R000009

READING SUB-TEST – TEXT BOOKLET: PART A

INSTRUCTIONS TO CANDIDATES
You must NOT remove OET material from the test room.

www.occupationalenglishtest.org
© Cambridge Boxhill Language Assessment – ABN 51 988 559 414 (2019)
 Psoriasis: Texts
Text A

Diagnosis of cutaneous psoriasis is usually straightforward based on the clinical appearance. The most
frequent presentation is chronic plaque psoriasis (psoriasis vulgaris) and is characterised by well demarcated
bright red plaques covered by adherent silvery white scales. These may affect any body site, often
symmetrically, especially the scalp and extensor surfaces of limbs. The differential diagnosis includes eczema,
tinea, lichen planus and lupus erythematosus. The appearance of the plaques may be modified by emollients
and topical treatments, which readily remove the scale. Scaling is reduced at flexural sites, on genital skin
and in palmoplantar disease. Guttate psoriasis describes the rapid development of multiple small papules of
psoriasis over wide areas of the body. The differential diagnosis includes pityriasis rosea, viral exanthems and
drug eruptions. Generalised pustular psoriasis is rare and is characterised by the development of multiple
sterile non-follicular pustules within plaques of psoriasis or on red tender skin. This may occur acutely and be
associated with fever. The differential diagnosis includes pyogenic infection, vasculitis and drug eruptions.

Text B

Adult Psoriasis Topical Treatment Pathway

Emollients should be applied regularly to reduce fall of scales at all steps in therapy and for all body areas
(excluding scalp)
Trunk and Limbs
Step ONCE daily potent corticosteroid +
1 ONCE daily vitamin D
preparation (betamethasone +
calcipotriol)
Review at 4 weeks*
Discontinue if Ineffective after
maximum of 8 weeks treatment
Step Vitamin D preparation (calcipotriol
2 or
tacalcitol) TWICE daily
Discontinue if ineffective after a
further 12 weeks treatment
Face, Flexures and Genitals
ONCE or TWICE daily mild or moderate corticosteroid
(clobetasone or hydrocortisone) applied for maximum
of 2 weeks. Discontinue if unsatisfactory response or
continuous treatment required to maintain control
Calcineurin inhibitor
TWICE daily (off-label use) for up to 4 weeks
To be initiated on the advice of a clinician with expertise in
psoriasis e.g. GPwSI
Continue to review for improvement as directed

Step Potent corticosteroid

3 (betamethasone or fluocinolone)
TWICE daily for 4 weeks * or
Coal tar containing preparations
ONCE daily for 4 weeks *
Discontinue if the patient cannot
tolerate or once daily is preferred
to improve adherence
Step Potent corticosteroid + vitamin Refer patients whose psoriasis is not controlled to the
4 D combination preparation specialist dermatology service
(betamethasone + calcipotriol)
ONCE daily for up to 4 weeks*
Discontinue if Ineffective after
maximum of 4 weeks treatment

*Aim for a break of 4 weeks between courses of treatment with potent or very potent corticosteroids.
Consider topical treatments that are not steroid-based to maintain psoriasis disease control during this
period.
Dithranol could be considered as an alternative to coal tar preparation at this stage in therapy for suitable
patient groups.
Text C
Psoriatic arthritis (PsA) is an inflammatory disease associated with psoriasis. It is unclear exactly how many
patients with psoriasis will develop PsA, but it could be as high as 42%. PsA may develop at any time, but
usually presents between 30-50 years of age. PsA is characterised by pain and stiffness in affected joints. If left
untreated, PsA could result in progressive joint damage leading to severe disability. Therefore, early detection
and treatment are paramount. On physical examination, affected joints may have asymmetric stress pain, joint-
line tenderness, and effusions, with approximately 50% of cases affecting the distal interphalangeal (DIP) joints.
CASPAR (ClASsification criteria for Psoriatic Arthritis) Criteria
A patient must have inflammatory articular disease and ≥3 points from the following
categories

Category Description Points

Current psoriasis or Current psoriasis: skin or plaque disease confirmed by 2 (current)
personal or family rheumatologist or dermatologist. OR
history of psoriasis Personal history: obtained from patient, family physician, 1 (history)
dermatologist, rheumatologist or other qualified health care
provider.
Family history: presence of psoriasis in 1° or 2° relatives as
reported by patient.
Psoriatic nail dystrophy Onycholysis, pitting, hyperkeratosis 1
on current examination
Negative rheumatoid Any method except latex, but preferably Enzyme-linked 1
factor (RF) immunosorbent assay (EUSA) or nephelometry, using local
laboratory reference range.
Dactylitis (current or Swelling of an entire digit 1
on history as recorded
by rheumatologist)
Radiographic evidence Ill-defined ossification near joint margins but excluding 1
of juxta-articular new- osteophyte formation on plain X-rays of the hand or foot.
bone formation

Text D

Children and Young People – Psoriasis Topical Treatment Pathway

Suitable quantities of preparations to be prescribed for specific areas of the body.

