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OfficialGuidetoOET®
TEST®isaregisteredtrademarkofthe...
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TableofContentsOfficialGuidetoOET®
CoverTitlePageCopyrightHowtoUseThisBook
PartOne:TheBasicsChapter1:TakingOET
UnderstandingOETAnOverviewofOET
Chapter2:PreparingforTestDayStudyPlannerOETStudyPlannerOETStudyPlannerGeneralStrategiesforOETTipsfortheFinalWeek
PartTwo:TheListeningSectionListeningintro:SectionOverviewChapter3:ListeningPartA
ObjectivesStrategiesListeningPartA:PracticeSetAnswersListeningTranscripts
Chapter4:ListeningPartBIntroductiontotheVerbalSectionStrategiesListeningpartB:PracticeSetAnswersListeningTranscripts
Chapter5:ListeningPartCListeningPartCStrategiesListeningPartC:PracticeSetAnswers
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ListeningTranscriptsPartThree:TheReadingSection
Readingintro:SectionOverviewChapter6:ReadingPartA
ObjectivesStrategiesReadingPartA:PracticeSetAnswers
Chapter7:ReadingPartBObjectivesStrategiesReadingPartB:PracticeSetAnswers
Chapter8:ReadingPartCObjectivesStrategiesReadingPartC:PracticeSetAnswers
PartFour:TheWritingSectionWritingIntro:SectionOverviewChapter9:TheWriting
ObjectivesStrategiesWritingPracticeSetAnswers
PartFive:TheSpeakingSectionSpeakingintro:SectionOverviewChapter10:TheSpeakingTask
ObjectivesStrategiesSpeakingPracticeSetAnswers
PartSix:ThePracticeTestListeningSectionReadingSectionWritingSectionSpeakingSectionAnswers
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Specialthankstotheteamwhomadethisbookpossible:
CatAhlberg,EdwardAntram,KimBowers,LouiseCook,LindseyDew,ScarletEdmonds,JoannaGraham,BradHissey,BrianHolmes,SirkkaHowes,AmnaHussein,EleanorLindberg,NimeshShah,DavidWiltshire,KevinYang,AmyZarkos
TheOETlogoisaregisteredtrademarkofCambridgeBoxhillLanguageAssessmentPtyLtd,usedunderlicence.
Thispublicationisdesignedtoprovideaccurateinformationinregardtothesubjectmattercoveredasofitspublicationdate,withtheunderstandingthatknowledgeandbestpracticeconstantlyevolve.Thepublisherisnotengagedinrenderingmedical,legal,accounting,orotherprofessionalservice.Ifmedicalorlegaladviceorotherexpertassistanceisrequired,theservicesofacompetentprofessionalshouldbesought.Thispublicationisnotintendedforuseinclinicalpracticeorthedeliveryofmedicalcare.Tothefullestextentofthelaw,neitherthePublishernortheEditorsassumeanyliabilityforanyinjuryand/ordamagetopersonsorpropertyarisingoutoforrelatedtoanyuseofthematerialcontainedinthisbook.
©2018byKaplan,Inc.
PublishedbyKaplanPublishing,adivisionofKaplan,Inc.750ThirdAvenueNewYork,NY10017
AllrightsreservedunderInternationalandPan-AmericanCopyrightConventions.Bypaymentoftherequiredfees,youhavebeengrantedthenon-exclusive,non-transferablerighttoaccessandreadthetextofthiseBookonscreen.Nopartofthistextmaybereproduced,transmitted,downloaded,decompiled,reverseengineered,orstoredinorintroducedintoanyinformationstorageandretrievalsystem,inanyformorbyanymeans,whetherelectronicormechanical,nowknownorhereinafterinvented,withouttheexpresswrittenpermissionofthepublisher.
ISBN:978-1-5062-4725-010987654321
KaplanPublishingbooksareavailableatspecialquantitydiscountstouseforsalespromotions,employeepremiums,oreducationalpurposes.Formoreinformationortopurchasebooks,pleasecalltheSimon&Schusterspecialsalesdepartmentat1-866-506-1949.
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HowtoUseThisBook
ThisbookhasbeencreatedtohelpyouachievethehighestpossiblescoreinOET.Eachpartincludeseasy-to-learnstrategiesandrelevanttest-takingtips.There’salsoaweeklystudyplanner,accesstolisteningtracks,samplewritingtasks,andafulllengthPracticeTestwithWritingandSpeakingspecifictotheNursingandMedicinehealthcareprofessions.Followthestepsbelowtogetthebestusefromthisbook.
StepOne:ReadPartOne
Inthefirstpartofthisbook,youwillbegivenanoverviewofOET,learnwhattoexpectonTestDay,andlearnaboutthekeystrategiestohelpyouachieveahighOETscore.
StepTwo:FillOutYourStudyPlanner
OETisahighstakestest.Ifyouwanttoscorewell,youcannotsqueezeallofyourstudytimeintooneweek.Beforegettingstartedwiththeexercisesinthisbook,youshouldturntoPart2andfilloutyourstudyplannerwithrealisticstudygoals.YoushouldconsiderhowmanydaysyouhaveuntilyoutakeOET,andhowmuchtimeyouwillrealisticallybeabletodedicatetorevisingeveryday.Rememberthatifyouhaveworkedallday,youmaynothavetheenergytolearnnewstrategies.Instead,usethetimetorevisethepartsofthetestyouhavealreadymastered,andsavethemorechallengingpartsforwhenyouarefreshandrested.
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StepThree:SharpenYourSkills
ThisbookcontainsexercisesandstrategiesforcorrectlyansweringeachsectionofOET.Themostimportantstrategiesforyoursuccessarehighlighted,soyoucaneasilyrefertothem.Attheendofeachsection,youwillfindpracticequestions.
Onceyouhavecompletedthequestions,turntotheanswersandmarkyourwork.Checkthroughanyincorrectanswers,usingthelisteningscriptsatthebackofthechapterifneeded.
StepFour:UsetheOnlineAudio
PartTwoandthefulllengthPracticeTestattheendofthisbookincludeaudio.Registeronlineatkaptest.com/booksonlinetoaccessyouraudioandonlineresources.Onceyou’veregistered,accessyouraudioandresourcesatkaptest.com/loginordownloadtheKaplanMobilePrepapponGooglePlayortheAppStoreforyourAndroidoriOSdevice.
StepFive:TakeKaplan’sOETPracticeTest
AfterpractisingthestrategiesforOET,youshouldusethePracticeTestasatestrunfortherealthing.Aftertakingthetest,usetheanswerkeytoscoretheListeningandReadingsectionsofyourPracticeTest,andusethemarkingcriteriafortheSpeakingandWritingsectionstogradeyourwork.
StepSix:Review
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ReturntoPartsTwo,Three,FourandFiveofthisbook,andreviewthosesectionsofthetestwhereyourperformancewasweak.ReadtheTipsfortheFinalWeektomakesureyouarefullypreparedonTestDay.
Followthesesixsteps,andyoucanbeconfidentthatyouaretrulyreadyforOET.
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THEBASICS
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CHAPTER1
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TakingOET
INTHISCHAPTER
UnderstandingOETHowandWhereOETisadministeredAnOverviewofOET
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UnderstandingOET
BeforegettingstartedwiththecontentofOET,let’slookatsomebackgroundinformationaboutthetest.
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WHATISOET?
TheOccupationalEnglishTest(OET)wasdevelopedtotesthealthcareprofessionals’Englishcommunicationabilities.OETtestsEnglishlanguageabilityinfourareas:Listening,Reading,WritingandSpeaking.Test-takerswillneedtodemonstratetheirabilitytounderstandandanswerquestionsaboutgeneralhealthcareconsultationsandpresentations,inadditiontotextsinageneralhealthcaresetting.Test-takersarerequiredtowriteaccurate,professionalletterswiththeaidofpromptsandusespeakingpromptstocarryoutappropriateandeffectiveconversationswithpatients,relatingtospecifichealthcareprofessions.
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WHOPRODUCESOET?
OETwasdevelopedbyProfessorTimMcNamaraattheUniversityofMelbourne.IthasbeenownedandproducedbyCambridgeBoxHillLanguageAssessmentTrust–aventurebetweenCambridgeEnglishandBoxHillInstitute–since2013.
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WHICHVERSIONOFOET?
OETcanbetakenbyhealthcareprofessionsinanyofthefollowing12professions:Dentistry,Dietetics,Medicine,Nursing,OccupationalTherapy,Optometry,Pharmacy,Physiotherapy,Podiatry,Radiography,SpeechPathology,andVeterinaryScience.TheReadingandListeningpartsofthisbookarerelevanttoall12healthcareprofessions.TheSpeakingandWritingpartsofthisbookcoverNursingandMedicinespecifictestcontent.Pleasenotethatifyouareahealthcareprofessionalfromadifferentprofession,theSpeakingandWritingsectionsofyourtestwillvaryfromthecontentprovidedinthisbook.
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WHENWASOETUPDATED?
InSeptember2018,CambridgeBoxhillLanguageAssessmentlaunchedanupdatedformatofOETintheReadingandListeningsectionsofthetext,tomoreaccuratelyassesstheEnglishlanguageabilitiesoftest-takersinahealthcaresetting,andcreateadditionalassessmentcriteriafortheSpeakingTest.Thisbookdiscussesthe2018OETtestformat.
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HOWTOAPPLYFOROET?
YoucanapplytotakeOETbyvisitingwww.occupationalenglishtest.org/apply-oet/.WhenyouregistertotakeOET,youmightonlybeabletoselectfromthenexttwoavailabletestdates,soyoushouldaimtobeginrevisingforthetestbeforeapplying.Toapplyonline,youwillneedtorefertoanidentificationdocumentanduploadacolourpassportphotographofyourself.
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AnOverviewofOET
FormatandContent
OETisapproximately2hoursand45minuteslongandconsistsof42Listeningquestions,
42Readingquestions,2Speakingrole-playsand1Writingtask.ThefollowingchartgivesabreakdownoftimesforeachpartoftheOET
Test
Section
Time Testscandidate’sabilityto
Listening 40minutes listenandunderstandarangeofrecordingsonhealthcaretopicsfrom
differenthealthcaresettings.
Reading 60minutes readandunderstandvarioustextsonhealthcaretopicsfromdifferent
healthcaresettings.
Writing 45minutes writealetter,usuallyareferralletterusinginformationprovidedinpatient
casenotes.
Speaking 20minutes communicatewithapatientinareal-lifecontextthroughtheuseofrole-
plays.
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SCORING
InOET,candidatesreceiveanumericalscorerangingfrom0to500inten-pointincrements(e.g.350,360,370…).Thenumericalscoreswillbemappedtoaseparatelettergradeforeachsectionofthetest,rangingfromA(highest)toE(lowest).Thereisnooverallgrade
Previous
OET
grading
New
format
OET
scores
from
September
2018
OETbanddescriptors IELTS
equivalent
bandscore
A
Cancommunicateveryfluentlyandeffectivelywith
patientsandhealthprofessionalsusingappropriateregister,
toneandlexis.Showscompleteunderstandingofanykind
ofwrittenorspokenlanguage. 8.0–9.0
B
Cancommunicateeffectivelywithpatientsandhealth
professionalsusingappropriateregister,toneandlexis,
withonlyoccasionalinaccuraciesandhesitations.Shows
goodunderstandinginarangeofclinicalcontexts.
7.5–7.0
500
490
480
470
460
450
440
430
420
410
400
390
380
370
360
350
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C+
Canmaintaintheinteractioninarelevanthealthcare
environmentdespiteoccasionalerrorsandlapses,and
followstandardspokenlanguagenormallyencounteredin
his/herfieldofspecialisation.6.5
C 6.0–5.5
D
Canmaintainsomeinteractionandunderstand
straightforwardfactualinformationinhis/herfiledof
specialisation,butmayaskforclarification.Frequent
errors,inaccuraciesandmis-oroveruseoftechnical
languagecancausestrainincommunication.
Lessthan5.5Canmanagesimpleinteractiononfamiliartopicsand
understandthemainpointinshort,simplemessages,
providedhe/shecanaskforclarification.Highdensityof
errorandmis-oroveruseoftechnicallanguagecause
significantstrainandbreakdownsincommunication.
340
330
320
310
300
290
280
270
260
250
240
230
220
210
200
190
180
170
160
150
140
130
120
110
100
90
80
70
60
50
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E 40
30
20
10
0
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TIMING
OETisatimedtest.Thismeansthatyourscoregreatlydependsonbeingabletocompletethequestionswithinthetimeallowed.
Wewillindicatetheamountoftimeyouwillbegiventocompleteeachpartofthe
testatthebeginningofeachchapter.IntheListeningTest,youwillnotneedtotimeyourself,asyouwillbeadvisedwhentoanswerquestionswhileyoulistentotherecording,butyouwillstillneedtokeepupwiththepaceoftherecording.Atfirst,youmaynotfeelyouhaveenoughtimetoanswerthequestionsandcompletethetasks
effectively.However,bypractisingthestrategiesinthisbook,youshouldbeabletogetthroughallofthe
testquestionsinthetimeprovided.Rememberthatevenifyouarenotabletocompleteawholesectionwithinthetimelimit,youshouldstillincludeananswer–evenifitisaguess.Youmaychoosethecorrectanswerbychance,andgainanadditionalpoint;ifyouleavethosequestionsunanswered,youwillreceivenopoints.
Asyougothroughthebook,payattentiontotheamountoftimeyouspendansweringquestionsandcompletingtasks;notewhenyouaremovingtooslowly,andpractisespeaking,writingandansweringquestionsmorequickly.WhenyouarereadytotakethePracticeTest,besuretotimeyourselfverycarefully,togiveyourselfthemostrealistic
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testexperiencepossible,andtoshowyouexactlywhereyouneedimprovement.
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CHAPTER2
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PreparingforTestDay
INTHISCHAPTER
StudyPlannerGeneralstrategiesforOETTipsforthefinalweekStressbusters
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StudyPlanner
Lookatthetemplateforafive-weekcalendaronthefollowingpage.Youcanaccessaprintableversionofthiscalendartousetoplanyourstudyschedule.Youshouldusetwoofthesecalendartemplatestofillinaspecificstudyscheduleforatenweekperiod.BerealisticabouttheamountoftimeyouhavetostudyandpractiseyourEnglishlanguageskills.Updateyourscheduleasnecessary.
DonotforgettoscheduletimetotakethePracticeTest,markyourPracticeTest,andreviewanypartofthetestwhereyoustruggledalongwithyourscheduleforlookingthroughtherestofthebook.TakethePracticeTestafteryouhavelookedatalloftheotherchaptersofthebookandcompletedalloftheexercises.TakethePracticeTestasifitweretherealthing:findaquietplacewhereyouwillnotbeinterrupted,andtakeitinonesession.Timeyourselfaccurately.Thiswillhelptoprepareyoufortheactualtest.
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GeneralStrategiesforOET
LookthroughthetipsinthissectiontomakesureyouareawareofthepracticalstepsyoushouldtakebeforeTestDay.Thissectionalsocontainstipsonhowandhowoftentorevise.AllOETtesttakersarealreadyfamiliarwithhighpressuretestsituations,buteachtestisdifferent,andrequiresdifferentpreparationandmaterials,somakesureyou'reawareofwhatyouneedtodobeforeyoutakethetest.
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TipsfortheFinalWeek
Intheweekbeforeyourtest,youshoulddothefollowing:
Recheckyourregistrationforaccuracy;contacttheOEThelpdeskifthereareanyproblems.Visitthetestvenueifpossible.Itcanbehelpfultoknowhowlongittakesyoutogetthere,andtoseethetestvenuewhereyouwillactuallytakeyourtest.PractiseworkingontestmaterialasifitwereTestDay.LookatyourresultsfromthePracticeTestandcontentinthisbook,andidentifyyourstrengthsandweaknesses.UsethelastweekbeforeTestDaytofocusonyourweakerareas,andrereadthosechaptersofthisbook.
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THEDAYBEFORETESTDAY
Trytoavoiddoingintensivestudyingthedaybeforethetest.Ashealthcareprofessionals,youarelikelyrevisingforthetestalongsideabusyworkschedule.Onthedaybeforethetest,youarelikelytoalreadyknowallyouneedtoabouttakingOET.Insteadoftryingtolearnnewinformation,youmightfindithelpfultoreviewkeystrategies,prepareeverythingyouwillneedforTestDay,andtrytofindsomefreetimetorelax.
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TESTDAY
Plantoarriveearlyatyourtestvenue;theadministratorswillnotadmitlatecomers.Makesureyouhaveyourtestkitwithyou,especiallyyourID.
Duringthetest,trynottothinkabouthowyouareperforming.Instead,focusonthetaskofprovidingthecorrectanswer,readingandlisteningactively,andspeakingandwritingclearly.Thinkabouthowwellyouhaveprepared,andbeconfidentandpositiveaboutyourabilities.
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AFTEROET
AfterallyourhardworkinpreparingforOET,besuretocelebrateonceitisover.Gettogetherwithyourfamilyandfriends,relax,andhavefun.Youhavealottocelebrate:Youpreparedforthetestaheadoftime.Youdidyourbest.You’vedoneallyoucantogetagoodscore.
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BeforetheTest
Asaqualifiedhealthprofessional,youarealreadyusedtorevisingforandpassingdifficulttests,anddealingwithstress.However,OETisanEnglishlanguagetest,andwillrequireyoutoprepareinaslightlydifferentwaythantheprevioustestsyouhaveencountered.Herearesometipsforpreparingyourselfaheadofyourtest,soyoucanperformwellonTestDay.
MakeEnglishaPartofEveryDay
SurroundyourselfwiththeEnglishlanguageintheweeksandmonthsleadinguptoyourtest.GetinthehabitofreadingorlisteningtosomethinginEnglisheveryday,andwritingandspeakinginEnglishaboutwhatyouhavelearned.Theseactivitiesshouldbecompletedseparatlyfromyourstudytime.EvenjusthalfanhourofpractisingeachdaywillhelpyoutoimproveyougeneralEnglishskills.Evenmoreimportantly,youwillbecomemoreandmorefamiliar,andthereforemorecomfortable,withEnglish.ThelevelofcomfortyouhavewithEnglish,whetheryouarelistening,reading,writingorspeaking,willhelpreducestressandnervousnesswhenyoutakeOET.
Talk
TalktofriendsorcolleagueswhoaretakingOET,orhavealreadytakenit.Sharingyourstrategies,andhearingtheirexperienceswithrevisingforandtakingthetestwillhelpyoutogetreadyforTestDay.Rememberthereisn'tonestrategythatwillworkforeveryone.Trythestrategiessuggestedbyyourfriendsandcolleaguesbutalsofeelconfidenttodevelopyourownortousetheones
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suggestedinthisbook.IfyoudodiscussOETwithcolleagueswhohavealreadytakentheOET,rememberthattheformatofthetesthaschangedovertheyears,somakesuretocheckwww.occupationalenglishtest.orgtoconfirmthatyouknowwhattoexpectforyourtest.
TakeaBreak
Rememberthatinordertolearnsomething,itisnecessarytogiveyourselfabreakeverysooften,toallowyourmindtoprocessnewinformation.Healthcareprofessionalsareusedtoworkinglongshifts,andabsorbinglargeamountsoffactualinformation,butimprovinglanguagerequiresadifferentapproach.Makesureyougiveyourselftimetohaveabreak,frombothOETrevisionandwork.Theeasiestwaytodothisistostartrevisingattheearliestopportunity,sothatyouhaveenoughtimetoreadthroughalloftheinformationinthisbook,andstillgiveyourselftimetorelax.
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DURINGTHETEST
OETrequiresahighlevelofconcentrationandquickresponses.Yourstateofmindasyoutakethetestwillaffectyourscore.HerearesometipsforperformingyourbestasyoutakeOET.
KeepMoving
WhenyoufindyourselfstuckduringOET,whetheryou’restrugglingtounderstandwhataspeakerissayingintheListeningTest,tryingtofindmeaninginadifficultparagraphintheReadingTest,ortryingtorememberthecorrectwordorphrasetouseintheSpeakingandWritingTests,remindyourselfthatitisokaytomakesomemistakesonOET.Youdonothavetogeteverythingrighttoachieveagoodscore,sodonotspendanexcessiveamountoftimeonaquestionthatistoodifficultforyou,ortryingtorememberaphrasetouse.Makeaneducatedguess,orexplainwhatyoumeanasbestyoucan,andthenmoveon!
Concentrate
Othertesttakersmayseemtobeworkingmorebusilythanyouare,butdonotpayattentiontothem!Otherpeople’sactivitylevelsarenotnecessarilysignsofprogressorhigherscores.Continuetoworkcarefullyandthoroughly,andaimtoanswerthequestionswithinthetimelimit.
ThinkPositively!
WhiletakingOET,remindyourself:
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Youdonothavetogeteverysinglequestionrighttoachieveahighscore.Byhavingstudiedthestrategiesinthisbook,youarebetterpreparedthanthemajorityofothertesttakers.Youareprobablydoingbetterthanyourealise.
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THELISTENINGSECTION
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ListeningIntroduction
SectionOverview
TheOETListeningTestconsistsofthreeseparatepartswithatotalof42questions,andlastsaround40minutes.Youonlyheareachrecordingonce,soyoushouldfamiliariseyourselfwiththeformatofeachofthethreeseparatepartsinthissectionbeforeTestDay.Allofthelisteningcontentisappropriateforhealthcareprofessionalsinanyofthe
12different
professions,anddoesnotrequirespecialistknowledgeinaparticularhealthcarefield,thoughthelisteningcontenttestsyourlevelofEnglishinahealthcare-specificenvironment.
ThethreedifferentpartsoftheListeningTest
aredescribedbelow.
InPartAyouheartwodifferentconsultationsineachofwhicha
healthcareprofessionalistalkingtoapatient.Thereisonenote-completiontaskwith12gapstofillforeachconsultation.PartAlastsaround10minutes
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Beforeeachrecording,youhearinformationaboutthecontextandinstructionsaboutwhatyouhavetodo.Thisinformationwillalsobeprintedonyourtestpaper.Beforeeachrecording,youhavetimetoreadthroughthequestionsandthinkaboutwhatyou'regoingtohearbeforeyouanswerthequestions.
andtestsyourabilitytounderstandandrecordspecificinformationaboutpatients.
InPartByouhearsixdifferentextractsfromtheworkplace.Ineachextract,youhear
healthcareprofessionalseithertalkingtoeachother,ortoapatient.Thereisonemultiple-choicequestiontoanswerabouteachextract.ThisPartlastsaroundtenminutesandtestsyourabilitytounderstandeverydayworkplaceinteraction.
InPartCyouheartwolongerrecordings.Eachrecordingiseitheranintervieworaworkplacepresentationonatopicrelatedto
healthcare.Therearesixmultiple-choicequestionstoanswerabouteachrecording.Thispartlastsaround15minutesandtestsyourabilitytounderstandthespeaker’sideasandexperiencesrelatedtothetopic.
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LISTENINGSTRATEGIES
TheOETListeningTestisafixedformattestwithstandardisedinstructions.TheinstructionsyouseeinthisbookaretheinstructionsyouwillreceiveonTestDay.Youshouldmakesureyouarefamiliarwiththeseinstructions,soyouknowwhattoexpectaheadofyour
test.
ThetopicsintheListeningTestareofgenerichealthcareinterest,accessibletocandidatesacrossallprofessions.UsethetimeyouaregivenbeforeeachtaskintheListeningTesttolookatthequestionsandthinkaboutwhatyou‘regoingtohear.YoucanusethisinformationinPartAandCtohelpyouunderstandthestructureoftherecordingyouwillhear,andinPartB,youshouldreadthroughthequestionssothatyouknowwhatinformationandideasyou’relisteningforwhenyouheartherecording.Youmayfindithelpfultounderlineimportantwordsinthequestionfor
Multiple-Choicequestions,andunderlineimportantwordsthatappearbeforeandafterthegapsinNoteCompletionquestions.
YouonlyheartherecordingforthetasksintheListeningTestonce,soyouwillneedtorecordyouranswersasyoulisten.MakesureyoufillinallofthegapsinPartA,andselectananswerchoiceforallofthequestionsinPartsBandC.Youwillnotlosemarksforincorrectanswers.Don’tworryifyoumissananswerasyouworkthroughthetask–continueto
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moveforwardwiththerecording,otherwiseyouwillmissthenextquestion,too.Onceyou’vefinishedthetask,youcanlookbackatthequestionyoumissed,selecttheanswerthatseemsmostlikely,andmoveon.ListentoEnglisheveryday.Youcanimproveyourlisteningabilitiesbylisteningtoarangeoflisteningmaterialsfromavarietyofsources,suchaspodcastsandvideos,ratherthanfocusingontest-relatedcontexts.Writeclearlyandlegibly–ifthe
assessorcan’treadwhatyouhavewritten,youranswerwon'tbemarkedascorrect.
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CHAPTER3
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ListeningPartA
LEARNINGOBJECTIVES
Bytheendofthischapter,youwillbeableto:
Listenfordetails,includingthepatient’ssymptoms,medicalhistoryandtreatment.Scanthenotestoidentifytheimportantwords.Identifythecorrectinformationinlongconsultations.PractisestrategiesforcompletingthenotesinListeningPartA.
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INTRODUCTION
InPartAoftheListeningTestofOET,youlistento2separateconsultationsandcompletenotesthatfollowthedetailsoftheconsultation,byfillinginthegaps.Thereare12gapsforeachconsultation.
EachconsultationinPartAlastsfor4to5minutes.Youhave30secondstolookthroughthenotesbeforetherecordingbegins,andyoumustanswerthequestionsasyoulistentotheconsultation.
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Strategies
KnowtheInstructions
Youshouldmakesureyouarefamiliarwithwhatyouhavetodobeforeyoutakethetest.Theinstructionslooklikethis:ListeningTest
TheListeningtesthasthreeparts.Ineachpartyou’llhearanumberofdifferentextracts.
You’llheareachextractONCEONLY.
PartA
Inthispartofthetest,you’llheartwodifferentextracts.Ineachextract,ahealthprofessionalistalkingtoapatient.
Forquestions1to24,completethenoteswithinformationyouhearintherecording.
Extract1:Questions1to12
YouhearaneurosurgeontalkingtoareferredpatientcalledHaleyWaterman.Forquestions1to12,completethenoteswithawordorshortphrase.
KnowtheFormat
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TheconsultationsyouhearinPartAarebetweenahealthcareprofessionalandapatient.Occasionally,thehealthcareprofessionaltalkswitharelativeofthepatient,insteadofthepatientthemselves.Thepatientspeaksmorethanthehealthcareprofessionalandmostoftheinformationinthenotescomesfromwhatthepatientsays.
Theconsultationbetweenthetwospeakerscoversanumberofaspectsofthepatient'sconditionandtreatment.Youshouldusethe30secondsofsilencebeforethePartAconversationbeginstoreadthenotesandthinkabouttheinformationthatyou'relisteningfor.
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READTHENOTESBEFORETHERECORDINGBEGINS
OnTestDay,youhave30secondstoreadthroughthenotesforeachPartAconsultation,beforetherecordingbegins.Usethistimewisely,tomakesurethatwhentherecordingbegins,youareanticipatingthetypeofinformationyouneedtolistenfortofillthegaps,suchasasymptom,aformofmedicationoratypeoftreatment.
Asyoulookthroughthenotes,makesuretoconsiderthefollowingpoints:1.Whatisthestructureoftheconsultation?
Lookattheheadingsandsub-headingsinthenotestounderstandtheorderoftheinformationyouaregoingtohear.Thiswillhelpyoutofollowtherecordingasyoulisten,andkeepyourplaceinthetask.
2.Whattypeofinformationisneededinthegap?
Lookatthenotesandthinkaboutthetypeofinformationthatismissing.Forexample,ifthenotesbeforethegapsaythatsymptomsare‘describedas’something,thistellsyouthatyou‘relisteningforthepatient’sactualwords,sothat'swhatyoushouldlistenfor.
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IDENTIFYINGIMPORTANTINFORMATIONINTHENOTES
Someoftheinformationinthenoteswillassistyourunderstandingofwhattypeofinformationyouneedtocompletetheblanks.Forexample,ifthenotessay‘patientdiagnosedwith(1)afterreportingextremebackpain’,theimportantwordsare‘diagnosedwith’,whichsuggeststhatyouneedtolistenoutforaparticularcondition,and‘extremebackpainandnumbness’,whicharethesymptomsyouneedtolistenoutforinthepatient’sspeech.Fromtheinformationinthenotes,wecanpredictthatthepatientcouldsaysomethinglike:Iwenttothedoctor’sbecauseIwashavingthisreallyterriblepaininmyback,andalsothisnumbnessinmylegs.Afterdoingsometests,theysaidIhadsciatica.
Theunderlinedwordsshowhowthemeaninginthenotesispresentedinthepatient’sspeech:theybeginbydescribingtheirsymptoms,andthentheyrefertothediagnosis.Thewordinboldmustbethegapinthenotes,asthebackpainandnumbnesstheyexperiencedledtoadiagnosisofsciatica.
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Exercise
Take20secondstolookatthenotesbelow,andunderlinethewordsthatwouldhelpyoutolistenforthe3gapsinthenotes.
Treatment Beganbytakingorlistatandfollowingthediet(limiting(1),lotsofvegetables)
After6months,beganexercisinggently,butfounditdifficultdueto(2).
After12months,nosignificantsustainedweightloss.
Underwent(3)in2014-nocomplications.
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Now,giveyourself20secondstolookthroughthenotesbelow,thenanswerquestions4–7.
Patient FelixLeak
(A) diagnosedwithstage1testicularcancerin2015
underwentanorchidectomyinlate2015
alsogiven2cyclesofchemotherapyfollowingsurgery
(B) hasrecentlyexperiencedhaematuria
reportsfeelingtired,achingmuscles
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describesthepainas‘alwayssore,butbearable’
(C) worksasanexecutivedirectoratalawfirm
reportsanincreaseinwork-relatedstressfollowingarecentpromotionmoderatedrinker
historyofsmoking
(D) bookultrasoundscan
givebloodteststocheckfortumourmarkers
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EachconsultationinPartAlastsforaround5minutes,andusuallycoversthefollowingareasofinformation.
1.RecentMedicalHistory
4. Forsections(A)–(D)ofthetext,describethetypeofinformationbeingrecorded.
5. Howwasthepatient’scancertreated?
6. WhatisthemostlikelyreasonforFelix’srecentconsultation?
7. WheredoesFelixwork?
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RecentmedicalhistoryisacommontopicinPartAconsultations,asthissectionofthetestisdesignedtotestyourabilitytounderstandrealisticpatientlanguageinEnglish,andrelatingmedicalhistoryisacommonfeatureinconsultations.
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Exercise
ListentoTrack1,whichgivesanexampleofthissectionofaPartAconsultation,andanswerquestions8–11below.
2.OtherMedicalHistory
Youmayalsoneedtofillingapsinthenotesaboutthepatient’smoregeneralmedicalhistory.Thismightincludethepatient’scurrentmedication,lifestylechoices,andpastsurgeriesandillnesses.
8. Howlongagodidthepatient’ssymptomsbegin?
9. Whatwasthepatientdoingdifferently,asaresultofthesymptoms?
10. Inadditiontobeingtired,whatothersymptomsdidthepatienthave?
11. WhatdidDrLopez’sbloodtestsshow?
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Exercise
Take10secondstoscanthenotesbelow,thenplayTrack2,andfillinblanks12–15asyoulisten.
MedicalHistory (12)throughout2016(noproblems)
diagnosedwithanaemiaafterfeeling(13)andtired
sufferedfromheavyperiods
regularly(14)
brokearmand(15)(2004)
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3.CurrentSymptoms
Inthissectionoftheconsultation,thehealthprofessionalaskshowthepatientiscurrentlyfeeling.Patientsoftendescribetheirsymptomsineverydayterms,usingidiomsandphrasesthatmaybeunfamiliar.Itisyourtasktorecordwhatpatientssayabouttheseissues.Notallthemissinginformationwillbemedicalterms–sometimesyouwillneedtowritedowntheword(s)thepatientusestodescribethesymptoms.
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Exercise
Take10secondstoscanthenotesbelow,thenplayTrack3,andfillinblanks16–19asyoulisten.
PresentCondition taking(16)medicationforthepast3months.
headachesinforehead,describedas(17)
somenauseaafterfood
hotflushesandsweating(clammyhands)
troublesleeping,feeling(18),andparanoid
formerbehavioursarereduced
butisnow(19)aboutdifferentthings
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4.Treatment
Thissectionoftheconsultationdiscussesthepatient'scurrentandfuturetreatment.Thepatientmaydescribehowtheyhavebeenfindingtheirtreatment,ortheymaysimplydescribethetreatmenttheyhavebeenfollowingsofar.
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Exercise
Take10secondstoscanthenotesbelow,thenplayTrack4,andfillinblanks20–23asyoulisten.
Treatment given(20)byparamedicsonwaytohospital
morphineadministeredaspainrelief
(21)usedundertonguetoimprovebloodflow
observed(22)usinganEKGmachine
(23)procedureperformed
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InPartAoftheListeningTest,youneedtomakesureyoucankeepupwiththeconversationandunderstandthekeythingsthatthespeakersaresaying.FamiliariseyourselfwithcommonphrasesandidiomsinEnglish,andpractise-listeningtonativeEnglishspeakersuseeverydaylanguage,tohelpyouscorewellinthissectiononTestDay.
IMPROVEYOURSCORE
Findarecordingofaconsultationonlineandlistenandwritedownthe:
namesofsymptomsnamesofmedications
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IMPROVEYOURSCORE
Usethe30secondpausebeforetherecordingplaystofocusyourlistening.Underlinewordsandphrasesbeforeandafterthegapsinthenotes,andlistenforthisinformationwhentherecordingstarts,sothatyouarepreparedtolistenfortheanswer.
IMPROVEYOURSCORE
IntheListeningTest,youhearspeakersfromavarietyofEnglish-speakingcountries.YouarelikelytoheararangeofaccentsonTestDay,including:American,Australian,Canadian,UK,IrishandNewZealand.Theseaccentswillbemildandeasilyunderstood.SearchforpodcastsandvideosonlinecreatedinthesevarietiesofEnglishtomakesureyou’refamiliarwiththerelevantaccents,andareabletounderstandwhatthesespeakersaresaying.Thelisteningcontentinthisbookusesarangeofspeakerswithvariousaccentstohelpyoutoprepare.
namesoftests/treatmentoptions,etc.
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ListeningPartA:PracticeSet
Questions1to12
Take30secondstoscanthepatientnotesonthispage,thenlistentoTrack5andanswerquestions1–12.
Extract1:Questions1to12
YouhearanoptometristtalkingtoanewpatientcalledAidanFitzpatrick.Forquestions1to12,completethenoteswithawordorshortphrase.
Patient AidanFitzpatrick
Symptoms
BackgroundDetails
firstnoticeddifficultyreadingtwoweeksago
describeshisvisionas‘(1)’,
hasdifficultyreadingprintedletters
needsincreasingly(2)toreadinevenings
foundhewashavingtoholdobjectsclosertosee
purchasedglassesfrom(3)
oftenfindsthathe’s(4)hiseyes,evenwhenwearingglasses
whenstrugglingtosee,canalsoexperience(5)
Aidantreatspainwith(6)(fast-acting)
woreglassesasachild
brotheralsowearsglasses,possibly(7)
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MedicalHistory
NextSteps
recentlysufferedfrom(8)
treatedwithantibiotics—
stillexperiencingsymptomsof(9)—
lostexcessweightfollowinga(10)(describesas‘wakeupcall’)
isn’twillingtowear(11)
mustbegiven(12)(neverhadone)
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EXTRACT1:QUESTIONS13TO24
Take30secondstoreadthroughthepatientnotesonthispage,thenlistentoTrack6andanswerquestions13–24.
Extract1:Questions13to24
YouhearanobstetriciantalkingtoanewpatientcalledHilaryJohnson.Forquestions13to24,completethenoteswithawordorshortphrase.
Patient HilaryJohnson
Reasonforreferral
Familyhistoryof
diabetes
Pregnancysymptoms
Occupation
glucosein(13)indicatesriskofdiabetes
describesherselfas(14)sugaryfoods
noticedextra(15)whichmaybeunrelatedtopregnancy
her(16)suffersfromdiabetes(Type2,controlledthroughdiet)
morningsickness–paininher(17),butnovomiting
(18)controlledwithmedication
recentlysufferingfrombackache,describedas‘(19)’pain
hasbeenfeelingincreasingly(20)
problemssleeping
concernedaboutdiet(takinga(21))
Secondaryschoolteacher
feeling(22),increasedworkload
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Nextappointment willtakean(23)glucosetest(she’sfamiliarwiththeprocedure,afriend’s
hadthetest).
hasbeengivena(24)toconsultaheadofherbloodtest
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IMPROVEYOURSCORE
PartAisdesignedtotestyourabilitytolisteneffectivelytopatients.Assuch,thegapsyouneedtofillininPartAaregenerallyfoundinthepatient’sspeech.Makesuretopayattentiontowhatthepatientsaysabouttheirtreatmentsofar,theirmedicalhistory,andtheircurrentsymptoms.
