting correct working practices.
32. ,QWKHSK\VLRWKHUDS\SURJUDPPHXVHGLQ'U'HDQ¶VWULDO
A the treatment given was tailored to the needs of each patient.
B patients had to build up their strength before starting it.
C some patients found the treatment too painful.
33. What GRHV'U'HDQVD\DERXWWKHUROHRIµVPDUWUHVW¶LQWKHWULDO"
A ,WZDVQ¶WDSSURSULDWHIRUFHUWDLQW\SHVRIWHQQLVHOERZ
B It formed the basis of two of the three treatment options.
C It kept all patients physically active despite the condition.

34. What did Dr Dean find interesting about the results of the trial?
A They were surprisingly conclusive in the short term.
B They underlined the advantages of timely intervention.
C They confirmed the findings of an earlier piece of research.
35. Dr Dean would advise anyone experiencing tennis elbow for more than three months to
A avoid using any steroid-based medication at that point.
B be ready to start more invasive forms of treatment.
C try a combination of physiotherapy and injections.
36. Dr Dean suggests that taking anti-inflammatories for tennis elbow
A is less effective than alternative forms of medication.
B is trying to treat a symptom that may not actually exist.
C is an area that needs to be researched more thoroughly.

You hear a presentation in which a researcher called Dr Sarah Jones is talking on the subject of weight loss
interventions by GPs.
37. Dr Jones suggests that few health professionals currently attempt weight loss interventions
because they
A have often found them to be ineffective.
B lack confidence in the chances of success.
C rarely have time to spare for non-clinical issues.
38. The specific aim of the trial Dr Jones describes was
A WRGUDZSDWLHQWV¶DWWHQWLRQWRWKHQHHGWRORVHZHLJKW
B to reduce the time that weight-loss interventions take.
C to promote greater understanding of the dangers of obesity.
39. Dr Jones now feels practitioners can justify weight loss interventions because
A patients are currently less sensitive about weight-related issues.
B a huge majority of patients feel that it is a suitable topic for discussion.
C circumstances demand that action is taken even if patients are reluctant.

40. When describing the trialling of the programme, Dr Jones says she was surprised by
A the fact that most patients offered a place did actually join it.
B the positive attitude of patients who accepted the treatment.
C the number of patients who dropped out early.
41. From the outcomes of the trial we learn that
A the results for all participants improved at a similar rate.
B intervention was consistently more successful than non-intervention.
C the advantages of intervention became less marked in the longer term.
42. What does Dr Jones feel are the implications of the findings of the trial?
A Areas other than weight loss may be suitable for similar initiatives.
B Doctors may find that their role in the community starts to change.
C There could be widespread benefits if they were applied nationally.

Reading
SampleTest1
READING SUB-TEST QUESTION PAPER: PART A
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
Passport Photo
E
PROFESSION:
L
VENUE:
TEST DATE:
P
TIME: 15 MINUTES
A M
S
DO NOT open this Question Paper or the Text Booklet until you are told to do so.
Write your answers on the spaces provided on this Question Paper.
You must answer the questions within the 15-minute time limit.
At the end of the 15 minutes, hand in this Question Paper and the Text Booklet.
SAMPLE
[CANDIDATE NO.] READING QUESTION PAPER PART A 01/04

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-DWR¿QGWKHUHOHYDQWLQIRUPDWLRQ
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.
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Fractures, dislocations and sprains: Questions
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Questions 1-7
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For each question, 1-7, decide which text (A, B, C or D) the information comes from. You may use any
letter more than once.
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3 M
procedures for delivering pain relief?
A
the procedure to follow when splinting a fractured limb?
what to record when assessing a patient?
7
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the terms used to describe different types of fractures?
the practitioners who administer analgesia?
what to look for when checking an injury?
how fractures can be caused?
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 should be used to elevate a patients fractured leg?
9 What is the maximum dose of morphine per kilo of a patients weight that can be given using
the intra-muscular (IM) route?
10 Which parts of a limb may need extra padding?

SAMPLE

11 What should be used to treat a patient who suffers respiratory depression?
12 What should be used to cover a freshly applied plaster backslab?
13 What analgesic should be given to a patient who is allergic to morphine?
14 What condition might a patient have if severe pain persists after splinting, elevation and
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repeated analgesia?
Questions 15-20
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Complete each of the sentences, 15-20, with a word or short phrase from one of the texts. Each answer may
include words, numbers or both.
15
A
the elbow.
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Falling on an outstretched hand is a typical cause of a of
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16 Upper limb fractures should be elevated by means of a .
17 Make sure the patient isnt wearing any on the part of the
body where the plaster backslab is going to be placed.
18 Check to see whether swollen limbs are or increasing

in size.
19 In a plaster backslab, there is a layer of closest to the skin.
20 Patients aged and over shouldnt be given the higher

dosages of pain relief.
END OF PART A
THIS QUESTION PAPER WILL BE COLLECTED
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Sample Test 1
READING SUB-TEST TEXT BOOKLET: PART A
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
Passport Photo
PROFESSION:
E
VENUE:
L
TEST DATE:
P
A M
S
S A MP L E
SAMPLE
[CANDIDATE NO.] READING TEXT BOOKLET PART A 01/04

Fractures, dislocations and sprains: Texts
Text A
Fractures;ďƵĐŬůĞŽƌďƌĞĂŬŝŶƚŚĞďŽŶĞͿŽŌĞŶŽĐĐƵƌĨŽůůŽǁŝŶŐĚŝƌĞĐƚŽƌŝŶĚŝƌĞĐƚŝŶũƵƌǇ͕Ğ͘Ő͘ƚǁŝƐƟŶŐ͕ǀŝŽůĞŶĐĞ
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ƚŚĞĂīĞĐƚĞĚũŽŝŶƚ͕Ğ͘Ő͘ĞůďŽǁĚŝƐůŽĐĂƟŽŶĂŌĞƌĨĂůůŝŶŐŽŶĂŶŽƵƚƐƚƌĞƚĐŚĞĚŚĂŶĚ͘
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Text B
Simple Fracture of Limbs
E
Immediate management:
• Halt any external haemorrhage by pressure bandage or direct pressure
L
• Immobilise the affected area
• Provide pain relief
P
Clinical assessment:
• Obtain complete patient history, including circumstances and method of injury
- medication history – enquire about anticoagulant use, e.g. warfarin
• Perform standard clinical observations. Examine and record:
M
- colour, warmth, movement, and sensation in hands and feet of injured limb(s)
• Perform physical examination
A
Examine:
- all places where it is painful
- any wounds or swelling
S
- colour of the whole limb (especially paleness or blue colour)
- the skin over the fracture
- range of movement
- joint function above and below the injury site
Check whether:
- the limb is out of shape – compare one side with the other
- the limb is warm
- the limb (if swollen) is throbbing or getting bigger
- peripheral pulses are palpable
Management:
• Splint the site of the fracture/dislocation using a plaster backslab to reduce pain
• Elevate the limb – a sling for arm injuries, a pillow for leg injuries
• If in doubt over an injury, treat as a fracture
• Administer analgesia to patients in severe pain. If not allergic, give morphine (preferable); if allergic
to morphine, use fentanyl
• Consider compartment syndrome where pain is severe and unrelieved by splinting and elevation or
two doses of analgesia
• X-ray if available
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Text C
Drug Therapy Protocol:

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Drug Form Strength Route of Recommended dosage Duration

administration
Adult only:
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10 mg Stat
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Text D
A M
Technique for plaster backslab for arm fractures use same principle for leg fractures
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below the elbow. Width should be 23 cm more than the width of the distal forearm.
2. Wrap cotton padding over top for the full length of the stockinette 2 layers, 50% overlap.
3. Measure a length of plaster of Paris 1 cm shorter than the padding/stockinette at each end. Fold the
roll in about ten layers to the same length.
4. Immerse the layered plaster in a bowl of room temperature water, holding on to each end. Gently
squeeze out the excess water.
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6. Lightly mould the slab to the contours of the arm and hand in a neutral position.
7. Do not apply pressure over bony prominences. Extra padding can be placed over bony prominences if
applicable.
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END OF PART A
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Sample Test 1
READING SUB-TEST QUESTION PAPER: PARTS B & C
CANDIDATENUMBER:
LASTNAME:
FIRSTNAME:
Passport Photo
OTHERNAMES: Your details and photo will be printed here.
E
PROFESSION:
VENUE:
TESTDATE:
CANDIDATESIGNATURE:
P L
TIME: 45 MINUTES
A M
DO NOT open this Question Paper until you are told to do so.
S

Mark your answers on this QuestionPaper by filling in the circle using a 2B pencil.
Example:
A
B
C
SAMPLE
[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 01/16
Part B
In this part of the test, there are six short extracts relating to the work of health professionals. For questions1-6,
choose the answer (A, B or CZKLFK\RXWKLQN¿WVEHVWDFFRUGLQJWRWKHWH[W
1. The manual informs us that the Blood Pressure Monitor
A is likely to interfere with the operation of other medical equipment.
B may not work correctly in close proximity to some other devices.
C should be considered safe to use in all hospital environments.
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Instruction Manual: Digital Automatic Blood Pressure Monitor
MP
Electromagnetic Compatibility (EMC)
With the increased use of portable electronic devices, medical equipment may be susceptible to
electromagnetic interference. This may result in incorrect operation of the medical device and create a
potentially unsafe situation. In order to regulate the requirements for EMC, with the aim of preventing
A
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interferences as well as maximum levels of electromagnetic emissions for medical devices. This medical
device conforms to EN60601-1-2:2001 for both immunity and emissions. Nevertheless, care should be
taken to avoid the use of the monitor within 7 metres of cellphones or other devices generating strong
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2. The notice is giving information about
A ways of checking that an NG tube has been placed correctly.
B how the use of NG feeding tubes is authorised.
C which staff should perform NG tube placement.
NGfeedingtubes
E
Displacementofnasogastric(NG)feedingtubescanhaveseriousimplicationsifundetected.Incorrectly
positionedtubesleavepatientsvulnerabletotherisksofregurgitationandrespiratoryaspiration.Itiscrucialto
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complications.InsertionandcareofanNGtubeshouldthereforeonlybecarriedoutbyaregistereddoctoror
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3. What must all staff involved in the transfusion process do?
A check that their existing training is still valid
B attend a course to learn about new procedures
C read a document that explains changes in policy
'RightPatient,RightBlood'Assessments
E
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'Right Patient, Right Blood' safety policy, all staff involved in the transfusion process must be competency
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assessed. To ensure the safe administration of blood components to the intended patient, all staff must be
aware of their responsibilities in line with professional standards.
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Staff must ensure that if they take any part in the transfusion process, their competency assessment is
updated every three years. All staff are responsible for ensuring that they attend the mandatory training
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Training Matrix.
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4. The guidelines establish that the healthcare professional should
A aim to make patients fully aware of their right to a chaperone.
B evaluate the need for a chaperone on a case-by-case basis.
C respect the wishes of the patient above all else.
Extract from Chaperones: Guidelines for Good Practice
E
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not always be the case that a chaperone is required. It is often a question of using professional judgement
L
to assess an individual situation. If a chaperone is offered and declined, this must be clearly documented
in the patients record, along with any relevant discussion. The chaperone should only be present for the
P
physical examination and should be in a position to see what the healthcare professional undertaking
the examination/investigation is doing. The healthcare professional should wait until the chaperone has
left the room/cubicle before discussion takes place on any aspect of the patients care, unless the patient
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A
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5. The guidelines require those undertaking a clinical medication review to
A involve the patient in their decisions.
B consider the cost of any change in treatments.
C recommend other services as an alternative to medication.
Annual medication review
E
To give all patients an annual medication review is an ideal to strive for. In the meantime there is an
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Our guidelines state that at least a level 2 medication review will occur, i.e. the minimum standard is a
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treatment review of medicines with the full notes but not necessarily with the patient present. However,
the guidelines go on to say that all patients should have the chance to raise questions and highlight
problems about their medicines and that any changes resulting from the review are agreed with the
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patient.
It also states that GP practices are expected to

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the whole care pathway.