Area of body Creams and Ointments (Steroid) Creams and Ointments (Non-Steroid)
Face and neck 15 to 30g 15 to 30g (face only)
Both hands 15 to 30g 25 to 50g
Scalp 15 to 30g 50 to 100g
Both arms 30 to 60g 100 to 200g
Both legs 100g 100 to 200g
Trunk 100g 400g
Groin and genitalia 15 to 30g 15 to 25g

Maximum amounts of Vitamin D analogues to prescribe:

Calcipotriol 6 – 12 years max. 50g weekly; over 12 years max. 75g weekly
Calcitriol – not more than 35% of body surface to be treated daily, max. 30g daily.
Tacalcitol – max. 10g ointment or 10mL lotion daily (max. total tacalcitol 280 micrograms in any one
week)

END OF PART A
THIS TEXT BOOKLET WILL BE COLLECTED
 R000009

READING SUB-TEST – QUESTION PAPER: PART A

TIME: 15 MINUTES

INSTRUCTIONS TO CANDIDATES
DO NOT open this Question Paper or the Text Booklet until you are told to do so.
Write your answers in the spaces provided in this Question Paper.
You must answer the questions within the 15-minute time limit.
One mark will be granted for each correct answer.
Answer ALL questions. Marks are NOT deducted for incorrect answers.
At the end of the 15 minutes, hand in this Question Paper and the Text Booklet.
DO NOT remove OET material from the test room.

www.occupationalenglishtest.org
© Cambridge Boxhill Language Assessment – ABN 51 988 559 414 (2019)
 Part A

TIME: 15 minutes

• Look at the four texts, A-D, in the separate Text Booklet.

• For each question, 1-20, look through the texts, A-D, to find the relevant information.

• Write your answers in the spaces provided in this Question Paper.

• Answer all the questions within the 15-minute time limit.

• Your answers should be correctly spelt.

Psoriasis: Questions

Questions 1-6

For each question, 1-6, decide which text (A, B, C or D) the information comes from. You may use any
letter more than once.

In which text can you find information about

1 how much psoriasis ointment is required for various areas of a patient’s body?

2 what the skin of a patient with psoriasis looks like?

3 a way of determining whether a patient has psoriatic arthritis?

4 the consequences of not treating a disease which patients with psoriasis may go on to develop?

5 prescribing vitamin D for adults with psoriasis?

6 various conditions that may be confused with psoriasis?

Questions 7-14

Answer each of the questions, 7-14, with a word or short phrase from one of the texts. Each answer may include
words, numbers or both.

7 In addition to the arms and legs, which area of the body is most likely to be affected by chronic
plaque psoriasis?

8 In what age range does PsA typically develop in patients with psoriasis?

9 When treating psoriasis with very potent corticosteroids, how long should be left between courses?

 10 What may be prescribed as an alternative to coal tar preparation?

11 How much non-steroid cream should be prescribed for application to a child’s trunk?

12 What is the maximum amount of Calcipotriol to be prescribed to a 13-year-old per week?

13 What should be prescribed for a patient with facial psoriasis, which doesn’t respond to moderate
cortiocosteroids?

14 What is the maximum percentage of a young patient’s body to which Calcitriol may be applied?

Questions 15-20

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 patient with a fever in addition to pustules, plaques and red skin, may be suffering

from .

16 There is less of the skin if the patient has palmoplantar

psoriasis.

17 The CASPAR criteria should be applied to patients who are already diagnosed

with .

18 Poor formation of the , including pitting, can indicate PsA.

19 Around half of all patients with PsA will have pain in the joints.

20 If psoriasis on the flexures fails to respond to a mild corticosteroid within

, the treatment should be stopped.

END OF PART A
THIS QUESTION PAPER WILL BE COLLECTED