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Answers
1.diet,limiting(youwouldexpecttolistenforatypeoffoodthepatientnolongereatsregularly)
2.exercising,difficultdueto(youwouldexpecttolistenforsomethingthatmakesexercisinghard)
3.underwent,2014(youwouldexpecttolistenforaprocedurethepatienthadin2014)
4.medicalhistorycurrentsymptomslifestyleORpersonaldetailsnextstepsORtreatmentplan
5.orchidectomy
6.haematuria,tired,achingmuscles
7.
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alawfirm
8.2months
9.goingstraighttobed
10.gainingweight,troublefocusingandpayingattention
11.thyroxinewaslow
12.pregnant
13.dizzy
14.donatedblood
15.(acoupleof)ribs
16.fluoxetine
17.
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shootingpain
18.anxious
19.compulsiveOROCD
20.aspirin
21.nitro-glycerine
22.heartrhythms
23.angioplasty
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PRACTICESETS
Questions1to12
1.fuzzy
2.morelight
3.(the)pharmacy
4.squinting
5.(aprettypersistent)headache
6.ibuprofen
7.short-sighted
8.sinusitis
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Questions13to24
9.(a)cold
10.myocardialinfarction,orMI
11.contactlenses
12.(an)eyetest
1.urinesample
2.craving
3.weight
4.aunt
5.stomach
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6.heartburn
7.throbbing
8.tired
9.prenatal
10.(alittlebit)stressed
11.oral
12.leaflet
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ListeningTranscripts
Track1
F: Couldyoutellme,inyourownwords,what’sbroughtyouheretoday?M: Yes,ofcourse.Well,Iwenttoseemygeneraldoctor,DrLopez,
becauseI’dbeenfeelingreallytired.Ithadbeengoingonforabouttwomonths,thoughIhadn’tbeentohimsoonerbecauseIwasn’tsureitwasseriousenoughtowarrantavisittothedoctor’s–I’mgenerallythesortofpersonthatjustgetsonwiththings,youknow,Itendtoletmybodyhealitself–butitgottothepointwhereIwasgoingstraighttobedwhenIgothomefrommyjob,andnotwakingupuntilthemorning.AndI’dstillbetiredthenextday,despiteallthatsleep!IalsofoundthatIwasgainingweight,eatingthesameamountoffoodI’vealwayshad–maybeevenless.Ibecameabitofazombie,really.Ihadtroublefocusingatwork,andpayingattentiontowhatpeopleweresaying.Itwasmywifethateventuallygotmetogoandseethedoctoraboutit,shesaidIlookedlikeIwasonautopilot.Anyway,whenIsawDrLopezhegavemelotsofbloodteststoseeifIwaslackinginanything...mosteverythingturnedoutfine,butthebloodtestsshowedthatmy...Ithinkitwasmythyroxinelevels...wereonthelowside,soDrLopezreferredmetoyou.
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TRACK2
F: Well,otherthanthis,I’mnotsureI’veeverhadanyserioushealthproblems.IsupposeIhadtovisitthedoctorafairamountin2016,becauseIwaspregnantwithmydaughter...eventhatwasfairlystraightforward,therewerenocomplicationsorconcerns...then,Isupposealittlewhilebeforethat,Isufferedfromanaemia...Ifeltreallytired,andIhaddizzyspells.Therewereabunchofdifferentthingsthatthedoctorsthoughtmightbecontributingtoit:Iwashavingheavyperiods,andIdonatedbloodasoftenasthey’dletme...Ithinktheyalsomentionedthatcaffeinecouldbeanissue.IrememberthinkingitwasweirdthatIhadit,becauseatthetimeIwaseatingquitealotofredmeat,andIthoughtthatwassupposedtogiveyouplentyofiron.Anyway,assoonasIvisitedthedoctorstheysortedmeout...Otherthanthat,IsupposetheonlyhealthissueIcanthinkofisfallingoffabikein2004andbreakingmyarm.Ibrokeacoupleofribs,aswell,buttheytendtosortthemselvesout.Ihadtowearaslingforalongtime,withthatarm.Sometimesitachesslightly;it’sbarelynoticeable,though,anditmightnotberelated.
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TRACK3
M: Ijustdon’tthinkthatmedicationisdoingmeanygood.Forthreemonths,eversinceIstartedtakingfluoxetine,I’vebeenfeelingreallybizarre...Igettheseterribleheadachesthatcomeandgo-it’slikeashootingpaininmyforehead-andIsometimesfeelnauseousaftereating...AndIkeephavingthesehotflushes,myhandswillgetclammy,andIfeelanxiousandstartshaking!Ifinditdifficulttosleep...ummwhenI’minbed,Igetkindofagitated,andI’llstartthinkingaboutallofthethingsthatwentwrongatwork,orthingsthatcolleaguessaidtome...well,perhapsIfeelabitparanoid,Idon’tknow.Ijustthinkit’sreallynotworthallthesesideeffects.IsupposeIengageinmyformerOCDbehaviourless,asaresultofthemedication?ButIthinkthatmightjustbebecauseI’mspendingmytimeworryingabouteverythingelse!It’slikeI’vejustswappedmyformerhabitsfornewones...I’mcompulsiveaboutdifferentthingsnow,likestressingatnight.Atleastbefore,myOCDwasonlyimpactingpartsofmyday...thesedrugs,though!They’remakingmylifesomuchmoredifficult.
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TRACK4
F: Okay,Mark,socanyoutellmeaboutwhathappenedwhenyouhadyourheartattack?
M: Yeahsure...Itallhappenedreallyquickly,butIrememberfeelingthisreallyweirdchestpain,likeatightnessinmychest,Itoldmywifemychestwashurting,andwhenImentionedIhadpainsinmyleftarmshecalledanambulanceimmediately...goodthingsheknew!SoIremembertheparamedicsputmeintotheambulanceandgavemesomeaspirin.TheytookmetotheERandtheretheygavemeamorphineshotforthepainIwasfeeling...umm...theyalsoputamaskonmeforoxygentohelpmebreath,andsomethingunderthetonguetohelp...Ithinkitwastohelpmyheartgetmoreblood.Itwascallednitroglycerin.Mywifewaswithme,Iremember,andshewasreallygreat,reallyhelpedmetokeepcalm,althoughshetoldmelaterthatshewasfreakingout!ThentheyhookedmeuptoanElectrocardiogram(ECG)machinetolookatmyheartrhythms.Evidentlyitmusthaveshowedsomekindofblockagebecausetheytookmetothecatheterlabstraightaway!Ihadtobeoperatedon,theycalleditanangioplasty,becauseIwashavingaheartattack.Thewaytheydescribedittome,itwasbasicallylikecleaningoutthepipesthatpumpedbloodtomyheartmuscle.TheysaidthatifI’dwaitedanylongertocallanambulance,theheartmusclewouldmostlikelyhavediedfromthelackofoxygen!
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TRACK5
N: YouhearanoptometristtalkingtoapatientcalledAidanFitzpatrick,whohasbeenexperiencingblurredvision.
F: HiAidan.I’mDrSalkeld...couldyoustartbytellingmeaboutwhat’sbeengoingonwithyourvision?
M: Sure...Well,Iguessitmust’vestartedawhileago,butIdidn’treallynoticeitproperlyuntilabout2weeksago.IwasworkinginmygardenandInoticedthatIwashavingahardtimereadingtheinstructionsonthegardeningproductsthatI’djustbought.InormallysticktotheoneI’vebeenusingforyears,butIthoughtit’dbenicetotrysomethingdifferent.Anyways,itkindoffeltlikeeverythingwasfuzzyaroundtheedges,andIjustcouldn’tseethelettersclearly.Aftertalkingtomydaughter,shementionedthatI’dbeenusingincreasinglymorelighttoreadatnightandevenpullingthingsclosertometoread.Ihadn’tevennoticed!SoIwentoutandgotsomeofthoseglassestheysellatthepharmacyandtheyhelped,butmydoctorsaidthatit’dbebetterifIcametoseeaneyedoctor...Welltheymadethingslessblurred,anyway,Iguess.Myvision’sstillnotcrystalclearoranythingwhenIusetheglasses,butIwasn’treallyexpectingthat.IstillnoticethatI’msquintingtoseethings...it’smostlywhenI’mtryingtoreadsomethingclose-up,likesmallwriting.I’mbetterwhenthingsareatadistance...Idon’tknowifit’srelated–butI’vealsonoticedaprettypersistentheadache...IguessIt’skindofatthesidesofmyhead,Isuppose.Itcomesandgoes,butit’sdefinitelyworstwhenI’mhavingtroubleseeingsomething.Whenitgetsreallybad,Ijusttakeafast-actingibuprofen,andthattendstosortitout.
F: Everhadanyvisionproblemsbefore?
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M: WhenIwaslittle,atsomepointinelementaryschool,IthinkIhadglasses,butI’msureIbrokethemandwejustnevergotroundtohavingthemreplaced.Mybrotherhasglassesthathe’sbeenwearingforyears,Idon’treallyknowawholelotaboutwhat’swrongwithhiseyes....maybehe’sshortsighted?Butthatremindsme,mybrotherthoughtIshouldmentionthatacoupleofmonthsorsoagoIwasreallyprettyill,Iwassufferingfromsinusitis.And,anyway,Ileftitprettylatetogoandseethedoctoraboutit.Kindofthoughtthatitwouldjustsortitselfout,anyway,itlingeredforawhile,sowhenItoldmydoctorhegavemesomeantibioticsanditclearedupprettyquicklyafterthat.Well,forthemostpart...althoughIstillfeellikeIhaveacold.OtherthanthatI’vebeeninreallygoodhealthforthelastfewyears.Itakemyhealthreallyseriously,I’mnotsureIfthedoctortoldyou,butIusedtobequiteoverweight,butIlostitallafterabitofawakeupcallsomeyearsback...Ihadwhatyouguyscallamyocardialinfraction...itwasprettyscary,andIwasquiteoverweightatthetime,andreallystressedoutaboutmyjob.SincethenI’vemadearealefforttolookaftermyselfproperly.
F: I’mgladtohearit.So,intermsofyourblurredvision,whatdoyouthinkmightworkforyou?
M: Well,Idon’tparticularlyliketheideaofwearingglassesallthetime,buttouchingmyeyesfreaksmeoutsocontactlensesaredefinitelynotanoption.IguessthebestthingmightbetojusthaveglassesthatIwearallthetimesoIdon’tkeepforgettingtoputthemonwhenIamoutsomewhereandnotathome.I’veactuallyneverhadaneyetest,soIshouldprobablyscheduleoneofthoseasanextstep.
F: Ithinkthatsoundsreasonable.Let’sdosometeststocheckoutyoureyesandgofromthere.
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TRACK6
M: HilaryJohnson?Hi,docomeinandtakeaseat.I’mDrSmithandI’maseniorobstetricianhere...So,Hilary,you’vebeenreferredtousbyyourmidwife.Ihavehernoteswithmehere,butcouldyoutellmeinyourownwordswhyyou’vebeenreferred?
F: Yeah,noproblem...umm,IthinkI’vebeenreferredtoyoubecausethemidwifesaidshefoundsomeglucoseinmyurinesampleandwasworriedaboutdiabetes.IfIunderstandcorrectly,Icouldhavediabetesduringmypregnancy,butifIdo,it’snotlikelytocontinueaftergivingbirth?I’venoticedthatI’mcravingsweetsandcakesallthetimeatthemoment,andI’vejustbeenlettingmyselfeatwhatever,soI’veputonabitofweight,andIdon’tthinkit’salljustbabyweight,either...I’veneverhadaproblemwithdiabetesbefore,andI’mhopingitwillturnouttobesomethingelse.Myauntactuallyhastypetwodiabetes,butshe’salwayseatenalotofsugar,soIthinkthatmightbeafactor.Shejustcontrolsherswithdietnowanddoesn’thavetotakeanymedication.
M: Oh.okay.Thanksforlettingmeknow...Iseefromyournotesthatyou’re24weekspregnantnow,howhasyourpregnancybeenuptonow?
F: Oh,I’vebeensolucky!Igottheusualsicknessearlyon–well,youknow,stomachpain,butnotactuallybeingsick–Ithinkthat’sprettycommon,anditsettledafterthefirsttrimester.I’vebeentakingsomemedicationbecauseIalsohadprettyhorribleheartburn,anditseemstotakecareoftheproblem...andalsoI’vestartedtogetabitofbackpaininthelastweekorso...I’dsayit’slikeathrobbingfeelingbutotherthanthatI’vebeenprettyfortunate.IsupposeI’vebeengradually
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gettingmoreandmoretiredsincethestartofmypregnancy.I’vejustputitdowntotheextraenergymybabyneeds,butitcouldalsobebecauseIhaven’tbeensleepingverywell.Also,sometimesthenauseastopsmefrommakingsomethinghealthyfordinner,whichisannoyingbecauseIknowIneedtoeathealthily.Itakeaprenatal,though,tomakesureI’mgettingtherightnutrition.
M: Well,itseemslikeyou’remanagingtodealwithmostofyoursymptomswell.
F: Yeah,thisismyfirstpregnancyandtobehonestIdidn’thaveacluewhattoexpectbutsofarsogood.It’sonlythisglucosethingthat’sgotmeworried,Iimagineit’sjustaoneoffbutIguessit’sbesttogetitseento.
M: Certainly,andI’mpleasedyou’reheresothatwecangetthingssorted.So,we’llneedtobookanotherappointmenttocarryoutsometests.
F: Okay,sowhenwillIhavetohavethisbecause,I’mabitbusyatworkattheminute?
M: Wellideallyassoonaspossible.CanIaskwhatyoudoforaliving?F: I’mahighschoolteacherandit’sjustgettingtothattimeofyearwhere
thekidsaregearingupfortheirexaminations.SoIcan’taffordtobetakingtoomuchtimeoffduringtheday.I’mactuallyalittlebitstressedatthemomentaswell,I’vehadtodoalotmoreworkoverthepastfewweeks...Ithinkit’sjustthattimeofyear.I’vebeenateacherfor4yearsnowsoI’mstartingtodevelopwaysofcopingwiththemadness.Withthatinmind,ifournextappointmentcouldbeatfive-ishorlater,thenthatwouldbeperfect.
M: Noproblem,justmakesuretoletthereceptionistknowyourpreferences.Whenwefindsugarinpreliminarytestsweofferanoralglucosetolerancetest,whichiswhatwe’lldowhenyoucomeinnext.Doyouknowwhatthatinvolves?
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F: Well,IaskedafewofmyfriendsabouttheirpregnanciesandmyfriendBethsaidthatshehadthesamethingandtoldmeaboutthattest.Shesaidthatshehadtocomeintothehospitalanddrinkasugarydrinkandthenhaveabloodtesttotellifshehaddiabetes.Isthatright?
M: Yesthat’sprettymuchit.Hereisaleafletthatexplainsthetestsothatyoucanhaveareadaboutitwhenyougethome.Doyouhaveanyotherquestionsforme?
F: NoIdon’tthinkso,I’llgoawayandreadthis,andwaitandseewhatthetestsays.Thankyouforyourhelptoday.
M: You’rewelcome.I’llseeyouoncewehavetheresultsandwecantakeitfromthere.
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CHAPTER4
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ListeningPartB
LEARNINGOBJECTIVES
Bytheendofthischapter,youwillbeableto:
Identifythequestiontype.Choosetheanswerthatrelatestothespokeninformation.PractisestrategiesforansweringGist,Detail,SpeakerPurpose,Function,OpinionandCourseofActionquestions.
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INTRODUCTION
InPartBoftheListeningTest,youlistento6differentshortrecordingsinahealthcaresettingandansweronequestionabouteachrecording.ListeningPartBtestsyourabilitytounderstandandidentify:
Eachofthe6shortlisteningtasksinPartBlastsforaround45seconds,andtherecordingisheardonlyonce.Therecordingwillcoveraworkplaceinteractioninvolvinghealthcareprofessionals,suchasabriefingorhandover.Youhave15secondstolookatthequestionbeforeeachindividualrecordingand5secondstomarktheanswerafterhearingtheworkplacecommunication.
IMPROVEYOURSCORE
ThereisonlyonequestionforeachrecordinginPartB.Usethe15secondpausebeforetheaudiobeginstofocusonthequestionbeingasked,andthinkabouthowthisquestioncouldbeanswered.
thegistoftherecordingspecificdetailswithininteractionsthespeaker’spurposetheopinionofthespeakertheactionsthatwillresultfromtheworkplacecommunication
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Strategies
KnowtheInstructions
Youshouldmakesureyouarefamiliarwithwhatyouareaskedtodobeforeyoutakethetest.Theinstructionslooklikethis:InPartBoftheListeningTest,you’llhearsixdifferentextracts.Ineachextract,you’llhearpeopletalkinginadifferenthealthcaresetting.
Forquestions25to30,choosetheanswerA,BorCwhichfitsbestaccordingtowhatyouhear.
KnowtheContext
PartBoftheListeningTestcontains6differentrecordings,eachfromadifferenthealthcaresetting.Therecordingsinthispartofthetestshouldbefamiliartoahealthcareprofessionalfromanyofthe12sectorscoveredbyOET,becausePartBtaskshavegeneric,hospital-basedcontexts.
Therecordingsyouhearinthissectionwillcontainoneortwospeakers.Thereisalwaysatleastonehealthcareprofessionalineachrecording,andeachrecordingwillgiveanexampleofaneverydayworkplaceinteractioninarangeofcontexts.
PreparefortheDifferentQuestionTypes
Usethe15secondsbeforetherecordingbeginstoanalysethequestion.Don’tlookatanyofthefollowingquestionsduringthistimeperiod,justfocusonthe
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questionfortherecordingyouareabouttohear.Whenyoulookatthequestion,underlinewordsthatwillhelpyoutolistenfortheanswer.
Thereare7differentquestiontypesinListeningPartB:Gist,Detail,SpeakerPurpose,Function,Opinion,AgreementandFutureActions.
1.Gist
Gistquestionsaskyoutochoosetheoptionthatcorrectlysummarisestheinformationheardintherecording.Toanswerthesequestions,youneedtoidentifytheidea,orgist,oftheinteraction.Thisquestionislookingforanoverviewoftheinformationgivenintheaudio,notaspecificdetail.Theanswerchoiceswillreporttheinformationintherecordingwithoutrepeatingtheexactwords.ThisisthemostcommonquestiontypeinthePartBsectionoftheListeningTest.ThefollowinglistgivesexamplesofGistquestions:
Whatarethenursestalkingabout?TheaimoftheresearchwasThevetisexplainingthat
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Exercise
PlayTrack7andanswerquestions1and2.
1. Youhearadentistdiscussingbookingproblemswithherreceptionist.
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Whathascausedtheproblem?
anerrorwiththebookingsystem(A)adoublebookedappointment(B)alackofcommunication(C)
2. YouhearadoctordiscussingchestX-rayinformationwithamedicalstudent.
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Whatisthedoctorexplaining?
theorderfordiscussingresultstothepatient(A)theinformationtoincludeinpatientnotes(B)howtocorrectlyexaminethepatient’scondition(C)
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2.Detail
Detailquestionsaskaboutaspecificpartoftherecording.Thedetailaskedforisoftenoneofthecentralideasintherecording,ratherthanamoretrivialpieceofinformation.Youheartheinformationthatallowsyoutoanswerthequestion–butthequestionmayormaynotusetheactualwordsheardintherecording.ThefollowinglistgivesexamplesofDetailquestions:
Whatwouldhaveimprovedthetrainee’sperformance?Thepatient’smedicationhaschangedbecauseWhatstrategydoesthesurgeonsuggest?
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Exercise
PlayTrack8andanswerquestions3and4.
3. YouhearanENTsurgeontalkingtoacolleagueaboutcochlearimplants.
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Thesurgeonisexplainingthatcochlearimplants
transmitvoicesmoreclearlythanothernoises.(A)emitavarietyofsoundsintoamicrophone.(B)restorehearingindeafpeople.(C)
4. YouhearaGPtalkaboutdiagnosingType2diabetesmellitus.
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3.SpeakerPurpose
Whyshouldafastingplasmaglucosetestbebookedinthemorning?
Thepatientwillneedtoattendan8hourappointment.(A)Thetestwillneedtobecarriedouttwice.(B)Toallowthepatienttoeatduringtheday.(C)
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SpeakerPurposequestionsaskaboutwhatoneofthespeakersisdoing,ortryingtodo.Toanswerthesequestions,youneedtounderstandwhythespeakerissayingwhattheyaresaying,andwhatresultthespeakerisaimingfor.ThefollowinglistgivesexamplesofSpeakerPurposequestions:
Whatdoeshewanttoknowabouthistreatment?ThedoctorexplainsthatthepracticeshouldThetraineeistryingtounderstand
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Exercise
PlayTrack9andanswerquestions5and6.
5. Youhearadentisttalkingtoapatientwithachippedtooth.
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Whatdoesthepatientwanttoknow?
howlongtheprocedurewilllast(A)whenhernextappointmentwillbe(B)whatherdifferenttreatmentoptionsare(C)
6. Youhearapodiatristtalkingtoapatientwithfallenarches
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4.Function
Thepatientexplainsthathistreatment
willneedtocontinueforsometime.(A)hasbecometootime-consuming.(B)isnotimprovinghiscondition.(C)
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Functionquestionsaskaboutwhatoneofthespeakersisdoing,orwhatthefunctionofwhattheyaresayingis.Toanswerthesequestionscorrectly,youneedtounderstandtheactionsthattheirlanguagedescribes.ThefollowinglistgivesexamplesofFunctionquestions:
Whatisthedentistdoing?Whyhasthepatientcalledthedoctor?
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Exercise
PlayTrack10andanswerquestions7and8.
7. Youhearadoctortalkingtoapatientinanemergencydepartment.
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Whatisthedoctordoing?
explaininghowthepatientwillbetreated(A)reassuringthepatientthatsheisnotatrisk(B)goingoverthecauseofthepatient’sinfection(C)
8. Youhearamedicalstudenttalkingtoaseniorresidentaboutassessingapatient.
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Whatistheseniorresidentdoing?
teachingthestudenthowtoexaminethepatient(A)explainingwhentoprescribeadditionalmedications(B)showingthestudentwheretoobservethejugularvein(C)
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5.Opinion
Opinionquestionsaskyoutoidentifytheopinionofaspeakerontheissuediscussed.WhenansweringOpinionquestions,payattentiontohowthespeakerssaythings,andtheirattitudetowardsthetopicinthequestion.ThefollowinglistgivesexamplesofOpinionquestions:
TheradiographerthinksthatthepatientHowdoesshefeelaboutherrole?Thenursebelievesthatthedoctor
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Exercise
PlayTrack11andanswerquestion9.
9. Youhearapsychiatristpresentingacasestudy.
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6.Agreement
Agreementquestionsaskyoutoidentifywhatthespeakersareinagreementabout.Toanswerthesequestionscorrectly,listentotheconversationandpayattentiontothereactionsofeachspeakertotheother’ssuggestions.ThefollowinglistgivesexamplesofAgreementquestions:
Whatdidthepsychiatristfindunusualaboutthecase?
Thesymptomssuggestedadifferentcause.(A)Effectswereexperiencedlongafterthecause.(B)Thecauseoftheillnesscouldnotbedetermined.(C)
ThespeechpathologistagreesthatWhatdotheyagreeabout?Thephysiotherapistsagreethattheywill
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Exercise
PlayTrack12andanswerquestion10.
10. Youhearadietitiantalkingwithapatient.
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7.CourseofAction
CourseofActionquestionsaskyoutodecidewhatthespeakerswilldoasaresultoftheconversationortalk.Payattentiontoanythingthatwillbedonelaterwhilelisteningtotherecording,andbeawareofwheninthefuturetheactionswillbedone.Forexample,aspeakermaytalkaboutwhatneedstobedonetonight,andwhatshouldbedonetomorrow.Thequestionspecifieswhichoftheseactionsiscorrect.ThefollowinglistgivesexamplesofCourseofActionquestions:
Whatdotheyagreeabout?
Thepatienthasforgottentheiroverallgoal.(A)Thepatienthasbeentooseverewiththeirdiet.(B)Thepatienthasbeentryingtolosetoomuchweight.(C)
Whatdoesthenursehavetodonext?
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Whatwillthedoctordotonight?Nextweek,thepatientmust
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Exercise
PlayTrack13andanswerquestion11.
11. Youhearaveterinariantalkingwithanowner.
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OnTestDay,youshouldaimtoidentifythefocusofthequestionduringyour15secondsofscanningtimebeforetheaudiobegins,sothatyouknowthetypeofinformationtolistenforintheaudio.Onceyouhaveidentifiedthequestiontype,youshouldlookforimportantwordsinthequestion,andthinkofparaphrasesfortheanswerchoices.Then,whentheaudiostarts,youwillbepreparedtolistenfortherightinformation.
IMPROVEYOURSCORE
Whatwilltheownerdolatertoday?
givehiscatplentyofattention(A)givehiscatdrugstoreduceovergrooming(B)givehiscatfoodatthesametimeaslastnight(C)
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ManyPartBrecordingsarebetweentwohealthcareprofessionalsinaworkplacesetting,andtheycanalsoincludepatients.YoumightfindithelpfultowatchatelevisionprogrammesetinahospitalfromtheUK,Australia,theUS,oranotherEnglishspeakingcountry.Whiletheseprogrammeswillrarelydiscusshealthcareinatechnicalway,theywillhelpyoufamiliariseyourselfwithcommonvocabularyandinteractionsinanEnglishspeakinghealthcaresetting.
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ListeningPartB:PracticeSet
Forquestions1to6,choosetheanswerA,BorCwhichfitsbestaccordingtowhatyouhear.
PlayTrack14andanswerquestions1–6.
1. YouhearanEDnursetalkingtotherelativeofapatientwhohasbeenrecentlyadmitted.
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Whatistherelativedoing?
describingherfather’smedicalhistory(A)suggestingwaystointeractwithherfather(B)explainingthatherfathercanbecomeviolent(C)
2. Youhearanobstetriciandescribingacaesareansectiontoapregnantpatient.
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Hesaysthattheprocedurewill
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beshorterandlesspainfulthanatraditionalbirth.(A)becarriedoutwhilethepatientisconscious.(B)notbenecessaryinthepatient’scase.(C)
3. YouhearaGPandhispracticenursediscussingtheiryearlyschedule.
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Theyagreethatthepracticeshould
hireagencystafftohelpduringthebusierweeks.(A)avoidtakingholidayinthebeginningofSeptember.(B)lookaftertheirhealth,tolowerthelikelihoodofsickness.(C)
4. Youhearanursepreparingapatientforaflushot.
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Whatisthenursedoing?
explainingwhytheflushotisnecessary(A)discussingwhytheflushotcausesreactions(B)describingcommonsideeffectsoftheflushot(C)
5. Youhearadoctortalkingtoapatientaboutherinjury.
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Whatwillhappenwhenthepatientreturnstothesurgery?
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Shewillhaveherstitchesremoved.(A)Thedoctorwillstitchupherwound.(B)Theywillseeifthewoundwillscar.(C)
6. Youhearatraineenurseaskingaseniorcolleagueaboutthetreatmentforapatientwithchronicobstructivepulmonarydisease,orCOPD.
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Theseniorcolleagueisexplainingthatgivingsuchpatientsnormallevelsofoxygen
caninhibitbreathingrate.(A)willcauselight-headedness.(B)lowerscarbondioxidelevels.(C)
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Answers
1. Calackofcommunication.
2. BTheinformationtoincludeinpatientnotes.
3. Atransmitvoicesmoreclearlythanothernoises.
4. CToallowthepatienttoeatduringtheday.
5. Cwhatherdifferenttreatmentoptionsare
6. Cisnotimprovinghiscondition.
7. Aexplaininghowthepatientwillbetreated
8. Ateachingthestudenthowtoexaminethepatient
9. B
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Effectswereexperiencedlongafterthecause.
10. BThepatienthasbeentooseverewiththeirdiet.
11. Agivehiscatplentyofattention
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PRACTICESET
1. Cexplainingthatherfathercanbecomeviolent
2. Bbecarriedoutwhilethepatientisconscious.
3. BavoidtakingholidayinthebeginningofSeptember.
4. Cdescribingcommonsideeffectsoftheflushot
5. AShewillhaveherstitchesremoved.
6. Acaninhibitbreathingrate.
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ListeningTranscripts
Track7
N: Youhearadentistdiscussingbookingproblemswithherreceptionist.F: HeyKieran,MrLaojustmentionedthathe’dtriedtoreschedulehis
appointmentyesterday,firstonline,andthen,whenthatdidn’twork,hecalledup.Butapparentlyhecouldn’treschedule...anyideawhy?
M: Hmm...Iwasn’tworkingyesterday,butletmecheckthenotes...so,Lanaleftanoteaboutthecall.ShesaysthatMrLaowantedtoreschedule,butwedidn’thaveanyotherappointmentsthisweekafter3pm,whichistheonlytimehecouldmake.Heaskedifhecouldmakeanappointmentnextweek,buthisprocedurewasmarkedonoursystemas‘urgent’,soshehadtomakeitinthesameweek–thesystemwouldn’thaveletherrescheduleitanylater.Shewouldn’thavehadtheauthorisationtochangethat...still,sheshouldhavediscussedthiswithyouatlunchorattheendoftheday,becausethenyoucouldhavedecidedwhetheritcouldhavebeenpostponedforaweek.
F: Yeah...Inhiscircumstance,itwouldhavebeenfinetorescheduleataslightlylaterdate.Weshouldpreventsomethinglikethisfromhappeningagain.
M: Mmm,you’reright.I’lltalktoheraboutittomorrow,andI’llsendoutanemailtoeveryoneelse,sothatthey’reaware.
N: YouhearadoctordiscussingchestX-rayinformationwithamedicalstudent.
F: Hey,DrYan,we’vegottheX-raysbackforMrRegisinbedeight...fromthismorning.
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M: Great,canyoudocumenttheminthenotes?F: Umm...Doyoumindshowingmehowtowritetheinterpretation
properly?M: Ofcourse.Makesureyouputthepatientdetails:fullname,dateofbirth,
patientnumberandhomeaddressfirst.Thenputthehospitalandward,dateandtime.Makesureyournameisonthedocument,too.IncludetheindicationfortheX-raylike“haemoptysis”or“dyspnea”beforedocumentingyourinterpretation.Now,IuseasimplemnemonictomakesureIdon’tmissanything,ABCDE:Airway–trachea,carina,bronchiandthehilarstructures;Breathing–lungfieldsandpleura;Cardiac-heartsizeandheartborders;Diaphragm–position,shapeandcostophrenicangles.Finally,Everythingelse:themediastinalcontours,bonesandtubesordevices.Makesureyoudocumenteverythingclearlyusingthissysteminthenotes.
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TRACK8
N: YouhearanENTsurgeontalkingtoacolleagueaboutcochlearimplants.M: Weimplantanelectrodearray,whichlookslikeseveralsmallwiresmade
ofaplatinum-iridiumalloyintodifferentregionsofthecochlea.Thesemetalwiresconducttheelectricalimpulsesgeneratedfromthemicrophone,whichpicksupsoundfromtheenvironmentandsendsthesignalstotheelectrodearraythroughatransmitter.There’salsoaspeechprocessorbetweenthetwothatfiltersmoreimportantsoundssothatthepatientcanhearpeopletalkingratherthanothersounds.
F: Right,okay.Sodoesthisrestorehearingtonormallevels?M: No,withthecurrenttechnology,we’regivingdeafpeopleagood
representationofsoundsfromtheenvironmentandhelptounderstandspeech.Aftersurgery,patientsundergotherapytorelearntheirsenseofhearing.Noteveryonebenefitsfromthedevicetothesameextent.
N: YouhearaGPtalkaboutType2diabetesmellitus.F: Hello!I’llbecoveringthediagnosisofType2diabetesmellitus.So,there
arefourmethodsthatwecanuse.Thefirstisafastingplasmaglucosetest.Thisisourpreferreddiagnostictest,asit’seasiertocarry-out,oftenmoreconvenient,andcostsuslessthantheotherthreetests.Ithelpstotryandbooktheseappointmentsinthemorning,asthepatienthastorefrainfromeatingforatleasteighthoursbeforetheycantakethetest.Normalfastingbloodglucosewillbebetween70and100milligramsperdeciliter.Avalueofover126milligramsperdeciliterindicatesadiagnosisofdiabetes.Bearinmindthatthistestshouldbecarriedouttwicetoconfirmapositiveresult.Thesecondmethodwecanuseistomeasuretheaverageglycemicloadoverthepastthreemonths...
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TRACK9
N: Youhearadentisttalkingtoapatientwithachippedtooth.M: Sowe’vetalkedaboutdifferentoptions,anditseemslikeaveneerwould
bethebesttreatment.Giventhecostoftheprocedure,areyouhappytogoahead?
F: It’squiteexpensive,butIdefinitelyneedtogetitfixed.Willitstayput?M: Veneerstendtoneedreplacingeverytentofifteenyears,sotheyarea
long-termsolution.Itwillcertainlybemoredurablethancompositebonding,anditwilllookmorerealistic,too.
F: Ah,okaythat’sgreat.AndisthereanythingIcandotoextendtheirlifespan?
M: Well,youneedtomaintaingoodoralhealth,youknow,brushing,flossing,regularcheck-ups.Youshouldavoidbrushingyourveneertoohard,asitcouldcausedamage.
N: Youhearapodiatristtalkingtoapatientwithfallenarches.F: Soyousayyou’reexperiencingfootpain,areyouwearingsupportive
shoes?M: Uh-hu,I’mwearingappropriateshoes,andI’malsowearingorthoticsthat
shouldbehelping,butI’mstillexperiencingpaininmyfeet.Sometimestheyfeelabitnumb,too.
F: Right,okay.Andyoumentionedthatyou’vebeengivensomefootexercisestodo?
M: Yeah,thephysiotherapistIwenttoshowedmethose.AtfirstIthoughttheywerehelping,butnowIthinkI’masbadasI’veeverbeen.Isthereanythingelsewecando?
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TRACK10
N: Youhearadoctortalkingtoapatientinanemergencydepartment.M: Helloagain,I’mDrOliveira,Ithinkwemetearlieratthebeginningof
myshift.Howareyoudoingnow,MrsJames?F: Idon’treallyknowwhat’sgoingon,I’mjusthopingtofindoutwhat’s
wrongwithme.M: OkayMrsJames,Iunderstand,andthankyouforwaiting.They’verun
thetestsandtheythinkyou’vegotaconditioncalledpseudomembranouscolitis.It’salongwayofsayingyou’vegotaninflamedcolon.You’vebeenwaitingsolonghereinA&Ebecauseyou’regoingtoneedasideroom,becauseoftheinfectionrisk.
F: Ohdear,thankyoufortellingme.HowlongwillitbetillIgetaroom?Isitserious?
M: Well,atthemoment,MrsJames,we’reoperatingona‘onein,oneoutbasis’...butIdothinkthatasideroomwillfreeupinthenextfewhours.Theoutlookisverygoodinmostcases,we’regoingtogiveyouantibioticsandfluidsbutthereisasmallriskoftheinfectionreturninginthefuture.
N: Youhearamedicalstudenttalkingtoaseniorresidentaboutassessingapatient.
M: IunderstandthatMrFredrickhaschronicheartfailure,andthatweareconcernedwithvolumeoverloadifhedoesn’tadequatelyexcreteenoughfluid.Buthowdowedeterminehisvolumestatusandwhetherornotheneedsdiureticmedications?
F: Thatisagoodquestion!So,thereareseveralwayswecanassessvolumestatus.First,wecanperformaphysicalexaminationonthepatient.Whatwouldwebelookingfor?
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M: Well,wecanassessforperipheraledema.Wewouldlookatthepatientshandsandfeettoassessswellinganddeterminewhetherornotthereispitting.
F: Yes!Verygood.Wecanalsoassessforjugularvenouspressure.Thisismosteasilydonebyhavingthepatientlayata45degreeinclineandthenobservinghisexternaljugularvein.Thefillinglevelofthejugularveinshouldbelessthan3centimetresabovethesternalangle.
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TRACK11
N: Youhearapsychiatristpresentingacasestudy.
M: Goodmorningeveryone!IwouldliketospeakaboutacuriouscasethatIwasinvolvedinlastyear.Thepatientwasayoungmanwhoreportedcontinuedvisualdisturbances.