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6. The purpose of this email is to
A report on a rise in post-surgical complications.
B explain the background to a change in patient care.
C remind staff about procedures for administrating drugs.
To: All staff
E
Subject: Advisory Email: Safe use of opioids
L
In August, an alert was issued on the safe use of opioids in hospitals. This reported the incidence
of respiratory depression among post-surgical patients to an average 0.5% thus for every 5,000
P
surgical patients, 25 will experience respiratory depression. Failure to recognise respiratory depression
and institute timely intervention can lead to cardiopulmonary arrest, resulting in brain injury or
M
death. A retrospective multi-centre study of 14,720 cardiopulmonary arrest cases showed that
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recommended that post-operative patients now have continuous monitoring, instead of spot checks, of
both oxygenation and ventilation.
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Part C
In this part of the test, there are two texts about different aspects of healthcare. For questions7-22, choose the
answer (A,B, C or DZKLFK\RXWKLQN¿WVEHVWDFFRUGLQJWRWKHWH[W
Text 1: Sleep deprivation
Millions of people who suffer sleep problems also suffer myriad health burdens. In addition to emotional distress
and cognitive impairments, these can include high blood pressure, obesity, and metabolic syndrome. In the studies
weve done, almost every variable we measured was affected. Theres not a system in the body thats not affected
by sleep, says University of Chicago sleep researcher Eve Van Cauter. Every time we sleep-deprive ourselves,
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things go wrong.
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A common refrain among sleep scientists about two decades ago was that sleep was performed by the brain in the
interest of the brain. That wasnt a fully elaborated theory, but it wasnt wrong. Numerous recent studies have hinted
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the patients reaction time, mood, and judgement all suffering if they are kept awake too long.
A M
In 1997, Bob McCarley and colleagues at Harvard Medical School found that when they kept cats awake by playing
with them, a compound known as adenosine increased in the basal forebrain as the sleepy felines stayed up
longer, and slowly returned to normal levels when they were later allowed to sleep. McCarleys team also found
S
that administering adenosine to the basal forebrain acted as a sedative, putting animals to sleep. It should come as
no surprise then that caffeine, which blocks adenosines receptor, keeps us awake. Teaming up with Basheer and
others, McCarley later discovered that, as adenosine levels rise during sleep deprivation, so do concentrations of
adenosine receptors, magnifying the molecules sleep-inducing effect. The brain has cleverly designed a two-stage
defence against the consequences of sleep loss, McCarley says. Adenosine may underlie some of the cognitive
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impaired their performance on an attention test, similar to that seen in sleep-deprived humans. But adenosine
levels are by no means the be-all and end-all of sleep deprivations effects on the brain or the body.
Over a century of sleep research has revealed numerous undesirable outcomes from staying awake too long. In
1999, Van Cauter and colleagues had eleven men sleep in the university lab. For three nights, they spent eight
hours in bed, then for six nights they were allowed only four hours (accruing what Van Cauter calls a sleep debt),
and then for six nights they could sleep for up to twelve hours (sleep recovery). During sleep debt and recovery,
researchers gave the participants a glucose tolerance test and found striking differences. While sleep deprived, the
mens glucose metabolism resembled a pre-diabetic state. We knew it would be affected, says Van Cauter. The
big surprise was the effect being much greater than we thought.
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Subsequent studies also found insulin resistance increased during bouts of sleep restriction, and in 2012, Van
Cauters team observed impairments in insulin signalling in subjects fat cells. Another recent study showed
that sleep-restricted people will add 300 calories to their daily diet. Echoing Van Cauters results, Basheer has
found evidence that enforced lack of sleep sends the brain into a catabolic, or energy-consuming, state. This is
because it degrades the energy molecule adenosine triphosphate (ATP) to produce adenosine monophosphate
and this results in the activation of AMP kinase, an enzyme that boosts fatty acid synthesis and glucose utilization.
The system sends a message that theres a need for more energy, Basheer says. Whether this is indeed the
mechanism underlying late-night binge-eating is still speculative.
Within the brain, scientists have glimpsed signs of physical damage from sleep loss, and the time-line for recovery,
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if any occurs, is unknown. Chiara Cirellis team at the Madison School of Medicine in the USA found structural
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colleagues saw signs of mitochondrial activation which makes sense, as neurons need more energy to stay
awake, she says as well as unexpected changes, such as undigested cellular debris, signs of cellular aging that
are unusual in the neurons of young, healthy mice. The number [of debris granules] was small, but its worrisome
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during which she expected normalcy to resume, those changes remained.
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Further insights could be drawn from the study of shift workers and insomniacs, who serve as natural experiments
on how the human body reacts to losing out on such a basic life need for chronic periods. But with so much of
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clear pathway of action for health conditions, says Van Cauter. With sleep deprivation, everything you measure is
affected and interacts synergistically to produce the effect.
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Text 1: Questions 7-14
7. ,QWKH¿UVWSDUDJUDSKWKHZULWHUXVHV(YH9DQ&DXWHU¶VZRUGVWR
A explain the main causes of sleep deprivation.
B reinforce a view about the impact of sleep deprivation.
C TXHVWLRQVRPHUHVHDUFK¿QGLQJVDERXWVOHHSGHSULYDWLRQ
D describe the challenges involved in sleep deprivation research.
8. What do we learn about sleep in the second paragraph?
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There is now more controversy about it than there was in the past.
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D Studies undertaken in the past have formed the basis of current research.
9.
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What particularly impressed Bob McCarley of Harvard Medical School?
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A the effectiveness of adenosine as a sedative
B WKHLQÀXHQFHRIFDIIHLQHRQDGHQRVLQHUHFHSWRUV
C the simultaneous production of adenosine and adenosine receptors
D the extent to which adenosine levels fall when subjects are allowed to sleep
10. In the third paragraph, what idea is emphasised by the phrase by no means the be-all and end-all?
A Sleep deprivation has consequences beyond its impact on adenosine levels.
B $GHQRVLQHOHYHOVDUHDVLJQL¿FDQWIDFWRULQVLWXDWLRQVRWKHUWKDQVOHHSGHSULYDWLRQ
C The role of adenosine as a response to sleep deprivation is not yet fully understood.
D The importance of the link between sleep deprivation and adenosine should not be underestimated.
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11. :KDWZDVVLJQL¿FDQWDERXWWKH¿QGLQJVLQ9DQ&DXWHU¶VH[SHULPHQW"
A the rate at which the sleep-deprived men entered a pre-diabetic state
B WKHIDFWWKDWVOHHSGHSULYDWLRQKDGDQLQÀXHQFHRQWKHPHQ¶VJOXFRVHOHYHOV
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an enzyme
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C a catabolic state
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13.
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A There was no reversal of a certain effect of sleep deprivation.
B The cortical neurons of the mice underwent structural changes.
C There was evidence of an increased need for energy in the brains of the mice.
D The neurological response to sleep deprivation only took a few hours to become apparent.
14. ,QWKH¿QDOSDUDJUDSKWKHTXRWHIURP9DQ&DXWHULVXVHGWRVXJJHVWWKDW
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B LWFRXOGEHGLI¿FXOWWRGHYHORSDQ\WUHDWPHQWIRUVOHHSGHSULYDWLRQ
C opinions about the best way to deal with sleep deprivation are divided.
D there is still a great deal to be learnt about the effects of sleep deprivation.
SAMPLE

Text 2: ADHD
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adults. In recent years, the USA has seen a 40% rise in diagnoses of ADHD in children. It could be that the disorder
is becoming more prevalent, or, as seems more plausible, doctors are making the diagnosis more frequently. The
issue is complicated by the lack of any recognised neurological markers for ADHD. The APA relies instead on a
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ADHD can be a controversial condition. Dr Russell Barkley, Professor of Psychiatry at the University of
Massachusetts insists; the science is overwhelming: its a real disorder, which can be managed, in many cases, by
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using stimulant medication in combination with other treatments. Dr Richard Saul, a behavioural neurologist with
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things, or to be forgetful or distracted. Under such subjective criteria, the entire population could potentially qualify.
Although some patients might need stimulants to function well in daily life, the lumping together of many vague and
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subjective symptoms could be causing a national phenomenon of misdiagnosis and over-prescription of stimulants.
A recent study found children in foster care three times more likely than others to be diagnosed with ADHD.
SA
Researchers also found that children with ADHD in foster care were more likely to have another disorder, such
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altered state, can easily be mistaken for manifestations of ADHD.
ADHD, the thinking goes, begins in childhood. In fact, in order to be diagnosed with it as an adult, a patient must
demonstrate that they had traits of the condition in childhood. However, studies from the UK and Brazil, published
in JAMA Psychiatry, are fuelling questions about the origins and trajectory of ADHD, suggesting not only that it
can begin in adulthood, but that there may be two distinct syndromes: adult-onset ADHD and childhood ADHD.
They echo earlier research from New Zealand. However, an editorial by Dr Stephen Faraone in JAMA Psychiatry
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and overestimating the prevalence of adult-onset ADHD. In Dr Faraones words, the researchers found a group
of people who had sub-threshold ADHD in their youth. There may have been signs that things werent right, but
not enough to go to a doctor. Perhaps these were smart kids with particularly supportive parents or teachers who
helped them cope with attention problems. Such intellectual and social scaffolding would help in early life, but when
the scaffolding is removed, full ADHD could develop.
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Until this century, adult ADHD was a seldom-diagnosed disorder. Nowadays however, its common in mainstream
medicine in the USA, a paradigm shift apparently driven by two factors: reworked many say less stringent
diagnostic criteria, introduced by the APA in 2013, and marketing by manufacturers of ADHD medications. Some
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or part by manufacturers. And as the criteria for the condition loosened, reports emerged about clinicians involved
in diagnosing ADHD receiving money from drug-makers.
This brings us to the issue of the addictive nature of ADHD medication. As Dr Saul asserts, addiction to stimulant
medication isnt rare; its common. Just observe the many patients periodically seeking an increased dosage
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as their powers of concentration diminish. This is because the body stops producing the appropriate levels of
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the staggering increase in opioid overdoses and abuse of prescription painkillers in the USA, but the abuse of
drugs used to treat ADHD is no less a threat. While opioids are more lethal than prescription stimulants, there are
parallels between the opioid epidemic and the increase in problems tied to stimulants. In the former, users switch
from prescription narcotics to heroin and illicit fentanyl. With ADHD drugs, patients are switching from legally
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prescribed stimulants to illicit ones such as methamphetamine and cocaine. The medication is particularly prone to
abuse because people feel it improves their lives. These drugs are antidepressants, aid weight-loss and improve
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work needs to be done before we can settle the questions surrounding the diagnosis and treatment of ADHD.
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15. ,QWKH¿UVWSDUDJUDSKWKHZULWHUTXHVWLRQVZKHWKHU
A adult ADHD should have been recognised as a disorder at an earlier date.
B ADHD should be diagnosed in the same way for children and adults.
C ADHD can actually be indicated by neurological markers.
D cases of ADHD have genuinely increased in the USA.
16. What does Dr Saul object to?
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the suggestion that people need stimulants to cope with everyday life
the implication that everyone has some symptoms of ADHD
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C the grouping of imprecise symptoms into a mental disorder
D the treatment for ADHD suggested by Dr Barkley
17.
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A KLJKOLJKWVWKHGLI¿FXOW\RIGLVWLQJXLVKLQJ$'+'IURPRWKHUFRQGLWLRQV
B focuses on children known to have complex mental disorders.
C suggests a link between ADHD and a childs upbringing.
D draws attention to the poor care given to such children.
18. In the fourth paragraph, the word They refers to
A syndromes.
B questions.
C studies.
D origins.
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19. Dr Faraone suggests that the group of patients diagnosed with adult-onset ADHD
A had teachers or parents who recognised the symptoms of ADHD.
B should have consulted a doctor at a younger age.
C had mild undiagnosed ADHD in childhood.
D were specially chosen by the researchers.
20. ,QWKH¿IWKSDUDJUDSKLWLVVXJJHVWHGWKDWGUXJFRPSDQLHVKDYH
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been overly aggressive in their marketing of ADHD medication.
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C attempted to change the rules about incentives for doctors who diagnose ADHD.
D encouraged the APA to rush through changes to the criteria for diagnosing ADHD.
21.
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A a physiological reaction.
B a substitute medication.
C a need for research.
D a common request.
22. ,QWKH¿QDOSDUDJUDSKZKDWGRHVWKHZULWHULPSO\DERXWDGGLFWLRQWR$'+'PHGLFDWLRQ"
A It is unlikely to turn into a problem on the scale of that caused by opioid abuse.
B The effects are more marked in certain sectors of the population.
C ,QVXI¿FLHQWDWWHQWLRQVHHPVWRKDYHEHHQSDLGWRLW
D The reasons for it are not yet fully understood.
ENDOFREADINGTEST
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SampleTest2
READING SUB-TEST QUESTION PAPER: PART A
CANDIDATENUMBER:
LASTNAME:
FIRSTNAME:
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PROFESSION:
L
VENUE:
TESTDATE:
P
CANDIDATESIGNATURE:
TIME: 15 MINUTES
A M
S
DO NOT open this Question Paper or the Text Booklet until you are told to do so.
Write your answers on the spaces provided on this Question Paper.
You must answer the questions within the 15-minute time limit.
At the end of the 15 minutes, hand in this Question Paper and the Text Booklet.
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PartA
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-DWR¿QGWKHUHOHYDQWLQIRUPDWLRQ
Write your answers on the spaces provided in this QuestionPaper.
Answer all the questions within the 15-minute time limit.
Your answers should be correctly spelt.
Paracetamol overdose: Questions
Questions 1-7
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P
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1 the various symptoms of patients who have taken too much paracetamol?
2 the precise levels of paracetamol in the blood which require urgent intervention?
6
A
the steps to be taken when treating a paracetamol overdose patient?
S
whether paracetamol overdose was intentional?
the number of products containing paracetamol?
what to do if there are no details available about the time of the overdose?
7 dealing with paracetamol overdose patients who have not received adequate nutrition?
Questions 8-13
Answer each of the questions, 8-13, with a word or short phrase from one of the texts. Each answer may
8 If paracetamol is used as a long-term painkiller, what symptom may get worse?
9 It may be dangerous to administer paracetamol to a patient with which viral condition?
10 What condition may develop in an overdose patient who presents with jaundice?
SAMPLE

11 What condition may develop on the third day after an overdose?
12 What drug can be administered orally within 10 - 12 hours as an alternative to acetylcysteine?
13 What treatment can be used if a single overdose has occurred less than an hour ago?
Questions 14-20
LE
Complete each of the sentences, 14-20, with a word or short phrase from one of the texts. Each answer may
P
14 If a patient has taken metoclopramide alongside paracetamol, this may affect the
of the paracetamol.
A M
15 After 24 hours, an overdose patient may present with pain in the
16 )RUWKH¿UVWKRXUVDIWHURYHUGRVLQJSDWLHQWVPD\RQO\KDYHVXFKV\PSWRPVDV
.
S
.
17 Acetylcysteine should be administered to patients with a paracetamol level above the high-risk treatment
line who are taking any type of medication.
18 A non-high-risk patient should be treated for paracetamol poisoning if their paracetamol level is above
mg/litre 8 hours after overdosing.
19 A high-risk patient who overdosed hours ago should be given
acetylcysteine if their paracetamol level is 25 mg/litre or higher.
20 If a patient does not require further acetylcysteine, they should be given treatment categorised as
only.
END OF PART A
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Sample Test 2
READING SUB-TEST TEXT BOOKLET: PART A
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Paracetamol overdose: Texts
Text A
WĂƌĂĐĞƚĂŵŽů͗ĐŽŶƚƌĂŝŶĚŝĐĂƟŽŶƐĂŶĚŝŶƚĞƌĂĐƟŽŶƐ
ϰ͘ϰ^ƉĞĐŝĂůǁĂƌŶŝŶŐƐĂŶĚƉƌĞĐĂƵƟŽŶƐĨŽƌƵƐĞ
tŚĞƌĞĂŶĂůŐĞƐŝĐƐĂƌĞƵƐĞĚůŽŶŐͲƚĞƌŵ;хϯŵŽŶƚŚƐͿǁŝƚŚĂĚŵŝŶŝƐƚƌĂƟŽŶĞǀĞƌǇƚǁŽĚĂǇƐŽƌŵŽƌĞĨƌĞƋƵĞŶƚůǇ͕ŚĞĂĚĂĐŚĞŵĂǇ
ĚĞǀĞůŽƉŽƌŝŶĐƌĞĂƐĞ͘,ĞĂĚĂĐŚĞŝŶĚƵĐĞĚďǇŽǀĞƌƵƐĞŽĨĂŶĂůŐĞƐŝĐƐ;DK,ŵĞĚŝĐĂƟŽŶͲŽǀĞƌƵƐĞŚĞĂĚĂĐŚĞͿƐŚŽƵůĚŶŽƚďĞ
ƚƌĞĂƚĞĚďǇĚŽƐĞŝŶĐƌĞĂƐĞ͘/ŶƐƵĐŚĐĂƐĞƐ͕ƚŚĞƵƐĞŽĨĂŶĂůŐĞƐŝĐƐƐŚŽƵůĚďĞĚŝƐĐŽŶƟŶƵĞĚŝŶĐŽŶƐƵůƚĂƟŽŶǁŝƚŚƚŚĞĚŽĐƚŽƌ͘
ĂƌĞŝƐĂĚǀŝƐĞĚŝŶƚŚĞĂĚŵŝŶŝƐƚƌĂƟŽŶŽĨƉĂƌĂĐĞƚĂŵŽůƚŽƉĂƟĞŶƚƐǁŝƚŚĂůĐŽŚŽůĚĞƉĞŶĚĞŶĐǇ͕ƐĞǀĞƌĞƌĞŶĂůŽƌƐĞǀĞƌĞŚĞƉĂƟĐ
ŝŵƉĂŝƌŵĞŶƚ͘KƚŚĞƌĐŽŶƚƌĂŝŶĚŝĐĂƟŽŶƐĂƌĞ͗ƐŚŽĐŬĂŶĚĂĐƵƚĞŝŶŇĂŵŵĂƟŽŶŽĨůŝǀĞƌĚƵĞƚŽŚĞƉĂƟƟƐǀŝƌƵƐ͘dŚĞŚĂǌĂƌĚƐŽĨ
ŽǀĞƌĚŽƐĞĂƌĞŐƌĞĂƚĞƌŝŶƚŚŽƐĞǁŝƚŚŶŽŶͲĐŝƌƌŚŽƟĐĂůĐŽŚŽůŝĐůŝǀĞƌĚŝƐĞĂƐĞ͘
ϰ͘ϱ/ŶƚĞƌĂĐƟŽŶǁŝƚŚŽƚŚĞƌŵĞĚŝĐŝŶĂůƉƌŽĚƵĐƚƐĂŶĚŽƚŚĞƌĨŽƌŵƐŽĨŝŶƚĞƌĂĐƟŽŶ
ͻ ŶƟĐŽĂŐƵůĂŶƚƐʹƚŚĞĞīĞĐƚŽĨǁĂƌĨĂƌŝŶĂŶĚŽƚŚĞƌĐŽƵŵĂƌŝŶƐŵĂǇďĞĞŶŚĂŶĐĞĚďǇƉƌŽůŽŶŐĞĚƌĞŐƵůĂƌƵƐĞŽĨƉĂƌĂĐĞƚĂŵŽů
ǁŝƚŚŝŶĐƌĞĂƐĞĚƌŝƐŬŽĨďůĞĞĚŝŶŐ͘KĐĐĂƐŝŽŶĂůĚŽƐĞƐŚĂǀĞŶŽƐŝŐŶŝĮĐĂŶƚĞīĞĐƚ͘
ͻ DĞƚŽĐůŽƉƌĂŵŝĚĞʹŵĂǇŝŶĐƌĞĂƐĞƐƉĞĞĚŽĨĂďƐŽƌƉƟŽŶŽĨƉĂƌĂĐĞƚĂŵŽů͘
ͻ ŽŵƉĞƌŝĚŽŶĞʹŵĂǇŝŶĐƌĞĂƐĞƐƉĞĞĚŽĨĂďƐŽƌƉƟŽŶŽĨƉĂƌĂĐĞƚĂŵŽů͘
ͻ ŽůĞƐƚǇƌĂŵŝŶĞʹŵĂǇƌĞĚƵĐĞĂďƐŽƌƉƟŽŶŝĨŐŝǀĞŶǁŝƚŚŝŶŽŶĞŚŽƵƌŽĨƉĂƌĂĐĞƚĂŵŽů͘
ͻ /ŵĂƟŶŝďʹƌĞƐƚƌŝĐƟŽŶŽƌĂǀŽŝĚĂŶĐĞŽĨĐŽŶĐŽŵŝƚĂŶƚƌĞŐƵůĂƌƉĂƌĂĐĞƚĂŵŽůƵƐĞƐŚŽƵůĚďĞƚĂŬĞŶǁŝƚŚŝŵĂƟŶŝď͘
ƚŽƚĂůŽĨϭϲϵĚƌƵŐƐ;ϭϬϰϮďƌĂŶĚĂŶĚŐĞŶĞƌŝĐŶĂŵĞƐͿĂƌĞŬŶŽǁŶƚŽŝŶƚĞƌĂĐƚǁŝƚŚƉĂƌĂĐĞƚĂŵŽů͘
ϭϰŵĂũŽƌĚƌƵŐŝŶƚĞƌĂĐƟŽŶƐ;Ğ͘Ő͘ĂŵǇůŶŝƚƌŝƚĞͿ
ϲϮŵŽĚĞƌĂƚĞĚƌƵŐŝŶƚĞƌĂĐƟŽŶƐ
ϵϯŵŝŶŽƌĚƌƵŐŝŶƚĞƌĂĐƟŽŶƐ
ƚŽƚĂůŽĨϭϭϴďƌĂŶĚŶĂŵĞƐĂƌĞŬŶŽǁŶƚŽŚĂǀĞƉĂƌĂĐĞƚĂŵŽůŝŶƚŚĞŝƌĨŽƌŵƵůĂƟŽŶ͕Ğ͘Ő͘>ĞŵƐŝƉ͘
Text B
Procedure for acute single overdose

Acute single overdose
Establish time since ingestion
<4 hours 4-8 hours 8-24 hours >24 hours or unable to establish
<1 hour since ingestion and >75mg/kg • Start acetylcysteine immediately • Start acetylcysteine
• Check immediate paracetamol
taken: consider activated charcoal
level. If level will not be obtained • Check paracetamol level • Check paracetamol level and measure
before 8 hours after ingestion: start AST/ALT
• If level on or above paracetamol
• Check paracetamol level at 4 hours acetylcysteine pending the result graph treatment line: continue
• Plot level against time on the • Plot level against time on the relevant acetylcysteine
relevant nomogram nomogram • If level below treatment line: stop If paracetamol level >5mg/L or AST/ALT
• Start acetylcysteine if on or above • Start acetylcysteine if on or above acetylcysteine increased or any evidence of liver or renal
treatment line treatment line dysfunction: continue acetylcysteine
Patient needs treatment with acetylcysteine?

No Yes
Supportive treatment only Check AST/ALT, INR/PT, serum electrolytes, urea, creatinine, lactate, and
arterial pH and repeat every 24 hours
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Text C
Paracetamol poisoning Emergency treatment of poisoning
Patients whose plasma-paracetamol
concentrations are above the normal
treatment line should be treated with
acetylcysteine by intravenous infusion
(or, if acetylcysteine cannot be used,
with methionine by mouth, provided the
Plasma-paracetamol concentration (mg/litre)
Plasma-paracetamol concentration (mmol/litre)

overdose has been taken within 10-12
hours and the patient is not vomiting).
Patients on enzyme-inducing drugs

(e.g. carbamazepine, phenobarbital,
phenytoin, primidone, rifampicin and St
Johns wort) or who are malnourished
(e.g. in anorexia, in alcoholism, or those
who are HIV positive) should be treated
with acetylcysteine if their plasma-
paracetamol concentration is above the
high-risk treatment line.
Time (hours)
Text D
Clinical Assessment
• Commonly, patients who have taken a paracetamol overdose are asymptomatic for the first 24 hours or just have
nausea and vomiting
• Hepatic necrosis (elevated transaminases, right upper quadrant pain and jaundice) begins to develop after 24
hours and can progress to acute liver failure (ALF)
• Patients may also develop:
• Encephalopathy • Renal failure – usually occurs around day three
• Oliguria • Lactic acidosis
• Hypoglycaemia
History
• Number of tablets, formulation, any concomitant tablets
• Time of overdose
• Suicide risk – was a note left?
• Any alcohol taken (acute alcohol ingestion will inhibit liver enzymes and may reduce the production of the toxin
NAPQI, whereas chronic alcoholism may increase it)
END OF PART A
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Sample Test 2
READING SUB-TEST QUESTION PAPER: PARTS B & C
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PROFESSION:
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P
CANDIDATESIGNATURE:
TIME: 45 MINUTES
A M
S
HOWTOANSWERTHEQUESTIONS:
Mark your answers on this QuestionPaper by filling in the circle using a 2B pencil.
Example:
A
B
C
SAMPLE
Part B
In this part of the test, there are six short extracts relating to the work of health professionals. For questions1-6,
choose the answer (A, B or CZKLFK\RXWKLQN¿WVEHVWDFFRUGLQJWRWKHWH[W
1. This guideline extract says that the nurse in charge
A must supervise the opening of the controlled drug cupboard.
B should make sure that all ward cupboard keys are kept together.
C can delegate responsibility for the cupboard keys to another ward.
Medicine Cupboard Keys
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MP
The keys for the controlled drug cupboard are the responsibility of the nurse in charge. They may
be passed to a registered nurse in order for them to carry out their duties and returned to the nurse
in charge. If the keys for the controlled drug cupboard go missing, the locks must be changed and
pharmacy informed and an incident form completed. The controlled drug cupboard keys should be kept
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separately from the main body of keys. Apart from in exceptional circumstances, the keys should not
leave the ward or department. If necessary, the nurse in charge should arrange for the keys to be held in
a neighbouring ward or department by the nurse in charge there.
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2. When seeking consent for a post-mortem examination, it is necessary to
A give a valid reason for conducting it.
B allow all relatives the opportunity to decline it.
C only raise the subject after death has occurred.
Post-MortemConsent
E
Aseniormemberoftheclinicalteam,preferablytheConsultantinchargeofthecare,shouldraisethe
possibilityofapost-mortemexaminationwiththemostappropriatepersontogiveconsent.Theperson
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consentingwillneedanexplanationofthereasonsforthepost-mortemexaminationandwhatithopes
ǤƤǦ
maybedesirable,asthereisnoneedtowaituntilthepatienthasdied.Manyrelativesaremore
preparedfortheconsentingprocedureiftheyhavehadtimetothinkaboutitbeforehand.
A M
S
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3. The purpose of these notes about an incinerator is to
A KHOSPD[LPLVHLWVHI¿FLHQF\
B give guidance on certain safety procedures.
C recommend a procedure for waste separation.
Low-costincinerator:Generaloperatingnotes
E
3.2.1 Hospital waste management
Materials with high fuel values such as plastics, paper, card and dry textile will help maintain high
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incineration temperature. If possible, a good mix of waste materials should be added with each batch. This
can best be achieved by having the various types of waste material loaded into separate bags at source,
i.e. wards and laboratories, and clearly labelled. It is not recommended that the operator sorts and mixes
waste prior to incineration as this is potentially hazardous. If possible, some plastic materials should be
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added with each batch of waste as this burns at high temperatures. However, care and judgement will be
needed, as too much plastic will create dense dark smoke.
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SAMPLE