Whatmadethiscasesointerestingwerethechangeshedescribedtohisvisualfield.Objectsbegantogetlargerandsmallerashelookedatthem,hisfather’sfaceslowlymorphedintothatofastranger,andhewouldseetrailsoflightzigzaggingacrosshisfieldofview.Theseareuncommonforvisualhallucinations,theyareunlikelycharacteristicsofaprimarypsychoticdisorder,buttheyareakintoapsychoactivesubstance-inducedhallucination.However,hisurinedrugscreenwasnegativeforanysubstances,
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andhereportedthathislastuseofanyhallucinogenwasthreemonthsago!WehavefoundseveralcasereportsofHallucinogenPersistingPerceptionDisorder(HPPD)andbelievethatthispatientmatchesthecriteriaforsuchadiagnosis.
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TRACK12
N: Youhearadieticiantalkingwithapatient.F: Okay,MrWeiss,soitlookslikeyouhaven’tlostanyweightthismonth..
.Doyouhaveanyideawhythatmightbe?M: Ugh...really?IfeellikeI’vebeentryingreallyhardtoloseweight.In
fact,IthoughtIwouldtakeitastepfurtherinthepastcoupleofweeks,becauseIwasabitbadinthefirstweekorso.SorecentlyI’vebeentryingtocutoutallcarbs,andanyjunkfood.Tobecompletelyhonestthough...I’vewoundupcheatingonmydiet.
F: Youneedtostopbeingsostrictwithyourself.Wedesignedyourdietsothatitwouldbeachievable.Whenyoutryanddothingstooquickly,andmaketoomanychangestowhatyourbodyisusedto,it’sdifficulttomaintainlong-term,andyouendupovereatingasaresult.Also,Ican’timaginethatitmadeyoufeelgoodaboutyourprogress,whenyoukeptgoingofftrack?
M: No,itreallydidn’t.Iseewhatyou’resaying...IguessIneedtobekindertomyself,andbemorepatientwiththeslowandsteadyroute.
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TRACK13
N: Youhearavetdiscussingtreatmentwithacat’sowner.F: Yeah...I’veseenthisbefore.Typically,whencatsbitetheirfuroff,or
overgroomthemselves,it’sasignofanxiety.CanyouthinkofanythingthatmightbecausingFelixtobecomestressed?
M: Urrr...gosh,thatmakesmefeelterrible!Well,Isupposewehavemovedhouserecently,andI’vetriedtogetFelixtoexploreourbackyard,buttheneighbourshaveadogthatbarks,andIguessthat’sbeenscaringhim.Also,I’vebeenworkinglatequiteoften,soIsupposehe’sgettingfedlaterthanusual,andseeingmeless.Butthere’sreallynothingIcandoatthemoment,IhaveadeadlinethatIhavetomeetthisweek,soI’llbeworkinglateuntilthen.
F: Right,okay...Inthatcase,I’dsuggesttryingtoimplementacoupleofchangesathome,startingnextweek.YoushouldsetaregulartimeforFelix’sdinner,andsticktoit.Ifyouhavetoworklate,canyouarrangeforFelixtobefedbysomeoneelse?Also,andyoushouldstartthisassoonasyougethome,youneedtomakesureyou’respendingenoughtimewithFelixeveryday.Ifheisn’tgoingout,thenyou’retheonlypersonhe’llseeeachday.I’llscheduleanotherappointmentinamonthtoreview,ifhe’sstillovergroominghisback,wecanputhimonacourseofmedication,tohelpwithanxiety.
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TRACK14
N: YouhearanEDnursetalkingtotherelativeofapatientwhohasbeenrecentlyadmitted.
M: Didyouwanttotalktome,MissTanaka?F: Oh...yes,yousee,Ijustwantedtoletyouknowthatmyfather...well,
asyouknow,he’srecentlybeendiagnosedwithdementia...mostofthetimeit’snotanissue,andhisspatsneverlastlong.It’sjustthatIwantedtoprepareyou,sometimeshe’sreallynothimself.
M: Ah,okay,MissTanaka,IthinkIunderstand.Canyourfatherbecomeaggressive?
F: Yes...Imean,Ithinkit’sjustthathegetsfrustratedsometimes.Hecan’trememberthings,andIthinkit’sscaryforhim.Hewasnever,everlikethisbeforehisdementia,andthoseperiods,well,theyreallydon’treflecthistruecharacter.
M: Ofcourse,thanksforlettingmeknow.N: Youhearanobstetriciandescribeacaesareansectiontoapregnant
patient.M: Labourcanprogressdifferentlyfordifferentpeople.Insome
circumstances,iflabourislongerthanexpectedandifwedetectthatthebabyisdistressedthenwemayhavetoconsideranemergecycaesareansection.It’saprocedurethatweperformintheatreanditiscarriedoutunderspinalorepiduralanaesthetic,sothatyoudon’tfeelanything,butyouwillbeawake.Ascreenisplacedacrossyourbodysoyoudon’thavetoseewhat’sbeingdone.Wemakeanincisioninyourtummyandwomb,justunderyourbikiniline,toremoveyourbabyandthenstitchupthewound.Ittakesaround40minutesandyourbirthpartnercanbethereatalltimes.Doesthatmakesense?
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N: YouhearaGPandhispracticenursediscussingtheiryearlyschedule.M: InSeptemberwe’llhavealotofnewpatients,asthefirstyearuniversity
studentswillallregisterduringfreshers.F: Yes,wewerereallyrunoffourfeetlastyear,weren’twe?M: Yep.Itwasamadhouse.F: Doyouthinkweshouldhireagencystafftohelpoutforthefirstcoupleof
weeksthistimearound?M: Well,Ithinkpartoftheproblemwasthatlastyear,DrIgweandNurse
Fletcherwerebothaway–DrIgwewenttoCostaRica,andNurseFletcherhadtheflu.
F: Right!Iremember.Well,wecan’tdomuchtopreventstaffillness.M: No,butwecanaskpeopletoavoidbookingtimeoffinthosefirstthree
weeks.F: Okay,I’llsendanemailouttoday.N: Youhearanurseprepareapatientforaflushot.F: GoodmorningMr.Henderson,Dr.Rayhasrecommendedthatyougeta
fluimmunisationshotbeforeyouaredischarged.I’vegottheinjectionreadytogivetoyou.Areyouallergictoanything?
M: I’monlyallergictolatexandpenicillin.Idon’tknowifIwanttheflushot.ThelasttimeIgottheshot,Igotsick.
F: I’msorrythathappenedtoyou.Whatkindofsymptomsdidyouhaveafterthatlastflushot?
M: Igotarunnynoseandaheadache.Myarmfeltlikesomeonepunchedme.F: Sometimestheflushotcancausereactionslikeasoreinjectionsiteand
headache.Othercommonsymptomsincludebeingtired,muscleandjointaches,shiveringandfever.Allofthesesymptomscanbeseenwiththeflu,buttheshotcan’tgiveyoutheflu.
N: Youhearadoctortalktoapatientaboutherinjury.M: Goodmorning,Mrs.Bowder.I’llbeyourdoctortakingcareofyourcut
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there.Whatexactlyhappened?F: It’sembarrassingreally,yousee,Iwasjusttryingtochopsometomatoes
fordinnerandtheknifeaccidentallyslipped.Oh,I’msoclumsy,Ihopeitdoesn’thurttoomuchtostitchbackup!
M: Well,we’regoingtonumbtheareanowwithashotofLidocaine.You’llfeelapokeoftheneedleandaslightburn,butafterwardstheareashouldbenumbandyou’llfeelnothingduringtheprocedure.Weshouldbefinishedinabout10minutes.
F: Ohgood!HowmanystitcheswillIneed?Howlongwilltheyhavetostayin?I’mreallyconsciousaboutmyhandssoIhopeIdon’thaveascar.
M: IwillonlyknowforsureonceIfinishsuturing,butbymyestimation,youmightrequireatleastfourtofivesutures.They’llhavetostayinfor5to10daysandyouwillneedtocomebackintogetthemremoved.I’lldomybesttotryandlinetheedgesuptocreateaslittlescarringaspossible,butIcan’tguaranteetherewillbenothingthere!
N: Youhearatraineenurseaskingaseniorcolleagueaboutthetreatmentforapatientwithchronicobstructivepulmonarydisease,orCOPD.
M: Ihaven’ttreatedanyonewithCOPDbefore;whatwouldweneedtododifferently?
F: Oneofthemostimportantthingswouldbetomakesuretoprescribeoxygenatlevelsbetween88–92%.
M: Okay...sowhywouldthatbenecessary?Ifhe’shavingtroublebreathing,shouldn’tweprescribehigheroxygenlevels?Mostpatientsreceiveoxygenatlevelsbetween94–98%.
F: Well,inhealthyindividuals,ariseincarbondioxidewouldresultinanincreaseddrivetobreatheinordertoeliminatetheexcessgas.
M: Right.F: However,insomepatientswithCOPD,thisresponseisbluntedandtheir
mainmechanismforrespiratorydriveiscontrolledbythelevelofoxygeninthebodyinstead.IfthelevelofoxygengiventoaCOPDpatientis
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increasedtoomuch,itcanactuallyreducethestimulustobreatheandcausehypoventilation,resultinginanincreaseinCO2.
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CHAPTER5
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ListeningPartC
LEARNINGOBJECTIVES
Bytheendofthischapter,youwillbeableto:
Followthelogicalflowofapresentationoraninterview.Listenforwordsindicatingexamplesandtheories.PractiseListeningPartCstrategies
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INTRODUCTION
InListeningPartC,youneedtolistentotworecordings,whichcanbeeitherpresentationsorinterviewsinvolvingahealthcareprofessional,andanswer6multiple-choicequestionsforeachone.Eachrecordinglastsaround4–5minutes.
Therecordingsinthissectioncouldbeintheformofaworkplacepresentationorpodcast-styleinterview.Therewillbearangeoftopicsofbroadhealthcareinterest.
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Strategies
KnowtheInstructions
Youshouldmakesureyouarefamiliarwithwhatyouhavetodobeforeyoutakethetest.Theinstructionslooklikethis:
Inthispartofthetest,you’llheartwodifferentextracts.Ineachextract,you’llhearhealthprofessionalstalkingaboutaspectsoftheirwork.
Forquestions31to42,choosetheanswer(A,BorC)whichfitsbestaccordingtowhatyouhear.
Extract1:Questions31to36
YouhearaSeniorNursecalledPierreDelacroixgivingapresentationaboutadrenalfatigue.
ThefirstpartoftheseinstructionsisthesameforthebeginningofeachPartCtest;youhearageneralintroductiontoPartC,thenthecontextsentenceandspecificinstructionsforeachtask.Intheexampleabove,forexample,youwouldexpecttohearaworkplacepresentation.
InListeningPartC,youheareitherapresentationoraninterviewineachrecording.ApresentationinPartChasonlyonespeaker,whowilltalkaboutanumberofdifferentpoints.AninterviewinPartCincludes2speakers;oneisahealthcareexpert,andtheotheristheinterviewer.Theinterviewerasksshort
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questions,andthehealthcareexpertgiveslonganswerstothesequestions.Theinterviewer’squestionsalwaysrelatetothequestionyouneedtoanswerinthesectionyou’relisteningtoatthatpoint.
ScantheQuestions
Beforetherecordingbegins,youhave30secondstoreadthroughthequestions.Whenlookingatthequestions,payattentiontothewordsinthequestionandtheanswerchoices.Thewordsinthequestionwillhelpyoutoidentifytherelevantpartoftherecording,andthecorrectanswercanbeheardintherecordingshortlyafterthis.Toselectthecorrectanswer,youwillneedtochoosetheoptionthatbestreflectsthemeaningofwhatyouhearintherecording.ThequestionsinPartCtendtoaskforthegeneralmeaning,orgist,ofthesectionofspeech.Thesequestionsalsoaimtotestyourunderstandingoftheargumentsthespeakertalksabout,andtheattitudeoropinionofthespeaker.
ListenActively,andAnswertheQuestions
InPartCoftheListeningTest,youhavetokeeptrackofwhichquestiontherecordingisreferringto.Youneedtoanswer6questionswhiletherecordingcontinues,soit'simportantthatyouknowwhentomoveontothenextquestion.Therecordingincludescuesthatyoucanusetoidentifywhentomoveontothenextquestion–forexample,theinterviewer’squestionsinarecordingmatchthequestionsinthetask,andapresentationwillfollowasimilarstructure,usingwordsinthepresentationtohighlightwhichpartsoftherecordingrelatetowhichquestions.Besuretoreadthequestionscarefullybeforetherecordingbeginssoyouhaveaclearideaofwhattheaudioforeachquestioncovers–usethisknowledgetokeepyouontrackthroughoutthispartofthetest.
Lookatthequestionandanswerchoicesintheexercisebelow,andlookforwordsinthetexttolistenoutforbeforeyouplaytherecording.
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Exercise
YouhearaGeneralPractitionercalledDrJeffordsgivingapresentationaboutpatientreferrals.
Take5secondstolookatthequestion,thenlistentoTrack15andanswerquestion1.
ListeningtoInterviews
Whenlisteningtoaninterview,usetheinterviewer’squestionsascuestomoveontothenextquestion.Payattentiontothekeywordsinthequestions,astheseareoftenreflectedinthequestionyouneedtoanswer.Practiseansweringthequestionsforeachsectionandmovingontothefollowingquestionintimebycompletingtheexercisebelow.
1. WhydoesDrJeffordsthinkit’simportanttoaskpatientswhythey’retakingcertainmedication?
tounderstandtheirmedicalhistory(A)tomeasurethepatient’sawareness(B)toquestionitseffectiveness(C)
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Exercise
YouhearaninterviewwithavetcalledAmandaChenaboutfelineimmunodeficiencyvirus(FIV).
Take15secondstoscanthequestions,thenlistentoTrack16andanswerquestions2–4.
2. DrChenexplainsthatmanypeoplebelieveFIV
canbecontagioustohumans.(A)mightaffecttheirpet’sbehaviour.(B)hasminimalimpactonacat’slife.(C)
3. WhatdoesDrChensaypeoplefindconfusingaboutthevirus?
thelackofavailableinformation(A)themanydifferenttreatmentoptions(B)itsnameissimilartoamoreseriousillness(C)
4. DrChenadvisesthosewhoownFIVpositivecatsto
avoidunnecessarycontact.(A)
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ListeningtoResultsofTrials
SpeakersinListeningPartCoftenmentionresearchtrialsthattheyhaveundertaken,orthattheyareawareof,orsurveysthathavebeencompleted,whicharerelevanttotheirresearchtopic.Youshouldbepreparedtoanswerquestionsabouttrialsandpatientsurveysduringthispartofthetest.
monitorthepet’shealthcarefully.(B)ensurethepetreceivesenoughexercise.(C)
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Exercise
YouhearahospitaldoctorcalledDrAbuMohammedgivingapresentationontheresultsofarecentpatientsurvey.
Take10secondstoscanthequestions,thenlistentoTrack17andanswerquestions5–6.
CaseStudies
5. DrMohammedwassurprisedbytheyear-longsurveyonthesatisfactionofpatientsstayinginhospitalbecauseofthe
happinessofthepatients.(A)severityofmostpatients’conditions.(B)numberofpatientsthatgotinvolved.(C)
6. WhydoesDrMohammedsuggestpatientsintheir20sweremoresatisfiedthantherestofthepatientssurveyedinthestudy?
Theyweremoreoptimistic.(A)Theyspentlesstimeinhospital.(B)Theyshowedagreaterrateofrecovery.(C)
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InPartC,healthprofessionalsoftendiscusscasestudies.Questionsinthissectionfocusontheindividualpatient’sexperiences,whatwasunusualabouttheirtreatment,andhoweffectivethetreatmentwas.Practiseansweringquestionsaboutspecificpatientsbycompletingtheexercisebelow.
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Exercise
YouhearanursecalledJonathanMcKenziegivingapresentationontreatingpatientswhoaredealingwithstress.
Take10secondstoscanthequestions,thenlistentoTrack18andanswerquestions7–8.
InPartCoftheListeningTest,youmustshowthatyouareabletofollowahealthcareprofessionaltalkingindetailonahealthcaretopic.Practiselistening
7. NurseMcKenziesaysthattheCEOhadtroublemanagingstressbecause
itwasprolonged.(A)itwascausinghimtolosehoursofsleep.(B)hewasunfamiliarwithsuchsituations.(C)
8. Thepatientwasencouragedtoreadbecause
itwasahobbyofhis.(A)itcreatedarelaxingatmosphere.(B)heneededtolearnaboutthecauseofhisissues.(C)
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topodcastsandpresentationsonlinecoveringhealthcaretopics,andmakenotesonthetopicasyoulisten.
IMPROVEYOURSCORE
Remembertoreadthequestionsfirstandunderlineanyimportantwords,sothatyoucanlistenactivelyfortheanswerswhenthespeakersbegintalking.
IMPROVEYOURSCORE
Don’tworryifthespeakersaretalkingaboutatopicyou’renotfamiliarwith.ThethelisteningsectionofOETisdesignedtobeunderstoodbyhealthcareprofessionalsfromavarietyofbackgrounds,soevenifthetopicisunfamiliartoyou,alltheinformationneededtoanswerthequestionsisgivenintherecording.
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ListeningPartC:PracticeSet
PartC
Inthispartofthetest,you’llheartwodifferentextracts.Ineachextract,you’llhearhealthprofessionalstalkingaboutaspectsoftheirwork.
Forquestions1to12,choosetheanswer(A,BorC)whichfitsbestaccordingtowhatyouhear.
Extract1:Questions1to6
YouhearaninterviewwithDrTaditaHussein,who’stalkingabouttreatingpatientswithcysticfibrosis.
Take30secondstoscanthequestions,thenplayTrack19andanswerquestions1–6.
1. DrHusseinsaysthatpatientswithcysticfibrosis
mayfindthesideeffectsalarming.(A)tendtorequiretreatmentfromayoungage.(B)canimprovetheirconditionwithfrequenthospitalvisits.(C)
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2. WhatdoesDrHussainsayisdifficultwhentreatingpatientswhoarenotinhospital?
Theyoftenfindtheexercisestoocomplicated.(A)Theytendtohavedifficultysocialisingwithotherpeople.(B)Theydon’talwaysunderstandtheimportanceoftheir
treatment.(C)
3. WhatdoesDrHusseinsayabouttheroleof‘distractiontherapy’incysticfibrosistreatment?
Itcanberelatedtothetreatmentbeingprovided.(A)Itallowspatientstocompletetheiractivitiesmorequickly.(B)Itprovidesstaffwithmoreinformationaboutthepatient’s
condition.(C)
4. WhatchangesdidDrHusseinobserveinoneofherpatients?
Heshowedrespiratoryimprovement.(A)Hedeterioratedrapidlyfollowingachangeintreatment.(B)Hebegantoenjoyaspectsoftheirtreatment.(C)
5. DrHusseinplanstousetechnologytohelpcysticfibrosispatientstocommunicate
withotherpatientswhosufferfromthecondition.(A)withfamilymemberswhocannotvisittheminhospital.(B)
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Extract2:Questions7to12
YouhearanpresentationgivenbyDrHubertJohnson,who’stalkingaboutwaystoimproveefficiency.
Take30secondstoscanthequestions,thenplayTrack20andanswerquestions7–12.
withpatientsofasimilaragesufferingfromdifferentconditions.
(C)
6. DrHusseinsuggeststhatfuturetreatmentsforcysticfibrosis
willalwaysincorporatelengthyprocedures.(A)couldpreventbreathingdifficultiesinsufferers.(B)mightbelesspainfulthanthecurrentoptionsavailable.(C)
7. DrJohnsonexplainsthatdelaysareincreasedwhenpatientsbelieve
theirappointmentwillnotbeginontime.(A)staffarenotconcernedaboutlate-arrivals.(B)beinglateforappointmentswillnotimpactothers.(C)
8. DrJohnsonusesanexampleofpoorefficiencytoillustratethepointthat
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healthcareprofessionalsshouldassiststaffduringbusytimes.(A)practicesshouldavoidlimitingappointmentbookingoptions.(B)staffshouldbetrainedtohandledemandingsituations.(C)
9. DrJohnsonexplainsthat,inordertoimproveefficiency,healthcarepracticesmust
sanctionpatientsarrivinglaterthan10minutes.(A)avoidbookingappointmentsinthemorning.(B)showpatientsthattheycanrunontime.(C)
10. DrJohnsonsayshealthcareprofessionalsoftenforgetthatpatientswhobookappointmentsmustfirst
feelthattheyneedaconsultation.(A)findatimeanddatethatworksforthem.(B)considerwhatmightbecausingtheirissue.(C)
11. WhathappenedwhenDrJohnsonbegangivingweeklypresentationstopatients?
DrJohnsonwasabletoworkfewerhours.(A)Thegeneralhealthofpatientswasincreased.(B)Thenumberofappointmentsatthepracticedecreased.(C)
12. HowdoesDrJohnsonfeelabouttheuseoftechnologywhenbooking
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appointments?
Practicesshouldbegintoencourageallpatientstomakebookingsonline.
(A)
Itcanincreaseefficiencyifotherbookingmethodsarecontinued.
(B)
Elderlypeoplearemostlikelytostruggletouseit.(C)
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Answers
1. Btomeasurethepatient’sawareness
2. Acanbecontagioustohumans.
3. Citsnameissimilartoamoreseriousvirus
4. Bmonitortheirhealthcarefully.
5. Camountofpatientsthatgotinvolved.
6. BTheyspentlesstimeinhospital.
7. Athestressfulsituationwasprolonged.
8. Aitwasahobbyofhis.
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PRACTICESETS
Questions1to6
Questions7to12
1. Btendtorequiretreatmentfromayoungage.
2. CTheydon’talwaysunderstandtheimportanceoftheirtreatment.
3. AItcanberelatedtothetreatmentbeingprovided.
4. CHebegantoenjoyaspectsoftheirtreatment.
5. CHebegantoenjoyaspectsoftheirtreatment.
6. Bcouldpreventbreathingdifficultiesinsufferers.
7. Atheirappointmentwillnotbeginontime
8. B
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practicesshouldavoidlimitingappointmentbookingoptions.
9. Cshowpatientsthattheycanrunontime.
10. Afeelthattheyneedaconsultation.
11. CThenumberofappointmentsatthepracticedecreased.
12. BItcanincreaseefficiencyifotherbookingmethodsarecontinued.
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ListeningTranscripts
Track15
M: Whendealingwithnewpatientsorpatientreferrals,youneedtoasknotonlywhatmedicationthey’recurrentlytaking,butwhythey’retakingit.Manydoctorsassumethatpatientsunderstandthereasonsfortheircourseoftreatment,butsomepatientsmayhavebeenprescribedthesedrugsalongtimeago,anddespitetheirpriordoctornodoubtoutliningthereasonswhysuchdrugsareneeded,patientscanforget,ormis-remembertheactualreasonwhytheseprescriptionsarenecessarytothem.Makesureyougothroughthisattheearliestconvenience-soagoodwaytostartthesediscussionsistoask‘Canyoutellmewhatyou’recurrentlytaking,andwhatit’sfor?’
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TRACK16
M: TodayI’mtalkingtoDrChen,aveterinaryexpertinfelineimmunodeficiencyvirus,orFIV.Dr.Chen,whatcanyoutellusaboutthedisease?
F: Well,FIVisatopicthatItendtodiscussquitefrequentlywithmypatients.AlthoughlotsofpeoplehaveheardofFIV,andknowgenerallythatitisavirusthataffectscats,therearemanymisconceptionsaboutthecondition,whatitmeansforthecat,andwhatownerswithFIVpositivecatsmustdo.ManypeopleworryaboutcatchingFIVfrominfectedcats,whichisactuallynotpossible,asthediseasecannotbetransmittedtohumans.Unfortunately,thisbeliefoftenpreventspeoplefromadoptingcatswhosufferfromFIV,asthey’reconcernedaboutthemselvesortheirchildrencontractingthevirusfromthecat.
M: Isee...andarethereanyotherthingsthatmightconfusepeopleaboutFIV?
F: Therecertainlyare!Thereisanothervirusthatcanaffectcatsthatpeoplemaybeawareof,calledFelineLeukemia,orFeLV.FeLVsignificantlyreducesacat’slifeexpectancyandhealth.Duetothesimilarityofthetwovirus’snames,I’vefoundthatpeopletendtomixthetwovirusesup,sowhenthey’retoldthatacathasFIV,theybelievethatthecatisextremelyill,andwillrequirelengthyandexpensivetreatment,wheninfact,thecatshouldbeabletoleadafairlynormallife.
M: I’msuremanyownerswillberelievedtohearthat!So,whatadvicewouldyougivetoownersofFIVpositivecats?
F: Well,theviruscandepletecertainwhitebloodcells,whichmeansthatcatswithFIVareoftenmoresusceptibletocatchingotherinfections,andwilloftenfinditmoredifficulttorecoverfromtheseinfections.FIVis
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oftencomparedtoAIDSinhumans,andthetwoimmunosuppressantvirusesareverysimilar.ThosewithFIVpositivecatsshouldbyandlargetreattheircatsthesameasanyothercats.However,thesecatsshouldbekeptindoors,tolowertheriskofinfection,andtopreventthemfromspreadingthevirus.Ownersshouldalsopaymoreattentiontothewell-beingoftheircat,andiftheirpetshowsanysignofillness,theyshouldbetakentothevetattheearliestopportunity.
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TRACK17
M: Ashealthcareworkers,wealwaysputourpatientsfirst.We’verecentlyconcludedayear-longsurvey,lookingintothelevelofsatisfactionofadultin-patientsatthishospital,andIwantedtosharesomeofthoseresultswithyoualltoday.I’vebeendoingthesesurveysforawhilenow,andletmetellyou,firstoff,thatIwasabsolutelyflabbergastedbythepatientengagementlevelhere.Seriously,outofallofthepatientsaskedtocompletethissurvey,aremarkable86%responded.ThatmaybethehighestproportionI’veeverseen!Moreresponsesnotonlyprovideuswithmoredata,butitalsosuggeststhatyou’vecreatedagreatenvironmentinwhichyourpatientsfeelcomfortableexpressingtheirviews.
Let’stakealookatwhatsomeoftheserespondentsfeltaboutthecaretheyreceived.We’llstartwithin-patientsintheir20s.Thisgrouphadthehighestsatisfactionrateofallrespondents.Now,that’sgreat,butthereareacoupleofinfluencingfactorsweshouldbearin
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mind,thatmightexplainwhythisgroupwasmoresatisfiedwiththeirtreatment.Thegroupofpatientsintheir20swasalsothegroupwiththeshortestaveragein-patientstay.Themajorityofthesepatientsweredischargedafterlessthanaweekinhospital.Assuch,thisgroupislesslikelytohaveexperiencedthefrustrationandworrythatcanbecomemoreofanissuewithpatientswhohaveextendedstaysatthehospital.
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TRACK18
M: Hieveryone.I’dliketotalktoyouallaboutcaringforpatientsexperiencingstress.Unfortunately,it’saphenomenonmanyofushealthcareprofessionalshavefirst-handexperiencewith,butI’mgoingtotalkaboutoneofmypatients,anewlyappointedCEOofawell-knownmultinationalcompany.Now,thepatienthadbeenworkinginhigh-poweredrolesforalongtime,soitwasn’tthathewasunfamiliarwithstress.Theproblemwasthatinhiscurrentrole,hewasconstantlyputtingoutfires.Thebusinesswasverywell-known,anddominatedthemarketthatitwasin,butbehindthescenestherewerefinancialissues.Therewasalwaysanissuethatneededhisurgentattention.Stressisanunpleasantexperienceinandofitself,butitcanalsocauseproblematicsideeffects.Thepatientalsoexperiencedweightgain,andtroublesleepingasaresult.
Thepatientwaitedforawhilebeforeseekinghelp,andbythetimehedid,hewasabsolutelywornout.Weworkedwiththepatienttodevelopanumberofcoping
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strategies,asitwasn’tpossibleforhimtoremovethemaincauseofstress–hisjob–fromhislife.Instead,ourtreatmentbeganwithreading.Thepatienttoldusthathehadlovedreadingfiction,buthadn’treadforpleasureindecades,andsooneofthefirstchangeshemadewastoreadforanhourbeforebed.Weneededtomakesurethepatientmadetimeforactivitiesthatheenjoyed.Thatonesmallchange,inturn,helpedhimtosleepbetter,whichgavehimmoreenergytodealwithstressfulsituationsduringtheday.
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TRACK19
M: Cysticfibrosisisaconditionthatcausesmucustobethickerandstickierthanitshouldbe.DrTaditaHusseinspecialisesincysticfibrosistreatment,andisheretoshareherthoughtsoncaringforpeoplewiththecondition.Tadita,canyoutellusabitmoreaboutpatientswhosufferfromcysticfibrosis?
F: Absolutely.Suffererstendtocarrytwotofivetimesasmuchsaltintheirbodiesasthosewithoutthecondition,soyoucanseewhytheirmucusisthickerthanaverage.Treatmentforthesepatientsisusuallyquitetimeconsumingandrepetitive,patientsareoftenrequiredtostayinhospitalforlongstretches,and,asthesymptomsoftheconditionbegintopresentveryearlyoninthepatient’slife,manyofmypatientsareyoungpeople,andsowetendtoseelotsofpatientswithcysticfibrosisfindingthesehospitalvisitsfrustrating.Infact,throughouttheUK,about80%ofpatientswithcysticfibrosiswhoarehospitalised,reportfeelingatleastminimallevelsofdepression.
M: Howaboutyoungpatientswhoaren’tcurrentlyhospitalised?Whatcanbechallengingabouttheirtreatment?
F: Well,patientscanberequiredtotakearound30pillsadaytokeepcysticfibrosisundercontrol,soit’sunderstandablethatteenagersandyoungpeople,whojustwanttobefreeandindependent,mightresentthisordeal,iftheythinktheycangetawaywithit.Oneofthemostdifficultthingswehavetocontendwithisthefactthat,ifpatientsstoptakingtheirmedication,ordoingtheirdailybreathingtreatments,theirconditionwon’timmediatelyworsen.Instead,itwillgraduallybecomemoresevere,untiltheycontractaseriousinfectionwhichputstheirlivesatrisk.
M: So,whatapproachesdoyouusewhentreatingpatientswithcystic
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fibrosis?F: Well,we’vefound‘distractiontherapy’tobeextremelyuseful.We’re
incrediblyluckytohavereceivedadonationofanumberofvirtualrealityheadsets,followingtheirsuccessinanumberoftreatmenttrials.Weusethevirtualrealityheadsetstotransportthepatienttooutdoorsettings,oftencorrespondingtotheactivitiesthey’rerequiredtodowithus.Whentheycompletebreathingexercisesonastationarybike,forexample,theVRheadsetsdisplayavirtualoutdoorbikeride.Ourpatientsfindithelpfultopretendtobesomewhereelseduringtreatment,andit’softeneasierforustoadministerbreathingtreatmentstopatientsusingtheseheadsets,asthey’remorerelaxedwhenthey’renotfocusedontheactualityofthetest.
M: Sowhatsortsofchangeshaveyouseeninyourpatientsasaresultofthesemethods?
F: Oneofmypatients,a24yearoldmanwithcysticfibrosiswhowasinhospitalwaitingforalungtransplant...well,hefoundtreatmentverydifficultatfirst.Hewaspreoccupiedbyhisneedforatransplant,andfrustratedbyfeelingsofpowerlessness.Hewouldoftenresisttreatment.Westartedusingthevirtualrealitysystemswithhimassoonaswegotthem,and,ittookawhileforhimtogetonboard,butwhenhedid,itwaslikesomeonehadbreathednewlifeintohim.Notonlydidhestophinderinghistreatment,heactuallybegantolookforwardtoit.He’sevenstartedhelpingustothinkaboutotherwayswecanimprovetheexperiencesofourpatients,likeimprovingsocialinteraction.
M: Yes.Iunderstandthattherearedifficultiesinvolvedinpatientcommunication.
F: Mmmm...We’relookingintothepossibilityofinstantmessagingfunctionsbetweenpatients,andevenvirtualgamesthattheycanplayagainsteachother.Unfortunately,patientswithcysticfibrosishavetobe
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keptapart,toavoidcross-infection.It’sjustonemorecrosstobearforourpatients,thattheycan’ttalktothosegoingthroughthesamething.Ourpatientsgetplentyofinteractionwithmyselfandtherestofthestaff,butwe’dliketomakesuretheyhaveaccesstoanetworkoffellowsufferers,too,forsupportandadvice.
M: Isee.Thatallsoundsquitefuturistic!Arethereanyotheradvancesonthehorizon,forthetreatmentofcysticfibrosis?
F: Well,there’sanewdrugthat’sbeeninthenewsrecently,it’sacombinationoflumacaftorandivacaftor,youmightknowitbythebrandnameOrkambi.Thedrugworksbyimprovingthelevelofwaterandsaltinthebody,therebyreducingthethickmucusthatcausesillnessandrespiratoryissuesinthosewithcysticfibrosis.Evenmoreexcitingandfuturistic,though,isthepossibilityofgenetherapy–wherethegeneticmutationthatcausescysticfibrosisinindividualsisreplacedwithahealthygene.Thiswouldeffectivelycurethosewiththecondition,andsignificantlyextendthelivesofthousandsofpeople,andremovetheneedforlengthystaysinhospital.
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TRACK20
Hieveryone!Myname’sDrHubertJohnson,andI’vebeenaskedtospeaktoyouaboutmyexperiencesinthehealthcareindustryconcerningsomethingthateffectsallhealthprofessionals-improvingefficiency.Itseemstobeagiventhesedaysthatpracticeswillstrugglewithalackofefficiency.We’veactuallyfoundthatthisexpectation,inandofitself,canreduceefficiencyandincreasedelaysevenfurther!Inarecentsurvey,whenpatientswereaskedwhytheyarrivedlatetotheirappointments,30%saidthattheyhadassumedthatthepreviousappointmentwouldrunlong.Patientsexpecttobekeptwaiting,and,tosomeextent,weexpectthatpatientswillbekeptwaiting,andsothefirstthingweneedtoaddressisourattitudes,andtheattitudesofourpatients.So,letmestartbytellingyouabouttheefficiencyIobservedinapracticeIvisitedacoupleofweeksago.Atthispractise,patientscouldnotmakeappointmentsonline,buttheycouldeitherphoneup,ormakeanappointmentinperson.Therewerenevermorethan2receptionistsworkinginthemorning,andthepracticegenerallyscheduled80appointmentseachday.Patientswhowerenotattendingafollow-upappointmentwererequiredtomaketheirappointmentonthedayof.Canyouimaginewhatthatpracticewaslikeinthefirstcoupleofhourstheywereopen?Thereceptionistswereinundatedbycallsandwalk-instryingtoscheduleappointments.Asyoucanimagine,patientswhohadseenwhatthepracticewaslikeinthemorningexpectedthatiftheydidn’thavethefirstslotoftheday,they’dbedelayedbyatleast10minutes.So,naturally,theyarrivedtotheirappointment10minuteslate.Oneofthemostimportantthingsyoureallymustaddressinyourpractice,inordertoimproveefficiency,isthewayyoupresentyourpracticetopatients.Iftheybelievethatyouarealwaysrunninglate,guesswhat?
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They’llberunninglatetoo.Now,let’sthinkforamomentaboutwhatneedstobedoneonthepatient’sendbeforeanappointmentcantakeplace.Youmightbethinkingthatthereareonlytwostepstotheprocess:one,thepatientbooksanappointment,andtwo,thepatientarrivesatthepracticeintimefortheirappointment.Well,wehealthcareprofessionalsoftenforgetthatthere’sactuallyastepthatcomesbeforethis:firstly,thepatientmustdecidethattheirissueissignificantenoughtowarrantanappointment.So,aboutadecadeago,mypracticewasreallystrugglingfromalackofefficiency.Iwasworkingextremelylonghourstotrytoaccommodateeveryone,andIwasbecomingincreasinglyfrustratedwithconductingappointmentsthatdidn’tseemstrictlynecessary.IgottothinkingabouthowImightbeabletohelppatientstoreconsidertheirinitialassumptionwhenbookingappointments,andtotreatminorissuesathome.Atthesametime,Ididnotwantmypatientstofeelunsupported.IdecidedthatIwouldbegintogiveweeklypresentationsintheeveningsaboutself-care.AsItendedtoseeamultitudeofpatientscominginforsimilarissuesthattheycouldactuallytreatthemselves,eachweekIfocusedonadifferentcommontheme.Thepresentationslastedforjust1hour,butIfoundthattheyresultedin7fewerunnecessaryappointmentseachweek.Thesedays,ofcourse,Inolongerhavetogiveaphysicalpresentation.Thankstomoderntechnology,Isimplyuploadinstructionalvideostoourpractice’swebsite.Wealsoemailthesevideosouttopatientsperiodically.Wecanandshouldmakeuseoftechnologyasatoolinourpractices,tohelpustoimproveefficiency.However,it’simportanttonotethatwhilemany,perhapseventhemajority,ofyourpatientswillbecapableofusingtechnologytoarrangetheirappointments,therearemanypeopleuncomfortable,orunabletousetechnology,soyoumustalwaysmakesurethatthesepatientsareaccommodated,too.Providingyourpatientswithmoreoptions,ratherthanreplacingoldoptions,isoftenthebestpracticeforimprovingefficiency.