4. What does this manual tell us about spacer devices?
A Patients should try out a number of devices with their inhaler.
B They enable a patient to receive more of the prescribed medicine.
C Children should be given spacers which are smaller than those for adults.
Manual extract: Spacer devices for asthma patients
Spacer devices remove the need for co-ordination between actuation of a pressurized metered-dose
inhaler and inhalation. In addition, the device allows more time for evaporation of the propellant so that a
larger proportion of the particles can be inhaled and deposited in the lungs. Spacer devices are particularly
useful for patients with poor inhalation technique, for children, for patients requiring higher doses, for
nocturnal asthma, and for patients prone to candidiasis with inhaled corticosteroids. The size of the spacer
is important, the larger spacers with a one-way valve being most effective. It is important to prescribe a
spacer device that is compatible with the metered-dose inhaler. Spacer devices should not be regarded as
interchangeable; patients should be advised not to switch between spacer devices.
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5. The email is reminding staff that the
A EHQH¿WVWRSDWLHQWVRIXVLQJEHGUDLOVFDQRXWZHLJKWKHGDQJHUV
B number of bedrail-related accidents has reached unacceptable levels.
C patients condition should be central to any decision about the use of bedrails.
To: All Staff
Subject: Use of bed rails
Please note the following.
Patients in hospital may be at risk of falling from bed for many reasons including
poor mobility, dementia or delirium, visual impairment, and the effects of treatment or
medication. Bedrails can be used as safety devices intended to reduce risk.
However, bedrails arent appropriate for all patients, and their use involves risks. National
data suggests around 1,250 patients injure themselves on bedrails annually, usually
scrapes and bruises to their lower legs. Statistics show 44,000 reports of patient falls
from bed annually resulting in 11 deaths, while deaths due to bedrail entrapment
occur less than one every two years, and are avoidable if the relevant advice is followed.
Staff should continue to take great care to avoid bedrail entrapment, but be aware that in
hospital settings there may be a greater risk of harm to patients who fall out of bed.
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6. What does this extract from a handbook tell us about analeptic drugs?
A They may be useful for patients who are not fully responsive.
B Injections of these drugs will limit the need for physiotherapy.
C Care should be taken if they are used over an extended period.
Analeptic drugs
Respiratory stimulants (analeptic drugs) have a limited place in the treatment of ventilatory failure in
patients with chronic obstructive pulmonary disease. They are effective only when given by intravenous
injection or infusion and have a short duration of action. Their use has largely been replaced by ventilatory
support. However, occasionally when ventilatory support is contra-indicated and in patients with
hypercapnic respiratory failure who are becoming drowsy or comatose, respiratory stimulants in the short
WHUPPD\DURXVHSDWLHQWVVXIÀFLHQWO\WRFRRSHUDWHDQGFOHDUWKHLUVHFUHWLRQV
Respiratory stimulants can also be harmful in respiratory failure since they stimulate non-respiratory as
well as respiratory muscles. They should only be given under expert supervision in hospital and must be
combined with active physiotherapy. At present, there is no oral respiratory stimulant available for long-
term use in chronic respiratory failure.
SAMPLE

PartC
In this part of the test, there are two texts about different aspects of healthcare. For questions7-22, choose
the answer (A,B, C or DZKLFK\RXWKLQN¿WVEHVWDFFRUGLQJWRWKHWH[W
Text 1: Patient Safety
Highlighting a collaborative initiative to improve patient safety
In a well-documented case in November 2004, a female patient called Mary was admitted to a hospital in Seattle,
USA, to receive treatment for a brain aneurysm. What followed was a tragedy, made worse by the fact that it
neednt have occurred at all. The patient was mistakenly injected with the antiseptic chlorhexidine. It happened, the
hospital says, because of confusion over the three identical stainless steel bowls in the procedure room containing
clear liquids chlorhexidine, contrast dye and saline solution. Doctors tried amputating one of Marys legs to save
her life, but the damage to her organs was too great: she died 19 days later.
This and similar incidents are what inspired Professor Dixon-Woods of the University of Cambridge, UK, to set
out on a mission: to improve patient safety. It is, she admits, going to be a challenge. Many different policies and
approaches have been tried to date, but few with widespread success, and often with unintended consequences.
Financial incentives are widely used, but recent evidence suggests that they have little effect. Theres a danger
that they tend to encourage effort substitution, explains Dixon-Woods. In other words, people concentrate on the
areas that are being incentivised, but neglect other areas. Its not even necessarily conscious neglect. People have
only a limited amount of time, so its inevitable they focus on areas that are measured and rewarded.
In 2013, Dixon-Woods and colleagues published a study evaluating the use of surgical checklists introduced in
hospitals to reduce complications and deaths during surgery. Her research found that that checklists may have
little impact, and in some situations might even make things worse. The checklists sometimes introduced new
risks. Nurses would use the lists as box-ticking exercises they would tick the box to say the patient had had
their antibiotics when there were no antibiotics in the hospital, for example. They also reinforced the hierarchies
nurses had to try to get surgeons to do certain tasks, but the surgeons used the situation as an opportunity to
display their power and refuse.
Dixon-Woods and her team spend time in hospitals to try to understand which systems are in place and how they
DUHXVHG1RWRQO\GRHVVKH¿QGGLIIHUHQFHVLQDSSURDFKHVEHWZHHQKRVSLWDOVEXWDOVREHWZHHQXQLWVDQGHYHQ
between shifts. Standardisation and harmonisation are two of the most urgent issues we have to tackle. Imagine
if you have to learn each new system wherever you go or even whenever a new senior doctor is on the ward. This
introduces massive risk.
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Dixon-Woods compares the issue of patient safety to that of climate change, in the sense that it is a problem
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identifying where the responsibility for solving the problem lies. Many patient safety issues arise at the level of the
system as a whole, but policies treat patient safety as an issue for each individual organisation.
Nowhere is this more apparent than the issue of alarm fatigue, according to Dixon-Woods. Each bed in an
intensive care unit typically generates 160 alarms per day, caused by machinery that is not integrated. You have
to assemble all the kit around an intensive care bed manually, she explains. It doesnt come built as one like an
aircraft cockpit. This is not something a hospital can solve alone. It needs to be solved at the sector level.
Dixon-Woods has turned to Professor Clarkson in Cambridges Engineering Design Centre to help. Fundamentally,
my work is about asking how we can make it better and what could possibly go wrong, explains Clarkson. We
need to look through the eyes of the healthcare providers to see the challenges and to understand where tools and
WHFKQLTXHVZHXVHLQHQJLQHHULQJPD\EHRIYDOXH¶7KHUHLVDGLI¿FXOW\KHFRQFHGHVµ7KHUH¶VQRIRUPDOODQJXDJH
of design in healthcare. Do we understand what the need is? Do we understand what the requirements are? Can
we think of a range of concepts we might use and then design a solution and test it before we put it in place? We
seldom see this in healthcare, and thats partly driven by culture and lack of training, but partly by lack of time.
Dixon-Woods agrees that healthcare can learn much from engineers. There has to be a way of getting our two
sides talking, she says. Only then will we be able to prevent tragedies like the death of Mary.
SAMPLE

7. What point is made about the death of a female patient called Mary?
A It was entirely preventable.
B Nobody was willing to accept the blame.
C Surgeons should have tried harder to save her life.
D It is the type of incident which is becoming increasingly common.
8. What is meant by the phrase ºLɈVY[Z\IZ[P[\[PVU» in the second paragraph?
A Monetary resources are diverted unnecessarily.
B Time and energy is wasted on irrelevant matters.
C Staff focus their attention on a limited number of issues.
D People have to take on tasks which they are unfamiliar with.
9. By quoting Dixon-Woods in the second paragraph, the writer shows that the professor
A understands why healthcare employees have to make certain choices.
B doubts whether reward schemes are likely to put patients at risk.
C believes staff should be paid a bonus for achieving goals.
D feels the people in question have made poor choices.
10. What point is made about checklists in the third paragraph?
A Hospital staff sometimes forget to complete them.
B Nurses and surgeons are both reluctant to deal with them.
C They are an additional burden for over-worked nursing staff.
D 7KHLQIRUPDWLRQUHFRUGHGRQWKHPGRHVQRWDOZD\VUHÀHFWUHDOLW\
SAMPLE

11. What problem is mentioned in the fourth paragraph?
A failure to act promptly
B outdated procedures
C poor communication
D lack of consistency
12. What point about patient safety is the writer making by quoting Dixon-Woods comparison with
climate change?
A The problem will worsen if it isnt dealt with soon.
B It isnt clear who ought to be tackling the situation.
C It is hard to know what the best course of action is.
D Many people refuse to acknowledge there is a problem.
13. The writer quotes Dixon-Woods reference to intensive care beds in order to
A present an alternative viewpoint.
B illustrate a fundamental obstacle.
C show the drawbacks of seemingly simple solutions.
D give a detailed example of how to deal with an issue.
14. :KDWGLIIHUHQFHEHWZHHQKHDOWKFDUHDQGHQJLQHHULQJLVPHQWLRQHGLQWKH¿QDOSDUDJUDSK"
A the types of systems they use
B the way they exploit technology
C WKHQDWXUHRIWKHGLI¿FXOWLHVWKH\IDFH
D the approach they take to deal with challenges
SAMPLE

Text 2: Migraine more than just a headache
When a news reporter in the US gave an unintelligible live TV commentary of an awards ceremony, she became
an overnight internet sensation. As the paramedics attended, the worry was that shed suffered a stroke live on
air. Others wondered if she was drunk or on drugs. However, in interviews shortly after, she revealed, to general
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an uncommon symptom of aura, the collective name for a range of neurological symptoms that may occur just
before a migraine headache. Generally aura are visual for example blind spots which increase in size, or have a
ÀDVKLQJ]LJ]DJJLQJRUVSDUNOLQJPDUJLQEXWWKH\FDQLQFOXGHRWKHURGGGLVWXUEDQFHVVXFKDVSLQVDQGQHHGOHV
memory changes and even partial paralysis.
Migraine is often thought of as an occasional severe headache, but surely symptoms such as these should tell
us theres more to it than meets the eye. In fact many scientists now consider it a serious neurological disorder.
One area of research into migraine aura has looked at the phenomenon known as Cortical Spreading Depression
(CSD) a storm of neural activity that passes in a wave across the brains surface. First seen in 1944 in the brain
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brain cells is somehow reversed. Nouchine Hadjikhani and her team at Harvard Medical School managed to record
DQHSLVRGHRI&6'LQDEUDLQVFDQQHUGXULQJPLJUDLQHDXUDLQDYLVXDOUHJLRQWKDWUHVSRQGVWRÀLFNHULQJPRWLRQ
having found a patient who had the rare ability to be able to predict when an aura would occur. ThisFRQ¿UPHGD
long-suspected link between CSD and the aura that often precedes migraine pain. Hadjikhani admits, however, that
other work she has done suggests that CSD may occur all over the brain, often unnoticed, and may even happen in
healthy brains. If so, aura may be the result of a persons brain being more sensitive to CSD than it should be.
Hadjikhani has also been looking at the structural and functional differences in the brains of migraine sufferers. She
and her team found thickening of a region known as the somatosensory cortex, which maps our sense of touch
LQGLIIHUHQWSDUWVRIWKHERG\7KH\IRXQGWKHPRVWVLJQL¿FDQWFKDQJHVLQWKHUHJLRQWKDWUHODWHVWRWKHKHDGDQG
face. Because sufferers return to normal following an attack, migraine has always been considered an episodic
problem, says Hadjikhani. But we found that if you have successive strikes of pain in the face area, it actually
increases cortical thickness.
Work with children is also providing some startling insights. A study by migraine expert Peter Goadsby, who splits
his time between Kings College London and the University of California, San Francisco, looked at the prevalence
of migraine in mothers of babies with colic - the uncontrolled crying and fussiness often blamed on sensitive
VWRPDFKVRUUHÀX[+HIRXQGWKDWRIPRWKHUVZKRVHEDELHVZHUHKDYLQJDURXWLQHWZRPRQWKFKHFNXSWKH
migraine sufferers were 2.6 times as likely to have a baby with colic. Goadsby believes it is possible that a baby
with a tendency to migraine may not cope well with the barrage of sensory information they experience as their
nervous system starts to mature, and the distress response could be what we call colic.
SAMPLE

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attacks. Marla Mickleborough, a vision specialist at the University of Saskatchewan in Saskatoon, Canada, found
heightened sensitivity to visual stimuli in the supposedly normal period between attacks. Usually the brain comes
to recognise something repeating over and over again as unimportant and stops noticing it, but in people with
migraine, the response doesnt diminish over time. They seem to be attending to things they should be ignoring,
she says.
Taken together this research is worrying and suggests that its time for doctors to treat the condition more
DJJUHVVLYHO\DQGWR¿QGRXWPRUHDERXWHDFKLQGLYLGXDO¶VWULJJHUVVRDVWRVWRSDWWDFNVIURPKDSSHQLQJ%XW
there is a silver lining. The structural changes should not be likened to dementia, Alzheimers disease or ageing,
where brain tissue is lost or damaged irreparably. In migraine, the brain is compensating. Even if theres a genetic
predisposition, research suggests it is the disease itself that is driving networks to an altered state. That would
suggest that treatments that reduce the frequency or severity of migraine will probably be able to reverse some of
the structural changes too. Treatments used to be all about reducing the immediate pain, but now it seems they
might be able to achieve a great deal more.
SAMPLE

15. Why does the writer tell the story of the news reporter?
A to explain the causes of migraine aura
B to address the fear surrounding migraine aura
C to illustrate the strange nature of migraine aura
D to clarify a misunderstanding about migraine aura
16. The research by Nouchine Hadjikhani into CSD
A has less relevance than many believe.
B GLGQRWUHVXOWLQDGH¿QLWLYHFRQFOXVLRQ
C ZDVFRPSOLFDWHGE\WHFKQLFDOGLI¿FXOWLHV
D overturned years of accepted knowledge.
17. What does the word This» in the second paragraph refer to?
A the theory that connects CSD and aura
B the part of the brain where auras take place
C the simultaneous occurrence of CSD and aura
D the ability to predict when an aura would happen
18. The implication of Hadjikhanis research into the somatosensory cortex is that
A migraine could cause a structural change.
B a lasting treatment for migraine is possible.
C some diagnoses of migraine may be wrong.
D having one migraine is likely to lead to more.
SAMPLE

19. :KDWGRHVWKHZULWHU¿QGVXUSULVLQJDERXW*RDGVE\¶VUHVHDUFK"
A the idea that migraine may not run in families
B the fact that migraine is evident in infanthood
C the link between childbirth and onset of migraine
D the suggestion that infant colic may be linked to migraine
20. According to Marla Mickleborough, what is unusual about the brain of migraine sufferers?
A ,WIDLOVWR¿OWHURXWLUUHOHYDQWGHWDLOV
B It struggles to interpret visual input.
C It is slow to respond to sudden changes.
D It does not pick up on important information.
21. The writer uses the phrase asilverlining»LQWKH¿QDOSDUDJUDSKWRHPSKDVLVH
A the privileged position of some sufferers.
B a more positive aspect of the research.
C the way migraine affects older people.
D the value of publicising the research.
22. What does the writer suggest about the brain changes seen in migraine sufferers?
A 6RPHRIWKHPPD\EHEHQH¿FLDO
B They are unlikely to be permanent.
C Some of them make treatment unnecessary.
D They should still be seen as a cause for concern.
ENDOFREADINGTEST
THISBOOKLETWILLBECOLLECTED
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Sample Test
READING SUB-TEST ±7(;7%22./(73$57$
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
Passport Photo
OTHER NAMES: <RXU details and photo will be printed here.
PROFESSION:
E
VENUE:
L
TEST DATE:
P
A M
S
SAMPLE
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Management of burns: 7H[WV
Text A
Burn depth
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Text B
6
Fluid resuscitation
If the burn area is over 15% of the TBSA (Total Body Surface Area) in adults or 10% in children, intravenous
fluids should be started as soon as possible on scene, although transfer should not be delayed by more
than two cannulation attempts. For physiological reasons the threshold is closer to 10% in the elderly (>60
years).
Suggested regimen for fluid resuscitation
Adults
Resuscitation fluid alone (first 24 hours)
࠮ Give 3–4ml Hartmann's solution (3ml in superficial and partial thickness burns/4ml in full
thickness burns or those with associated inhalation injury) per kg body weight/% TBSA burned. Half
of this volume is given in the first 8 hours after injury and the remaining half in the second 16-hour
period
Children
Resuscitation fluid as above plus maintenance (0.45% saline with 5% dextrose):
࠮ Give 100ml/kg for the first 10kg body weight plus 50ml/kg for the next 10kg body weight plus
20ml/kg for each extra kg
SAMPLE

Text C
Management for Burns

1. Assess the patient status: airway, breathing, circulation, IV access.
2. Assess the burn depth and extent. A sheet can be placed on burns during this time.
&RROLQJ5HPRYHMHZHOOHU\RUKRWFORWKLQJ/LPLWLQÁDPPDWLRQDQGSDLQE\XVLQJFRROZDWHUFRRO
saline soaked gauze or a large sheet in the case of a large wound. Cool the wound not the patient,
taking care not to cause hypothermia.
4. Pain Control: Acetaminophen usually helpful but may need to use opiates such as codeine.
5. Check immunization status and update tetanus if necessary.
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7. Debridement of blisters – there are some differences of opinion regarding breaking of blisters.
a. Some suggest leaving intact because the blister acts as a barrier to infection and others
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debride all blisters.
b. Most agree that necrotic skin should be removed following blister ruptures.
8. Application of antibiotics in the form of ointment. Should always be used to prevent infection in any
3
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9. Apply suitable dressing to the wound area.
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Text D
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Adult Analgesic Guidelines
The following table provides recommended short term (<72 hours) oral analgesia guidelines for the
6
management of burn injuries. Aim for pain scores of 4 or less at rest. Analgesia should be reviewed after
72 hours and adjusted according to pain scores. Patient management should be guided by individual
case and clinical judgement.
Pain score elicited from patient (Scale 1 – 10)

Mild Pain Moderate Pain Severe Pain
Pain Score 1 - 3 Pain Score 4 - 6 Pain Score 7 - 10
Recommended analgesia: Recommended analgesia in Recommended analgesia in
addition to column 1: addition to column 1 & 2:
Paracetamol 1g 4 x daily Tramadol 50 – 100mg 4 x daily Strong opioids
Oxycontin SR 10mg (2 x daily)
And if needed: If above unsuccessful:
Naproxen 250mg 2 x daily Endone (immediate release Endone, 2 - 4 hourly as needed
oxycodone) 5 – 10mg (2 - 4
hourly)
Review in 72 hours Review in 72 hours
If pain cannot be controlled
with oral medications, consider
admission to burns unit.
Paediatric Analgesia Guidelines

࠮ Paracetamol (15 mg/kg (max 90 mg/kg/day) orally or per rectum (PR))
࠮ 1RQ6WHURLGDO$QWL,QÁDPPDWRU\'UXJV
• naproxen 5 - 10 mg/kg (max 500 mg) 12-hrly orally or PR
• ibuprofen 2.5 - 10 mg/kg (max 600 mg) 6-8hrly orally
࠮ Opioids (codeine 0.5 - 1 mg/kg orally)
END OF PART A SAMPLE


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C Boxhill Language Assessment – ABN 51 988 559 414

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Management of burns: Questions
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caused.
Patients recovering from third degree burns are likely to experience a great deal of shrinkage and
of their skin.
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Sample Test
READING SUB-TEST – QUESTION PAPER: PARTS B & C

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
MIDDLE NAMES: Passport Photo
PROFESSION: Candidate details and photo will be printed here.
E
VENUE:
TEST DATE:
CANDIDATE DECLARATION
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By signing this, you agree not to disclose or use in any way (other than to take the test) or assist any other person to disclose or use any OET
test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice
or information, you may be disqualified and your results may not be issued at the sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
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malpractice, their personal details and details of the investigation may be passed to a third party where required.
A
TIME: 45 MINUTES
INSTRUCTIONS TO CANDIDATES S
HOW TO ANSWER THE QUESTIONS

Mark your answers on this Question Paper by filling in the circle using a 2B pencil. Example: A
B
C
SAMPLE
Part B
In this part of the test, there are six short extracts relating to the work of health professionals. For questions 1-6,
choose the answer (A, B or CZKLFK\RXWKLQN¿WVEHVWDFFRUGLQJWRWKHWH[W A
B
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A failure to do so would put other people in danger.
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patients may be reluctant to seek medical attention or to give doctors the information they need in order
to provide good care.
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However, faced with a situation in which a patient’s refusal to consent to disclosure leaves others
exposed to a risk so serious that it outweighs the patient’s and the public interest in maintaining
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disclosed promptly to an appropriate person or authority. The patient should be informed in advance that
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to disclose without the patient’s consent.
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2. According to the guidance notes, all staff involved in transferring patients from critical to general care must
A obtain all necessary consent from any interested parties.
B ensure that the patient’s personal care plan is also transferred.
C make arrangements for ongoing co-operation once the transfer is complete.
Transfer of patients
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1.15
The critical care area transferring team and the receiving ward team should take shared responsibility for
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the care of the patient being transferred. They should jointly ensure that:
• there is continuity of care through a formal structured handover from critical care area staff to ward
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. staff (including both medical and nursing staff), supported by a written plan;
• the receiving ward, with support from critical care if required, can deliver the agreed plan.
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1.16
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information about their condition and encouraged to actively participate in decisions that relate to their
recovery. The information should be tailored to individual circumstances. If they agree, their family and
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carers should be involved.
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3. The memo says failure to screen a patient for malnutrition may result in
A a change in overall health.
B a prolonged stay at the care facility.
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Re: Nutrition screening
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4. This policy document states that nurses
A must sign a paper form if they want any new stock.
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C should speak to the pharmacist if a drug is needed urgently.
Stock requisitioning
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arrange urgent stock replenishment. If the ward-based team is unavailable, the nurse should complete
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a request form online and email it to the pharmacy stores. Paper-based ordering systems are available
(e.g. the ward medicines requisition book); however these should not be relied on if ward stock is urgently
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needed.
“At risk medicines” – Diazepam/Codeine Phosphate/Co-codamol – may only be ordered for stock when
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a paper requisition is written. Paper-based requisitions should be complete, legible and signed, and then
sent to the pharmacy department.
A
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on a daily basis, as stock is used.
SAMPLE

5. The extract from the guidelines states that
A ICU staff can be seconded to other wards.
B only a consultant can refer a patient to the ICU.
C the ICU is fully responsible for a patient in their care.
6.2 Intensive Care Unit (ICU)
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would lead to the rapid deterioration of a patient.
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6.2.2 All patients discussed with the ICU staff but not admitted remain under the care of the primary team
and as such they remain responsible for reviewing and escalating care should deterioration occur.
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This means that when patients are admitted into the ICU, they are under the care of the ICU team. It is
expected that members of the primary referring team will liaise daily with the ICU team to discuss the
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A saying anything until the facts have been established.
B speculating on the possible causes of the incident.
C contradicting what has been said by other staff.
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Information about a patient safety incident must be given to patients and/or their carers in a truthful
and open manner by an appropriately nominated person. Patients want a step-by-step explanation of
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what happened that considers their individual needs and is delivered openly. Communication must also
be timely – patients and/or carers should be provided with information about what happened as soon
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as practicable. It is also essential that any information given is based solely on the facts known at the
time. Healthcare staff should explain that new information may emerge as an incident investigation is
undertaken, and patients and/or their carers will be kept up-to-date with the progress of an investigation.
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The Duty of Candour Regulations require that information be given as soon as is reasonably practicable
and be given in writing no later than 10 days after the incident was reported through the local systems.
S A
SAMPLE