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Now,let’smoveontolookatapracticethatusedtechnologyinasurprisingway...
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THEREADINGSECTION
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ReadingIntroduction
SectionOverview
TheOETReadingTestconsistsofthreeseparatepartswithatotalof42questions,andtakes1hourtocomplete.
ThethreedifferentpartsoftheReadingTestaredescribedbelow.
PartAoftheReadingTestcontains4textsonthesametopicthatahealthcareprofessionalmightuseinthecourseoftheirwork.Youwillhave15minutestoanswer20questionswhichcoveravarietyofquestiontypesabouttheinformationinthefourtexts.
PartBoftheReadingTestcontains6extractsfromworkplacecommunicationsinahealthcaresetting.Youshouldaimtospendroughly10minutesonthissection.
PartCoftheReadingTestcontains2longpassagesprovidinginformationondifferenthealthcaretopicswith8questionseach.Youshouldaimtospendroughly35minutesonthissection.
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READINGSTRATEGIES
UnliketheOETListeningTest–whereyoumustkeeppacewiththerecordingtoavoidfallingbehind–youmustpaceyourselfintheReadingTest.Youshouldtimeyourselfwhileyouattemptthequestionswithinthischapter.MakesureyouarefamiliarwiththeReadingTestinstructionsinadvance,sothatonTestDay,youcanfocusonansweringthequestions.FamiliariseyourselfwiththedifferentpartsoftheReadingtest,andbepreparedforeachquestiontype.UsethischaptertobuildyourknowledgeofthedifferenttasksintheReadingtest,thenassessyourskillswiththepracticesetofquestionsattheendofeachpart.Revisitandreviseanyquestionsyoustruggledwith,identifywhatcausedyoutostrugglewiththequestion,andpractiseansweringsimilarquestions.Lookoutfortheimportantwordsinthequestionthatcanhelpyoutolocatetheinformationinthetext.
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CHAPTER6
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ReadingPartA
LEARNINGOBJECTIVES
Bytheendofthischapter,youwillbeableto:
Scanthe4textstolocatetheinformationneeded.Readsectionsofthe4textstofinddetailedmeaning.PractisestrategiesforansweringMatching,SentenceCompletion,andShortAnswerquestions.
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INTRODUCTION
InPartAoftheOETReadingTest,youhavetoanswer20questionson4separatetexts.Youhave15minutestodothisonTestDay.ThetextsinthissectionwillbelabelledTextAtoTextD,andpresentinformationindifferentways,butallrelatetoonehealthconditionortypeoftreatment.
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Strategies
KnowtheInstructions
Youshouldmakesureyouarefamiliarwithwhatyouhavetodobeforeyoutakethetest.TheinstructionsforReadingPartAlooklikethis:
TIME:15minutes
KnowtheFormat
InPartAoftheReadingTest,youneedtolookatthe4textsprovidedacrosstwopagesofyourtestbooklet.The4textsinthissectionareexamplesofavarietyoftexttypesyoumightfindintheworkplace-includingatleastonethatpresentsvisualortabularinformation,suchas:aflowchart,table,ordiagram.OthertextsinPartAwillincludeinformationinparagraphsandbullet-pointedlists.Someofthetextsinthissectionwillcontainnumbers,butyouarenotrequiredtomakeanycalculations.
Lookatthefourtexts,A–D,intheTextBooklet.Foreachquestion,1–20,lookthroughthetexts,A–D,tofindtherelevantinformation.WriteyouranswersonthespacesprovidedinthisQuestionPaper.Answerallthequestionswithinthe15-minutetimelimit.
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The4textsinReadingPartAtestyourabilitytoconsultandunderstandpracticalreferencedocumentsforspecificconditionsandtreatments,forexample,oneofthetextsmightoutlinethecorrectproceduretofollowwhenapatienthasabrokenarm.Don’tworryifatfirstthetopicofthetextsareunfamiliartoyou,youwillnotneedtohavepriorknowledgeofthespecificconditionortreatmentdiscussedinthetextsforReadingPartA.Simplyfocusonfindingthewordorphraseintherelevanttextthatallowsyoutoanswereachindividualquestion.
WhenyoubeginPartA,youshouldstartbylookingbrieflyateachofthefourtextsinthetestbooklettounderstandthetypeofinformationbeingprovidedineachtext.Youshouldspendonlyashorttimeatthe4textsbeforeansweringthequestions,asthefirsttaskwillhelpyoutounderstandtheinformationprovidedinthe4texts.
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Exercise
Brieflylookatthefourtextsonthefollowing2pages,thenanswerquestions1–5asquicklyasyoucan.
Hypertension:Texts
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TEXTA
Themedicationsusedtotreathighbloodpressurefallunderoneofthefollowingcategoriesdescribingtheirmechanismofaction:
Whichmedicationapatientreceivesdependsontheirageandethnicity.BlackpatientsofAfricanorCaribbeandescentareknowntohavehigherriskofhypertension.Wheneverapatient’streatmentregimefailstowork,itisstepped-upbyaddinganadditionalmedicationofadifferentcategory.
ACE-inhibitorAngiotensin-IIantagonistCalcium-channelblockerThiazide-typediuretic
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TEXTB
ControllingHighBloodPressure
Advisepatientstostopsmoking;offeradviceforhelpandcounselling.Patientscanusenicotineaidsandjoinlocal‘stopsmoking’schemes.Ifunabletoquitsmoking,encouragethemtoreducedailycigaretteconsumption.Patientsmustnotdrinkalcoholtoexcessandsticktoweeklyalcohollimits,whichare14UnitsperweekMAXIMUMforbothmalesandfemales.Encourageregularexercise,atleast150minutesofmoderateaerobicactivity(suchaswalking,cycling,swimming)perweek,includingstrengthexercisesonatleasttwodaysperweek.Recommendabalancedandhealthydiet,lowinsaturatedfatsandsugars.Patientsshouldoptforleanproteins,browncarbs,andfruitandvegetables.Advisethosewithhighbloodpressuretopurchaseabloodpressuremonitortouseathomesothattheycanmeasurebloodpressureregularly.Patientsshouldkeepabloodpressurelogandtaketoeachcheck-upappointment.Providestrategiestohelpminimisestressandanxietyathomeandatwork.Offeradviceabouthelpandcounselling,recommendlocalservicesforstress,anxiety,ordepression.
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TEXTC
Thefollowingareindicatorsofhighbloodpressure:
Highbloodpressureisoneofthebiggestriskfactorsforheartdiseaseandstroke.Itisaworldwideissueandisbecomingincreasinglycommon.TherewouldbeasignificantreductionintheincidenceofheartdiseaseandstrokeintheUKifallpatientswithhighbloodpressuremadelifestylechangesandtookstepstolowerandcontrolit.
Severe,suddenandrecurringheadachesFrequentnose-bleedsVisualchanges,suchasblurredvisionDizzinessShortnessofbreathChestpainNumbness
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TEXTD
Thetablebelowshowsthesystolicanddiastolicvaluesfornormalandabnormalbloodpressure.
Category: SystolicPressure
(mmHg):
DiastolicPressure
(mmHg):
Hypotension 70–89 or 40–59
NormalBloodPressure 90–119 and 60–79
Prehypertension 120–139 or 80–89
Stage1(Mild)Hypertension 140–159 or 90–99
Stage2(Moderate)-
Hypertension
160–179 or 100–109
Stage3(Severe)Hypertension 180–209 or 110–119
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1. Foreachofthefourtexts,A–D,brieflysummarisetheinformationgiven.
2. LookinTextAtofindwhohasanincreasedriskofhighbloodpressure.
3. LookinTextDtofindwhichcategoryofbloodpressureadiastolicmeasureof85mmHGwouldbelongto?
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InPartAoftheReadingTest,youneedtoanswerquestionsusinginformationinthetextsasyouhavejustdoneinthisexercise.However,unlikethepreviousexercise,onTestDayyouwillnotbetoldwhichtexttofindtheinformationin,soyouneedtobepreparedtoscanallfourtextstofindtherelevantinformation,beforeyoucancompletethequestion.
Thequestionsinthispartofthetestdon’tfollowtheorderofthetexts.Eachtaskinthispartofthetestoperatesinadifferentway,andeachtaskwillrefertoall4texts.
Beforeyouscanthetextsforanswers,however,youshouldpayattentiontothewordsinthequestion,asthesecouldsuggestwhichtextyouwillfindthecorrectanswerin.Foreachquestion,underlinethemostimportantwordsorphrasestohelpyouscanthetextstofindtheanswers.
IdentifytheQuestionTypes
InPartAoftheReadingTestthereare4possibletasktypes:Matching,ShortAnswer,SentenceCompletionandNoteCompletion.ThefirsttaskwillalwaysbeMatching,andthistaskwillalwaysbefollowedby2oftheother3tasktypes.InPartA,the20questionswillbesplitacross3or4groupsofquestions.
4. LookinTextBtofindwhattypeofexercisepatientsshoulddotwotimeseachweek?
5. LookinTextCtofindwhatwouldhappenifpatientswithhighbloodpressuremadeanefforttolowerit.
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Questions6–25onthefollowingpagescanbeansweredbyreferringtothe4textsaboutthethyroidonpages71and74.
MatchingQuestions
ThefirsttaskinReadingPartAalwaysasksyoutoidentifywhichtextcontainstheinformation.Youshouldalwaysanswerthesequestionsfirst,astheywillhelpyoutogainanunderstandingofthecontentwithineachtext.
Toanswerthesequestions,lookattheinformationgiveninthequestion.Thequestionswillavoidrepeatingwordsandphrasesexactlyastheyappearinthetexts,soyouwillneedtounderstandthemeaningofthequestion,andfindthematchinginformationinoneofthepassages.Thequestionsinthissectionaskyoutoidentifywhichtextcontainsaparticulartypeofinformationorinformationaboutaparticularaspectoftheconditionorissue.Forexample,aMatchingQuestionmightask‘Whichtextprovidesinformationaboutidentifyingdeliriuminpatients?’Toanswerthesequestions,youneedtounderstandthegeneralmeaningofthe4texts,ratherthanthespecificdetails.
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Exercise
Answerquestions6–11usingthe4textsonpages71to74.Youshouldcompletethesequestionsin3minutes.
Inwhichtextcanyoufindinformationabout...
6. identifyingtheriskofmalignantcancerofthethyroid?
7. whichpatientsaresuitableforathyroidectomy?
8. thesymptomsofpatientsreceivinginsufficienttreatment?
9. changingthedosageofthyroidmedication?
10. assessingthethyroidfunctioninthosetakingL-thyroxine?
11. possiblecomplicationsinvolvedinthyroidremovalprocedure?
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ShortAnswerQuestions
ToanswerShortAnswerquestions,youneedtolocatethecorrectwordorshortphrasefromthetexts.Youwillhavetowritetheanswertothesequestionsusingonlytheinformationgiveninthetexts.ShortAnswerquestionswillrequireyoutolookatthefourtextsinmoredetailthanyoudidforMatchingquestions,astheanswerstoShortAnswerquestionsmightbefoundinasinglesentenceinoneofthetexts.Thesequestionswilloftenincludespecificwords,suchastypesofmedication,treatmentorreactionsinpatients,thatyoucanlookforinthefourtextstofindwherethistypeofinformationinpresented.Onceyou’vefoundtheinformation,youneedtounderstandthetypeofwordorphraseyouneedtoanswerthequestion.Lookatthequestiontounderstandwhattypeofinformationisbeingaskedfor;forexample,aquestionthatasks‘Whatshouldpatientssufferingfromfeverbegiven?’couldbeansweredwithatypeofmedication,abeverage,oranitem.Thequestioncouldnot,ontheotherhand,beansweredwithanumberalone,oratypeofillness.Whenyou’restrugglingtofindtheanswertothequestion,itcanbehelpfultonarrowdownthetypeofansweryouneed,andlookforthepossibleanswersintherelevanttext.
Makesureyoucopythewordsexactly,anddonotincludewordsorphrasesthatarenotpresentinthetext.Theanswerwillgenerallyrequire1to3wordsfromthetext.Keepyouranswersshort,andavoidincludingunnecessaryinformation,asitmayleadtheassessortobelievethatyoudonotunderstandthetextfully,orarenotsureofthecorrectanswer.
IMPROVEYOURSCORE
Ifyou‘reconfidentyou’veidentifiedtheinformationinoneofthetexts,withoutcheckingtheothertexts,writeyouranswerdownandmoveon.
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Exercise
Answerquestions12–16usingthe4textsonpages71to74.Foreachanswer,useawordorshortphrasefromthetext.Eachanswermayincludewords,numbersorboth.Youshouldcompletethesequestionsin5minutes.
12. WhatwillthelevelofFT4beinpatientsundergoingthyroxinereplacementtherapy?
13. WhatshouldpatientswhoaretakingL-thyroxinedoiftheynoticearrhythmiaandmoodswings?
14. Whichtypeofthyroidectomyhasanincreasedchanceofmorbidity?
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SentenceCompletion
ToanswerSentenceCompletionquestions,youneedtofillthegapsineachsentencewithawordorshortphrasefromoneofthetexts.
TheprocessforansweringthesequestionsissimilartothatusedforShortAnswerquestions.Lookatthewordsinthesentencethatarelikelytoguideyoutotheinformationinthetext,scanthetextforthesewordsuntilyoufindtheinformation,andidentifythewordorshortphrasethatismostlikelytocompletethesentence.
Beforecompletingthesentence,readthesentencetoyourself(inyourhead,notoutloud)withyouranswer,toconfirmthatthesentencemakessenseusingthewordsyouhavechosen.Ifitdoes,completethesentence.Ifitdoesnotmakesense,readtherelevantpieceofinformationmoreclosely,andchooseanotherwordorshortphrase.
IMPROVEYOURSCORE
15. TestresultsforapatientwithsubclinicalhyperthyroidismwillshowwhatlevelofFT3?
16. Whatcanbetestedforusingacommerciallyavailablekit?
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Thequestionsinthissectionarenotgivenintheorderthatthefourtextsappear,soifyou’vejustansweredaquestionwithinformationfromthethirdtext,thisdoesnotmeanthatthenextquestionwillbeinthefinaltext.Makesuretocheckallfourofthetextstofindtheanswer.
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Exercise
Answerquestions17–21usingawordorshortphrasefromthe4textsonpages71to74.Eachanswermayincludewords,numbersorboth.Youshouldcompletethesequestionsin5minutes.
17. IfthyroidfunctiontestsindicatethatTSHhas(17),thiscouldsuggestheterophileantibodies.
18. Followingathyroidectomy,ifthepatientexperiencesaphonia,thissuggestsinjurytothe(18).
19. IftestsrevealthattheBRAFV600Emutationispresent,itisextremelylikelythatthepatienthas(19).
20. Duringathyroidectomy,theendoscopeisinsertedintoacutmadeinthe(20).
21. Tooptimisehypothyroidismtreatment,(21)canbeusedtodetecteuthyroidism,oncethecurrenttreatmentisstopped.
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Thyroid:Texts
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TEXTA
DiagnosisofHypothyroidisminPatientsTakingL-thyroxine
Patientsfrequentlytakethyroidhormonewithaninadequatediagnosisofhypothyroidism,thisisclinicallyrelevantandshouldbeaddressedtooptimisetreatment.Presentingcomplaintsincludefatigue,weightgain,andoligomenorrhea.Ifthepatientanddoctorestablishthatthediagnosiswasnotcomplete–thebestapproachistostoptreatmentfor5weeks.L-thyroxineanddesiccatedthyroidextractarethemostcommontreatmentoptions.Afterstoppingtreatment,serumT4andTSHconcentrationswillindicateeuthyroidismoraprimaryhypothyroidstate.
Carryouttests10-14daysafterstoppingdrugtherapyandanalysetheresultsforphysiologicalhypothyroidismfromsuppressionofthepituitary-thyroidaxisbytheexogenoushormone.
Alternativeapproach:halvetheL-thyroxinedoseandassessthyroidfunctionafter5weeks.
PatientstakinganexcessiveamountofL-thyroxinemayexperiencethefollowingsymptoms:
moodchanges/swingsarrhythmiatremorchestpain
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Advisepatientstobeawareofthesesymptoms,andtoseekimmediatemedicalhelpifmorethanoneofthesesymptomsoccurs.
bonepaindiarrhoea
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TEXTB
Minimallyinvasivevideo-assistedthyroidectomy
Procedure:
Safety:
Usuallyundertakenwiththepatientundergeneralanaesthesia.SmallincisionmadeabovethesternalnotchEndoscopeinsertedthroughincisionDissectionofthyroidlobeundertakenOperativespacemaintainedusingexternalretractionDonotusegasinsufflation
Caremustbetakentoidentifyandpreserverecurrentlaryngealnerve
Postoperativemorbidityrates,meta-analysisof9studies:10%(29outof289)forminimallyinvasivevideo-assistedthyroidectomy14%(42outof292)forconventional,openthyroidectomy
Superficiallaryngealnerveinjuryreportedin2%(5outof300)ofpatientsCanleadto:
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Training:
Weakenedvoice(hoarseness)Lossofvoice(aphonia)Problemswiththerespiratorytract
Minimallyinvasivevideo-assistedthyroidectomyrequiresskillsadditionaltothoseofconventional,openthyroidsurgery.Adequatetrainingisimportantforsurgeonsusingtheminimally
invasiveprocedureTheprocedureisonlysuitableforaminorityofpatientswith
thyroiddiseaseThoserequiringsurgeryThosewiththyroidglandsofanappropriatesize
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TEXTC
BRAFV600EMutationTestingforThyroidCancer
Mutationtestingshouldbeundertakentoavoidunnecessarysurgeryandreducethenumberofsurgicalproceduresforpatientswithsuspectedthyroidcancer.
FineneedleaspirationisthemostcommonmethodtoobtainthyroidtissuesamplesCytologicalexaminationcannotdistinguishbetweenbenignandmalignant
neoplasmsIfthebiopsyispositive–theaffectedlobeissurgicallyremovedThesampleundergoesapathologicalmicroscopicexaminationIfthetestingindicatescancer–theremainderofthethyroidglandisremoved
AtestforaBRAFV600EmutationcanbeperformedusingacommerciallyavailabletestingkitTheBRAFV600Emutationhasmorethan99%specificityforthyroid
cancerApositiveresultmeansthatthereismorethan99%chancethecancerismalignant
Thismakesitpossibletoremovethethyroidinoneoperationratherthantwo
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TEXTD
ThyroidFunctionTestResultsandAnalysis
TSH FT4 FT3 Clinical
Decreased Normal Normal
Decreasedor
Normal
Decreasedor
Normal
Decreasedor
Normal
Increased Normal Normal
Normalor
Increased
Normalor
Increased
Normalor
Increased
thyroxinetreatment/ingestion—
subclinicalhyperthyroidism—
drugs:steroid,dopamine—
non-thyroidalillness—
non-thyroidalillness—
earlyphasepost-treatmentfor-
hyperthyroidism
—
pituitarydisease—
congenitalTSHdeficiency—
subclinicalhypothyroidism—
heterophileantibody(interfereswithTSH
assay)
—
erraticcompliancewiththyroxinetherapy—
malabsorptionofthyroxineinpreviously
stablepatient
—
drugs:amiodarone,cholestyramine,iron—
recoveryphaseofnon-thyroidalillness—
TSHresistance—
drugs:heparin,amiodarone—
anti-iodothyronineantibodies,anti-TSH-
antibodies
—
familialdysalbuminaemic-—
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hypothyroxinaemia(FDH)
thyroxinereplacementtherapy(including
non-compliance)
—
non-thyroidalillness,acutepsychological
disorders
—
TSH-secretingpituitarytumour—
resistancetothyroidhormone—
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Remember,youonlyhave15minutestoanswerall20questionsinPartA,soyoumustuseyourtimewisely.Bythetimeyougettothedifferentsetsofquestions,suchasShortAnswer,NoteCompletionandIncompleteSentences,youshouldbefamiliarenoughwiththetextsthatyoucanidentifythetextthattheinformationislikelytoappearin,justbyreadingthequestion.Whenthisisthecase,checkthetexttoconfirm,findtheanswer,andmoveontothenextquestion.WorkingbrisklyandefficientlyarethekeystosucceedingonTestDay.
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ReadingPartA:PracticeSet
TIME:15minutes
Anaemia:Questions
Questions1–6
Foreachquestionbelow,decidewhichtext(A,B,CorD)theinformationcomesfrom.
Youmayuseanylettermorethanonce.
Inwhichtextcanyoufindinformationabout...
Lookatthefourtexts,A–D,onpages78–81.Foreachquestion,1–20,lookthroughthetexts,A–D,tofindtherelevantinformation.WriteyouranswersinthespacesprovidedinthisQuestionPaper.Answerallthequestionswithinthe15-minutetimelimit.
1. treatingpatientswithanaemia?
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Questions7–14
Answerthequestionsbelow.Foreachanswer,useawordorshortphrasefromthetext.Eachanswermayincludewords,numbersorboth.
2. thesymptomsofhypoxia?
3. methodsusedtoidentifyanaemicpatients?
4. thedifferenttypesofanaemia?
5. thelevelsofhaemoglobininawomanwithanaemia?
6. howredbloodcellsizeaffectsanaemia?
7. Whatshouldveganpatientswithvitamindeficiencyanaemiabeencouragedtoaddtotheirdiets?
8. Ifthereisadecreasednumberofyoungredbloodcells,whattypeofanaemiaisbeingdealtwith?
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9. Howwillapatient’sbreathingsoundwhenexperiencingasignificantreductionofoxygeninthebody’stissues?
10. Amalewithanaemiamusthavelessthanwhatpercentageofredbloodcells?
11. Whatisanincreaseinthenumberofreticulocytesanindicationof?
12. Whatreducestheamountofredbloodcellsinsomepatients?
13. Whatshouldbetreatedinanaemicpatients,afteridentifyingthecause?
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Questions15–20
Completethesentencesbelowbyusingawordorshortphrasefromthetext.Eachanswermayincludewords,numbersorboth.
14. Howarethedifferenttypesofanaemiamostcommonlydistinguished?
15. Anaemiacausedby(15)shouldbetreatedwithabloodtransfusion.
16. Patientssufferingfromhypoxiaandchestpainarelikelytoalsohavea(16).
17. If(17)isfunctioningproperly,highreticulocyteanaemiaislikelytobepresent.
18. Anumberoftestsmaybenecessarytodiagnoseanaemia,duetothedifficultiesinvolvedinmeasuring(18).
19. Patientswithanaemiacausedby(19)shouldbeinstructedtoadjusttheirdiet.
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20. Whenidentifyingthetypeofaetiology,(20)ofthepatientshouldbeconsidered,inadditiontolaboratorystudies.
Anaemia:Texts
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TEXTA
Anaemiaisdefinedasanoveralldecreaseinredbloodcellmass.Therearemanyvaryingcausesofanaemia,whichallpresentwithsomegeneralsymptoms.Anaemiaresultsinalackofredbloodcellsintheblood.Becauseitisthehaemoglobininredbloodcellsthatcarriesoxygenfromthelungstotherestofthebody,adecreaseinredbloodcellsresultsinlessoxygengoingintothetissues.Thiscausesastateknownashypoxia,orreducedoxygeninbodytissues.
Thecommonsymptomsofallanaemiasarethoseofhypoxia:
Weakness,fatigue,difficultorlabouredbreathingPaleskinHeadacheandlight-headednessChestpain(ifthepatientalreadyhasadiseaseofthearteriessupplyingtheheart)
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TEXTB
Therearemanyclassificationsystemstodifferentiateanaemias.Themostcommonlyusedisbasedonthesizeoftheredbloodcell.Anaemiaswithredbloodcellsthataresmallerthannormalareknownasmicrocyticanaemias.Iftheanaemiahasnormallysizedredbloodcells,itisreferredtoasanormocyticanaemia.Finally,iftheredbloodcellsaretoobig,itisknownasamacrocyticanaemia.Normocyticanaemiasarefurtherbrokenupintowhetherornotthereisanincreasednumberofyoungredbloodcells(a.k.a.reticulocytes),whichisanindicationifthebonemarrowisworkingproperly—forexample,iftheredbloodcellsarebeingdestroyed(haemolysis),thereshouldbehigherreticulocytesbecausethereisnoeffectonthebonemarrow’sabilitytoproducenewcells.
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TEXTC
Whiletherearemanydifferentcausesofanaemia,laboratorystudiesanduniquefeaturesofthepatientcanbeusedtohelpdifferentiatebetweenvariousaetiologies.
Laboratorystudiesusedtodiagnoseanaemiainclude:
Ageneraldiagnosisofanaemiacanbedeterminedbythefollowingvalues:
Haemoglobin(Hb)—ameasureoftheproteinthattransportsoxygenintheredbloodcellHaematocrit(Hct)—ameasureofthepercentageofredbloodcellsinthebloodRedbloodcellamount(erythrocytecount)—ameasureofthenumberofredbloodcellsintheblood
HaemoglobinlevelMales:lessthan13.5g/dLFemales:lessthan12.5g/dL(womenhaveagenerallylowerhaemoglobinbecauseofbloodlossduringthemonthlymenstrualcycle)
HaematocritMales:lessthan45%redbloodcellsFemales:lessthan37%redbloodcells(womenhaveagenerallylowerhaematocritbecauseofbloodlossduringthemonthlymenstrualcycle)
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Whiletheselaboratorytestsaregoodestimatesoftheredbloodcellmass,theyarenotperfect.Redbloodcellmassisverydifficulttomeasure,andthereforetheselaboratorytestsareusedtogethertoassesswhetherornotsomeonehasanaemia.
RedbloodcellamountMale:lessthan4.7millioncells/mLFemale:lessthan4.2millioncells/mL(womenhaveagenerallylowerredbloodcellamountbecauseofbloodlossduringthemonthlymenstrualcycle)
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TEXTD
Thetreatmentofanaemiadependsheavilyonthetypeofanaemiathatthepatientisexperiencing.However,thereareseveraloverarchinggoalsoftreatment.
Ifpossible,treattheunderlyingcauseoftheredbloodcellloss.Forexample,ifthepatienthasanaemiabecauseofbloodloss,
giveabloodtransfusion.
Identifyandtreatanycomplicationsthathaveoccurredbecauseoftheanaemia.Educatethepatientonhowtomanagetheiranaemia.Forexample,apatientwithanaemiabecauseofirondeficiency
cansupplementtheirtreatmentwithironrichfoods,suchasleafygreenvegetables.Alternatively,apatientwithanaemiacausedbyvitamin
deficiencyshouldbeadvisedtoincreasetheirintakeoffolicacidandB-12.NotethatpatientswhofollowvegetarianorvegandietsmaystruggletomeetB-12requirements,soeatingfortifiedfoodsandusingsupplementsshouldbeadvised.
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Answers
1.A–Medicationoptionsforpatientswithhighbloodpressure.B–AdvicetogivepatientswithhighbloodpressuretocontroltheirconditionC–symptomsofhighbloodpressureD–systolicanddiastoliclevelsfornormalandabnormalbloodpressure
2.BlackpatientsofAfricanorCaribbeandescent
3.Prehypertension
4.strengthexercises
5.Therewouldbeasignificantreductionintheincidenceofheartdiseaseandstroke
6.C
7.B
8.A
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9.D
10.B
11.B
12.normalorincreased
13.seekimmediatemedicalhelp
14.(conventional)openthyroidectomy
15.normal
16.aBRAFV600Emutation
17.increased
18.superficiallaryngealnerve
19.malignantcancer
20.sternalnotch
21.serumT4andTSHconcentrations
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PRACTICESET
1.D
2.A
3.C
4.B
5.C
6.B
7.fortifiedfoods(andsupplements)
8.lowreticulocytes
9.laboured
10.45
11.reticulocytes
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12.menstrualcycle
13.complications
14.sizeoftheredbloodcell
15.bloodloss
16.diseaseofthearteries
17.bonemarrow
18.irondeficiency
19.chestpain
20.uniquefeatures
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CHAPTER7
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ReadingPartB
LEARNINGOBJECTIVES
Bytheendofthischapter,youwillbeableto:
Understandthedifferentreadingtexttypes.Readthetextcarefullytoidentifythecorrectanswer.PractisestrategiesforansweringReadingPartBquestions.
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INTRODUCTION
PartBoftheReadingTestinOETisverysimilartoPartBoftheListeningTest.InReadingPartB,youwillread6differentextractsfromdocumentsgivingbackgroundinformationforhealthcareprofessionals,andansweronequestionabouteachextract.Youhave45minutestocompletePartsBandCoftheReadingTest.Youshouldallowroughly10minutestocompletethissectionsoyouleaveyourselfenoughtimetocompletePartC.Thismeansyoushouldaimtospendonaverage1minute30secondstocompleteeachPartBquestion,althoughyoumayfindsomequestionsquickertoanswerwhileothersmaytakemoretime.
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Strategies
KnowtheInstructions
YoushouldmakesureyouarefamiliarwithwhatyouwillbeaskedtodoonTestDay.TheinstructionsforPartBoftheReadingTestwilllooklikethis:
Inthispartofthetest,therearesixshortextractsrelatingtotheworkofhealthprofessionals.Forquestions1to6,choosetheanswer(A,BorC)whichyouthinkfitsbestaccordingtothetext.
KnowtheSettings
ReadingPartBcontains6differenthealthcaretexts.Thetextsinthispartofthetestaregenerichospital-basedtextswhichcanbeusedandunderstoodbyanyofthe12healthcareprofessionscoveredbythetest.
Thetextsthatyouwillseeinthissectionofthetestrepresentthetypesoftextsanddocumentsthathealthcareprofessionalswilloftenrefertoforspecificreasons.Ratherthanfocusingontechnicalmedicalinformationthatyoumightfindinatextbook,forinstance,thesedocumentswillcoverguidelines,policiesandprocedures.Theymightremindhealthcareprofessionalsofthebestpracticetofollowinagivencircumstance,orupdatestoadatastoragesystem,oreveninstructemployeeshowtousemachinery.PartBtextswillgenerallybemadeupextractsfromthefollowingtesttypes:
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Toanswerasmanyquestionsinthissectioncorrectlyaspossible,youneedtofocusyoureffortsonunderstandingthemainpointoftheinformationprovidedineachofthetexts.
ScantheQuestion
UnliketheListeningTest,theOETReadingTestdoesnotprovideadditionaltimetolookthroughthequestionsbeforeansweringthem,soyoushouldfactorthisintoyourtotaltime.Youshouldaimtoanswer6questionsinroughly10minutes,sodon’tspendtoolongonanyonequestion.Ifyoucan’tfindtheanswer,moveontothenextquestionandcomebacktothisoneattheend.
Inthissectionofthetest,therearethreedifferentquestiontypes.We’llgothrougheachquestiontypenow,andprovideexamplesforeachquestiontype.
MainIdea
Thesequestionsaskforthemainideaofthepieceofinformation.Toanswerthesequestions,youwillneedtoassesswhatthemainpointisofwhatisbeingcommunicated.
NoticesEmailsManualsMemosGuidelines
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Exercise
Take4minutesand30secondstoanswerquestions1–3below.
1. Continuityandcoordinationofcare
Allhealthcareprofessionalsmustbeinvolvedinthesafetransferofpatientsbetweeneachotherandsocialcareproviders.Thisincludes:
Whencareistransferredordelegatedtoanotherhealthcareprofessional,itisyourresponsibilitytoensurethatthepersonprovidingcarehastheappropriateskills,qualificationsandexperiencetoprovideadequatelysafecareforthepatient.
Sharingallrelevantinformationwithcolleaguesthatareinvolvedwithyourpatient’scare,bothinsideandoutsidetheteam,includingwhenthecarehandoverisdoneattheendofduty,andwhencareisdelegatedorreferredtootherhealthorsocialcareproviders.Whenpossible,checkthatanamedteamorclinicianhasappropriatelytakenoverresponsibilitywhenyourrolehasendedinprovidingapatient’scare.Thisismostimportantinvulnerablepatientswhodonothavecapacity.
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Thepolicydocumenttellsusthatahealthcareprofessional’s
dutytocareforapatientcontinuesafterareferral.(A)abilitytolookafterapatientshouldbedecidedbysuperiors.(B)obligationtocheckupontransfersdoesnotapplytoall
patients.(C)
2. AssessingPhysicalRestraints
Wefirstadviseproviderstoverballyde-escalateandoffermedicationsasamethodofcalminganagitatedpatientdown.However,ifthesedonotworkandthepatientbecomesviolent,astandardprotocolforphysicalrestraintsshouldbefollowed.Trainedpersonnelshouldcarryouttheactualactionofphysicallyrestrainingthepatientandabedwithrestraintsshouldbepreparedaheadoftime.MedicationsshouldbedrawnupinIMformandbereadytobegivenoncethepatienthasbeenphysicallyrestrained.Aphysicianshouldthenassessthepatient,firstdebriefingstaffonthesituationthatcausedthepatienttobeplacedinrestraintsandthenspeaktothepatientpersonallytodeterminetheirunderstandingofthesameevents.Cardiopulmonarystatusandrestrainttightnessmustbeassessedandthepatient’slevelofpainanddistressdocumented.
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Theguidelinesinformusthatphysicalrestraints
canonlybeadministeredtopatientsbyqualifiedstaff.(A)mustbeappliedbeforepatientsbecomeaggressive.(B)shouldonlybeusedonpatientsasalastresort.(C)
3. CallingaConsult
Nophysiciancanhandleeverypatientbythemselves.Nomatterthespecialty,therewillcomeatimewhereyouneedtoreachoutforadditionalhelp.Ifyou’reworkingatanoutpatientoffice,you’lllooktoaspecialistinadifferentinstitution.Ifyou’reworkinginsidethehospital,you’llcallaparticularservicewithaconsult.Differentinstitutionshavedifferentprotocolsonhowtocalltheconsult,butattheverycore,youwillneedtopresentthepatienttothephysicianyou’veconsulted.Youshouldstartbyintroducingyourselfandyourroleonthetreatmentteam.Giveashortsummaryofthepatient,theirmedicalhistory,whythey’reinthehospitalandwhat’shappenedsofar.Youshouldthengointothereasonyou’reconsultingthespecialistandwhatyou’relookingfor–whetherit’streatmentrecommendations,aprocedure,ortoarrangeaservicetransfer.Concludebyaskingiftheyhaveanyotherquestionsthatyoucanhelpanswer.
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Detail
Detailquestionswillaskyoutoansweraquestionaboutaspecificpartofthetext.Theywilloftenincludewordsinthequestionthatyoucanusetoskimthetextfortherelevantinformation.
Theguidelinesadvisephysicianson
seekingadvicefromothers.(A)receivingauthorisationforcare.(B)referringpatientstodifferentdepartments.(C)
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Exercise
Take6minutestoanswerquestions4–7below.
4. EnsuringPatientPrivacy
PatientprivacyislegallygovernedbyHIPAA,whichestablishesstrictstandardsforhealthcareproviderswhensharingpatientinformation.EveryhospitalwillhaveguidelineshealthcareemployeesmustfollowtoavoidcommittinganHIPAAviolation,whichcanresultinterminationfromemploymentand/orseverefines.Employeesmustavoidtalkingaboutidentifiablepatientinformationwithotherpeoplethatarenotinvolvedintheircare.Thisalsoincludesdiscussingpatientdetailsinapublicsettinglikeahallwayorelevator.Whensendinginformationaboutpatientstootherproviders,itisimportanttousesecureformsoftransmissionsuchashospitalemailandfax.Avoideasybutunprotectedmethodsliketextingorpersonalemail.Disposeofanyidentifiableinformationinspeciallymarkedbinsforlaterincineration.
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Whatpointdoesthetrainingmanualmakeaboutconfidentialdocuments?
Theymustnotbeconsultedinanopenarea.(A)Theymustonlybesharedviaworkemail.(B)Theymustbedestroyedafteruse.(C)
5. Extractfromguidelines:Post-ExposureProphylaxisforHIV
WhenworkingwithpatientswithsuspectedorconfirmedHIVinfectionorotherbloodborneviralillnesses,medicalstaffmustrememberthattheyareatriskofinoculationinjury,andtakenecessaryprecautionstopreventinfection.
Itisimportantthatstrictguidelinesareadheredtoandrapidactiontakenpost-exposure,inordertoreducepotentialriskofinfectionpost-incident,controlspread,andpreventfutureincidents.Exposuresaredefinedaspercutaneousinoculationviaaneedlestickinjury,orasplashofpotentiallyinfectedbodyfluids/bloodintomucousmembranes(suchaseyesormouth)oranopenwound.Immediateactionshouldbetakentowashtheinjuryorexposedregionwithcopiousamountsofwater;anywoundsshouldbeencouragedtobleed,andpreventedfrombeginningtoclotbeforetheareahasbeencleaned.Seniormembersofstaffshouldbeinformedimmediately,andtheOccupationalHealthdepartmentcontacted.Allcaseswillbedealtwithconfidentiallyandallbloodsamplestakenfromthe
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affectedmemberofstaffwillbelabelledanonymously.AnIncidentFormshouldbecompletedurgently.OccupationalHealthwillrapidlyarrangecontactwith,andtestingof,thesourcepatient.
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Whatshouldstaffwithopencutsexposedtoabloodborneviralillnessdo?
avoidcontactwithotherstaff.(A)preventascabfromforming.(B)disinfectandcoverthewound.(C)
6. CodeineandUltra-RapidMetabolisers
Codeineisawidelyusedopioidanalgesicusedtotreatmildtomoderatepain.Theabilitytometabolisecodeinetomorphinecanvaryconsiderablybetweenindividuals.Codeinehasaverylowaffinityforopioidreceptorsanditsanalgesiceffectisduetoitsconversiontomorphine.ThehepaticCYP2D6enzymethatmetabolisesaquarterofallprescribeddrugs,includingcodeine,regulatesthisprocess.
IndividualswhohavetwoormorefunctionalcopiesoftheCYP2D6geneareultra-rapidmetabolisers-abletometabolise
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codeinetomorphinemorerapidlyandcompletely.Evenatnormaldoses,individualswhoareultra-rapidmetabolisersmayhavelife-threateningorfatalrespiratorydepression,orexperiencesignsofoverdose.IndividualswithnoactivecopiesofCYP2D6(“poormetabolisers”)showreducedmorphinelevels.Inthisscenario,alternativepainmanagementstrategiesmustbeestablished.
Healthcareprofessionalsandprescribersareencouragedtoeducatepatientsaboutpossiblesideeffectsassociatedwithcodeineuse.
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Theguidelinesinformusthatcodeinecancausesideeffectsinpatients
whosufferfromopioidaddiction.(A)whotakeittogetherwithmorphine.(B)whohaveaparticulargeneticmakeup.(C)
7. Guidelines:IncisionalHernia
In12–15%ofabdominaloperations,incisionalherniasoccurpost-operatively.Anincisionalherniapassesthroughanincisionpreviouslymadeduringsurgery,whentheclosureofabdominal
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tissuesfailstohealproperly.Besuretocoverduringcheck-ups:incisionalherniasarethesecondmostcommontypeofhernia.
Checkforhernia
Rememberthatthemajorriskwithincisionalherniasisstrangulation:theorganintheherniadevascularisesandthetissuedegenerates.Thismustbeidentifiedattheearliestopportunity–delaycanleadtosepticaemiaandshock.
Treatmentismostlysurgical:ameshcanbeusedtostrengthenthearea.Otherwise,openandkeyholerepairsremainanoption,however,betteroutcomeshavebeenreportedwiththeuseofmeshrepairs.
Lookforabnormalprotrusionoftissueororganthroughthecavityinwhichitissituated.
—
Rememberthatherniasaremostcommonintheabdomen,butcanalsoappearintheupperthighsandgroinregion.
—
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Theguidelinesinformusthatincisionalhernias
arecausedbysurgery.(A)formwhenpatientscutthemselves.(B)occurmorefrequentlythanotherhernias.(C)
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Purpose
Purposequestionsrequireyoutochoosetheanswerthatbestexplainsthepointofthetext.Thinkaboutwhythetextwaswritten,whatshouldhealthcareprofessionalsreadingthetextdoasaresultofreadingit?
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Exercise
Take4minutesand30secondstoanswerquestions8–10below.
8. ProceduralGuidelinesforSet-upandAdministrationofIntravenousFluids
Intravenous(IV)fluidsareinfuseddirectlyintotheveinsofpatientsviaacannulaincasesofseveredehydration,electrolyteimbalance,bloodloss,andinsurgery.Intravenouslinescanalsobeusedforadministrationofdrugsdirectlyintothebloodofapatient,resultinginfasteraction.TheguidelinesbelowillustratethecorrectprocedureforsettingupandadministeringIVtherapy.
Firstly,alwayscheckthatthefluidbagisnotdamagedandthattheliquidinsideitisclear.Secondly,therehavebeenreportsofincompletepatientnotes,soitiscrucialthatyoucheckfordetailssuchasfluidtypeandexpirationdateandrecordtheseinthepatientnotesimmediately.Thirdly,itisvitalthatallclinicalstaffintroducethemselveswiththeirfullnameandroletoallpatientstheyengagewith;onlyafterconfirmingpatientdetailsandobtainingtheirconsentshouldonebegintheIVset-up.Finally,beextradiligentwhencalculatingthedriprateasto
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avoidanyerrors.Feelcomfortabletoapproachafellowcolleagueforassistanceifuncertainatanystage.
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Themainpurposeoftheguidelinesistoadvisestaffon
theproceduretofollowwhenfittinganIV.(A)howtocheckforissueswithIVinfusions.(B)whattodobeforeadministeringanIV.(C)
9. Fortheattentionofallpaediatricians:
Asapaediatrician,onemustalwaysrememberthatthepatientsarenotthedoctor’sonlyconcern;wemustalsofactorintheanxiousparentsworriedabouttheirchild.Thiscanbeanadditionalchallengeforstaffinadepartmentthatisalreadybusyandstressful,butadutywhichmustnotbeneglected.Parentswhoseekpaediatriccareforminorconditionsarenotintentionallyimpingingonmedicalcareforthosepatientswhomoreurgentlyneedit.Therefore,timeshouldbespentspeakingtotheseparentsandofferingreassuranceandsupportasappropriate,ratherthanignoringthemormakingthemalastpriority.Tentofifteenminutesspentinconversationwiththesefamilieswillsavemuchmoretimeinthelong-runandpreventcountlessbleepsandcallsfromthem,whichcouldotherwisehavebeenavoided.Inaddition,itisvitaltobeawareof
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alternativepotentialcausesfortheparentalanxietythatcouldberootedinpasteventsandexperiences,orcausedbyproblemsintheirpersonallife.
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Thepurposeoftheemailistoadvisepaediatricianstobe
mindfulthatparentsmaynotalwaysagreewiththeproposedtreatment.
(A)
awarethatevenminorillnessescanbedistressingforparents.(B)understandingandpatientwhenexplainingconditionsto
children.(C)
10. Toallfront-linemedicalstaff,
Recently,wehavebeennoticingasteadyincreaseinno-showappointmentsatthepractice.Previously,wedidnothaveaconcretepolicyoncancellationdeadlinesormissedappointmentfees.Giventhatno-showappointmentsnotonlytakeupvaluabletimefromourproviders,butalsopreventanotherpatientfromutilisingthesetimeslots,itisinourbestinteresttodiscouragepatientsfrommissingtheirappointment.Goingforward,officestaffwillcalleverypatientatleast48hoursbeforetheirappointmenttoremindthemofthedateandtimeoftheirappointment.Ifthepatientcancelswithin24hoursoftheirappointmenttime,officestaffwillmakeanoteinthepatient’s
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chart.Ifthepatienthasmorethanthreesuchcancellations,heorshewillthenbeissuedwitha$25feetorescheduletheappointment.Patientswhoareusingmedicalinsuranceareexemptfromthisfeeandinsteadshouldhavetheirchartforwardedtoaproviderforfurtherevaluation.Weunderstandthatthisnewpolicymayresultinsomedifficultiesforstaff,sowewillallowfeestobewaivedinextremecircumstances.Wewillalsosetthestartdateofthispolicysixmonthsfromtoday’sdate,soallpatientswillhavesufficienttimetobeinformedofthenewrules.Pleasemakesurethatallpatientsareawareofthesechangesattheendofeachappointment.
Manythanks,
Theadminteam
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Whatistheemailfromtheadminteamaskingfront-linestafftodooverthenext6months?
Chargeafeetopatientswhocanceltheirappointmentsthreetimes.
(A)
Callpatientswithareminder24hourspriortotheirappointment.
(B)
Informpatientsofthechangestobeimplemented.(C)
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PartBoftheReadingTestisdesignedtoassessyourabilitytoscanandselectrelevantinformationfromhealthcaretextsthatyouarelikelytoencounterwhileworkinginyourprofession.Practiseforthissectionofthetestbyreadingthroughinstructivematerialsandmakingnotesonwhatisbeingexplained.TakenoteofthepurposeofanyemailsorcommunicationsyoureceiveinEnglish,andpayattentiontosignsandnoticesinEnglish,asthesewilloftenusesimilarlanguageandsettingstothoseusedinthispartofthetest.
IMPROVEYOURSCORE
Theanswerchoiceswillavoidrepeatingwordsorphrasesfromthetext.Assuch,itisimportanttothinkabouttheoverallmeaningoftheextract,andchoosetheanswerchoicethatbestcorrespondstothis.TheextractsinReadingPartBareshort,sogiveyourselftimetoreadthroughtheentiretext,usingthequestiontodirectyourunderstanding,beforeyouconsidertheanswerchoices.
IMPROVEYOURSCORE
Thequestioncanhelpyoutoidentifythetypeoftext.Generally,PartBmultiple-choicequestionswillhelptounderstandthetextbyexplainingthetypeoftext,orwhereyoumightfindit.Usethisinformationtohelpyoutounderstandthetext,forexample,ifthetextisanextractofapolicyupdateforhealthcarestaff,it’slikelytodiscussrecentchangestopracticesandprotocol.
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ReadingPartBPracticeSet
PartB
Inthispartofthetest,therearesixshortextractsrelatingtotheworkofhealthprofessionals.Forquestions1to6,choosetheanswer(A,BorC)whichyouthinkfitsbestaccordingtothetext.
1. PreparationofInjection
Lidocaineisalocalanestheticthatisofteninjectedsubcutaneouslybeforeminormedicalproceduressuchaslacerationrepair,excisionalbiopsy,andhormoneimplantation.Akeysteptoprepareforthisprocedureisclearingasuitableworkspaceandobtaininganynecessarysupplies.First,besuretocheckwithyourproviderabouttheconcentrationandmixtureofLidocainetobeused.Epinephrineisoftenincludedtoconstrictlocalbloodvesselsforlongerduration,butcanincreasetheriskofcausingischemiainareaswithpoorbloodsupply(fingers,ears,toes).SodiumbicarbonatecanalsobeaddedtoavoidpainduringinjectionduetoLidocaine’sacidicpH.Besuretoobtainthepropersizedneedleandsyringe,whichwillbedependenton
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thelocationoftheinjectionandthesizeofthearearequiringanesthesia,respectively.
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WhyisepinephrineaddedtoLidocaineinjections?
tonumbthearea(A)toprolongtheeffects(B)toreducepatientdiscomfort(C)
2. PolicyReminder:CollectingCollateralInformation
CollateralinformationisanimportantfactorindeterminingappropriatedispositionforpsychiatricpatientsintheEmergencyDepartment.Often,patientswithpsychiatriccomplaintsareunabletoaccuratelyorthoroughlydescribetheirmedicalhistory,baselinecondition,oreventsleadinguptotheirarrivalatthehospital.Thus,itbecomesimperativetocontactthosewhomightknowthepatientbestorwereinthepatient’scompanypriortotheirarrival.Contactinformationcanbeobtainedfromthepatientthemselves,personsaccompanyingthepatient,orthemedicalrecord.Wheninitiatingcontact,confirmtheotherperson’sidentitybeforerevealingthepatient’snameorthereasonyouarespeakingwiththem.Ifyoureachvoicemailandtheansweringmachinedoesnotclearlyidentifythepersonyou
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arelookingfor,donotrevealanyinformationaboutthepatient–simplystateyourname,number,position,andwhomyouarerequestingacallbackfrom.
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Thepolicydocumentoncollateralinformationoffersadvicetostaffabouthowto
gatherinformationfromcolleaguesaboutspecificpatients.(A)collectinformationaboutpatientsfromtheirfriendsand
relatives.(B)
informpatientsandtheircarersaboutrecentdiagnosesoverthephone.
(C)
3. AssessingandManagingPeripheralArterialDisease
Staffshouldassesspatientswhohavesymptomssuggestiveofperipheralarterialdiseaseordiabeteswithnon-healingwoundsforthepresenceofperipheralarterialdisease.
AskaboutthepresenceofintermittentclaudicationandcriticallimbischaemiaExaminethelowerlimbsforevidenceofcriticallimbischaemiaExaminepulsesinthelowerlimbs:femoral,poplitealandfeet
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Imagingispossibleforpatientswithperipheralarterialdisease:duplexultrasoundisthefirst-lineimagingtechnique.Ifpatientsrequireadditionalimaging,contrast-enhancedmagneticresonanceangiographyisused.Ifthisiscontraindicatedornotpossible,usecomputedtomographyangiographyinstead.
Lifestylechangesarethefirst-linetreatmentforperipheralarterialdisease,thisincludes:smokingcessation,bettercontrolofdiabetes,bettermanagementofhypertension,managementofhighcholesterol,incombinationwithantiplateletdrugs.Finally,regularexercisehasshowntobeneficiallyrevascularisetissuesinthosewithclaudication.
Measuretheanklebrachialpressureindex
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Whendealingwithpatientswithsymptomsofperipheralarterialdisease,staffshould
lookforsignsofswellingintheupperbody.(A)confirmthatthepatienthasahistoryofpoordiet.(B)identifythecausethroughphysicalexaminationandtests.(C)
4. Guidelines:AlcoholWithdrawalTreatment
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Alcoholwithdrawalcanpresentasalife-threateningemergencyandrequirestreatmentatahospital.Providersusealgorithmstodeterminewhenandhowmuchmedicationtoadministerforasafeandoptimaloutcome.AkeycomponentofthisassessmentisdeterminingtheseverityofalcoholwithdrawalusingtheClinicalInstituteWithdrawalAssessmentforAlcohol(CIWA-Ar).Thescalecontains10subjectiveandobjectiveitemsthatcanbequeriedandscoredinminutes.Symptomsaskedaboutincludenausea,vomiting,tremors,sweating,anxiety,agitation,tactile/auditory/visualdisturbances,headache,andcognitivedysfunction.Everyhospitalhasdifferentcutoffsfortreatment,butasageneralrule,treatmentwithbenzodiazepinesbeginstartingatascore8–10,withhigherscoringindicatingincreasingamountandfrequencyofmedication.
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Theguidelinesonalcoholwithdrawaltreatmentinformshealthcareprofessionalsabout
determiningthequantityofmedicationrequired.(A)reducingthedosageasthesymptomsimprove.(B)varioustypesofdrugstoprescribetopatients.(C)
5. Fortheattentionofallstaff:
RE:AGITATEDPATIENTS
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AgitatedpatientsareacommonoccurrenceintheEmergencyDepartment.Therearemanyreasonsforagitation,rangingfrommedicalconditions,substanceintoxication,psychiatricillness,anddistressingcircumstances.Whilebothphysicalandchemicalrestraintsareavailabletoproviders,theseareitemsoflastresortastheirusecreatessignificantrisktothepatient,staff,andotherpersonsinthearea.Verbalde-escalationisaproven,effectivetechniquethatcanbeusedtocalmapatientdownandpromoteasafetreatmentenvironment.Whende-escalating,designateonepersontospeakforthegroup.Agitatedpatientscanbeeasilyconfusedbymultiplespeakersandaunifiedmessagemustbepresented.Respectpersonalspacetopreventthepatientfromfeeling‘trapped’andmaintainsufficientdistancetoavoidanyresultantphysicalaggression.Remembertointroduceyourselfandyourroleonthetreatmentteamtothepatient.Usetheirnameandorientthemtotheirsurroundingsandwhytheyarehereinthehospital.
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Thememoisadvisingstaffdealingwithagitatedpatientsonhowto
identifythecauseoftheagitation.(A)avoidaddingtothefeelingsofagitation.(B)dealwithviolentbehaviourcausedbytheagitation.(C)
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6. ExtractfromAppropriateTreatmentforPain
Painisoneofthemostcommoncomplaintsthatwillbebroughttoaphysician’sattention.Thissectionwillcovertreatmentofmildtomoderatepainwithouttheuseofopioids.Moreseverepainmayrequirejudicioususeofshort-actingopioidmedicationsoraconsulttopainmedicine.Formostpatients,thefirstlinemedicationsforpainareacetaminophenandibuprofen.Maximumdailydosageofacetaminophenissuggestedtobe4grams,reducedtounder2gramsforpatientswithliverissuessuchasacirrhosis.Ibuprofenisparticularlyeffectiveinpatientswhosepainiscausedbyinflammation,thoughcautionisurgedinelderlypatients,patientswithdiagnosedbleedingissues(especiallygastrointestinalbleeds),oranycardiacissues.Maximumdailydosagesuggestedis2.4grams.Acombinationofacetaminophenandibuprofencanbeusedifeitheroneusedaloneisnotsufficient.Formorelocalisedpainrelief,considerusinglidocainedermalpatchesovernon-brokenareasofskin.
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Theguidelinesadvisethatpatientswithheartproblems
mayneedtoavoidibuprofen.(A)shouldbegivenlidocaineforpainrelief.(B)mustreceivealowerdoseofacetaminophen.(C)
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Answers
1. Adutytocareforapatientcontinuesafterareferral.
2. Cshouldonlybeusedonpatientsasalastresort.
3. Aseekingadvicefromothers.
4. CTheymustbedestroyedafteruse.
5. Bpreventascabfromforming.
6. Cwhohaveaparticulargeneticmakeup.
7. Aarecausedbysurgery.
8. CwhattodobeforeadministeringanIV.
9. B
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awarethatevenminorillnessescanbedistressingforparents.
10. CInformpatientsofthechangestobeimplemented.
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PRACTICESET
1. Btoprolongtheeffects
2. Bcollectinformationaboutpatientsfromtheirfriendsandrelatives.
3. Cidentifythecausethroughphysicalexaminationandtests.
4. Adeterminingthequantityofmedicationrequired.
5. Cdealwithviolentbehaviourcausedbytheagitation.
6. Amayneedtoavoidibuprofen.
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CHAPTER8
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ReadingPartC
LEARNINGOBJECTIVES
Bytheendofthischapter,youwillbeableto:
Brieflylookthroughthetexttounderstandthegeneralmeaning.Lookforcuesandpromptsinthequestiontofindtherelevantinformationinthetext.Identifythemainideaofatextandofeachparagraph.PractisestrategiesforansweringDetail,AttitudeandOpinion,VocabularyandReferencequestions.
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INTRODUCTION
InPartCoftheReadingTest,therearetwotexts,witheightquestionsoneachone.Thetypeoftextsyouwillencounterwillbeinthestyleofarticlespublishedforahealthcareaudienceinahealthcaresetting.Theywillnotbespecificallyaimedatanyonehealthcareprofession,andwilluseterminologythatcanbeunderstoodbyanyhealthcareprofessional.
Thereisacombinedtimeof45minutesforPartsBandC.Ifyouspentroughly10minutestocompletePartBoftheReadingTest,youwillhave35minutestocompletePartCofthetest.
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Strategies
KnowtheInstructions
Youshouldmakesureyouarefamiliarwithwhatyouwillbeaskedtodobeforeyoutakethetest.TheinstructionsforPartCoftheReadingTestwilllooklikethis:
Inthispartofthetest,therearetwotextsaboutdifferentaspectsofhealthcare.Forquestions7to22,choosetheanswer(A,B,CorD)whichyouthinkfitsbestaccordingtothetext.
KnowtheFormat
Eachquestionreferstoadiscretepartofthetext,andthequestionsappearintheorderoftheinformationinthetext.Youneedtoanswer8questionsoneachofthe2textsinthissectionofthetest.Thequestionswilldirectyoutothepartofthetextwhichthequestionrefers,soyoudon’tneedtoskimtheentiretexttofindtheinformation.Inaddition,onceyouhaveansweredaquestionaboutonepartofthetext,youonlyneedtolookattheinformationthatfollowsfortheremainingquestions,youwillnotneedtolookatthepreviousinformation.
LookattheText
Thefirstthingyoushoulddo,whentacklingaPartCtext,istoquicklylookthroughthetext,tounderstandhowthetextisorganisedandwhatit'sabout.As
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youskimthroughthetext,youmightfindithelpfultomakeafewbriefnotesaboutthemainideaortopicofeachparagraph,tohelpyoutorememberwhatthetextdiscusses.Don’tworryaboutunderstandingthetextindetailatthispoint,justgiveyourselfageneralsenseofthetext.Whenyoucometoanswerthequestions,thequestionswillguideyouthroughthetext.
Exercise
Take5minutestoskim-readthetextbelow.Asyoulookthrough,makebriefnotesaboutthecontent–aimforjust4or5wordsorphrasesperparagraph.Timeyourself.
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TEXT1:SYNTHETICVOICES
Therearemanyreasonswhyapatientmaylosetheirvoice;indeed,manyofuswillalreadyhaveexperiencedpartiallossofvoice,whensufferingfromacoldorflu.Whilewetendtodismissahoarsevoiceasamildannoyance,whenpermanentvoicelossoccurs,itcanbetremendouslydifficultforthepatienttodealwith,bothpractically,andemotionally.Whenourvoiceworks,wedon’tspendtoomuchtimethinkingaboutwhatlikewouldbelikewithoutit,butthetruthisthatourvoiceisanintegralpartofwhoweare.Ourvoicesdefineus,theyallowourlovedonestoidentifyusoverthephone,orwhenvisibilityispoor.Theydistinguishusasindividualsfromcertainpartsoftheworld,andtheycanevenindicateoursocialstanding.Untilrecently,patientswhoexperiencedpermanentlossofvoicewouldhavehadrelativelyfewoptionsattheirdisposal.However,astechnologyadvances,therangeofspeechreplacementoptionsavailablebecomesincreasinglysophisticated.
Today,syntheticvoicesarethemostcommontypeofspeechreplacementdeviceusedbythosewhohavepermanentlylosttheirvoice.Thetechnologyusedtocreatethissoftwarecanalsobeseeninspeechcontrolledhomedevices,andmodernsmartphones.Aspermanentlossofvoiceisoftencausedbyrespiratoryissuesresultingfromotherillnesses,however,it’simportantthatspeechreplacementdevicesforthosewhohavelosttheirvoicetakethepatient’sotherdisabilitiesintoaccount.Speech-to-textsystemstypicallyinvolveasystemofleversorasimplifiedkeyboard;thelattertendstobeeasierforthosewithlimitedmobilitytooperate.Usersareabletomanipulatethesecontrolsinordertoselectwordsfromacomputerinterfaceandbuildthemintosentences.Somesystemscanalsooperateviaeyemovementalone,sothatwhenauserstaresataparticularwordonthescreenforacertainamountoftime,itisselected.
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Thesesystemsshowaremarkableadvancementfromoneoftheearliestspeech-to-textmechanismsdesignedinthesixties:atypewriteroperatedthroughanairpipe,knownasasipandpufftypewriter.Thefirstelectricalcommunicationdevicefordisabledpeoplewhocouldnotspeak,asipandpufftypewritercalledthePOSM(PatientOrientedSelectorMechanism),wasdevelopedbyRegMaling,avolunteeratahospitalforparalysedpeople,afterhediscoveredthatpatientsatthehospitalwhohadlosttheuseoftheirvoicewereonlyabletocommunicateusingabell.Throughouttherestofthetwentiethcentury,thesetechnologiesweregraduallydeveloped,andinthe1970s,thefirstportable,commerciallyavailable,adaptivealternativecommunicationdevices(orAACs),wereproduced.Althoughtheywereadvertisedasportable,thesedevicesoftenweighedahefty15–20pounds,andtendedtorangefrom20to25inchesinsize.AsmanyoftheearlyportableAACusersalsousedawheelchair,inwhichitwasrelativelystraightforwardtodesignaholsteratthebackofthechairtostorethesedevices.
Thankfully,thetechnologycontinuedtodevelop,anddevicesbecamesmaller,easiertouseandmoresophisticated.IntheUnitedStatestherearenowovertwomillionpeoplewhorelyonsuchdevicesintheirday-to-daycommunications,yetmanyusersstillhavetomakedowithalimitednumberofvocalchoices—oftenlessthanadozen,withthemajorityofavailablevoicessoundingadultand/ormale.Thisisextremelyproblematic,asusersneedtochooseavoicethattheyfeelrepresentswhotheyare.Proponentsofnewdigitalvoicebanksareworkingtowardraisingthebarbysteadilywideningthescopeforself-expressionamongthemanymillionsofdiverseusersofAACs.
Ifpatientsaregraduallylosingtheirvoice,butstillabletospeak,theymaybeabletorecordtheirownvoicetousewiththeirAAC.Anotheralternativeopentopatientsistomakeuseoftheincreasingnumberofvoicesbeingdonated.Althoughvoicedonationdoesnotrequirethecontributortophysicallygivea
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partofthemselvesaway,asisthecasewithclassicmedicaldonations,donatorscertainlymustgotheextramile.Theprocessofvoicedonationismuchmoreextensivethan,say,donatingakidney,orotherphysicalorgan.Whilethedonationofanorganrequiresarelativelyshortstayinhospital,todonateavoicerequiresmanyweeksofdonorcommitment.Donorsmustspeakmanythousandsofpreselectedwords,phrasesandsentencesintoarecordingmicrophone.Somecompaniesofferaservicetailoredtotheuser,whocanreadsciencefictionorfantasystoriesoutloud—ortextsaccordingtotheirinterests—inordertoremainmoreengagedintheprocess.
Onceavoicehasbeencomprehensivelyrecorded,itthenbecomespartofthesoftwareforAACs,andmadeavailabletoanypatientthatneedsit.ProfessorStephenHawking,thefamousCambridgephysicist,begantouseanearlytext-to-speechsystemin1986calledCallText.Interestingly,theprofessorneverchangedhissyntheticvoicetoamoresophisticateddesignthatbetterimitatednaturalspeech.Instead,HawkingretainedCallText,explainingthathefeltthelimitedmodulationsofthevoiceallowedhisspeechtobeeasiertohearandunderstandduringlectures.Clearly,Hawkingalsocametoseeitasapartofhisidentity.30yearsafterhebeganusingCallText,thesoftwarewasnearingbreakdown,butratherthansimplyreplaceit,hehadateamofresearchersreverseengineerthevoiceontoamoremodernplatform.
AnswertheDifferentQuestionTypes
Onceyou’vescannedthetext,youcanbegintoworkthroughthe8questions.Youshouldaimtospendonetooneandahalfminutesansweringeachquestioninthissection,somakesuretotimeyourselfaccuratelyasyoucompletetheexercisesinthischapter.
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WhenyoucometoanswerthequestionsinPartC,firstlookatwhatthequestionisaskingyoutodo,thenscantherelevantparagraphofinformation,thenlookattheansweroptions.Markanyansweroptionsthatdefinitelydonotanswerthequestionwithacross,andifyou’restuckbetweentwoanswerchoices,readthroughtherelevantinformationagain,thenifyoustillcan’tfindtheanswer,selectoneoftheanswerchoicesasaguessandmoveon.
ThequestionsinPartCoftheReadingTestcanbebroadlydividedinto3differentquestiontypes.Wewillgothrougheachquestiontypebelow,andprovideexamplesforeachquestiontype.
Detail,AttitudeandOpinion
Detail,AttitudeandOpinionquestionswillaskyoutoidentifyinformationfromasectionofatext,andwillmostoftenfocusontheviewsandopinionsofthewriter.ThesequestionsarethemostcommonquestiontypeinPartC.ThefollowinglistgivesexamplesofthetypesofDetail,AttitudeandOpinionquestionsthatoccurinthissection:
Whatpointdoesthewritermakeinthethirdparagraph?ThewritersuggeststhatmaculardegenerationmayincreaseInthefourthparagraph,thewritersaysthatconventionaltreatmentscanbeproblematicbecause
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Exercise
Take5minutestoanswerquestions1–4.Timeyourself.
1. Inthefirstparagraph,thewritersuggestslossofvoiceisdifficultforpatientsbecauseitis
partoftheiridentity.(A)necessaryforinteraction.(B)usedtoformrelationships.(C)anindicatorofsocialclass.(D)
2. Whydoesthewriterbelieveitisimportantthatspeechreplacementdevicesbeoperatedbyavarietyofmethods?
Thetechnologyshouldbekeptuptodate.(A)Patientsoftensufferfromvariousconditions.(B)Healthcareworkersmightalsoneedtousethem.(C)Thedevicesshouldbeusableacrossarangeofplatforms.(D)
3. Inthethirdparagraph,weleanthatRegMallingdevelopedthePOSMdueto
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Vocabulary
Vocabularyquestionswillpresentyouwithasinglewordorphrasethatwillbeunderlinedandformattedinboldinthequestionandthetext.Toanswerthesequestionscorrectly,youwillneedtolookatthesurroundingwordsanddeducethemeaningaddedbythewordorphrase.Thesequestionsarenottestingyourknowledgeofthedefinitionofthewordorphraseitself.YoushouldexpecttoansweroneVocabularyquestionineachtextinPartC.ThefollowinglistgivesexamplesofVocabularyquestions:
thenumberofpeoplewhohadpermanentlylosttheirvoice.(A)thelackofaccessibilityinprevioussipandpuffdesigns.(B)thelimitedcommunicationoptionsfordisabledpeople.(C)therecentdevelopmentofsimilarsoundtechnology.(D)
4. Accordingtothewriter,whywereearlyportableAACsproblematicforthosenotinwheelchairs?
Theywereheavyandbulky.(A)Theywereremarkablyfragile.(B)Theycouldnotbeusedwhilewalking.(C)Theyneededaccesstoapowersource.(D)
Thewriterusesthephrase‘cutcorners’toreinforcetheideathatInthefinalparagraph,thewriterusesthephrase‘intheloop’tounderlineWhatissuggestedabouttheattitudetowardsthetrialbytheuseofthephrase‘onthefence’?
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Exercise
Take2minutesand30secondstoanswerquestions5–6.Timeyourself.
Reference
Referencequestionswillaskyoutodecidewhatthewordorphraseunderlinedandinboldinthequestionandinthetextrelatesto.Toanswerthesequestions,youmightneedtobeabletokeeptrackofwhatisbeingdiscussedinlong
5. Thewriterusesthephrase‘raisingthebar’tounderlinethe
complexityofmoderndevices.(A)needforadiverserangeofvoices.(B)highqualityofthesoundrecordings.(C)numberofnewcommunicationsystems.(D)
6. Whatissuggestedaboutvoicedonationbythephrase‘gotheextramile’?
donationcentresareoftenfaraway(A)alargenumberofvoicesarerejected(B)donatorssacrificemorethanorgandonators(C)theprocessisextremelytime-consuming(D)
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sectionsoftextwithcomplexsentences.YoushouldexpecttoansweroneReferencequestionineachpassageinPartC.ThefollowinglistgivesexamplesofReferencequestions:
Inthesecondparagraph,whatdoestheword‘it’referto?Whatdoestheword‘they’referto?Thephrase‘becauseofthis’refersto
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Exercise
Take2minutesand30secondstoanswerquestions7–8.Timeyourself.
PartCoftheReadingTestisdesignedtoevaluateyourabilitytoquicklyreadandunderstandEnglishtextsinahealthcaresetting.MakereadinghealthcaretextsinEnglishahabittoprepareyourselfforthetest.OnTestDay,takeadeepbreath,readeachsectioncarefully,selectananswer,thenmoveontothenextquestion.
7. Inthefifthparagraph,theword‘user’refersto
healthcareworkerswhotreatlossofvoice.(A)patientswithpermanentlossofvoice.(B)AACtechnologydevelopers.(C)voicedonators.(D)
8. Whatdoestheword‘it’refertointhefinalparagraph?
Apresentationgivenbytheprofessor.(A)Theresearchcarriedoutfortheprofessor.(B)Thesyntheticvoiceusedbytheprofessor.(C)Thepermanentlossofvoiceoftheprofessor.(D)
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IMPROVEYOURSCORE
QuestionsinPartCoftheReadingTestalwaysappearintextorderandwilloftendirectyoutotherelevantparagraph.Onceyou’veansweredaquestionaboutonepartofthetext,moveontothenextpart.
IMPROVEYOURSCORE
Wronganswerchoiceswilloftenfeatureotherdetailsfromthetextthatarenotaskedaboutinthequestion,orwillnotreflectthemeaningofthetext.Makesureyouarepickingthedetailthatanswersthequestionbeingasked.
IMPROVEYOURSCORE
PractiseforPartCoftheReadingTestbyreadingnewspaperarticles,papersandstudieswritteninEnglishonhealthcaretopics.Pickanarticlewitharound800wordsandgiveyourself5minutestoreadthetextandmakenotesonthecontent.
IMPROVEYOURSCORE
Wheneveryoureadarticles,papersorstudiesinEnglish,makealistofanywordsyoudonotrecognise.Besuretolookupthemeaningofeach
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word,andnoteasynonymornon-technicaltermforthisword.Buildingyourvocabulary,andyourconfidencewithunfamiliarwordswillboostyourperformanceonTestDay.
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ReadingPartC:PracticeSet
Forquestions1to16,choosetheanswer(A,B,CorD)whichyouthinkfitsbestaccordingtothetext.
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TEXT1:DELIVERINGSERIOUSNEWS
Deliveringseriousnewstopatientsandrelatives:it’smanyhealthcareprofessionals’mostdreadedtask.Unfortunately,it’snotsomethingthatcanbeavoided,andit’ssomethingthatmustbedoneright.Patientsandrelativesneedourguidanceandsupport,particularlywhentheprognosisisserious.Inthisarticle,weusethephrase‘seriousnews’or‘life-alteringnews’ratherthanchoosingatermwithnegativeconnotations,suchas‘badnews’,forexample,asithelpstoreframethediscussion.Ifyoudiscuss‘seriousnews’withapatient,theycandecidehowtorespond,whereasgivingapatient‘badnews’,maypreventthemfrombeingabletoacceptthenewsinamoreconstructivelight.
Studiesshowthevastmajorityofpatientswouldprefertobeinformedofalife-alteringdiagnosis,ratherthanremaininignorance.However,theamountofinformationtheywishtoreceivecanvary,withmostwantingtoknowdetailsconcerningthedifferenttreatmentoptions,andtheeffectivenessofproposedtreatments,whiletheymaywanttohearlessaboutthespecificdetailsoftheirprognosis.Accordingtostatistics,inwesterncultures,themajorityofpatientsmaynotwishtoknowcertaindetails,suchaslifeexpectancy.Healthcareworkersmayalsofindfamiliesaskingthatdiagnosesbekeptfromthepatient,orthatpatientsprefertohavecarewhollymanagedbytheirfamily,ratherthanthemselves.
OnemodelfordeliveringseriousnewsiscalledSPIKES,developedbyWalterBaileandinitiallyusedfordiscussionswithcancerpatients.ThefirststepinSPIKESissettinguptheinterview.Aquietprivateareasuchasanexamroomorfamilymeetingroomisanidealsetting.Thepatientshouldbeabletochoosefamilymembersorfriendstobepresentforsupport.Forthosewhodon’tspeak
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fluentEnglish,ahospital-contractedmedicalinterpretershouldbeused.Thehealthcareprofessionalshouldbepreparedtoanswerdifficultqueriesaboutprognosis,treatment,andoverallplangoingforward,butalsoknowwhentorefertoaspecialistformoreesotericinformation.Ifthereisamulti-disciplinaryapproach,everyteammembershouldbeonthesamepagewithregardstothecareplantoavoidconfusion.
TheseconditeminSPIKESisthepatient’sperception.Lastweek,Iaskedapatient,let’scallhimHarry,ifheunderstoodhiscurrentcondition.Ofcourse,hesaidhedid,butwhenhecametoexplainittome,Isawthatthereweremanygapsinhisknowledgethatneededtobeaddressed.Agoodwaytoassessthepatient’sunderstandingistoaskwhatthepatientalreadyknowsabouttheirconditionandwhattheyhavebeentoldsofar.Makesuretoassesstheleveloftheirunderstanding,aswellastheirawarenessofthebasicfacts.Thiswillallowyoutoassesstheirlevelofbackgroundknowledge,theircurrentknowledge,andwheretobeginyourowndiscussion.
ThethirditeminSPIKESisthepatient’sinvitationfordiscussion.Differentpatientsdesiredifferentlevelsofinformationabouttheircondition.Someofthemoretechnical-mindedoryoungerpatientsmaywanttoknowtheirdiagnosis,prognosis,treatments,courseofillness,etc.Others,includingolderpatients,maysimplywishtoknowthediagnosisandaccepttherecommendationsofthetreatmentteamasbeingintheirbestinterests.Beforebeginningtodiscusstheircondition,youmightfindithelpfultoask“Wouldyoulikemetodiscussalltheinformationweknowaboutyourconditionorjustcertainparts?Whatwouldyoulikeustotellyourfamily?”