Part C
In this part of the test, there are two texts about different aspects of healthcare. For questions 7-22, choose the
A
answer (A, B, C or DZKLFK\RXWKLQN¿WVEHVWDFFRUGLQJWRWKHWH[W B
C
Fill the circle in completely. Example: D
Text 1: Allergic to eating
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caused by a newly-acquired food allergy – to red meat. Food allergies affect one per cent of the adult population of
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of the less common allergenic foodstuffs. Only after several further attacks of varying severity, was her suspicion
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An allergy, according to immunologists, is the immune system over-reacting to a substance that would ordinarily
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are allergic to a substance because it brings about some kind of adverse reaction in their bodies, some of which
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diarrhoea can all be signs of food allergies. Intolerance can bring on similar warning signs as well as things such as
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headaches, bloating, and general lethargy. Over time, some allergy sufferers lose weight because there are so few
foods they can eat. Of course the social implications are huge too – eating is a major social event.
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testing method is, however, somewhat unreliable in detecting intolerances, because, while not fully understood,
they operate YLDDGLIIHUHQWELRORJLFDOPHFKDQLVP possibly involving chemicals in food irritating nerve endings
in the body. They are generally diagnosed by following an exclusion diet in which suspect foods are gradually
reintroduced and their effects monitored.
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According to paediatric immunology specialist Dr Velencia Soutter, around six to eight per cent of babies are
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Broadly speaking, Dr Soutter says the ideal recipe for a food allergy is to be born of allergic parents and then
to have a high exposure to an allergenic foodstuff. But there are so many exceptions to this rule that other
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immunology has only just scratched the surface of understanding.
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tendency, women in allergic families could be advised to avoid certain foods during pregnancy and breastfeeding. It
is possible, though, that some allergies or intolerances are purely imaginary and this can also have consequences
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for children. One US study found that parents sometimes avoided foods to which they erroneously believed their
children were allergic, occasionally leaving the children severely underfed.
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In Australia, the number of people with genuine and severe allergies is growing. Some doctors speculate whether
the increased amount of new chemicals in the environment and in food is perhaps damaging immune systems
í PDNLQJWKHPPRUHSURQHWRUHDFWDGYHUVHO\0XFKPRUHUHVHDUFKQHHGVWREHGRQHWRSURYLGHHYLGHQFHIRU
that hypothesis. Anecdotally though, some experts say that staying off processed foods resolves the problem in
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grown in popularity, and the diet-conscious population is increasingly turning to nuts as a source of healthy fats.
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7. The case of Lucy Smith highlights the fact that food allergies
A PD\EHGLI¿FXOWWRGLDJQRVHLQFHUWDLQSHRSOH
B are relatively rare in the adult population.
C can cause debilitating symptoms.
D often require urgent treatment.
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A Scientists continue to disagree about their root causes.
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D The distinction between them and allergies is not widely appreciated.
9.
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The phrase ‘YLDDGLIIHUHQWELRORJLFDOPHFKDQLVP’ in the third paragraph explains
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A the way the skin-prick test works in diagnosing food intolerances.
B how the presence of food impurities impacts on the skin-prick test.
C why the skin-prick test may not accurately diagnose food intolerance.
D how food allergies are triggered by substances used in the skin-prick test.
10. 'U6RXWWHUXVHVWKHLPDJHRID¿UHZRUNVIDFWRU\WRLOOXVWUDWHWKDW
A the factors triggering an allergic reaction still remain unclear.
B allergic attacks can occur suddenly any time in a person’s life.
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A They both appear to be credible.
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A the likelihood of having an inherited allergy to certain foods
B the type of diet in which food allergies more commonly occur
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D the order of events most commonly found prior to allergic attacks
13.
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A It is only possible with particular individuals.
B It can result in instances of malnourishment.
C It may be avoidable if certain precautions are taken.
D It is most likely to take place before the baby is born.
14. Dr Soutter suggests that the rise in cases of one allergy may be partly due to
A attempts to improve eating habits.
B changes in food manufacturing methods.
C the adoption of new agricultural practices.
D increased levels of harmful substances in the atmosphere.
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Australia. A concept which is familiar to us all is that traditional risk factors such as smoking, obesity, and genetic
make-up increase the risk of heart disease. However, it is now becoming apparent that another factor is at play – a
developmental programming that is predetermined before birth, not only by our genes but also by their interaction
with the quality of our prenatal environment.
Pregnancies that are complicated by sub-optimal conditions in the womb, such as happens during pre-eclampsia or
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are necessary to maintain viable pregnancy and sustain life before birth, they come at a cost. The biological trade-
off is reduced growth, which may in turn affect the development of key organs and systems such as the heart and
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circulation, thereby increasing the risk of cardiovascular disease in adult life. Overwhelming evidence in more than
a dozen countries has linked development under adverse intrauterine conditions leading to low birth weight with
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increased rates in adulthood of coronary heart disease and its major risk factors – hypertension, atherosclerosis
and diabetes.
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The idea that a foetus’s susceptibility to disease in later life could be programmed by the conditions in the womb
has been taken up vigorously by the international research community, with considerable efforts concentrating on
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nutrient supply across the placenta as a risk factor. But that is just part of the story: how much oxygen is available
to the foetus is also a determinant of growth and of the risk of adult disease. Dr Dino Giussani’s research group
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at Cambridge University in the UK is asking what effect reduced oxygen has on foetal development by studying
populations at high altitude.
Giussani’s team studied birth weight records from healthy term pregnancies in two Bolivian cities at obstetric
hospitals and clinics selectively attended by women from either high-income or low-income backgrounds. Bolivia
lies at the heart of South America, split by the Andean Cordillera into areas of very high altitude to the west and
areas at sea-level to the east, as the country extends into the Amazon Basin. At 400m and almost 4000m above
sea-level, respectively, the Bolivian cities of Santa Cruz and La Paz are striking examples of this difference.
Pregnancies at high altitude are subjected to a lower partial pressure of oxygen in the atmosphere compared with
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with low-altitude babies, even in cases of high maternal nutritional status. Babies born to low-income mothers at
sea-level also showed a reduction in birth weight, but the effect of under-nutrition was not as pronounced as the
effect of high altitude on birth weight; clearly, foetal oxygenation was a more important determinant of foetal growth
within these communities. Remarkably, although one might assume that babies born to mothers of low socio-
economic status at high altitude would show the greatest reduction in birth weight, these babies were actually
heavier than babies born to high-income mothers at high altitude. It turns out that the difference lies in ancestry.
The lower socio-economic groups of La Paz are almost entirely made up of Aymara Indians, an ancient ethnic
group with a history in the Bolivian highlands spanning a couple of millennia. On the other hand, individuals of
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higher socio-economic status represent a largely European and North American admixture, relative newcomers
to high altitude. It seems therefore that an ancestry linked to prolonged high-altitude residence confers protection
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against reduced atmospheric oxygen.
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eggs: fertilised eggs from Bolivian birds native to sea-level show growth restriction when incubated at high altitude,
whereas eggs from birds that are native to high altitude show a smaller growth restriction. Moving fertilised eggs
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from hens native to high altitude down to sea-level not only restored growth, but the embryos were actually larger
than sea-level embryos incubated at sea-level. The researchers could thereby demonstrate something that only
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A the availability of supplies
B the simplicity of the procedure
C the reliability of the data obtained
D the speed with which results are seen
END OF READING TEST

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Procedural sedation and analgesia for adults in the emergency department
Patients in the emergency department often need to undergo painful, distressing or unpleasant
diagnostic and therapeutic procedures as part of their care. Various combinations of analgesic,
sedative and anaesthetic agents are commonly used for the procedural sedation of adults in the
emergency department.
Although combinations of benzodiazepines and opioids have generally been used for procedural
sedation, evidence for the use of other sedatives is
i emerging and is supported by guidelines
based on randomised trials and observational studies. Patients in pain should be provided with
analgesia before proceeding to more general sedation.n. The intravenous route is generally the
most predictable and reliable method of administration for most agents.
Local factors, including availability, familiarity, and clinical experience will affect drug choice, as
will safety, effectiveness, and cost factors. There may also be cost savings associated with
providing sedation in the emergency department for procedures that can be performed safely in
either the emergency department or the operating theatre.
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Levels of sedation as described by the American Society of Anesthesiologists
Non-dissociative sedation
¥! Minimal sedation and analgesia: essentially mild anxiolysis or pain control. Patients respond
normally to verbal commands. Example of appropriate use: changing burns dressings
¥! Moderate sedation and analgesia: patients are sleepy but also aroused by voice or light
touch. Example of appropriate use: direct current cardioversion
¥! Deep sedation and analgesia: patients require painful stimuli to evoke a purposeful response.
Airway or ventilator support may be needed. Example of appropriate use: major joint
reduction
¥! General anesthesia: patient has no purposeful response to even repeated painful stimuli.
Airway and ventilator support is usually required. Cardiovascular function may also be
impaired. Example of appropriate use: not appropriate for general use in the emergency
department except during emergency intubation.
Dissociative sedation
Dissociative sedation is described as a trance-like cataleptic state characterised by profound
analgesia and amnesia, with retention of protective airway reflexes, spontaneous respirations,
and cardiopulmonary stability. Example of appropriate use: fracture reduction.
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Drug administration: General principles

International consensus guidelines recommend that minimal sedation Ð for example, with 50% nitrous oxide-
oxygen blend Ð can be administered by a single physician or nurse practitioner with current life support
certification anywhere in the emergency department. Guidelines recommend that for moderate and
dissociative sedation using intravenous agents, a physician should be present to administer the sedative, in
addition to the practitioner carrying out the procedure.
For moderate sedation, resuscitation room facilities are recommended, with continuous cardiac and oxygen
saturation monitoring, non-invasive blood-pressure monitoring, and consideration of capnography (monitoring
of the concentration or partial pressure of carbon dioxide in the respiratory gases).
During deep sedation, capnography is recommended, and competent personnel should be present to provide
cardiopulmonary rescue in terms of advanced airway management and advanced life support.
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Drugs used for procedural sedation and analgesia in adults in the emergency department
Class Drug Dosage Advantages Cautions
Opioids Fentanyl 0.5-1 µg/kg over 2 Short acting analgesic; May cause apnoea,
mins reversal agent (naloxone) respiratory depression,
available bradycardia, dysphoria,
muscle rigidity, nausea and
vomiting
Morphine 50-100 µg/kg then Reversal agent (naloxone); Slow onset and peak effect
0.8-1 mg/h prolonged analgesic time; less reliable
Remifentanil 0.025-0.1 µg/kg/ Ultra-short acting; no solid Difficult to use without an
min organ involved in infusion pump
metabolic clearance
Benzodiazepines Midazolam Small doses of Minimal effect on No analgesic effect; may
0.02-0.03 mg/kg respiration; reversal agent cause hypotension
until clinical effect (flumazenil)
achieved; repeat
dosing of 0.5-1 mg
with total dose !
5mg
Volatile agents Nitrous oxide 50% nitrous oxide - Rapid onset and recovery; Acute tolerance may
50% oxygen cardiovascular and develop; specialised
mixture respiratory stability equipment needed
Propofol Propofol Infusion of 100 Rapid onset; short-acting; May cause rapidly
µg/kg/min for 3-5 anticonvulsant properties deepening sedation, airway
min then reduce obstruction, hypotension
to~50 µg/kg/min
Phencyclidines Ketamine 0.2-0.5 mg/kg Rapid onset; short-acting; Avoid in patients with
over 2-3 min potent analgesic even at history of psychosis; may
low doses; cardiovascular cause nausea and vomiting
stability
Etomidate Etomidate 0.1-0.15 mg/kg Rapid onset; short-acting; May cause pain on
may re-administer cardiovascular stability injection, nausea, vomiting;
caution when using in
patients with seizure
disorders/epilepsy Ð may
induce seizures
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Manual extract: Kuschall ultra-light wheelchair
Intended use
The active wheelchair is propelled manually and should only be used for independent or assisted
transport of a disabled patient with mobility difficulties. In the absence of an assistant, it should only
be operated by patients who are physically and mentally able to do so safely (e.g., to propel
themselves, steer, brake, etc.). Even where restricted to indoor use, the wheelchair is only suitable
for use on level ground and accessible terrain. This active wheelchair needs to be prescribed and fit
to the individual patientÕs specific health condition. Any other or incorrect use could lead hazardous
situations to arise.
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MRSA Screening guidelines
It may be necessary to screen staff if there is an outbreak of MRSA within a ward or department.
Results will normally be available within three days, although occasionally additional tests need to
be done in the laboratory. Staff found to have MRSA will be given advice by the Department of
Occupational Health regarding treatment. Even minor skin sepsis or skin diseases such as
eczema, psoriasis or dermatitis amongst staff can result in widespread dissemination of
staphylococci. If a ward has an MRSA problem, staff with any of these conditions (colonised or
infected) must contact Occupational Health promptly, so that they can be screened for MRSA
carriage. Small cuts and/or abrasions must always be covered with a waterproof plaster. Staff with
infected lesions must not have direct contact with patients and must contact Occupational Health.
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Extract from staff guidelines: Insulin pumps
Many patients with diabetes self-medicate using an insulin pump. If you're caring for a hospitalised
patient with an insulin pump, assess their ability to manage self-care while in the hospital. Patients
using pump therapy must possess good diabetes self-management skills. They must also have a
willingness to monitor their blood glucose frequently and record blood glucose readings,
carbohydrate intake, insulin boluses, and exercise. Besides assessing the patient's physical and
mental status, review and record pump-specific information, such as the pump's make and model.
Also assess the type of insulin being delivered and the date when the infusion site was changed
last. Assess the patient's level of consciousness and cognitive status. If the patient doesn't seem
competent to operate the device, notify the healthcare provider and document your findings.
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Extract from a monograph: Salbutamol Sulphate Inhalation Aerosol
Pregnant women
Salbutamol has been in widespread use for many years in humans without apparent ill
consequence. However, there are no adequate and well controlled studies in pregnant women and
there is little published evidence of its safety in the early stages of human pregnancy.
Administration of any drug to pregnant women should only be considered if the anticipated benefits
to the expectant woman are greater than any possible risks to the foetus.
During worldwide marketing experience, rare cases of various congenital anomalies, including cleft
palate and limb defects, have been reported in the offspring of patients being treated with
salbutamol. Some of the mothers were taking multiple medications during their pregnancies.
Because no consistent pattern of defects can be discerned, a relationship with salbutamol use
cannot be established.
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Speaking
PHASAMPLE04
WRITING SUB-TEST – TEST BOOKLET
INSTRUCTIONS TO CANDIDATES
You must write your answer for the Writing sub-test in the Writing Answer Booklet.
You must NOT remove OET material from the test room.
© Cambridge Boxhill Language Assessment – ABN 51 988 559 414 (2020)
WRITING SUB-TEST: PHARMACY
TIME ALLOWED: READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES
Read the case notes and complete the writing task which follows.
Notes:
Assume that today's date is 30 August 2019.
You are a pharmacist at Newtown Hospital. Mrs Paloma is undergoing chemotherapy and radiotherapy for breast
cancer.
PATIENT DETAILS:
Name: Mrs May Paloma