ThefourthiteminSPIKESisgivingknowledgetothepatient.Youshouldbedirect,butavoidbeingunfeelingorbluntwhenyoudiscusstheircondition,andutilisenon-technicaltermsinsmallchunks.Prognosisandcourseofillness
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shouldberealistic,butalsoconveyhopeandplanningforthefuture.Anappropriateopeningforourpatientwouldbe,“I’mafraid,wehavesomeseriousnewsabouttheCTscanthatwasperformed.Itshowedthatthecancerinyourliverhasspreadtoyourspine.”Takenoteofhowthewords‘hepatocellularcarcinoma’and‘metastasis’wererephrasedintolayman’sterms.
ThefifthiteminSPIKESisaddressingthepatient’semotions.Youshouldidentifytheemotionthepatientisexperiencing,thereasoning,andprovidesupportduringthisdifficulttime.Don’ttrytochangethepatient’semotions,justhelpthemtoexpresshowtheyfeel.Forexample,inapatientwhoisdysphoricandcrying,youcanofferatissueboxandphysicalsupportifappropriate.Youmightsaysomethinglike,“Iknowtheseresultsweren’twhatyouwantedtohear.Iwishwehadbetternewsforyou.”Otherresponsescanrangefromaskingthepatienttoelaborateontheirreaction,“Canyoutellmewhatyou’reworriedabout?”tovalidatingtheirconcerns,“Icanunderstandwhyyoufeltthatway.Manyotherpatientshavehadsimilarreactions.”
ThesixthiteminSPIKESisstrategyandsummary.Patientswhoreceiveseriousnewswilloftenfeelthattheyareinovertheirhead,soyoushouldmakesurethattheyleavewithaclearplanforthefuture.Thiswillhelpthemtofeellessanxiousandmorehopeful.Patientsshouldknowwhatoptionsareavailableforthemandwhatfollow-upisplanned.Youshouldalsorecheckthattheyunderstandwhathasjustbeendiscussedandhavehadalltheirquestionsanswered.Agoodopeningstatementcouldbe,“Iunderstandthisisalottotakein,butyouhaveseveraloptionsavailable.Adecisiondoesnotneedtobemadenow,butwewouldliketoreferyoutoanoncologistandfollow-upwithusinaweektodiscussyournextsteps.”
Givingseriousnewsisoneofthemostdifficultpartsofbeingahealthcareprofessional.However,withcarefulplanningandaneffectiveprotocol,patients
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canleavefeelingwell-informedandincontroloftheirownoutcome.
Text1:Questions1to8
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1. Whydoesthewriterprefertheterm‘seriousnews’?
Itenablesdoctorstoavoidunnecessaryconversations.(A)Itavoidsinfluencingthepatient’semotionalresponse.(B)Ithelpspatientstobetterunderstandtheircondition.(C)Itoffersamorespecificdefinitionoftheinformation.(D)
2. Thewriter’spurposeinthesecondparagraphistohighlight
thetreatmentoptionsavailabletomostpatients.(A)thedifficultyofknowingwhatapatientwantstobetold.(B)thetrendsconcerningwhatpatientsandrelativeswanttohear.(C)thedifferenttopicsthathealthcareworkersshouldcoverwith
patients.(D)
3. Whatdoestheword‘those’referto?
healthcarestaff(A)treatmentexperts(B)languagetranslators(C)patientsandrelatives(D)
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4. Inthefourthparagraph,thewritermentionsthepatient,Harry,inordertoexplainthat
patientsareoftenreluctanttoaskforhelp.(A)patientsmaynotbeawareoftheirignorance.(B)healthcareprofessionalsoftenfindithardtorelatetopatients.(C)healthcareprofessionalsmaynotalwaysexplainthings
effectively.(D)
5. Thewritersuggeststhatolderpatientsmaybemorelikelyto
requiremoreinformation.(A)limittheirfamily’sinvolvement.(B)acceptthestaff’ssuggestedplan.(C)inquirefurtherabouttheirtreatmentplans.(D)
6. Inthesixthparagraph,thewriteroffersanexampletoemphasisethatwhenexplaininginformationprofessionalsshould
avoidusingcomplexmedicallanguage.(A)preventpatientsfrombecomingupset.(B)discusshowtheillnesswasidentified.(C)repeatinformationmultipletimes.(D)
7. Theseventhparagraphfocuseson
ensuringthepatientunderstandshowtoreact.(A)
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Inthispartofthetest,therearetwotextsaboutdifferentaspectsofhealthcare.Forquestions9to16,choosetheanswer(A,B,CorD)whichyouthinkfitsbestaccordingtothetext.
helpingthepatienttofeelmorepositive.(B)comparingdifferentpatientresponses.(C)empathisingwiththepatient’sreaction.(D)
8. Theexpression‘inovertheirhead’isusedtostressthatpatientsmight
findtheinformationoverwhelming.(A)struggletorememberinformation.(B)makeachoiceabouttheirtreatmentquickly.(C)havedifficultyunderstandingtheirprognosis.(D)
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TEXT2:TREATINGOPIUMADDICTION
IntheUnitedStatesalone,therearearound115deathscausedbyopioidaddictioneveryday.Theaddictionimpactsindividualsrapidlyanddrastically,damagesfamilies,andcoststheUShugeamountsofmoney:thetotaleconomicburdenofprescriptionopioidabuseisestimatedtobe$78.5billionayear,whiletheeconomicburdenofnon-prescriptionopioidabusesimplycannotbecalculated.Measuresareconstantlybeingimprovedtopreventpatientsfromdevelopingopioidaddictionstobeginwith,butitisalsoimperativethatwecontinuetoprovidetreatmentforthosealreadyinthethrallofopioidaddiction.
Jane’sstoryisoneheardoverandoveragaininopioidaddictionclinics.Whenshewas20,shehadabadautomobileaccidentthatrequiredtwosurgeries.Shewassoonhomefromthehospitalbutherresidualpainmeantshewasprescribedscheduledopiates.Jane’sbodysoonbecametolerantofthedosage;however,andsheneededhigherandhigherdosesinordertoachievethesamepainrelievingeffect.Sheeventuallyreachedalevelthatherphysicianfeltuncomfortableprescribing.Unabletofindanotherprescriberintime,Janeturnedtoalternativesourcesofnarcotics.Unfortunately,whenpurchasedonthestreet,thesepillsareexorbitantlyexpensiveandincreasinglyhardtocomebyinaneraofprescriptionmonitoringthroughouttheUnitedStates.Heroinismuchcheaperand,whendeliveredbyIV,producesamuchmorepotenthighandgreaterpainrelief.
Eventually,afterdestroyingrelationshipswithherlovedones,bankruptinghersavings,andhittingrock-bottom,Janeturnedtoalocalopioidaddictionclinicforhelp.Attheclinic,theyputheronMethadone,along-actingopioidagonistthatisstandardforaddictiontreatment.Itbindstothemu-opioidreceptors,preventswithdrawalsymptoms,reducescravings,andcanalsoprovidealevelof
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painrelief.Ofcourse,asanopioidagonist,methadoneservesasasubstitutefortheprimaryaddiction,meaningmanyoftheissuesassociatedwithlong-termopioidusageremain.Patientsmustoftenbegintreatmentwithdailyvisits,whichcanbedisruptive.FortunatelyforJane,thesevisitsareherfirststepstowardsputtingherlifebacktogether.AsJane’sroadtorecoveryislikelytobelongandfraughtwithdifficulty,manydoctorsareledtowonder:doesshehaveanyotheroptions?
Oneoftheincreasinglypopularalternativestomethadoneisbuprenorphine,apartialmu-opioidagonist.Asidefromitsuniquemechanismofaction(MOA),therearetwomajordifferenceswhencomparedtoMethadone:first,itcanbeadministeredasoraltablets,sublingual/buccalfilms,andalong-actingimplant,second,Itcanbeprescribedmonth-to-monthfromaclinician’sofficedirectlytoalocalpharmacy.Thesefactorsmakeitmucheasiertouseinthecommunity,andareidealforpatientswhocannotvisitamethadonecliniceveryday.
Toinitiatebuprenorphine,apatientmustalreadybeinamildstateofwithdrawalduetothehighaffinityforthemu-opioidreceptordisplacingotheropioids.Thismeansthatpatientsgenerallytransitionbestfromashort-actingopioidlikeheroinoroxycodoneratherthanalong-actingopioidagonistlikeMethadone,giventhelengthoftimeneededuntilmildwithdrawaloccurs.AsJanehadbeenusingopioidsforalongtimepriortoheradmission,however,shewasbettersuitedtotreatmentwithMethadone,asthereisnoceilingeffecttothisdrug,andJanehaddevelopedahightolerancetoopioids.Buprenorphine,beingapartialagonist,hasamaximumlevelofeffectwhichitcannotbeincreasedbeyond.Forthisreason,buprenorphinecanbeusedasamaintenancetherapyinsomepatients,butitcanalsobetapereddownovertime.Thisallowspatientstoresumetheirnormalliveswithminimalinterruptionsandavoidrelapsethroughpharmacologicalblocking.
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Alongsidetreatmentwithmedication,patientsrecoveringfromopioidaddictionmustalsodealwithrecoveryatamentallevel.Aswithmanyhealingprocesses,thefirststageisacceptance.Janewasnotabletoseekthetreatmentsheneededuntilshehadnowhereelsetohide.Onceeverythingwaslost,shecouldn’tdenythatshewasintroubleanymore,soshecametotheclinic.Manypatientssufferingfromopioidaddictionsarereluctanttoadmitthattheyareaddicted,andreluctanttoaskforhelp.Patientsareoftenworriedaboutbeingjudged,beingtreatedlikeacriminal,andmeetingwithdisapprovalfromthehealthcareprofessionalswhomusttreatthem.
Whenpatientsdoseekaid,healthcareprofessionalsneedtohelpthemtobuildasupportnetworkaroundthemselves,sothattheyareprotectedwhentheyfeeltheneedtorelapse.Opioidaddictsarelikelytohaveburnedbridgeswithfriendsandfamilywhohavenotenabledtheiraddiction,sopatientsbeginningrecoverymaynothavepositiverolemodelstosupportandinfluencetheirrecovery.Talkingtherapies,suchascognitivebehaviouraltherapy(CBT)canbeofferedtorecoveringpatientsexperiencinganxietyordepression,thoughpatientsmayfinditmoreusefultojoinlocalconfidentialsupportgroups,suchasNarcoticsAnonymous,astheycandiscussrecoverywiththosewhohavefirst-handexperience.ThoughJanewashesitanttodiscussherexperienceswithanyonewhenshewasfirstadmittedtotheclinicfortreatment,shehassincegoneontoattendweeklysessionsatNarcoticsAnonymous,whereshenotonlylistenstootherssharetheirstoriesofrecovery,butwhereshealsoisbeginningtotellherown.
Text1:Questions9to16
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9. Inthefirstparagraph,thewriterhighlightsthatopioidaddictionintheUS
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hasbeengraduallyincreasingforanumberofyears.(A)islargelyinfluencedbytheillegalsaleofdrugs.(B)causesmoredeathsthananyotheraddiction.(C)hasasignificantfinancialandsocialimpact.(D)
10. Inthesecondparagraph,thewriteroutlinesJane’scaseinordertoemphasisethat
opioidaddictionisincreasinglyrare.(A)itcanberemarkablyeasyforapatienttobecomeaddicted.(B)insomecases,heroinislessharmfultoaddictsthanopioids.(C)healthcareprofessionalsmusttakeresponsibilityforopioid
addiction.(D)
11. Thewriterusesthephrase‘hittingrockbottom’aboutthepatientJaneinordertodescribe
howheraddictionledtothemostdistressingpointinherlife.(A)hersuddenawarenessthatshehadtorecover.(B)thelargetoleranceshedevelopedforopioids.(C)thephysicalpainshefeltatthattime.(D)
12. Inthefourthparagraph,thewritersuggeststhatbuprenorphinemaybepreferablebecause
itislessaddictivethanalternatives.(A)
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itcanbeeasierforpatientstoaccess.(B)itdoesnotinterferewithothertreatments.(C)itcanbepickedupmoreoftenthanothermedications.(D)
13. Whatdoes‘thismeansthat’referto?
Theeffectivenessofbuprenorphinewhencombatingopioiddisplacement.
(A)
Therequirementforthemedicationtobereservedforheroinaddicts.
(B)
Theneedforpatientstohavebeguntoexperiencewithdrawals.(C)Theimpactofmu-opioidsonrecoveredopioidaddicts.(D)
14. Inthefifthparagraph,thewritersuggeststhatJanewasprescribedmethadone,ratherthanbuprenorphinebecause
buprenorphineistoosimilartoheroin.(A)theeffectsofmethadonelastforlonger.(B)shewasdependentonhighdosesofopioids.(C)itismorereadilyavailableataddictionclinics.(D)
15. Accordingtotheseventhparagraph,whydopatientsoftendelayseekingtreatmentforopioidaddiction?
Theyareunwillingtofacethedamagetheyhavecaused.(A)Theydonotrealisetheyareaddicteduntilit’stoolate.(B)Theythinkthattheycanrecoverwithouthelp.(C)
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Theydonotwanttobelabelledasanaddict.(D)
16. Inthefinalparagraph,thewritersuggeststhatrecoveringaddictsmayprefertodiscusstheirexperienceswith
thosewhohaveexperiencedaddiction.(A)peoplewhoarenotawareoftheirhistory.(B)healthcareprofessionals.(C)friendsandfamily.(D)
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Answers
1. Apartoftheiridentity.
2. Bpatientsoftensufferfromvariousconditions.
3. CThelimitedcommunicationoptionsfordisabledpeople.
4. ATheywereheavyandbulky.
5. Bneedforadiverserangeofvoices.
6. Dtheprocessisextremelytime-consuming.
7. Dvoicedonators.
8. CThesyntheticvoiceusedbyStephenHawking.
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PRACTICESETS
Questions1to8
1. BItavoidsinfluencingthepatient’semotionalresponse.
2. Cthetrendsconcerningwhatpatientsandrelativeswanttohear.
3. Dpatientsandrelatives
4. Bpatientsmaynotbeawareoftheirignorance.
5. Cacceptthestaff’ssuggestedplan.
6. Aavoidusingcomplexmedicallanguage.
7. Dempathisingwiththepatient’sreaction.
8. Afindtheinformationoverwhelming.
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Questions9to16
9. Dhasasignificantfinancialandsocialimpact.
10. Bitcanberemarkablyeasyforapatienttobecomeaddicted.
11. Ahowheraddictionledtothemostdistressingpointinherlife.
12. Bitcanbeeasierforpatientstoaccess.
13. CTheneedforpatientstohavebeguntoexperiencewithdrawals.
14. Cshewasdependentonhighdosesofopioids.
15. DTheydonotwanttobelabelledasanaddict.
16. Athosewhohaveexperiencedaddiction.
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THEWRITINGSECTION
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WritingIntroduction
SectionOverview
TheWritingTestinOETconsistsofonetask,whichyoumustcompletein40minutesafterbeingallowed5minutesofreadingtime.Youmustreadthenotesprovidedaboutapatientandtheirtreatment,thenwritealetterofbetween180and200wordsapproximatelytoapersonnamedinthetask.Youwillbeprovidedwithaletterwritingtask,whichwilltellyouwhatsortoflettertowrite,whotowriteto,andseveralpagesofpatient'scasenotes,whichyouwillwriteaboutinyourletter.
Thewritingtaskwillbespecifictoyourhealthcareprofession.Inthisbook,wewillcoverwritingtasksforthoseworkinginMedicalandNursingprofessions.
Theletteryouwriteshoulduseinformationfromthepatientnotestocompletethetaskeffectively,andbewithinthewordlimit.
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WRITINGSTRATEGIES
KnowtheinstructionsandformatbeforeTestDay,soyouknowwhattoexpectaheadofthetest:youwillalwaysbeaskedtowritealetterof180to200words,andyouwillalwaysbegivenpatientcasenotes.Startbyreadingthewritingtasksectionattheendofthetesttofindoutwhatsortofletteryouneedtowrite,andwhotowritetheletterto.Readthroughthecasenotes,startingwithwhoyouareinrelationtothepatient.Continuereadingthroughthecasenotes,thinkingaboutwhat'srelevanttoyourletterasyoudoso.Pleasenotethatyouareunabletounderlinekeywordsorphrasesduringthe5minutes’readingtime.Planyourletterbyoutliningwhatyouwillincludeinresponsetothewritingtask.Keepyourplanbriefandwriteinnoteform.Writeyourletter,usinginformationinthepatientcasenoteswherenecessary.Donotwriteadditionalpatientinformationintoyourletterwhichisnotcontainedinthecasenotes,youmustnotmakeuppatienthistory,orproposetreatmentoptionsiftheyarenotgiveninthenotes.Donotincludeanyinformationfromthepatientcasenotesthatisnotrelevanttotheletterrequirements.Makesurethetoneofyourwritingisappropriate.Ifyou’rewritingtoanotherhealthcareprofessional,youshouldusemedicalterminologywhererelevant.Ifyou’rewritingtoalayperson,suchterminologyshouldbeavoided.Thetoneofthelettershouldalwaysbeformal.Wherepossible,usearangeoftenses,grammarandvocabularytodemonstrateyourwritingskills.Aimtocompleteyourletteratleast3minutesbeforetheendofthetest,so
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thatyouhavetimetoreadthroughyourletterandcorrectanymistakes.
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CHAPTER9
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TheWritingTask
LEARNINGOBJECTIVES
Bytheendofthischapter,youwillbeableto:
Analysethetask.Scanthepatientcasenotesforrelevantinformation.Planyourlettereffectively.Practisewritingaletterwithinthewordandtimelimits.
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INTRODUCTION
IntheOETWritingTest,youwillbeaskedtowriteonelettertoaanotherpersoninvolvedinapatient’scare.Youwillhave40minutestoplan,writeandreviewyourletter,withanadditional5minutesatthestarttoreadtheletterwritingtaskandpatientcasenotes.
TheWritingTestwillbespecifictoyourhealthcareprofession.Inthischapter,wewilllookatexamplesforNursingandMedicine.
TheWritingTestisassessedusing5criteria.Togetagoodmarkinthissectionofthetest,youmustscorewellineachsection.BelowisanoverviewofthemarkingcriteriausedbyOETassessorstogradethewritingtasks,wewillgointomoredetailabouthowtoscorewellineachsectionlateroninthischapter.
Overalltaskfulfilment
Youmustcompletethetaskwithanappropriateresponsethataccuratelyaddressesthewritingtaskandisroughlywithinthewordcount.Forexample,thelettershouldbebetween180and200words,andifthetaskasksyoutowritealetterofdischarge,youmustmakesurethattheletteractuallystatesthatthepatientisbeingdischarged.
Appropriatenessoflanguage
Youmustmakesurethetoneofyourletterisappropriatetothetask,andtheregister(levelofformalityandtechnicality)issuitableforthesituation.Ifthewritingtaskasksyoutowritetoanotherhealthcareprofessional,itisappropriatetousemedicallanguage,whileifthetaskasksyoutowritetoalayperson,you
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mightusemoreeverydaylanguage,andexplaintechnicalwords.Thiscriteriaalsotakesintoaccounttheorganisationoftheletter,withappropriatesequencingoftheinformationappropriatetothegenre.
Comprehensionofstimulus
Youmustwritealetterforthetaskthatusesthenecessaryinformationfromthecasenotes,anddoesnotuseunnecessarypoints.Thiscriteriontestsyourabilitytounderstandthewritingtaskandthepatient’snotes.Toachieveagoodscore,youshouldmakesureyouusealloftheinformationthatisrelevanttothetaskinthecasenotesforyourletter,andonlytherelevantinformation.Forexample,itisunlikelythatyouwouldneedtoincludeinformationaboutthepatient’shistoryofillnessifyouarewritingalettertotheirGPorfamilydoctor.
Controloflinguisticfeatures
Youmustusecorrectgrammarinyourletter,showarangeofgrammaticalstructuresandwritealetterthatiscohesiveandfollowsalogicalorder.Makesuretoreadthroughyourletterafteryouhavefinishedwritingit,tolookforanyerrorsinyourwriting,sothatyoucanfixthesebeforeyoufinishyourtest.
Controlofpresentationfeatures
Youmustavoidspellingerrors,usecorrectpunctuation,anduseclearletterlayout.
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Strategies
Beginwiththeletterwritingtask
Beforeyoustarttolookattheinformationinthepatientcasenotes,youshouldfirstturntolookattheletterwritingtask.Thiswillinformyouofthetask,includingwhoyouneedtowriteto,andwhatyouneedtosay.Youshouldaimtospend30secondslookingatthewritingtasktodeterminewhatinformationisimportant,thereasonthatyouarewritingtheletter,andtothinkaboutwhatyourresponsewillinclude,beforemovingontothenextstage.
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Exercise
Take30secondstolookatthewritingtaskbelow,thenanswerquestions1–5thatfollow.
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WRITINGTASK
Usingtheinformationgiveninthecasenotes,writealetterofreferralforMrWalterPeterstoDrNShah,theAdmittingOfficeratNewCanterburyHospital,1ChurchStreet,Canterbury,forfurtherassessmentandtreatment.
Inyouranswer:
Thebodyofthelettershouldbeapproximately180–200words.
ExpandtherelevantnotesintocompletesentencesDonotusenoteformUseletterformat
1. Whoisthepatient?
2. Whowilltheletterbeaddressedto?
3. Whatishappening,thatmustbedescribedintheletter?
4. Wheremusttheletterbeaddressed?
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Thesectionofthewritingtaskshowninboldwillbethesameforeverywritingtask,somakesureyouarefamiliarwiththeseinstructions.Theinstructionsemphasisetheimportanceoftakingthecasenotesandalteringthemwherepossible,tocreatealetterthatnotonlycommunicatesthetaskgivenintheletterwritingtask,butdoessoinawaythatdemonstratesyourwritingabilities.Togetahighscore,youmustexpandthecasenotes,andcreatealetterthatusescomplexsentences,arangeofappropriatevocabulary,andvariousgrammaticalstructures.Thecasenotesyouwillbeprovidedwithwillbewritteninbriefnoteform.Thecasenoteswilloftenincludeshortwordsandphraseswhicharenotcompletesentences,andtheymayincludecommonlyusedmedicalabbreviations.Thecasenoteshavebeenwrittenbyahealthcareprofessional,forotherhealthcareprofessionalswithintheirhospitalorclinic,soacertainamountofunderstandingisexpected.Assuch,aswellasexpandingthecasenotesintofullsentences,youshouldalsomakesurethatyouchangethewordingsothatitissuitablefortheintendedaudience,giveninthetask.Whileyoureadthetask,youshouldbegintoconsiderhowyoumightdemonstrateyourwritingskillsinthistaskandrespondappropriatelytothetask.
Thewritingtaskwillusuallyaskyoutowritealetterofreferral.Othertypesofletterwhichmightbeusedinthetestincludeadischargeletteroraletterofexplanation.
ScantheCaseNotesActively
Thenextstageinthewritingtaskistoscanthepatientcasenotes,whilekeepingtheletterwritingtaskinmind.Thepatientcasenotesprovidedwillcoverseveralpages,andprovidealotofinformation.Youarenotallowedtounderlinewordsorwriteonthecasenotesduringthistime,butyoushouldscanthecasenotesactively,andidentifykeywords,phrasesandinformationthatarerelevanttothe
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letteryouwillneedtowrite,sothatyoucanincorporatethemintoyourletter.Youshouldspendthewhole5minutesreadingtimescanningthepatientcasenotescarefully,andidentifyingrelevantinformation.
Exercise
Scanthepatientcasenotesbelow,andmakeamentalnoteofanykeypiecesofinformationthatwouldberelevantforaletterwritingtaskthataskedyoutowritealetterofdischargetoarehabfacility.Timeyourselffor5minutesandafterthistimehaselapsed,gothroughthecasenotes,underlininganythingwhichyouthoughttoberelevant.
Notes:
MsLydiaFrankisa49-year-oldfemalewhowastransferredfromtheneurointensivecareunit(NICU)totheneurotelemetryunit.
Hospital: LexingtonHospital
Patientdetails:
Name: LydiaFrank
Maritalstatus: Divorcedfor8years
Nextofkin: Darlene(daughter–24-years-old,unemployed)
Admissiondate: 20January2018
Dischargedate: 13April2018
Diagnosis: Subarachnoidhemorrhage(SAH)
Pastmedicalhistory: Hypertension(2015)
Hyperlipidemia
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Migraine
Anxietyanddepression
Smoker(approx.10cigsperweek)
Socialbackground: Worksfulltime–accountant,financiallyindependent.
Presenting
Complaint:
Foundunresponsiveatwork.Complainingof“worstheadacheever”.
Admission20/01/2018
Assessment: Vomituspresent.SAH.Pupilsequal,round+reactivetolight.
BP220/110mmHg.Endotrachealintubationperformed(weanedfrom
mechanicalventilationweek2).
Nosupplementaloxygenrequired
CraniotomyandendovascularcoilingperformedtotreatSAH
Developedcentralline-associatedbloodstreaminfectionandurinarytract
infection–multipleroundsofIVantibiotics.
21/01/2018: Orientedtoperson,place,time,andsituation-slowtorespond.
BPveryunstable.
Antihypertensivemedicationsadjusted5timessinceadmission(currently
takingclonidinePRN,scheduledlisinopril,scheduledlabetalol).
BPwithinnormallimits(145/90-150/80mmHg-oneweek)
Noreportsofheadache1/7.Left-sidedweaknessslowlyimproving.
Nursing
management:
NeurologicandBPchecksevery4hours.
Encouragepatienttobeseatedinbedsidechairformeals(→requires2
assiststopivotfrombedtochairsecondarytoleft-sidedweakness).Requires
assistancewithfeeding.
Nectarthickliquidsrequired.
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Medicationscrushedwithapplesauce.
Assessment: Goodprogressoverall.
Dischargeplan: Dischargetorehabfacility,continuenursingmanagementasabove.
PlanYourResponse
Duringthereadingtime,readtheletterwritingtaskandidentifyrelevantpointstoincludeinyourletterfromthecasenotes.Youshouldnowhaveanideaofwhatyourletterwillinclude.Oncethewritingtimestarts,thenextstageistoplanyourletterbyoutliningthestructureofyourcorrespondence.Thekeywordsinthecasenotesarethewordsandphrasesthatrelatetothepurposeoftheletteryouneedtowrite,forexample,ifyouneedtowritealetterreferringthepatientforfurtherassessment,thenyoushouldlookforwordsinthecasenotesthatrelatetotreatment.Theinformationinthecasenotesthatrelatestopastmedicalhistoryislikelytoincludeinformationthatisnotrelevanttoyourletter.
Beginplanningyourletterbythinkingaboutthepersonyouarewritingto.Asmentionedearlier,thinkaboutthetoneyouwilluseforthepersonyouarewritingto,andalsothinkabouttheinformationtheywillneedtocompletenecessaryactionsafterreceivingyourletter.Askyourselfthefollowingquestionsasyouplan:
Whoareyouwritingto?Whyareyouwritingtothem?Whatdotheyneedtoknow?Whatdotheyknowalready?
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Thelastquestionisimportantasinsomecases,thepersonyouarewritingtowillalreadybefamiliarwithsomeoftheinformation,soyoushouldavoidusinginformationfromthecasenotesthattheyarealreadylikelytoknow.
Asyoucontinuetoplanyourletter,thinkaboutwherethedifferentpartsofinformationmightappear.Thecasenotesyouareprovidedwithwillnotnecessarilypresenttheinformationinthebestorderforyourletter,soyoushouldplantousedifferentareasofthecasenotesforvariouspartsofyourletter.Itmightbebesttothinkaboutthreeorfourbroadpointsthatyouwanttocover.Forexample,whenwritingaletterofdischarge,youmightwanttodiscuss:
Onceyou’vedecidedonthepointsyouwillcover,youcanbegintoaddtoeachpointfromthecasenotes.Rememberthatthereareavarietyofdifferentapproachestotheletterwritingpartofthetest.Theoutlineprovidedbelowoffersanexampleofhowyoumightstructureyourresponsetothetask,butyoumayprefertouseadifferentoutlinetoplanyourletter.Asyoupractisethewritingtask,trytovaryyourresponsesforeachtask,ratherthanfollowingasetformat.Practisingdifferentwaystowritewillimproveyouroverallwritingabilities,prepareyouforanunexpectedwritingtaskonTestDay,andmakesureyouarepreparedtowritehealthcarelettersinEnglishintherealworld.
Asanexample,youmightcreatethefollowingplanforaletterofreferralusing
Whythepatientwasunderyourcare.Howthepatientwastreated.Whenthepatient’scurrentsituationwillchange(iftheyarebeing
dischargedorreferred).Whatthepatient’scurrentstateis,andwhatthepatient’scurrenttreatment
is.
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thecasenotesaboutLydiaFrankontheprevioustwopages.Pleasenotethatyoushouldavoidspendingmorethan5minutesplanningsoyoumaynotbeabletodevelopsuchadetailedplanonTestDay.
LydiaFrank(F)torehabfacility
Noticethattheplanbreakstheletteroutintofourseparatesections,andusesinformationfromthecasenotestosupporteachsection.
WhywasFadmitted?NICU20January2018–becausesubarachnoidhemorrhage(SAH)at
work.unresponsiveandreceivingmechanicalventilation
Whatwastreatment?2ndweektakenoffmechanicalventilation-madegoodprogressat1st-craniotomy+endovascularcoiling–SAHMs.treatment
complicated-centralline-associatedbloodstreaminfection+urinarytractinfection
CurrentconditionFwithoutinfectiongoodcougheffort,nosupplementaloxygenreq.,+
awareofperson,place,time,situation–BUTslowrespond.
Current/futuretreatment?F’sbloodpressurenowcontrolled-scheduledlisinopril,scheduled
labetalol,+PRNclonidine-crushedwithapplesaucenectarthickliquidsamustneedsassistance2people-pivotingbedtochair+ambulation–left-
sidedweakness.BP+neurologicalchecksevery4hours.
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Now,completetheexercisebelowusingthecasenotesthatbeginbelowandfinishonthefollowingpage,andtherelevantTask1onpage130.
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Exercise
Lookatthewritingtaskandpatientcasenotesonthefollowingpages.Take5minutestoreadthecasenotesandidentifythekeywords,thentakeafurther5minutestomakeabriefplanforyourletter.
Notes
Ms.BethanyTailorisa35-year-oldpatientinthepsychiatricwardwhereyouareworkingasadoctorornurse.
Hospital: St.Mary’sPublicHospital,32FredrickStreet,Proudhurst
PatientDetails: MsBethanyTailor
NextofKin:HenryTailor(father,65)andBarbaraTailor
(mother,58)
Admissiondate: 01March2018
Dischargedate: 18March2018
Diagnosis: Schizophrenia
Pastmedicalhistory: Hypertensionsecondarytofibromusculardysplasia
PrimaryhypothyroidismLevothyroxine88mcgdaily
Socialbackground: Unemployed,ondisabilityallowanceforschizophrenia.
Historyofpolysubstanceabuse,mainlycocaineandalcohol.
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Lastusedcocaine28/02/18:
Admission01/03/2018: Patientself-admitted:decompensatedschizophrenia
Medicalbackground: Notcompliantwithmedications.
Admittedforauditorycommandhallucinationstellingpatientto
harmself.
Visualhallucinations–shadowfigureswithgrinningfaces.
Delusion–personalconnectionstovariouspoliticalleaders.
01/03/2018–agitatedandaggressive,respondingtointernal
stimuliwiththoughtblockingandlatency.
Commencedantipsychoticmeds(rispoderone).
10/03/2018:Patientceasedreportingauditoryorvisual-
hallucinations.
Lessdisorganisedthinking.Nosignsofthoughtblockingor
latency.
Abletominimisedelusionsandfocusonactivitiesofdaily
living.
Nursingmanagement: Assessforobjectivesignsofpsychosis.
Redirectpatientfromdelusions.
Ensuremedicalcompliance.
Helpmaintainbehaviouralcontrol,providetherapyifpossible.
Assessment: Goodprogress,chronicmentalillness,candecompensateifnot
onmedicationsorabusingsubstances.Insightgood,judgment
fair.
Dischargeplan: DischargeonRisperidone4gnightlybymouth.
Risperidone1milligramavailabletwicedailyp.r.nforagitation
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orpsychosis.
Dischargebacktoapartmentwithfollow-upatProudhurst
MentalHealthClinic.
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MedicalWritingTask1
Usingtheinformationgiveninthecasenotes,writeadischargelettertothepatient’sprimarycarephysician,Dr.GiovanniDiCoccio,ProudhurstFamilyPractice,231BrightfieldAvenue,Proudhurst.
Inyouranswer:
Thebodyofthelettershouldbeapproximately180–200words.
NursingWritingTask1
Usingtheinformationgiveninthecasenotes,writealettertothereceivingnurseatthelong-termcarehomewherethepatientwillgofollowingdischarge,MariaDiCoccio,ProudhurstMentalHealthHome,231BrightfieldAvenue,Proudhurst.
Inyouranswer:
ExpandtherelevantnotesintocompletesentencesDonotusenoteformUseletterformat
Expandtherelevantnotesintocompletesentences
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WriteYourLetter
Onceyou’veoutlinedthestructureofyourresponse,youcanmoveontowritingtheletteritself.Readthroughthefollowingstrategiestofamiliariseyourselfwiththetypeofletteryoumustwrite.Thestrategieswillcoverhowyoushouldwriteyourletter,andthecriteriayouwillbemarkedagainst.
HeadingsandEndings
Yourlettershouldalwaysbeginbygivingthedate,theaddressandnameoroccupationofthepersonyou’rewritingto,andagreetingtothepersonyou’rewritingto.Belowisanexampleofanappropriateintroductiontoaletter.
Thebodyofthelettershouldbeapproximately180–200words.
DonotusenoteformUseletterformat
DJHorus
PerthRehabilitationHospital
23-40MainStreet
Perth
20April2018
DearDrHorus,
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Exercise
Practisefollowingasimilarformatwhenyouattemptyourwritingresponses,untilyouarefamiliarwiththeseheadings.
Overalltaskfulfilment
Toaddressthiscriteria,youshouldaimtowritebetween180-200wordsinthebodyofyourletter(after‘Dear___’andbefore‘Yourssincerely’).Thereisnoneedtocounttheexactnumberofwordsyouhavewrittenbutitisagoodideatoknowroughlyhowmanylinesofyourhandwritingare180-200words.Youcanworkthisoutbycountingthewordsofonefulllineofyourwritingandthendividing200bythisnumbertogiveyouthenumberoflines.Then,everytimeyoucompleteapractisetest,youcancheckyouhaveroughlythisnumberoflines.Ifyouhavewrittenmorethanthis,checkyouhaveincludedallrelevantinformationandleftoutallirrelevantinformationtheneditaccordingly.Keepinmindthatyourwordcountisjustoneindicationthatyou’veincludedrelevantinformation.It’spossiblethatyoumighthaveincludedtherightinformationbutstillmightfallslightlyoutsideofthe180to200wordrange.Fallingoutsideofthiswordrangedoesnotnecessarilymeanyou’llscorepoorlyinthiscriteria.
Youmustalsomakesurethatyouarewritingthetypeofletterspecifiedinthetask.Paycloseattentiontowhatthissectionsays,andbuildyourresponse
5. Usingtheletterwritingtaskprovidedonpage124,writeanappropriateheadingtoaletter.
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aroundthetask.Don’ttrytopreparearesponsebeforelookingatthetask,ortryandmemorisealetterthatyoucanreproduceonTestDay,asthiswillnotshowthatyouareabletorespondappropriatelytothetaskthatisgiven.
Youshouldalsoavoidcopyingentirephrasesexactlyastheyappearinthecasenotes.Thisisnotagoodplanfortworeasons:
Demonstrateyourskillsbywritingaletterthatincorporatestherelevantfactsappropriatelyandinyourownwords.
Appropriatenessoflanguage
LettertasksintheWritingTestwillalwaysaskyoutowritelettersintheroleofahealthcareprofessional.Assuch,youshouldalwaysuseasuitablyformaltoneinthewritingsection.Youshouldavoidusingcasuallanguageoridioms(‘how’sitgoing?’),andwriteinfullwords,ratherthancontractions(‘can’t’‘isn’t’)orSMStextabbreviations(use‘before’,not‘b4’).
Ifyouarewritingtoahealthcareprofessional,youcanusetechnicalterminology,whereas,ifyouarewritingtoalayperson,youshouldmakesuretoexplainmedicalterminologythatmaybeunfamiliar.
Thephrasesusedinthecasenotesareinnoteform.Theyaregenerallynotappropriateintheircurrentstateforaletter,soyoumustexpandthesephrases,inordertowriteinanappropriatestyle.