DOB:
Address:
Social history: Married – husband (Mr Luke Paloma)

Medication history: 24 Apr 2019 Ondansetron (Zofran) 4mg for nausea
26 May 2019 Zofran 4mg repeat
25 Jun 19 Imodium 2mg (loperamide) for gastroenteritis
27 Jul 2019 Zofran 4mg repeat
Oxazepam (Serepax) 15mg for anxiety/difficulty sleeping
30 Aug 2019 Serepax 15mg repeat
Diphenhydramine (Unisom Sleepgels) 50mg for difficulty sleeping
Prescribing doctors:

Dr Paul de Luc (GP)
Newtown Medical Clinic, 92 Green Street, Newtown
Oncologist Dr June Windslow
Newtown Hospital, 613 Main Street, Newtown
Allergies: Eggs
Treatment Record
Prescription Zofran 4mg prescribed by Dr Windslow (Oncologist)
Directions: Take ONE three times daily for 1-2 days after chemotherapy
Pt advised to contact prescribing Dr if:
• continues to vomit after taking the antiemetic
• vomits 4-5 times in 24 hour period
• has pain in stomach before nausea & vomiting occurs
Zofran repeat
Client called Pharmacy Department still experiencing vomiting 24hrs after chemotherapy
treatment – wants recommendations for another antiemetic
Advice given: vomiting may be caused by other reasons – client to contact Dr de Luc (GP)
Prescription Imodium 2mg by GP for gastroenteritis – the cause of vomiting
Client returned to Pharmacy Department. Asked about side effects of Imodium and
chemotherapy. Wants to cease Imodium
Symptoms: dry mouth, gas
Advice given: keep up fluids
Imodium was ceased
Zofran 4mg repeat

New medication added by oncologist: Serepax 15mg for anxiety and difficulty sleeping
Directions: Take 1 tablet 3x/day
Serepax 15mg (from oncologist) repeated

New prescription (from GP - Dr de Luc): Unisom Sleepgels 50mg – client still not
sleeping despite taking Serepax, went to GP for medication – did not tell GP about
Serepax Discussions with client:
• potential for interaction between Serepax/Unisom Ò increased side effects e.g.,
dizziness, drowsiness, confusion & difficulty concentrating
• suggested client see oncologist again
• client requested I write to oncologist
Script for Unisom not dispensed
Plan: Letter
to oncologist re Serepax not working effectively and risk of interaction
with Unisom
Writing Task:
Using the information provided in the case notes, write a letter to Mrs Paloma’s oncologist, Dr Windslow, suggesting a
review of the client’s current medication regime. Address the letter to Dr June Windslow, Newtown Hospital, 613 Main
Street, Newtown.
In your answer:
●● Expand the relevant notes into complete sentences
●● Do not use note form
●● Use letter format
The body of the letter should be approximately 180–200 words.
Any answers recorded here will not be marked.
N K
L A
B
PHASAMPLE04

SAMPLE RESPONSE: LETTER
Dr June Windslow
Newtown Hospital
613 Main Street
Newtown
30 August 2019
Dear Dr Windslow
Re: Mrs May Paloma

DOB: 11.04.1993
Mrs Paloma is a current patient of yours with breast cancer and associated anxiety. Dr de Luca, her regular GP, is also
managing her care. I am writing to recommend you undertake a review of Mrs Paloma’s current medications.
Mrs Paloma takes ondansetron (Zofran) 4mg for nausea following chemotherapy, which is working well. On 24 June she
was prescribed Imodium 2mg by her GP for a bout of gastroenteritis. This caused her to experience side effects of dry
mouth and gas. I advised her to ensure she kept up her fluids. She ceased the Imodium.
On 27 July you prescribed oxazepam (Serepax) 15mg for Mrs Paloma’s anxiety and difficulty sleeping. Today, when
she returned for a repeat prescription of Serepax, she also presented me with a new prescription from her GP for
diphenhydramine (Unisom Sleepgels) 50mg. When questioned, she admitted that she did not mention to her GP that she
was taking Serepax, which she reports is not working properly.
I advised Mrs Paloma of the potential risk of a drug interaction between Serepax and Unisom. Instead of dispensing the
Unisom, I have referred her back to you for a medication review.
Thank you for your assistance with this matter.
Yours sincerely
Pharmacist
PHASAMPLE03
Notes:
Assume that today's date is 30 August 2019
A diabetic client, Mr James Davidson, is planning to travel abroad alone and has come to your
pharmacy today seeking your advice. He is wondering whether it is safe for a diabetic to travel. He is
concerned about several issues: problems with customs and security at the airport, not being allowed
to take his medication on board the plane, not being able to carry on food/drink or get adequate food
on board during a long flight, losing his medication and whether changes in climate will affect his
medication and equipment.
You decide to write down your advice and reassurances in a letter to the client. Using information from the
notes below, address each of his concerns.
Notes from a seminar you attended on travelling with diabetes medication

Before you go: • Get letter from your doctor (several copies) explaining medication, devices/
equipment
• Get spare prescription
• Arrange travel insurance (worthwhile, despite the extra cost)
• Plan with healthcare worker when to use insulin/eat during flight
• Tell airline about your diabetes when booking
What to take: • Adequate supplies for the entire trip (and extra in case of loss/damage)
– Take medications in packaging dispensed by pharmacy
– Labels should be clear on medications
• Adequate pump batteries for insulin pump (where relevant)
• Small first aid kit
• National healthcare card
• Quick acting carbohydrate (e.g., glucose tablets, jelly beans)
• Small sharps container for syringe disposal (where relevant)
At airport security: • Carry all diabetes supplies for flight in hand luggage
• Answer questions about your equipment
• No need to declare diabetes equipment
• Show letter from doctor
• Insulin should not be affected by X-rays
• Ask for hand-checking if concerned
On the flight: • Wear comfortable, loose shoes
• Plan to eat regularly
• Eat glucose tablets / jelly beans or ask for lemonade if feeling hypoglycaemic
• Do some exercise e.g., walking in aisles
• Use regular doses of insulin (where relevant)
• No alcohol
• Plenty of water
• Sleep whenever possible
• Do not inject insulin until meal has been served
Where to go if you lose your medication when travelling:

• Hospital emergency department
• Local diabetes organisation
Precautions: • Wear identification that states you are diabetic

• Carry written details of your next of kin, medications and devices you use
• Store insulin and blood glucose test strips below 30˚C, and above 0˚C i.e.,
in cabin baggage on flight (insulin can be left out of the fridge between these
temperatures for 28 days)
• Use insulated bag if travelling in hot/cold climates
• Check blood glucose levels more often than usual
Writing Task:
Using the information given above, write a letter to Mr Davidson, addressing his specific concerns. Address the
letter to Mr James Davidson, 11 Cedar Street, Stillwater.
In your answer:
N K
L A
B
PHASAMPLE03

Mr James Davidson
11 Cedar Street
Stillwater
30 August 2019
Dear Mr Davidson
Thank you for your query about travel safety related to your diabetes. I can assure you that it is safe for you to travel with
diabetes as long as you take certain precautions.
At airport security, there is no need to worry about the X-rays affecting your insulin or equipment. However, if you prefer,
you can have your luggage hand-checked. You are not required to declare your medication, but should be prepared to
answer customs staff’s questions. A letter from your doctor will show you are entitled to carry these medications and
devices.
For the flight, notify the airline in advance of your requirements and carry fast-acting carbohydrates such as glucose
tablets or jelly beans. Do not be afraid to ask for lemonade or extra food. Avoid using insulin before the meal is actually
served to you, in case of delay.
Because medications can be affected by extreme temperatures, they must be stored above freezing and below 30°C. If
you are travelling somewhere very hot or very cold, protect your medicines by packing them in an insulated bag.
If you lose or run out of medication, the best contact is the local hospital emergency department or diabetes organisation.
Please do not hesitate to contact me if you have any questions.
Yours sincerely
Pharmacist
PHASAMPLE03
Notes:
A diabetic client, Mr James Davidson, is planning to travel abroad alone and has come to your
pharmacy today seeking your advice. He is wondering whether it is safe for a diabetic to travel. He is
concerned about several issues: problems with customs and security at the airport, not being allowed
to take his medication on board the plane, not being able to carry on food/drink or get adequate food
on board during a long flight, losing his medication and whether changes in climate will affect his
medication and equipment.
You decide to write down your advice and reassurances in a letter to the client. Using information from the
notes below, address each of his concerns.
Notes from a seminar you attended on travelling with diabetes medication

Before you go: • Get letter from your doctor (several copies) explaining medication, devices/
equipment
• Get spare prescription
• Arrange travel insurance (worthwhile, despite the extra cost)
• Plan with healthcare worker when to use insulin/eat during flight
• Tell airline about your diabetes when booking
What to take: • Adequate supplies for the entire trip (and extra in case of loss/damage)
– Take medications in packaging dispensed by pharmacy
– Labels should be clear on medications
• Adequate pump batteries for insulin pump (where relevant)
• Small first aid kit
• National healthcare card
• Quick acting carbohydrate (e.g., glucose tablets, jelly beans)
• Small sharps container for syringe disposal (where relevant)
At airport security: • Carry all diabetes supplies for flight in hand luggage
• Answer questions about your equipment
• No need to declare diabetes equipment
• Show letter from doctor
• Insulin should not be affected by X-rays
• Ask for hand-checking if concerned
On the flight: • Wear comfortable, loose shoes
• Plan to eat regularly
• Eat glucose tablets / jelly beans or ask for lemonade if feeling hypoglycaemic
• Do some exercise e.g., walking in aisles
• Use regular doses of insulin (where relevant)
• No alcohol
• Plenty of water
• Sleep whenever possible
• Do not inject insulin until meal has been served
Where to go if you lose your medication when travelling:

• Hospital emergency department
• Local diabetes organisation
Precautions: • Wear identification that states you are diabetic

• Carry written details of your next of kin, medications and devices you use
• Store insulin and blood glucose test strips below 30˚C, and above 0˚C i.e.,
in cabin baggage on flight (insulin can be left out of the fridge between these
temperatures for 28 days)
• Use insulated bag if travelling in hot/cold climates
• Check blood glucose levels more often than usual
Writing Task:
Using the information given above, write a letter to Mr Davidson, addressing his specific concerns. Address the
letter to Mr James Davidson, 11 Cedar Street, Stillwater.
In your answer:
N K
L A
B
PHASAMPLE03

Mr James Davidson
11 Cedar Street
Stillwater
30 August 2019
Dear Mr Davidson
Thank you for your query about travel safety related to your diabetes. I can assure you that it is safe for you to travel with
diabetes as long as you take certain precautions.
At airport security, there is no need to worry about the X-rays affecting your insulin or equipment. However, if you prefer,
you can have your luggage hand-checked. You are not required to declare your medication, but should be prepared to
answer customs staff’s questions. A letter from your doctor will show you are entitled to carry these medications and
devices.
For the flight, notify the airline in advance of your requirements and carry fast-acting carbohydrates such as glucose
tablets or jelly beans. Do not be afraid to ask for lemonade or extra food. Avoid using insulin before the meal is actually
served to you, in case of delay.
Because medications can be affected by extreme temperatures, they must be stored above freezing and below 30°C. If
you are travelling somewhere very hot or very cold, protect your medicines by packing them in an insulated bag.
If you lose or run out of medication, the best contact is the local hospital emergency department or diabetes organisation.
Please do not hesitate to contact me if you have any questions.
Yours sincerely
Pharmacist
PHASAMPLE02
Notes:
Assume that today's date is 10 February 2019
Today, a new patient, Ms Alexia Rollinson, visited your community pharmacy to collect repeat medications. You also
discussed her dieting concerns.
PATIENT DETAILS:
Name:
DOB:
Address:
Date:
Social/Family Background:
Single. Works full time as an accountant
Diagnosis: Hypertension, hypercholesterolaemia, low vitamin D since 2011
Medication: Betaloc (metoprolol), 100mg b.d.