Theassessorcanalsoseethecasenotes.Ifyoucopythelanguageinthecasenotesexactly,theassessorwillnotbeabletoassessyourunderstandingofthecasenotes,oryourwritingability.
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Youshouldalwaysbeginyourletterbystatingwhatthepurposeofyourletteris.Ifyou’rewritingaletterofreferral,youmightbeginyourletterwithasentencelike
Notethatinthisexampleweincludedthedate,tomakesurethatthemostimportantinformationisprovidedtotherecipientoftheletterinthefirstsentence.Youshouldalsoincludedates,timesandtimeperiodsthroughoutyourletter,anduselanguagethatclearlysequencesthetime-periodoftheinformation,inordertoprovideaclearordertoyourletter.Forexample,insteadofwriting
Youcouldsaysomethinglikethis:
Lookatthevariouswaysthesecondexamplelinksthedifferentpiecesofinformation,andallowsreadertoseethesequenceoftheeventsmoreclearly.
Ifthetaskrequiresyoutowriteanurgentletter,youshouldmakethisclearin
JoannaHowardswillbedischargedtoyourNursingFacilityon12October2018.
Thepatientwasdiagnosedwithcanceroftheoesophagusandhadanoesophagectomyandchemotherapyandlostaconsiderableamountofweight.
Thepatientwasdiagnosedwithcanceroftheoesophaguson24thApril.Chemotherapywasscheduledtobegininthefollowingweekandlastforatotalofthreeweeks.Thepatientlostaconsiderableamountofweightasaresultofthistreatment.Anoesophagectomywasthensuccessfullycarriedouton3rdJune.
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yourletter,too.Anurgentlettermayalsorequireyoutochangethestructureoftheletter,forinstance,youwouldneedtoputthepatient’scurrentconditionatthebeginningofanurgentletter,whileiftheletterwasnoturgent,itmightbemoreappropriatetobeginwiththepatient’shistory.Thetoneofyourlettershouldalwaystakeintoaccountyouraudienceandthepurposeofyourletter.Youcanonlyuse180–200wordsinyourletter,sothereisnotenoughroomforyoutoincludeanyunnecessarydetails.
Comprehensionofstimulus
Tomeetthiscriterion,youneedtoshowthatyouhaveunderstoodthecasenotes.Youcandothisbyusingthecasenotesappropriatelytocreatealetterthatfullyaddressesthetask.
Ratherthantryingtouseasmanycasenotesaspossible,thinkaboutwhattheindividualyouarewritingtoneedstoknow.Ifyouincludeinformationthatisnotrelevanttothetask,youwillreceivealowerscore,soonlyincludeitifyouthinkitisrelevanttoyourletter.Ifyouincludetoomuchsurroundingdetail,thenitwillalsomakeitdifficultfortheassessortoassessthatyouhaveunderstoodthetask.
Putthecasenotesintoyourownwordswhereverpossible,andconnectthecasenotestogetherappropriately.Remember,youshouldnotaddanyinformationtoyourletterthatisnotincludedinthecasenotes.
Exercise
Nowthatyou'vespentthe5minutesreadingtimereadingthroughthecasenotes,andanother5minutesplanningyourresponse,spendanother35minutestocompleteyourletterusingtheletterwritingtaskandpatientcasenotesonpages
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128–130.Besuretoallow3-5minutesattheendtocheckyourwritingforerrors.
CheckYourLetterforErrors
Onceyouhavefinishedwritingyourletter,youshouldmakesuretocheckthroughwhatyouhavewrittenandcorrectanyerrors.Onceyouhavelookedthroughyourletterandidentifiedyourerrors,makealistofyourmostcommonerrors,andmakeanefforttotargettheseareasinparticular,beforecompletinganotherwritingtask.Forexample,ifyoucommonlymakearticleerrors,makesuretorevisethecorrectarticlestouse,forexample,youshoulduse‘inthebloodstream’ratherthan‘inbloodstream’,and‘aheartattack’shouldbeused,ratherthan‘anheartattack’.
GrammarandCohesion
Makesurethatyoushowthatyoucanvaryyourlanguagewhilewritingthetask.Onewaythatyoucanshowvariationinyourwriting,istotalkaboutpatientcareinthepast(forexample,whathasbeendonesofar),thepresent(forexample,thepatient’scurrentcareplan)andthefuture(forexample,howthepatient’streatmentshouldprogress).Youcanusesimplesentences,butyoushouldalsousecomplexsentencestoo.Whenyoureadthroughyourletter,lookatthelengthofthesentencesyouuse.Ifyouhavelotsofshortsentences,considerusingconnectivestojoinsomeofthesesentencesintolonger,complexsentences.Ontheotherhand,ifyouhavealotofverylongsentences,youmightwanttosplitthiscontentupintosmallersentences,orremoveinformationthatisnotnecessary,tomakesurethatyourwritingiscontrolled.
SpellingandPunctuation
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Yourspellingandpunctuationwillalsobeassessedsowhenyoureviewyourworkyoushouldmakesurethatyourwordsarespelledcorrectly,andyourpunctuationisappropriate.InOET,youcanuseanyspellingconvention,suchasAmerican,AustralianorBritish.Whicheverspellingconventionyouchoosetouse,youmustkeeptothisconventionthroughoutyourwritingtask.Foryourinformation,thisbookiswritteninBritishEnglish.
Whencheckingyourwork,ifyouspotawordthatlookslikeitisspelledincorrectly,butyoucannotrememberhowthewordshouldbespelled,considerreplacingitwithasynonymthatiseasierforyoutospell.Itismoreimportantthatyoucommunicateeffectivelythanthatyouuselongwords.Rememberthatmostofthehealthcaretermsyouusewillbeinthecasenotes,sobesuretocheckyourspellingofthesewordsagainstthecasenotesasyoureviewyourletter.
Makesurethatyouareusingenoughfullstopstoseparatedistinctpiecesofinformation,andusingenoughcommastoseparateyourideaswithinsentences.Asyoureadthroughyourwork,readyourlettertoyourselfinyourhead,pausingforcommasandfullstops,andcheckthatit‘sounds’righttoyou.Ifitdoesn’t,lookatchangingyourpunctuation.Remembertoleavespace(oneblanklineisideal)betweeneachparagraph,sothattheassessorcanclearlyseethatyouhavesectionedyourwritingintoalogicalstructure.Eachparagraphshouldaddressonemainpointinyourletter.
Youneedtowriteclearlyandneatly,sothattheassessorcaneasilyreadyourhandwriting.Ifyourwritingisdifficulttoread,theassessormaynotbeabletoassessyourwritingability.Ifyoustrugglewithwritingneatlyandlegibly,practisewritinginEnglish,andaskotherpeopletoreadwhatyouhavewritten.
Exercise
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Afterreadingthroughthelasttwocriteriainthesectionabove,take10minutestogooveryourletterandcorrectanymistakes.
TrytomakereadingandwritinginEnglishapartofyoureverydaylife.Themoreyouread,thebetteryourwritingwillbecome.WhenyoupractisewritinginEnglish,youcanfocusonwritingonmoregeneraltopics,aswellasfocusingonhealthcaretopics.Thiswillbroadenyourwritingskills,andhelpyoutoscorewellonTestDay.
IMPROVEYOURSCORE
Eachtimeyouwriteapracticeletter,youshouldassessitbasedontheofficialOETcriteria.Visitwww.occupationalenglishtest.orgtofindthelatestversion.Ifpossible,youcouldalsoaskafriend,familymemberorcolleaguewithgoodEnglishskillstoassessyourresponse.
IMPROVEYOURSCORE
Timeyourselfeverytimeyouwriteapracticeletter.Alwaysallowafewminutesbeforethetimeisuptocheckyourworkforspellingmistakes,inappropriatewordsandanyotherproblemswithyourgrammarorphrasing.
IMPROVEYOURSCORE
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Makesureyouunderstandanycasenotesyouwillincludeinyourletter,andmakesuretoputthepatientcasenotesintoyourownwordswherepossible,toachieveahighscoreonTestDay.
IMPROVEYOURSCORE
Don’ttrytomemoriselongsectionsofletterstoreproduceonTestDay.Whileitcanbehelpfultoknowgeneralphrasesandterminologytouseinyourletter,preparinglargersectionsofwritingtouseinyourletterisunlikelytorelatetothewritingtask,ormakegooduseofthepatientcasenotes,andwillresultinalowerwritingscore.
IMPROVEYOURSCORE
Themoreyoupractisewritingwithinthewordcount,theeasieritwillbecometopredicthowmanywordsyouneedwithoutcounting.ThiswillsavevaluabletimeonTestDay.Toquicklyestimatehowmanywordsyouhaveused,youcancountthenumberofwordsinonelineofyourletter,andthenmultiplythisbythenumberoflines.However,aslongasyoumakesureyouarechoosingalloftherelevantcasenotesfromthecasestudy,andonlytherelevantcasenotes,yoursampleresponseshouldnaturallyfallwithinthewordcount.
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WritingPracticeSet
ReadthecasenotesbelowandcompletetheWritingTasksthatfollows.ForeachWritingSet,therearetwoWritingTasks,oneforNursing,andoneforMedicine.Choosethetaskthatbestreflectsyourhealthcareprofession.Youshouldspend5minutesreadingthecasenotesand40minuteswritingyourletter.
Notes:
YouareanurseORafirstyearresidentinasurgicalward.SallyFletcherisa25-year-oldwomanwhohasrecentlyundergonesurgery.Youarenowdischargingherfromhospital.
Hospital: Fairbanks
Hospital,1001NobleSt,Fairbanks,AK99701
Name: MrsSallyFletcher
DateofBirth: 3/10/1993
Maritalstatus: Married,5years
Appointmentdate: 25/03/2018
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Diagnosis: Endometriosis
Pastmedicalhistory: Painfulperiods
3years
Wantschildren,trying
1year++
Socialbackground: Accountant,regularwesterndiet.
Exercises3xweek
localgym
Medical
background:
Frequent
acutemenstrualpainlocalisedtothelowerleftquadrant.
PainpersistsdespitetakingOTC
naproxen.
Shydiscussingsexualhistory.
Occasionalconstipation,
associatedwithpaininlowerleftquadrant.
Trans-vaginalultrasoundshowing6cmcyst,likelyofendometrial
origin.
Patientrecoveringpostopfromlaparoscopicsurgery(25/03/2018)
–nocomplications.
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Postopcare: Keepincisionscleananddry.
Showeringispermitted26/03/2018
Mobilitypostop: Patientcanambulateifconfident.
Drivingisprohibitedwhenonanalgesics.
Drivingcanberesumed24-48hrsafterfinaldose
analgesics.
Sexualactivitycanberesumed2weekspostop.
Nursing
management:
Encourageoralfluids.
Patientmayreturntoregulardiet.
Ambulationencouragedasperpatienttolerance.
Medicalprogress: Afebrile.Hct,Hgb,Plts,WBC,BUN,Cr,Na,K,Cl,HCO3,Glu
allwithinnormallimits.Patient
sittingcomfortably,
alert,
oriented×4(person,place,time,situation).
Assessment: Goodprogressoverall.
Dischargeplan: Patienttobedischargedwhencaneat,ambulate,urinate
independently.
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Patientmustbedischargedtosomeonewhocandrivethemhome.
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MedicalWritingTask2
Usingtheinformationgiventoyouinthecasenotes,writealetterofdischargetothepatient’sGP,DrStevens,MillStreetSurgery,Farnham,GU101HA.
Inyouranswer:
Thebodyofthelettershouldbeapproximately180–200words.
NursingWritingTask2
Usingtheinformationgiventoyouinthecasenotes,writealettersummarisingthepatient’sconditionandcommunicatingdischargeinstructionstothehomehealthnurse,JoanStevens,MillhouseVisitingNursesAssociation,Farnham,GU101HA.
Inyouranswer:
ExpandtherelevantnotesintocompletesentencesDonotusenoteformUseletterformat
ExpandtherelevantnotesintocompletesentencesDonotusenoteformUseletterformat
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Thebodyofthelettershouldbeapproximately180–200words.
Notes
YouareaphysicianOR
anurseatafamilymedicalpractice.MsTabithaTaborlinisa45-year-oldpatientatyourpractice.
Office: FirstFamilyPrimaryCare,3959AbaloneLane,Omaha
PatientDetails
Name: TabithaTaborlin(Ms)
Maritalstatus: Single
Nextofkin: GregoryTaborlin(69,father)
Dateseen: 08April,2018
Diagnosis: Type1diabetesmellitus
Pastmedicalhistory: Essentialhypertension
Type1diabetesmellitus(non-compliantwithinsulinregimen)
Multipleepisodesofdiabeticketoacidosis(DKA)
Socialbackground: Schoolteacher,livesaloneinapartment
Doesnotexercise,BMI
18.2(underweight-48kg)
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Smokesmoderately(2cigsdaily)
Medical
background:
LonghistoryofType1diabetes(since7y.o.)andnoncompliance
withinsulinregimen.
On
45units
LantusnightlyandpreprandialcorrectionalscaleHumalogwith
12unitnutritionalbaseline.
02/04/2018:admittedDKA(glucose530mmo/L)
IVfluidsandinsulinadministered.Dischargestable-HbA1c.
Appointmenttoday: Doingwellsincedischarge.
Stillnotusinginsulin.Hasinsulinavailable.
Notfollowingrecommendeddiet.
Discusseddiabeteseducation,
necessityofglucosetesting,insulinadministration,smoking
cessationeducation.
Discussedmicrovascular/macrovascularcomplicationsofdiabetes.
Plan: Dischargetoday–provideeducationalpamphletsandrefillsfor
LantusandHumalog.
Referraltoendocrinespecialistforstricterglycemiccontroland
possibleinsulinpump.
Follow-upin1month.
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MedicalWritingTask3
Usingtheinformationgiveninthecasenotes,writeareferrallettertoDr.Sharon
Farquad,EndocrinologistatEndocrineSpecialistsandAssociates,115BurkeSt.Omaha.
Inyouranswer:
Thebodyofthelettershouldbeapproximately180–200words.
NursingWritingTask3
Usingtheinformationgiveninthecasenotes,writeareferrallettertothediabeticnurseeducator,Dr.Hank
Farquad,CertifiedDiabetesEducatoratEndocrineSpecialistsandAssociates,115
BurkeSt.Omaha.
Inyouranswer:
ExpandtherelevantnotesintocompletesentencesDonotusenoteformUseletterformat
Expandtherelevantnotesintocompletesentences
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Thebodyofthelettershouldbeapproximately180–200words.
DonotusenoteformUseletterformat
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Answers
1.MrWalterPeters
2.DrNShah
3.thepatientisbeingreferred
4.NewCanterburyHospital,1ChurchStreet,Canterbury
5.DNShahAdmittingOfficerNewCanterburyHospital1ChurchStreetCanterbury15September2018DearDrShah
WritingTask1MedicalSampleResponse
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19/03/2018
DearDr.DiCoccio,
Re:BethanyTailor(aged35),
Yourpatient,MsTailor,admittedherselfon1March2018withdecompensatedschizophrenia.Sheisnowreadyfordischargeandfollow-upatyourclinic.
Onadmission,shewasexperiencingsignificantthoughtdisorder,includingthoughtblockingandlatency.Shewasalsoexhibitingdelusionsandexperiencingauditorycommandandvisualhallucinations.
DuringherstayinhospitalMsTaylorwasplacedbackonhermedications,andhermentalconditionhasstabilisedandsheisabletofocusonheractivitiesofdailyliving.Herinsightisnowgoodandjudgmentfair.Hernursingmanagementinthehospitalfocusedoncompliancewithherantipsychoticmedications,behaviouralcontrol,andtherapy.Since10March,shehasnotreportedvisualorauditoryhallucinations.
MsTailorisonoralRisperidone4mgnightly.Additionaloralrisperidone1mgcanbeadministeredasneededtwicedailyforagitationorpsychosis.Shewillbedischargedfromthehospitaltoherapartmentwhereshelivesalone.Shewillfollow-upwithyouinordertocontinuehertreatmentofchronic
Dr.GiovanniDiCoccioProudhurstFamilyPractice231BrightfieldAvenueProudhurst
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schizophreniaandtoavoidnon-complianceofhermedicationsorsubstanceabuse.
Ifyouhaveanyqueries,pleasecontactme.
Yourssincerely,
Doctor
[183words]
NursingSampleResponse
19/03/2018
DearMsDiCoccio,
Re:BethanyTailor(DOB:April20,2018),
MsBethanyTailorwillbedischargedtoyourfacilitytoday.Shewasadmittedtothehospitalon1March2018withdecompensatedschizophrenia,probablysecondarytomedicationnoncomplianceandsubstanceabuse.
Onadmission,shewasexperiencingsignificantthoughtdisorder,includingthoughtblockingandlatency.Shewasalsoexhibitingdelusionsand
MariaDiCoccioProudhurstMentalHealthHome231BrightfieldAvenueProudhurst
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experiencingauditorycommandandvisualhallucinations.
Afterherstayinhospitalandbeingplacedbackonhermedications,hermentalconditionhasstabilisedandsheisabletofocusonheractivitiesofdailyliving.Sheisdemonstratingappropriateinsightandjudgement.Hernursingmanagementinthehospitalfocusedoncompliancewithherantipsychoticmedications,behaviouralcontrol,andtherapy.Since10March,shehasnotreportedvisualorauditoryhallucinations.
Ms.Tailorisonoralrisperidone4mgnightly.Additionaloralrisperidone1mgcanbeadministeredasneededtwicedailyforagitationorpsychosis.Sheisalsoprescribedlevothyroxine88mcgbymouthforhypertensionandhypothyroidism.Shewillrequiremedicationmonitoringtoavoidnon-complianceofhermedicationsorsubstanceabuse.
Ifyouhaveanyqueries,pleasecontactme.
Yourssincerely,
Nurse
[191words]
WritingTask2MedicalSampleResponse
DrStevensMillStreetSurgeryFarnhamGU101HA
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25March2018
DearDrStevens,
Re: MrsSallyFletcherD.O.B3/10/1993
Yourpatient,SallyFletcher,wasadmittedtothesurgicalwardofFairbanksMemorialHospitalon25March2018forthepurposeoflaparoscopicsurgerytotreatanendometrialcyst.Sheisnowreadyfordischargeintothecareofherhusband.
Whenadmitted,Sallyhadbeensufferingfrompainfulperiodsoverthepast3years,whichshehadbeenattemptingtotreatwithnaproxen,butthepainpersisted.Anultrasoundscanrevealedacysthadformedinherabdomen.Shearrivedatthewardthismorningandunderwentlaparoscopicsurgery,whichsuccessfullylocatedandremoveda6cmcystfromherabdomenwithoutcomplication.
Shehasbeenadvisedtokeeptheincisionsitescleananddry.Shehasreceivednarcoticpainmedicationandhasbeenadvisedthatsheisunabletodrivewhiletakingthismedication.Youshouldmonitorherprogress,andadvisewhentoceasetakingthismedication.Shemayresumedriving24-48hoursafterthelastdoseistaken.
Sallymayresumehernormaldiettoday,andisencouragedtodrinkplentyoffluids.Sheisalsoencouragedtowalkasmuchasshecantolerate.Sexualactivitycanresumeintwoweeks.
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Ifyouhaveanyquestionspleasefeelfreetocontactme.
Yourssincerely,
Doctor
[194words]
NursingSampleResponse
25March2018
DearMsStevens,
Re: MrsSallyFletcherD.O.B3/10/1993
Yourpatient,SallyFletcher,wasadmittedtothesurgicalcentreofFairbanksMemorialHospitalon25March2018forlaparoscopicsurgerytotreatanendometrialcyst.Sheisnowreadyfordischarge.
Whenadmitted,Sallyhadbeensufferingfrompainfulperiodsoverthepast3years,causedbyendometrialtissuepresentoutsidetheuterus,whichformedacystinherabdomen.Shearrivedatthecentrethismorningandunderwent
JoanStevensMillhouseVisitingNursesAssociationFarnhamGU101HA
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laparoscopicsurgerytoremovethecyst.Thesurgerysuccessfullylocatedandremoveda6cmcystfromherabdomenwithoutcomplication.
Shehasbeenadvisedtokeeptheincisionsitescleananddry.Shehasreceivednarcoticpainmedicationandhasbeenadvisedthatsheisunabletodrivewhiletakingthismedication.Shemayresumedriving24-48hoursafterthelastdoseistaken.Sheshouldbemonitoredforconstipation,urinaryretentionandpaincontrolwhiletakingthenarcotic.
Sallymayresumehernormaldiettoday,andisencouragedtodrinkplentyoffluids.Sheisalsoencouragedtowalkasmuchasshecantolerate.Sexualactivitycanresumeintwoweeks.
Ifyouhaveanyquestionspleasefeelfreetocontactme.
Yourssincerely,
Nurse
[196words]
WritingTask3MedicalSampleResponse
Dr.SharonFarquadEndocrinologistEndocrineSpecialistsandAssociates115BurkeSt.Omaha
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08/04/2018
DearDr.Farquad
Re:TabithaTaborlin(aged45)
ThankyouforseeingMsTablorinasanewpatientatEndocrineSpecialistsandAssociates.Sheisa45yearoldfemalewithapastmedicalhistoryofessentialhypertensionanduncontrolledType1diabetesmellitus.
MsTablorinwasseenatmyclinictodayasafollow-upfromahospitaladmissionfordiabeticketoacidosiswithaglucosemeasureof530mmol/L.Shehashadmultiplepriorhospitalisationsforthesameissue.Shealsohasalonghistoryofbeingnoncompliantwithherinsulinmedications,whichare45unitsofLantusnightly,andpreprandialcorrectionscaleHumalogwith12unitsofnutritionalbaseline.HerHbA1cis11.0%.
Shehasbeeneducatedmultipletimesondiabetesrisksandcomplications,regardingherinsulinregimen,exercise,diet,andtobaccocessation.However,shehascontinuedtoignoretheserecommendationsandherconditionhasprogressivelyworsened.Itismyrecommendationthatsheseekahigherlevelofcare,thusIreferhertoyourpractice.MsTablorinwouldlikelybenefitfromastricterinsulinregimenandglycemicmonitoring,aswellasaninsulinpumpforreliabilityofmedicationadministration.
Ifyouhaveanyqueries,pleasecontactme.
Yourssincerely,
Doctor
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[183words]
NursingSampleResponse
DearDr.Farquad
Re:TabithaTaborlin(aged45),
ThankyouforseeingTabithaTaborlinasanewpatientatEndocrineSpecialistsandAssociates.Sheisa45yearoldfemalewithapastmedicalhistoryofessentialhypertensionanduncontrolledType1diabetesmellitus.
MsTablorinwasseenatmyclinictodayasafollow-upfromahospitaladmissionfordiabeticketoacidosiswithaglucosemeasureof530mmol/L.Shehashadmultiplepriorhospitalisationsforthesameissue.Shehasalonghistoryofbeingnoncompliantwithherinsulinmedications,whichare45unitsofLantusnightly,andpreprandialcorrectionscaleHumalogwith12unitsofnutritionalbaseline.HerHbA1cis11.0%.
Educationwasprovidedondiabetesrisksandcomplications,usingherinsulinregimen,exercise,diet,andtobaccocessation.Todate,shehasnotcompliedwiththeserecommendationsandherconditionhasprogressivelyworsened.It
Dr.HankFarquadCertifiedDiabetesEducatorEndocrineSpecialistsandAssociates115BurkeSt.Omaha08/04/2018
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isrecommendedthatsheseekahigherlevelofcare,thusIreferhertoyourpractice.MsTaborlinwouldlikelybenefitfromastricterinsulinregimenandglycemicmonitoring,aswellasaninsulinpumpforreliabilityofmedicationadministration.Shewillrequiresupportwiththesechangestocare.
Ifyouhaveanyqueries,pleasecontactme.
Yourssincerely,
Nurse
[191words]
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THESPEAKINGSECTION
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SpeakingIntroduction
SectionOverview
TheOETSpeakingTestisaface-to-faceexamination,betweenaninterlocutorandyou.YourSpeakingTestwillbespecifictoyourhealthcareprofession;inthisbook,wewillcovermedicalandnursingtopics.IntheSpeakingTest,youwillcompletetworole-plays,whereyoutaketheroleofthehealthcareprofessional,andtheinterlocutortakestheroleofthepatient,thecarerorfamilymemberofthepatient.
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SPEAKINGSTRATEGIES
Treattherole-playasifyouwerewitharealpatient.Allowtimetoestablisharelationshipwiththepatientandaskforrelevantinformation.RememberthattheassessoristestingyourabilitytocommunicateeffectivelywithpatientsinEnglish;theyarenottestingyourmedicalknowledge.Payattentiontothetypeofinformationyouneedtocommunicatetothepatient,andadjustthewayyoucommunicatethisinformationfordifferentsituations.Ifthepatientisbeinggivenbadnews,forexample,youshouldshowempathyandkindness.Don’tmemoriselonganswers.Anythingtheassessorthinkshasbeenmemorisedwillnotbeassessed.Usevariedvocabularywhichmatchestheneedsofthepatientandthecontextoftherole-play.Youneedtoshowyoucancommunicatewiththepatientinavarietyofways.Speakloudly,clearlyandconfidentlysotheinterlocutorcanhearyou.Pronouncewordsasclearlyandcorrectlyaspossible.Varyyourintonation-yourvoiceshouldriseandfallasanativespeaker’swould.Readtherole-playcardcarefully,soyoudonotmisunderstandormissoutonanyofthetopicorbulletpoints.Makebriefnotesforeachpointonthecard.Includeideasandexamples,butnotfullsentences.Trynottobenervous.Takeadeepbreath,smileandmakeeyecontactasyoubeginyourspeakingtask.Whileeyecontactisnotassessed,itcanhelpyoutofeelmoreconfident.Underlinekeywordsandphrasesonthecard,toassistyouwiththerole-play.Don’tbeafraidtoasktheinterlocutortoclarifyanythingontherole-playcard
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whichisunclear.Thiscanincludethemeaningorpronunciationofvocabularyandthecontextoftherole-play.Ensurethatanyquestionsareaskedbeforetherole-playbegins.
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CHAPTER10
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TheSpeakingTask
LEARNINGOBJECTIVES
Bytheendofthischapter,youwillbeableto:
Analysetherole-playcard.PractisestrategiesfortheSpeakingTest.Assessyourownspeaking.
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INTRODUCTION
TheSpeakingTestwilltakeapproximately20minutes.Youwillcomplete2role-plays,andwilltalktotheinterlocutorfor5minutesduringeachrole-play.Youwillhave2to3minutestoprepareforyourrole-play,usingyourrole-playcardbeforeeachrole-playbegins.
WewilloutlinecriteriathatwillbeusedtoassessyourSpeakingTestinthischapter.Whencompletingspeakingtasks,makesuretokeepthecriteriaprovidedinmind,andtrytodemonstrateyourabilitiesineachindividualsection.Wewillgiveexamplesforhowthesecriteriacouldbeaddressedinthespeakingexam,however,wedonotadvisestudentstotrytomemorisetheseexamples,orattempttoreproducethemwordforwordonTestDay.
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Strategies
Gettingreadytospeak
ThefirststepintheSpeakingTestistofamiliariseyourselfwiththerole-playcard.Youwillonlybegivenonerole-playcardatatime,andyouwillnotbegiventheinterlocutor’srole-playcard.Beawarethatthenterlocutor'scardwillincludeinformationthatisnotincludedinyourrole-playcard,sothecardyouaregivenwillnotfullyprepareyouforeverythingthepatientwillsay,thoughitshouldgiveyouagoodideaoftheoutlinethattheconversationwilltake.
Belowaretworole-playcards.OneisaMedicalrole-play,andtheotherisaNursingrole-play.Selectthemostappropriaterole-playcard,anduseittoworkthroughthefollowingstrategies.
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MEDICALTASK
CANDIDATE
CARDNO.1
MEDICINE
SETTING GeneralPractice
DOCTOR A44-year-oldhasbeenreferredtoyourclinicduetohighcholesteroland
hypertension.Theyarefrustratedaboutattendingtoday.
TASK Findoutwhatthepatientthinksthepurposeofthevisitistoday.
Explaintheimplicationsofhighbloodpressureandcholesteroloncurrentand
futurehealth(e.g.strokes,heartattacks,kidneydamage,etc).
Discusscholesterolloweringdrugsandanti-hypertensivesandexplaintheir
benefits.
Findoutaboutthepatient’slifestyle(e.g.smokinganddrinkinghabits)andadvise
thepatientonhowtoimprovehis/herhealth(e.g.reducingsmokingandalcohol
consumption,joiningasupportgrouporseeingacounsellor,increasingexercise,
etc.).
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NURSINGTASK
CANDIDATE
CARDNO.2
NURSING
SETTING GeneralPractice
NURSE A67-year-oldpatientwhohashadhypertensionwithnoknowncauseformanyyears
hascomeinforafollow-upappointment.His/herbloodpressureismoderately
elevatedtodayandhe/sheappearsanxious.
TASK
Whoisthepatient?
Thefirstthingyoushouldidentifyisthetypeofpatientyouaregoingtotalkwith.Role-playcardswillinformyouofthekeydetailsaboutthepatientandthereasonfortheirappointment.Youmayalsobetoldaboutthepatient’semotions.Youshouldtakeallofthesepiecesofinformationintoconsideration,andplanyourapproachaccordingly.Forexample,ifapatientisnervousorworriedaboutaprocedure,youwillneedtoofferthemreassurance.
Findoutifthepatienthashadanyissuescomplyingwiththemedicationsor
exercising/eatinghealthily.
Explaintheimportanceofmedicationsforbloodpressurecontrol.
Discusslifestylechangesthatthepatientcanmaketoreducetheirbloodpressure
(e.g.takethemedicationsasprescribed,increaseexercise,andeatahealthierdiet,
etc.).
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Exercise
Matchthefollowing3patientdescriptionswiththemostappropriateapproach.
1. An83yearoldneedsanMRIscan,andseemsconfused.
2. A56yearoldhasterminalcancer,andisextremelyupset.
3. A24yearoldhasaviralinfectionandisimpatientlyrequestingtreatment.
Listentowhattheyhavetosayandfindoutwhatthepatientwantstoknow.
Explaincarefully,perhapsmultipletimes,whilecheckingforunderstandingthroughouttheexplanation.
Brieflyoutlinetheoptionsavailableandrecommendtheoptimalcourseofaction.
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Lookatthedescriptionofyourpatientintherole-playcardonthepreviouspage.Take30secondstoconsiderhowtobestcompletethetasksinbulletpoints
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andmakebriefnotesbelow.Thinkaboutthelanguagerequiredtocheckforunderstanding.
Whatdoyouneedtofindout?
Next,lookatthebulletpointedtasks.Atleastoneofthesetaskswillaskyoutofindoutinformationfromthepatient.Identifywhatitisthatyouneedtofindoutfromthepatient,andthinkofwaystorephrasethetaskintoaquestionthatwouldbeappropriateforconversationalEnglish.Takeanother30secondstothinkaboutrephrasingtheinformationinthefirstbulletpointofyourrole-playcard,toturnthisintoappropriatequestions.Yourinitialquestionshouldbeanopenquestion(forexample,‘howareyoufeeling?’),whichshouldthenbefollowedupwithmoreclosedquestions(forexample,‘howlonghaveyoubeenexperiencingthesesymptoms?’).
Whatdoyouneedtotellthepatient?
Youwillberequiredtoprovideyourpatientwithnecessaryinformationabouttheircondition,testsandcourseoftreatment,andshouldensurethatthepatientunderstandstheinformation.Whatyouneedtocommunicatetothepatientwillbeoutlinedinthebulletpointsoftherole-playcard.Youmaysimplyneedtoexplainapointtothepatient,oryoumayneedtofindoutrelevantinformationfirst,beforetailoringyourresponsetothepatient’sindividualcase.Ifyouhavealotofinformationtocommunicatewiththepatient,youshouldbreaktheinformationdownintosections,sothatyoucancheckthepatient'sunderstandingforeachsectionofinformationbeforemovingontothenextsection.
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SPEAKINGINENGLISH
Onceyourplanningtimeisup,youshouldhaveagoodideaofthestructureyourconversationwilltake.Whenspeaking,youneedtocoverthefollowingfourlinguistic,tomakesurethatyouareshowingtheassessoryourabilitytointeracteffectively.YouneedtoshowthatyoucanhavemeaningfulconversationswithothersinEnglish.Youshouldcommunicateconfidently,takecontroloftheinteraction,leadthetopicofconversation,andeffectivelycompletethespeakingtask,byaddressingallofthepointsinthetaskcard,andrespondingappropriatelytothepatient.Whileitisnotessentialthatyoucoveralloftheinformationinthe5minutesprovidedforeachconversation,youshouldnotwastetimeortalkaboutpointsnotmentionedintherole-playcard.
Intelligibility
Toscorewellinthiscriterion,youneedtocommunicateinawaythatcanbeeasilyheardandunderstood.Theassessorwillpayattentiontoyourpronunciation,therhythmyouusewhenyouspeak,thestressyouputonindividualwords,yourintonationandyourpitch.Avoidmemorisinglargechunksofspeechbeforethetest,asthiswillsoundunnatural.Instead,speakatanappropriatespeedandclearly,allowyourvoicetoriseandfall.PractisepronouncingwordsinEnglishsothattheysoundthesameaswhenanativeEnglishspeakersaysthem.Toaddressthefirstbulletpointedtaskinthenursingrole-playcard,youcouldsay:
“Tellmeifyouhavehadanyissuesfollowingthedietthatwediscussedatyourlastappointment.”
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Thewordsshowninboldinthesentenceaboveshouldbestressedastheyarethewordswhichcarrythemeaninginthesentence.Stressisaslightincreaseinvolume,andaslightincreaseinthesoundlength.
Fluency
Thiscriterionaddressestherateandflowofyourspeech.Youneedtospeakatanappropriatespeedandcarefully,thinkaboutthesentenceyouaregoingtosaybeforesayingitratherthansayingsomethingthatyoulaterneedtocorrect.Youshouldavoidoverusingfillernoiseswherepossible,suchas
“Ah”“umm”“err”
andfocusonspeakingsmoothly,linkingyourspeechtogether,andpausingappropriately,forexample,youmightpausetoseparatedifferentpointsyouaremaking.Youcouldsay,forexample
“First,weneedtoaddressyourdiet(pause)then,wecanlookatmoreinvasivetreatments.”
Youcanalsopauseforemphasis,orbeforebeginninganewtaskontherole-playcard,givingyourselfamomenttothinkaboutwhatyouwillsaynext.
Appropriateness
Thiscriterionassessestheappropriatenessofyourlanguageandtone.Rememberthatyouarespeakingtoapatient,notamedicalprofessional,soyoushouldexplainanytermsthattheymightnotunderstand.Forexample,youwouldrephrase‘hypertension’intherole-playercardto‘highbloodpressure’.
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Yourlanguageandtoneshouldalsoremainprofessionalandconfident,andyoushouldadjustyourtonetomatchtheemotionofthepatient,andthetopicbeingdiscussed.
Resourcesofgrammarandexpression
Youneedtoshowthatyoucanusegrammarcorrectlyandspeakinavarietyoftensesandsentencestructures.
Youshouldusegrammaticaldevicessuchaschunkingtomakeyourspeechclearer,andeasiertounderstand.Ifyouaregivingthepatientalargeamountofinformation,youmightsaysomethinglike
“I’mgoingtodiscussthevariousoptionsavailabletoyou.Thefirstis…”
Youshouldshowthatyoucancommunicateinformationinavarietyofways.Youmightrephrasesomethingyouhavealreadysaid,tomakesurethattheinformationcanbeunderstoodbythepatient.Makesurethatyouareusingthecorrectwordorderwhenspeaking,anddonotomitwordsfromyourspeech.
Youshouldusethecorrecttensewhenspeaking,tomakesurethatthepatientknowsifyouaretalkingaboutsomethingthathasalreadyhappened,orsomethingthattheywillneedtodo.
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SPEAKINGWITHTHEPATIENT
AsOETisatestforhealthcareprofessionals,aswellashavingagoodcommandoftheEnglishlanguage,youalsoneedtobeabletocommunicateeffectivelyandresponsivelywithpatients.Therearefiveclinicalcommunicationcriteriawhichyouwillbeassessedon.Youdonothavetoaddressallpartsofeachofthe5criteriatoscorewellintheSpeakingTest.