Lipitor (atorvastatin), 20mg mane Ostevit-D 1000IU mane
Current Status: BP 147/100mmHg (taken in pharmacy)

Lipid profile: LDL – 131, HDL – 64, Triglycerides – 269mg/dl Vitamin D < 54 (60-160nmol/L) (print
out with customer)
Ht 153cm, Wt 65kg (verbal from customer), BMI 27.8
Does no regular exercise – drives to work, no sport or recreational activity Low mood
Overweight
Discussions in Pharmacy:
Asked for weight loss advice

Monitoring diet to decrease Wt – target 58kg, BMI <25.
• Exercise – Started own exercise program (e.g., walk 30 min 4 times/wk).
Says ‘never sticks to it’. Has tried all types of exercise aids advertised on TV, video programs,
getting desperate & upset. Wants some help due to lack of progress.
• Diet – Discussed fruit & vegetables, low fat milk, low GI foods & low saturated fats.
Bought two electronic scales last week, one for kitchen (food) & one for bathroom (self).
Discussed fruit & nut snacks, not chocolate bars (admitted to loving them). Always
browsing for Wt loss products. Tried several tablets, drinks, powders, etc. Getting desperate &
upset. Wants help due to no progress with Wt loss or change in exercise & daily activities.
Offered to write to local doctor for support. Also mentioned a dietitian – customer liked idea.
Pharmacy Management:
• Provided free booklets
- Healthy eating and exercise
- Council brochure on walking tracks, walking groups, etc.
- Local gymnasiums & sports groups
• Letter to doctor – suggest referral to dietitian
Writing Task:
Using the information in the case notes, write a letter of referral to Dr Sally Windwood, 9 Blewston St, Newtown, to
explain your discussion and advice including a suggestion of consulting a dietitian.
In your answer:
N K
L A
B
PHASAMPLE02

SAMPLE RESPONSE: LETTER OF REFERRAL
Dr Sally Windwood
9 Blewston St
Newtown
10 February 2019
Dear Dr Windwood,
Re: Ms Alexia Rollinson (DOB: 12/11/1973)
I am writing to you out of concern for a customer in our pharmacy today. Ms Rollinson was diagnosed and began
treatment for hypertension, hypercholesterolaemia and low vitamin D in 2011. Her current medication is metoprolol
100 mg b.d., atorvastatin 20 mg mane and Ostevit-D 1000IU mane.
Ms Rollinson expressed frustration at her current weight, 65 kg, which she indicated was overweight: BMI 27.8. She
has tried diet modification in the past mainly through weight loss products. She has also tried to increase her exercise
through her own plans and aids but is never compliant. She currently drives to work and does not participate in
sporting activities.
In our discussion she also expressed low mood, and desire for guidance. I provided her with some booklets on diet,
walking groups, and local sport institutions. I also made suggestions of simple changes to her diet: eating fruit and
nuts as snacks instead of chocolate bars.
Finally, I offered to write to you so that she can have a doctor’s referral to a dietitian. Ms Rollinson was agreeable to
the idea as she would like support from a GP as she currently does not have a regular doctor.
Please do not hesitate to contact me with any questions.
Yours sincerely,
Pharmacist
PHASAMPLE01
Notes:
You are a pharmacist at Newtown Hospital. An elderly patient who has been treated for a fractured femur is being
discharged. You are writing a letter to her carer (her daughter) to ensure the medication regime is followed when she
returns home.
PATIENT DETAILS:
Name: Mrs Alice Ramsey
DOB: 04 Jan 1929
Allergies: Nil
Current Medication:
On Admission: Zantac (ranitidine) (for GORD): 150mg bd
Lipitor (atorvastatin): 20mg mane (on empty stomach)
Pt stabilised on medications for some years
On Discharge: Zantac (ranitidine) (for GORD): 150mg bd

Lipitor (atorvastatin): 20mg mane
Dalteparin (Fragmin - low molecular weight heparin (LMWH) (anti-coagulant)): 2500IU– SC to be
continued until mobile - Pt advised SC administration process
Panadeine Forte (paracetamol & codeine for pain relief): 500mg 4-hourly/prn
Durolax (to prevent constipation): 10mg nocte
Maxolon (metoclopramide) (for nausea with codeine): 10mg tds prn
Drug Information: Adverse Drug Reactions

Ranitidine headache; GI upset; rash; CNS disturbances (rare)
Atorvastatin Serious: rhabdomyolysis, myopathy, myalgia (0.2%); GI upset (1%); headache (2%); rash (2.5%);
flu-like symptoms (1.5%); raised LFTs (1.3%)
Heparin haemorrhage, easy bruising, nausea, vomiting
Codeine/Paracetamol
constipation, stomach pain, nausea, vomiting;
Rare: dependence, tolerance; CNS disturbances incl. impaired alertness
Metoclopramide CNS disturbances incl. impaired alertness (rare); tardive dyskinesia (rare)
Social History: Pt normally lives alone. On discharge, staying with daughter.

Pt non-driver. Public transport.
Relevant History for Surgical Procedure:

Height 168cm; Weight 75kg; BMI 26.8
Non-smoker
Dentures – upper & lower
Gastro-oesophageal reflux disease (GORD) – controlled by medication
Hypercholesterolaemia – controlled by medication
11 Jul 2018
2:45pm: Pt brought to Emergency Department by ambulance. Knocked down by car in Garden Nursery
car park – landed on bitumen. Driver failed to see her in rear-view mirror → reversed into her.
Not run over. Fell on R side on femur.
Presenting symptoms: pain & difficulty standing or walking
3.00pm: Pt seen by Dr Hogarth. Pain relief: pethidine (opiate)

X-rays of affected femur – anterior-posterior & lateral views Repeat films with hip at 15-20°
internal rotation Ò MRI
5:30pm: Transferred to ward

Pt booked for surgery 12 July am – nil by mouth from midnight
Full pre-operative general investigation: LFTs, platelet count, WBC count, WBC types, RBC
count, RBC indices, Hg, haematocrit, blood smear, ECG & chest X-ray
12 Jul 2018
Open reduction & internal fixation (ORIF) performed
GA given: induction – propofol; sevoflurane, fentanyl, midazolam, suxamethonium,
ondansetron
Heparin – thrombus prevention
IV antibiotic prophylaxis – cefazolin 2g IV 8-hourly for 24 hours post-surgery Immobilised with
spica cast
Post-Op • pressure sore prevention & care of pressure areas; wound care
• pain relief
• fluid balance & blood loss monitoring: IV fluids
• nutritional management: oral protein supplementation
• thrombus prevention: low dose, low molecular weight heparin, & compression stockings
• lower limb circulation & sensation
• early mobilisation & weight bearing on injured leg
24 Jul 2018 Transferred to Rehab Unit
08 Aug 2018 Due for discharge home – appointment made for 22 Aug 2018 for removal of cast. Letter to
carer/daughter (NB: heparin to be continued only until mobile)
The patient is being discharged to the care of her daughter.
Writing Task:
Using the information in the case notes, write a letter to the daughter, Mrs Holly Kerr, 3 Rose Avenue, Springbank,
outlining her mother’s medication regime, any potential adverse effects to be aware of, and when to seek medical
advice.
In your answer:
N K
L A
B
PHASAMPLE01

Mrs Holly Kerr

3 Rose Avenue
Springbank
8 August 2018
Dear Mrs Kerr
Your mother, Mrs Alice Ramsey, is being transferred into your care following her operation and it is important that you
ensure her medications are taken correctly. This letter lists her current medications and advises what you should do if
you notice side effects.
On admission, she was using Zantac, twice daily to control her acid reflux, and cholesterol-lowering medication,
Lipitor, in the morning on an empty stomach. These medicines are to be continued as before.
During hospitalisation, she has been prescribed several additional medications.
Panadeine Forte is to be used for pain relief as required, but not more frequently than four-hourly. It can cause
stomach pain, constipation, nausea and vomiting, in addition to drowsiness. To prevent constipation, she should take
Durolax at night when using Panadeine Forte. To counteract nausea, Maxolon can be taken up to three times daily as
needed.
Fragmin, a blood-thinning medication will prevent clot formation from the surgery or immobility. This medication needs
to be given by injection under the skin. Your mother has been shown how to do this.
Continue this medication until your mother is mobile, and if any bleeding or bruising occurs seek medical advice.
Please feel free to contact me if you have any questions.
Yours sincerely,
Hospital Pharmacist.

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OET Materials

Book Contents MBBS University of Khartoum

OET Practice test 1 OET Sample test 1 Msc Degree in Molecular

OET Practice test 2

OET Sample test 2

OET Sample test 3

OET Online Mock test

OET Practice test 2

OET Practice test 3

OET Sample test 1

OET Sample test 2

OET Sample test 3

OET Online Mock test

LISTENING SUB-TEST  QUESTION PAPER

TIME: APPROXIMATELY 40 MINUTES

DO NOT remove OET material from the test room.

HOW TO ANSWER THE QUESTIONS:

Example: Patient: Ray Sands

[CANDIDATE NO.] LISTENING QUESTION PAPER 02/12

[CANDIDATE NO.] LISTENING QUESTION PAPER 03/12

You now have thirty seconds to look at the notes.

Patient Ray Sands

18 months ago  back injury sustained (lifting (1) )

1 year ago  sciatica developed

6 months ago  clear of symptoms

Last month  recurrence of symptoms

 pain described as (3)

 (5) sensation (calves)

 (6) (involves travel/some manual work)

Initial treatment  prescribed NSAIDs

 application of (7) (provided some relief)

Referrals  (8) EULHÀ\

 sports injury specialist for manipulation and exercise programme

Further treatment  epidural injections

 decided not to try (10)

 patient attributes recovery to (11)

Previous diagnosis  sciatica probably related to (12) SAMPLE

[CANDIDATE NO.] LISTENING QUESTION PAPER 04/12

You now have thirty seconds to look at the notes.

Patient Jake Ventor

Reason for referral  skin lesion

Patients description of condition

 on the (13) of his left hand

P L  GP describes appearance of lesion as (16)

 normally resolves within two weeks

A M  also had a lesion on his (17)

 recurs regularly on different parts of his left hand

 no apparent link to general state of health, (19)

Medical history  (20) on lower back in 2006  no sign

 reports no history of (21)

Information given  advised that (22) was unlikely to be effective

 told him to take care if the skin is (23)

Outcome  says his quality of life isnt affected

 a (24) will be arranged

That is the end of Part A. Now look at Part B.

[CANDIDATE NO.] LISTENING QUESTION PAPER 05/12

For questions 25-30, choose the answer (A, B or C ZKLFK¿WVEHVWDFFRUGLQJWRZKDW\RXKHDU<RX¶OOKDYHWLPH

Now look at question 25.

The patient is allergic to some types of antibiotics.

C Oxygen may be needed if the patient becomes breathless.

A interruptions while calculating dosages.

B a failure to check for patients allergies.

C administering drugs late in the day.

LISTENING SUB-TEST QUESTION PAPER

18 months ago back injury sustained (lifting (1) )

1 year ago sciatica developed

6 months ago clear of symptoms

Last month recurrence of symptoms

pain described as (3)

(5) sensation (calves)

(6) (involves travel/some manual work)

Initial treatment prescribed NSAIDs

application of (7) (provided some relief)

Referrals (8) EULHÀ\

sports injury specialist for manipulation and exercise programme

Further treatment epidural injections

decided not to try (10)

patient attributes recovery to (11)

Previous diagnosis sciatica probably related to (12) SAMPLE

Reason for referral skin lesion

Patients description of condition

on the (13) of his left hand

P L GP describes appearance of lesion as (16)

normally resolves within two weeks

A M also had a lesion on his (17)

recurs regularly on different parts of his left hand

no apparent link to general state of health, (19)

Medical history (20) on lower back in 2006 no sign

reports no history of (21)

Information given advised that (22) was unlikely to be effective

told him to take care if the skin is (23)

Outcome says his quality of life isnt affected

a (24) will be arranged

For questions 25-30, choose the answer (A, B or CZKLFK¿WVEHVWDFFRUGLQJWRZKDW\RXKHDU<RX¶OOKDYHWLPH

B a failure to check for patients allergies.

For questions 31-42, choose the answer (A, B or CZKLFK¿WVEHVWDFFRUGLQJWRZKDW\RXKHDU&RPSOHWH\RXU

B illustrate the problems caused by raising a patients hopes.

LISTENING SUB-TEST QUESTION PAPER

Background has had (1) over long period

reports a frequent (2) sensation in the last year

most recently (3) has become a problem

word used to describe symptoms (4)

situation at work means patient is (7)

claims to keep hydrated

has experimented with excluding (10) from diet

very slight reduction in caffeine intake

has undergone (11) no indications of anything

Medication has taken an anti-spasmodic not very effective

now trying (12)

experienced discomfort and a (13) feeling in neck

osteopathy exacerbated problem