Relationshipbuilding
Youshouldstartwithanappropriategreeting.Fromthebeginningofyourinterview,youshouldmakethepatientfeelwelcome,andatease.Beginbyintroducingyourself,thengiveyourrole,andexplainorremindthepatientwhytheappointmenthasbeenscheduled.Thefollowinggivesanappropriateexampleofagreeting:
“Hello,I’mDrAlbert,isitMargaretFrench?I’moneoftherheumatologistsattachedtothehospital.Yourfamilydoctorhasaskedmetoseeyouaboutthejointproblemsyou’vebeenhaving”
Astheinterviewprogresses,youshouldmakesuretoshowthatyouarepayingattentiontothepatient’sneedsandconcerns,andshowthatyouarelisteningtowhatthepatientistellingyou.Thiswillhelpyoutocreateacollaborativeenvironmentbetweenyouandthepatient,andallowthepatienttofeelatease
Initiatetheinteractionappropriately
Demonstrateanattentiveandrespectfulattitude
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withyou.Tomeetthesecriteria,youcouldaskforthepatient’spermissiontodiscusstopicsthatcouldpotentiallycausethemtofeeluncomfortable,checkthatthepatientiscomfortablewithwhatisbeingdiscussedifthereareanysignsthattheymaynotbe,andshowsensitivitywhendiscussinganythingthatthepatientmayfindembarrassingorpersonal.Thefollowingisanexampleofhowyoumightdemonstraterespectforthepatient:
“WhatIwouldliketodoisspendafewminuteswithyounowdiscussingyoursymptoms?Isthatokay?Pleaseletmeknowifyouarefeelinguncomfortableatanytime”
Whenthepatientsharesinformation,youshouldacceptthisinformationwithoutreproachorjudgement.Donotdevalueorcriticisethepatientwhentheysharetheirthoughtsorbehaviours,asthiswilldiscouragethemfromcontinuingtoshareinformationwithyou.Youneedtomaintainrespectfulcommunication,soyoushouldacknowledgethepatient’semotionswhereverpossible.Thefollowinggivesanexampleofhowyoumightrespondtoapatientwhohasvoicedconcerns:
“Sowhatworriesyoumostisthattheabdominalpainmightbecausedbycancer.Icanunderstandthatyouwouldwanttogetthatcheckedout.”
Youshouldshowthepatientthatyouunderstandwhytheyfeelacertainway,iftheyareemotionalinyourinterview.Youshouldalsobepreparedtochangeyourapproachifthereisanemotionalelementtoyourinterview;forinstance,ifyouhavetobreakbadnews.Youcanshowthatyouaremeetingthesecriteria
Demonstrateanon-judgementalapproach
Showempathy
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throughyourwords,butyoucanalsoshowempathythroughthetoneofyourvoice,andthroughnon-verbalsoundsofagreement,sympathyandencouragement.Youcoulddemonstrateyourempathyforthepatient,bysayingsomethinglike:
“Youmentionedearlierthatyouwereconcernedthatyouhadangina.Anginaisaveryparticularkindofpain,whichrelatestoseveralunderlyingconditions.IsitalrightifIaskyouafewmorequestionstoruleoutmuscularpain?”
“Icanseethatyourhusband’smemorylosshasbeenverydifficultforyoutocopewith;IimagineIwouldfeelsimilarlyifthesamethinghappenedtome.”
Understandingandincorporatingthepatient’sperspective
IntheSpeakingTest,youneedtoshowthatyou’reputtingthepatientatthecentreoftheconversation,planningyourspeecharoundhowyouexpectthepatienttoreactandmodifyingyourspeechiftheyreactinadifferentway.Followthenextthreestepstomakesureyouareusingtheinformationyourpatientprovidestoalteryourconversation.
Encouragethepatienttogivetheirthoughtsandopinionsabouttheircondition.Don’tsimplyaskthemtolisttheirsymptoms,butalsoexplorewhattheythinkmightbethecause.Forexample,youcouldsay:
Elicitandexplorethepatient’sconcerns
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“Didyouhaveanythoughtsaboutwhatmightbecausingyoursymptoms?”
or,togetanideaofwhatthepatientmightbefeeling,youcouldsay:
“Wasthereanythingparticularyouwereconcernedabout?”
Ifthepatienthasnotexplainedsomethingfully,oryouwanttoexploresomethingfurther,youcandothisbysayingsomethinglike:
“Youmentionedthatyouwereconcernedabouttheeffecttheillnessmighthaveonyourwork,couldyoutellmemoreaboutthat?”
Alongsideencouragingthepatienttoprovideinformation,youwillalsoneedtoshowthatyou’retakingthisinformationintoconsideration,andshapingtheconversationaroundwhatthepatientistellingyou.Manytest-takersdonotscorewellintheSpeakingTestbecausetheytrytofollowaspecificstructurefortheconversation,whichtheydonotadaptandalteraccordingtonewinformationprovidedbythepatient.DonotmemoriselongdialoguetouseonTestDay.Instead,practisereactingtonewinformation,andincorporatingitintoyourspeech.Whenreactingtoemotionalpatients,youmightsaysomethinglike:
“Youusedthewordworried,couldyoutellmemoreaboutwhatyouareworriedabout?”
or,whenpatientsshowemotion,butdonottellyouthattheyfeelacertainway,youcouldsay,forexample:
“Isensethatyouarenothappywiththeexplanationsyou’vebeengivenin
Pickuponpatientcues,andreactaccordingly
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thepast.”
Toshowthepatientthatyouareusingtheinformationthey’vegivenyoutostructureandguideyourspeech,youshouldletthepatientknowthattheirwordshavebeenheard.Ifapatientgivesnewinformationthatchangesthestructureofyourconversation,youcouldindicatethisbysayingsomethinglike:
“Asyousayyou’rehavingtroublesleepingatthemoment,let’stalkaboutthingsthatmighthelpyouaddressthisbeforewemoveon.”
If,ontheotherhand,thepatientprovidesinformationthatdoesnotaltertheconversation,youcanstillacknowledgetheirinputbysayingsomethinglike:
“Youmentionedearlierthatyouwereconcernedthatyouhadangina.Anginaisaveryparticularkindofpain,whichrelatestoseveralunderlyingconditions.IsitalrightifIaskyouafewmorequestionstoruleoutmuscularpain?”
ProvidingStructure
Youshouldstructuretheinterviewclearlyandefficiently.Beginbygreetingthepatient,discusswhythey’reseeingyoutoday,thentackleeachbulletpoint,onebyone.Afteryouhaveprovidedanexplanation,orcompletedaseriesofquestions,checkthatthepatienthasnofurtherquestionsandhasunderstoodyou
Relateyourexplanationstotheideas,concernsandexpectationsyouhaveelicitedfromthepatient
Sequencetheinterviewpurposefullyandlogically
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beforemovingon.Whilemakingnotesonyourrole-playcardinthepreparationtime,lookthroughwhatyouhavetotalkabout,andthinkabouthowyoumightconnectthebulletpointstooneanotherinyourspeech,sothatyourspeakingflowslogically-thisrelatestosignposting.
Signpostsfunctionasapausebetweentopicsandallowyoutocheckforunderstandingandaskforpermissiontodiscusstopics.Theyalsoallowyoutosummariseinformationgivenbytheinterlocutor(thisrelatestolatercriteria).Whenmovingfromonetopictothenext,youneedtomakeitcleartothepatientwhatyouwilldiscuss.Aftergreetingthepatient,youshouldoutlinethetopicthatwillbediscussedbeforegettingintodetails.Wheneveryoumoveontoadifferenttopic,tellthepatientwhatyouaremovingontotalkaboutnext.Youmightstarttodiscussatopicbysayingsomethinglikethis:
“Sincewehaven’tmetbefore,itwillhelpmetolearnsomethingaboutyourpastmedicalhistory.Canwedothatnow?”
Afterapatienthasfinishedtellingyouaboutsomething,youmightoutlinewhatyouwanttodiscussnextbysayingsomethinglikethis:
“Youmentionedtwoareastherethatareobviouslyimportant,firstthejointproblemsandthetiredness,andsecond,howyouaregoingtocopewithyourkids.CouldIstartbyjustaskingafewmorequestionsaboutthejointpains,andthenwecancomebacktoyourdifficultieswiththechildren?”
Signpostinganychangesintopichelpsthepatienttokeeptrackofwhat’sbeingdiscussedandgivesaclearerstructuretoyourdiscussion.
Signpostchangesintopic
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Thereareanumberofdifferentwaysthatyoumightorganiseyourexplanations.Again,yourprimaryconcernwhenorganisingyourexplanationsshouldbetomakeyourspeechasclearanddigestibletothepatientaspossible.Tohelpthepatientunderstand,andtomakeiteasierforthemtorememberinformationdiscussedatalaterdate,itcanbehelpfultodividewhatyouwilltalkaboutintocategories,andinformthepatientofthesecategoriesbeforeyougointomoredetailabouteachpoint.Forexample,youcouldsay:
“TherearethreeimportantthingsIwanttoexplain.FirstlyIwanttotellyouwhatIthinkiswrong,secondly,whattestsweshoulddo,andthirdly,whatthetreatmentmaybe.”
Theuseofcategorisationabovehelpstostructurethediscussionyouwillhave,sothatthepatientcanunderstandwhatwillhappennext.Whenyougointomoredetail,youshoulduseatechniquecalledchunking.Thisiswhenyoudeliverinformationinchunks,leavingcleargapsbetweeneachpieceofinformation,beforemovingontothenextone.Youmayalsofindithelpfultouseatechniquecalledlabelling.Labellingallowsyoutohighlightsignificantinformationtothepatient.Forexample,youcouldsay:
“Itisparticularlyimportantthatyourememberthis...”
Onceyouhaveexplainedallofthepointsyouwantedtocover,itcanalsobeusefultorepeatandsummarisethemostimportantpointstothepatient.Youcouldsay,forexample:
“Sojusttorecap:wehavedecidedtotreatthisasafungalinfectionwithacreamthatyouputontwiceadayfortwoweeksandifitisnotbetterby
Useorganisingtechniquesinyourexplanations
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then,youaregoingtocomebacktoseeme.”
Repeatingandsummarisinginformationmakesiteasierforthepatienttostoretheinformationintheirmemory,andimprovestheirabilitytorecallthisinformationlater.Afteryouhavesummarisedtheinformation,youcancheckforthepatient'sunderstanding,whichmeetsothercriteriadiscussedlater.
Exercise
Spendoneminutethinkingaboutthestructureoftheconversationthatwilltakeplace,coveredintherole-playcardabove.Thinkabouthowyouwillguidetheconversation,andhowyoumightrephrasethetasksintoconversationalEnglish.
InformationGathering
It’simportanttogetasmuchrelevantinformationfromthepatientasyoucan.Ifyou’vefollowedthestepsoutlinedabove,youshouldhavecreatedanenvironmentwhereyourpatientfeelscomfortablesharinginformationwithyou.Now,youshouldreadthroughthenext5pointstomakesureyou’relisteningactivelytothepatient,andgatheringnecessaryandrelevantinformation.Thiscriterionassesyourabilitytoaddressthewaythepatientisthinkingandfeeling,ratherthanyourmedicalaccuracy.
Whenthepatientistalking,youneedtoshowthatyouarepayingattentiontothemandfollowingtheirspeech,withoutinterruptingthem,orhaltingtheflowoftheirnarrative.
Youcandemonstratethatyouarelisteningbyusinganumberoftechniques:
Facilitatethepatient’snarrative
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or
“notcoping?”
Similarly,toshowagreaterunderstandingofwhatthepatientissaying,youcanrephrasewhatthepatientissayingintoyourownwords,orsuggestaninterpretationforwhatthepatientiscommunicating.Youcouldsay,forexample:
“AreyouthinkingthatwhenJohngetsevenmoreill,youwon’tbestrongenoughtonursehimathomebyyourself?”
Whenthepatientpausesduringtheirspeech,don’ttrytostarttalkingimmediately,anddon’tinterruptthepatientifthey’restilltalking.Instead,waituntilthepatienthasfinished,andpausetoconsiderwhattheyhavesaidbeforeresponding.Youcanuseshortverbalandnon-verbalsoundsofencouragementwhilethepatientisspeakingtoshowthatyouarepayingattention.Examplesinclude:
“Um”,“uh-huh”,“Isee”
Asthepatientrevealsinformation,youshouldshowthatyou’retakingthisonboardbyechoingthepatient,orrepeatingkeyphrasesandwordsfromtheirspeech,suchas
“chestpain?”
Useopenquestionsatthebeginningandclosedquestionsastheinterviewprogresses
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Atthebeginningofyourinterview,youshouldaskthepatientopenquestions,tofindoutasmuchgeneralinformationaspossible.Thefollowingareexamplesofopenquestions:
“Startatthebeginningandtakemethroughwhathasbeenhappening...”
“Howhaveyoubeenfeelingsinceyouroperation...?”
“Tellmeaboutyourheadaches.”
Astheconversationdevelopsandyouhaveabetterideaoftheinformationyouneedfromthepatient,yourquestionscanbecomemoredirected,butshouldremainopen.Atthisstage,youcouldask:
“Whatmakesyourheadachesbetterorworse?”
Oncethepatienthasprovidedenoughgeneralinformationabouttheircondition,youcanmovetomorespecific,closedquestionstogetfurtherinformation.
“Doyoueverwakeupwiththisheadacheinthemorning?”
Toensurethatyouarereceivingreliableinformation,youshouldavoidinfluencingyourpatientwhenyouaskquestions,oraskingmultiplequestionsatonce.Anexampleofacompoundquestionis:
“Haveyoueverhadchestpainorfeltshortofbreath?”
Thepatientmaysimplyrespond‘yes’or‘no’,eveniftheanswerdoesnotrelate
Avoidcompoundquestionsandleadingquestions
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toboththeirexperienceofchestpainandtheirexperienceofshortnessofbreath.Youshouldalwaysbreakcompoundquestionsupandaskonequestionatatime.
Leadingquestionsincludeassumptions.Thismakesitmoredifficultforthepatienttocontradicttheassumption.Avoidaskingleadingquestionsinyourinterview,suchas:
“You’velostweight,haven’tyou?or“youhaven’thadanyankleswelling?”
Thesequestionsareunlikelytoprovideyouwithreliableinformation.
Ifpatientsrespondtoyourquestionswithoutprovidingenoughinformation,orwitharesponsethatcouldbeinterpretedinanumberofdifferentways,itisimportanttoaskthepatienttoexplainwhattheymean.Youmightask,forexample:
“Couldyouexplainwhatyoumeanbylight-headed?”
Ifthepatientsayssomethingthatrequiresfurtheramplification,forinstance,iftheyappeartodescribeasymptom,butyou’dliketogetaclearerideaofwhattheyareactuallyexperiencing,youcanlookforamplificationbyaskingsomethinglike:
“Whenyousaydizzy,doyoumeanthattheroomseemstoactuallyspinround?”
Don’tmoveontodiscusssomethingelseuntilyou’recomfortablethatyou’veunderstoodwhatthepatienthassaid.Rememberthatpatientsmaybeless
Clarifystatementsthatarevagueorrequireamplification
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precisewiththeirvocabulary,soitisimportanttoclarifytheirstatements.
Oncethepatienthasfinisheddiscussingatopic,andyouthinkthatyouhavealloftherelevantinformationyouneed,youshouldgiveabriefoverviewofwhatthepatienthastoldyou,andaskthepatienttoconfirmthis,andprovidemoreinformation.Youmightsay,forexample:
“CanIjustseeifI’vegotthisright–you’vehadindigestionbefore,butforthelastfewweeksyou’vehadincreasingproblemswithasharppainatthefrontofyourchest.Thishasbeenaccompaniedaccompaniedbywindandacidandit’sstoppingyoufromsleeping.It’smadeworsebydrinkandyouwerewonderingifthepainkillersweretoblame.Isthatright?”
Onceyou’vesummarisedtheinformation,andifthepatienthasagreed,pauseforamomentlonger,toallowthepatienttoprovideanyadditionalinformation,ortocorrectoralterpartoftheinformation.
InformationGiving
Afterthepatienthasfinishedprovidinginformation,andyouhavegatheredeverythingyouneed,andconfirmedthatitiscorrect,itisyourturntoprovideinformationtothepatient.Readthroughthenext5points,tomakesurethatyouexplaininformationaseffectivelyaspossible.Remember,itisnotaboutgivingthemostmedicallyaccurateexplanationspossible,butitisaboutcheckingthatthepatienthasunderstoodtheinformation.
Summariseinformationtoencouragethepatienttocorrectorgivemoreinformation
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Thefirststepinexplaininginformation,istounderstandwhatthepatientisawareofalready,sothatyoucanfocusonexplainingthingstheydon’tknow,andavoidgoingoverthingsthey’realreadyfamiliarwith.Don’tassumethatthepatientisfamiliarwiththeirillnessortreatment,astheymaynotbe.Toestablishhowmuchthepatientknows,youmightasksomethinglike:
“ItwouldbehelpfulformetounderstandalittleofwhatyoualreadyknowaboutdiabetessothatIcantrytofillinanygapsforyou.”
“Basedonyourbloodtestresults,weneedtodiscusswaystoloweryourcholesterol.WhatdoyouknowaboutLipitor?”
Onceyouareawareofwhatthepatientneedstoknow,youcanbegintoexplaininformationtothem.Makesureyoutakebreaksthroughoutyourexplanation,allowingthepatienttimetoaskquestionsbeforemovingon.Forexample,youmightsaysomethinglike
“Soreally,giventhesymptomsyouhavedescribedandtheverytypicalwaythatyouwheezemoreafterexerciseandatnight,Ifeelreasonablyconfidentthatwhatyouaredescribingisasthmaandthatweshouldconsiderwayswemighttreatit.(Pause)Howdoesthatsoundsofar?”
Youshouldmakesurethatthepatientfeelscomfortablewithwhatyouare
Establishwhatthepatientalreadyknows
Pauseperiodicallywhengivinginformation,usingthepatient’sresponsetoguidenextsteps
Encouragepatientstocontributereactionsandfeelings
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explainingsothatyoucanaddressthisbeforemovingon.Patientswhoarefeelinguncomfortable,confusedordistressedmayfinditmoredifficulttotakeininformation,soyoushouldchecktheirreactionstotheinformationfromtimetotime.Youcoulddothisbyaskingsomethinglike:
“Whatquestionsdoesthatleaveyouwith,haveyouanyconcernsaboutwhatIhavesaid?”
Aswellascheckingthepatient’semotionalreactionstotheinformation,youalsoneedtomakesurethatthepatientunderstandswhatyouareexplainingtothem.Youcanevaluatethepatient’sunderstandingbyaskingthemtorepeattheinformationthatyouhavejustgiventhem.Forexample:
“IknowI’vegivenyoualotofinformationtodayandI’mconcernedthatImightnothavemadeitveryclear–itwouldhelpmeifyourepeatedbacktomewhatwehavediscussedsofarsoIcanmakesureweareonthesametrack.”
Makesurethatthepatientcoverseverythingthatyouhaveexplained,andifanyinformationismissedinthepatient’srecap,remindthemoftheinformation,andcheckthattheyunderstandthisinformationbeforemovingon.
Afterconfirmingthatthepatienthasunderstoodeverythingthatyouhaveexplained,youshouldfindoutifthereisanythingelsethatthepatientwantstoknow.Youcouldask,forexample:
Checkthatthepatienthasunderstood
Discoverwhatfurtherinformationthepatientneeds
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“Arethereanyotherquestionsyou’dlikemetoansweroranypointsIhaven’tcovered?”
Exercise
Askafriendorfamilymembertousetherole-playcardonthefollowingpages(theyshouldmakesuretheychoosetherole-playcardthatcorrespondswithyourrole-playcardearlierinthechapter,eithermedicalornursing)andplaytheroleofthepatient,whileyouplaytheroleofthehealthcareprofessional.Recordtheaudio(youcanuseyourmobilephoneorlaptoptodothis)sothatyoucanreviewitlater,andsetatimerfor5minutes.
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NURSINGTASK
ROLEPLAYER
CARDNO.1
NURSING
SETTING GeneralPractice
PATIENT Youarea67-year-oldandhavehadhighbloodpressureformanyyears.Your
bloodpressurewaswellcontrolledwithmedicationanddiet/exercisewhenyou
wereworking,butsinceretiring2yearsagoyouhaveletyourroutinelapse.You
arenervousaboutseeingthenursebecauseyoudon’twanttobejudgedfornot
managingyourbloodpressurecorrectly.
TASK Whenasked,reluctantlyadmitthatyouhaven’tbeentakingyourmedication,
exercising,andeatinghealthilyallthetime.Explainthatyouhavebeenfeeling
fineanddon’tthinkthatyourbloodpressureisanissue.
Askthenursewhyyouhavetotakesomanymedications.
Beresistanttomakinganychangestoyourlifestyleinitially,buteventually
agreetothenurse’ssuggestions.
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MEDICINETASK
ROLEPLAYER
CARDNO.2
MEDICINE
SETTING GeneralPractice
PATIENT Youarea44-year-oldwhohasrecentlybeentoldthatbothyourcholesteroland
bloodpressurearehigh.Youdon’treallywanttotakeanymedication.Youdon’t
reallywanttochangeyourlifestylebecauseyourhealthhasbeenfine.
TASK
Onceyou’vecompletedthespeakingexercise,lookthroughtheassessmentcriteriaagain,andevaluatewhetherornotyoumeteachcriteria.Thinkabouthowyoucouldhaveimprovedyourspeaking,andmakenotesonyourweakestareas.Practisetheskillsnecessarytomeetthecriteria,thentrycompletingthespeakingrole-playsattheendofthischapter.Youshouldalwaysrecordyourself,andlistenbackoveryourspeakingafteryou’vecompletedtherole-plays.
Witheachnewspeakingtask,youshouldimproveyourspeakingabilitiesfurther,untilyourspeakinglevelissufficientlyimprovedforyoutoapplytothetestsituationonTestDay.
Tellthedoctorthatthenursereferredyoubutyouthinkyou’rewasting
everybody’stimebecauseyourhealthisfine.
Bedismissiveofthedoctor’swarningaboutthefuture.Yourfriendhashigh
bloodpressureandcholesterolandtheyarefine.
Ifasked,tellthedoctorthatyouarereluctanttotakestatinsbecauseyouhave
heardthattheycancauseproblemswithyourjoints.
Ifthedoctorasks,divulgeyouralcoholandsmokinghistory(10cigarettesper
dayforthepast25years,2pintsofbeereachnight).Reluctantlyagreeto
reducehowmuchyoudrinkandsmoke.
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SpeakingPracticeSet
Usethe4speakingrole-playsonthefollowingpagestopractiseyourspeakingskillswithafriend,relativeorcolleague.Giveyourself2to3minutestopreparefortherole-plays,usingonlyyourcandidaterole-playcard,thenrecordyourselfspeakingfor5minutes.Onceyouhavefinishedeachrole-play,assessyourabilitiesusingthespeakingcriteriainthischapter.Whenpractising,youshouldonlyreadthecandidatecard,asyouwillnotseetheroleplayercardinthetest.Youmightfindithelpfultophotocopyandprintthesetaskcardsontoonepage,andthenfolditinhalf,soyoucanfocusonthecandidatecardwhileyou'regettingreadytospeak.
MedicalTaskCards
CANDIDATE
CARDNO.3
MEDICINE
SETTING PainMedicineClinic
DOCTOR This32-year-oldpatienthasbeenattendingyourpainmedicineclinicfor
severalyearsandhasbeenprescribedopioids(painkillers)duetoa
workplaceinjury.He/sheisrequestinganearlyrefill,butyourclinichasa
noearlyrefillpolicy.
TASK Findoutwhythepatientisrequestinganearlyrefill.
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ROLE-
PLAYER
CARD
NO.3
MEDICINE
SETTING PainMedicineClinic
PATIENT Youare32andhavebeenattendingapainmedicineclinicforseveralyears
duetoaworkplaceinjury.Youareonshort-actingandlong-actingpainkillers,
whicharerefilledeverymonth.However,thisweekend,someonestoleyour
medications.Younowhavenoneandyourrefillistwoweeksaway.Youare
hopingtogetanearlyrefillbutarenervousthattheclinichasapolicyofnot
replacingstolenmedication.
TASK
Discusstheclinic’snoearly-refillpolicyandthereasonbehindit
(abuseofopioidmedication).
Tactfullyexplainthatyoucannotwritearefill,butthatyoucanhelpthe
patientmanagetheirpaininotherways(e.g.topicalcreams,over-the-
counterpainkillers,anti-depressantslikeCymbalta,etc.).
Tryandreassurethepatient.Explainthatifthepainbecomes
unbearable,theyshouldvisittheEmergencyDepartment.
Explainyoursituationtothedoctorandexpressyouranxietyabouthaving
tobeinpainagain.
Explainthatyouunderstandtheprovider’spolicyandtherationalebehind
it,butareaskingforleniencygiventhefirst-timenatureofthisincident.
Insistthatyoushouldbeabletoobtainarefill.
Becomeanxiousaboutmanagingyourpain.Bedifficulttoreassure.
CANDIDATE
CARDNO.4
MEDICINE
SETTING GeneralHospitalEmergencyDepartment
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DOCTOR Youaretalkingtoa54-yearoldpatient,whohasbeenrecentlydiagnosed
withadenocarcinoma(lungcancer).AchestX-raywascompletedinthe
EmergencyDepartmentandrevealsbilateralopacifications(anunderlying
conditionsuchaspneumonia,oedema,haemorrhage,etc.isblockingair
gettingintothelungs).Youareconcernedthatthepatientmaybe
sufferingfromamalignantpleuraleffusion(fluidinthelungs)andrequire
athoracentesis(removalofthefluidviaaneedle).
TASK
ROLEPLAYER
CARDNO.4
MEDICINE
SETTING GeneralHospitalEmergencyDepartment
PATIENT Youarea54-year-oldpatientwhohasbeenrecentlydiagnosedwith
lungcancer.YouvisitedtheEmergencyDepartment(ED)andexplained
tothedoctorsthatyoucan’tcatchyourbreathandtakingdeepbreaths
causeschesttightness.Youarescaredandworriedbecauseyouwent
throughcancerrecoverybeforeandhadchemotherapyandradiationto
treatanaggressiveB-celllymphoma.Youareworriedthatyoumaynot
toleratemorechemotherapyandthisnewshortnessofbreathisrelated
toyourlungcancer.
TASK
Findoutaboutthepatient’sconcernsregardingtheirdiagnosis.
SharewiththepatienttheX-rayfindingsandthepossiblereasons
behindhis/hershortnessofbreath.
Reassurethepatientregardingthelikelycourseoftreatment:
ultrasoundtoseeifhe/shehasapleuraleffusionwithchemotherapyto
beorganisedwhentheothersymptomsresolve.
Findoutwhatfurtherinformationthepatientneeds.Referthepatientto
acounsellorandexplainthepossibletreatmentoptions(diuretics,
thoracentesis,notreatment,etc).
Expressconcernregardingchemotherapyandyournewsymptoms.
Askifyourshortnessofbreathmaybecausedbyyourlungcancer.
Askifchemotherapyisnecessaryandwhatyoucanexpectifyou
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havechemotherapytreatment.
Whenasked,explainthatyoudon’treallywantmoreprocedures;
youjustwanttogohome.Youwouldliketospeaktoacounsellor.
Reluctantlylistentothedoctor’soptions.
NursingTaskCards
ROLEPLAYER
CARDNO.5
NURSING
SETTING OutpatientMentalHealthClinic
NURSE This24-year-oldpatientwasrecentlyprescribedlithiumforhis/her
bipolardisorderbutisnowworriedcontinuingwiththisdrug.He/sheis
wouldliketoknowmoreaboutthemedication,includingits
indications,sideeffects,andmonitoring.
TASK
ROLEPLAYER
CARDNO.5
NURSING
Findoutthewhythepatientisconcernedandiftheyare
experiencingsideeffects.
Explainhowlithiumworks(e.g.veryeffectivemoodstabiliser)and
thattheywillhavetotakeitforever,althoughthedosemaybe
adjusted.
Gooversomesideeffectswiththepatientwhileproviding
reassurance(e.g.acneandhairlossarecommonbutothersideeffects
likeseizuresarerare).
Checkthatthepatienthasunderstoodyourexplanationsandfindout
whatfurtheradvicetheyneed.Providefurtherreassurancethatthey
aredoingtherightthing.
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SETTING OutpatientMentalHealthClinic
PATIENT Youare24yearsoldandhaveadiagnosisofbipolarmooddisorder.The
psychiatristhasprescribedyoulithiumasamoodstabiliser.Youhave
beentakingitforaweekanddonesomeresearchonline.Youare
worriednowbecauseeveryoneappearstoreporthavingnegativeside
effectsonthemedication.Youwouldliketoknowifyoushould
continuetotakethemedication,howitworksandwhatsideeffectsto
watchoutfor.
TASK Explainyourworryoverwhatyouhavereadonlineandyourconcern
aboutthesafetyofcontinuingthismedicine.
Askhowittreatsyourcondition.Willyouneedtotakeitforever?
Findoutwhatsortofsideeffectsaretypical.Howlikelyisitthey
willoccur?
Bereluctanttocontinuetakinglithium.Eventuallyagreetothe
nurse'sadvice.
CANDIDATE
CARDNO.6
NURSING
SETTING RehabFacility
PATIENT Youhavebeenaskedbyafamilymembertospeaktoapatientwhois
recoveringfromasubarachnoidhaemorrhage(SAH)(bleedingbetween
theskullandthecortex).Thepatientisconcernedthatafullrecoverywill
notoccurandthatanotherSAHisinevitable.
TASK Findoutthespecificsofthepatient’sconcerns.Reassurethepatient
thatfatiguewilllessenandphysicalenduranceandmemorywill
improveasthebraincontinuestoheal.
Explainthatsomepatientsareabletogobacktowork/live
independently.
Discusshowthepatientcouldliveindependently:e.g.,assistive
devices(walkerorcane,grabbarsinbathroom),visualcuestotrigger
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ROLE-
PLAYER
CARD
NO.6
NURSING
SETTING RehabFacility
PATIENT Youare49-years-oldandrecoveringfromasubarachnoidhaemorrhage
(SAH)(bleedingbetweentheskullandthecortex)thatoccurredthreemonths
ago.Youweredischargedfromanacutecarefacilitytoarehabfacility
yesterday.Youweretoldthatyouwillcontinuetoimproveoverthenext12
months,butyouareconcernedaboutthehighestleveloffunctioningthatyou
willachieve.YoualsowouldliketoknowhowtopreventanotherSAH.
TASK
memory(post-itnotes,pictures),settingalarmclockstoserveas
reminders(timeformedications,phonecalls,etc.).
StresstheimportanceoftakingBP(bloodpressure)medicationsas
prescribed.Suggestthatthepatientusea7-daypillorganiser.
Tellthenursethatyouareconcernedthatyouwillnotregainyourstamina,
financialcontrolorbeabletoliveindependently.
Askthenurseifpatientsareeverabletoliveindependentlyandgobackto
workafterrecoveringfromaSAH.
AskthenursehowyoucanmaintaingoodBP(bloodpressure)toprevent
anotherSAH.
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Answers
1.B
2.A
3.C
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THEPRACTICETEST
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THEPRACTICETEST
OET
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ListeningSection
PlayTrack21tocompletetheListeningTest.
ListeningTest
Thistesthasthreeparts.Ineachpartyou’llhearanumberofdifferentextracts.
You’llheareachextractONCEONLY.
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PARTA
Inthispartofthetest,you’llheartwodifferentextracts.Ineachextract,ahealthprofessionalistalkingtoapatient.
Forquestions1to24,completethenoteswithinformationyouhearintherecording.
Extract1:Questions1to12
YouhearafoundationdoctortalkingtoarecentlyadmittedpatientcalledRoyMiller.Forquestions1to12,completethenoteswithawordorshortphrase.
Name RoyMiller
Reasonsforadmission shortnessofbreath
difficultywalking(1),oftenbecomesshortofbreath—
breathlessnesshasincreased—
coughingandwheezing
soundslike‘(2)’andhasn’timproved—
worsewhen(3),preventingsleep—
coughingupphlegm,describedas(4)incolour—
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Medicalhistory
Medication
phlegmhasgraduallydarkenedovertheweek—
sufferinghotandcoldspells,feels(5)
diagnosedwith(6)lastyear
wasa(7),stoppedsixyearsago
occasionallysuffersfromgout(treatedwith(8))
arthritislocatedin(9)
using(10)morefrequently
takesastatinfor(11)
occasionallyusesparacetamolforarthritis
(12)causesanallergicreaction
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Extract2:Questions13to24
YouhearanoptometristtalkingtoapatientcalledMarshaSamarina.Forquestions13to24,completethenoteswithawordorshortphrase.
Patient MarshaSamarina
Descriptionofinitialsymptoms
InitialGPtreatment
painineye,feltlikesomethingwas(13)
noticedheadache
eyewas‘(14)’profusely(comparestochoppingonions)
roommatenoticedthateyewas(15),tooktoER
painwassevere,unableto(16)
unabletoidentifycause,performed(17)test
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Optometristtreatment
Athometreatment
Currentcondition
GPsuggestedpossibilityof(18)
given(19)forpain-relief
eyeexamshowed(20)
advisedtoavoidwearingcontacts
prescribed:
(21)-usingtwicedaily—
and(22)lessoften,findsapplicationunpleasant—
alsotaking(23)forpainrelief
conditionhasimproved
paincausedby(24)
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PARTB
Inthispartofthetest,you’llhearsixdifferentextracts.Ineachextract,you’llhearpeopletalkinginadifferenthealthcaresetting.
Forquestions25to30,choosetheanswer(A,BorC)whichfitsbestaccordingtowhatyouhear.
25. Youheartwodoctorsdiscussthetransferofcareforapatient.
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Thepatient’sCURB-65scoremeansthathewill
betransferredfromtheEmergencyDepartment.(A)receiveadditionalmedicationandtreatment.(B)betreatedasanout-patient.(C)
26. Youhearaspeechpathologisttalkingtothewifeofapatientwhohasrecentlysufferedastroke.
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Whatdoesshewanttoknowaboutherhusband’scondition?
howlongitwilltakehimtomakeafullrecovery(A)
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whetherhiscommunicationissueswillimprove(B)whatshecandotospeedthehealingprocess(C)
27. Youhearatraineedoctoraskingaseniorcolleagueaboutchesttubes.
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Whatistheseniorcolleaguedoing?
explaininghowtousethemcorrectly(A)recommendinganalternativetothem(B)demonstratingwhatcangowrongwiththem(C)
28. Youhearapharmacisttalkingtoacustomeraboutpainrelief.
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Whathasthecustomerbeenmisinformedabout?
thestockofmedicationinthepharmacy(A)theusefulnessofatypeofpainrelief(B)theavailabilityofamedicine(C)
29. Youhearatraineenursereceivingfeedbackfromhistutor
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Whatdoessheexplain?
listeningtoapatient’sconcernsisessential(A)
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howtobecomemoreself-assuredwheninteractingwithpatients
(B)
theimportanceofprovidingadequateemotionalsupporttopatients
(C)
30. Youheartwodoctorsplanningtheirpatient-careschedule
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Whatistheirpriority?
identifyingthepatientsatgreatestrisk(A)dealingwithpatientswhoneedtestsarranging(B)ensuringthatallpatientshavekeydocumentation(C)
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PARTC
Inthispartofthetest,you’llheartwodifferentextracts.Ineachextract,you’llhearhealthprofessionalstalkingaboutaspectsoftheirwork.
Forquestions31to42,choosetheanswer(A,BorC)whichfitsbestaccordingtowhatyouhear.
Extract1:Questions31to36
YouhearaninterviewwithDrMatthewLeach,who’stalkingaboutmeningitiscausedbyNeisseriameningitides.
31. DrLeachsaysthatduringtheonsetofmeningitis,manypatients
donotrealisetheyareunwell.(A)mistaketheillnessforsomethingelse.(B)experiencelife-threateningsymptoms.(C)
32. DrLeachsaysthatmeningitisiscommonincollegestudentsbecauseoftheir
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poorhygienehabits.(A)proximitytonewpeople.(B)weakenedimmunesystems.(C)
33. WhydoesDrLeachsaythepatientdidn’tseektreatmentsooner?
Hewasunsureofwhattodo.(A)Hedidn’tthinkheneededtreatment.(B)Hewastryingtofinishhisassignments.(C)
34. DrLeachbegantreatingformeningitisbeforereceivingthespinalfluidresultsbecause
theillnessprogressesrapidly.(A)thetreatmentisthesameforallcauses.(B)thetestresultsdidnotaffectthediagnosis.(C)
35. DrLeachexplainsthatmeningitisismorelikelytocauselongtermafter-effectsif
itisnotaccuratelydiagnosed.(A)patientsdonotseektreatmentquickly.(B)reactionstothevirusareextremelysevere.(C)
36. DrLeachadvisesthosewhothinktheymaybeinfectedwithmeningitisto
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Extract2:Questions37to42
YouhearapresentationgivenbyaclinicalpsychiatristcalledDrEvalinaHoughtonaboutagitatedpatientsinanemergencysetting.
getvaccinatedattheearliestopportunity.(A)avoidpeoplewhomaybesufferingfromthevirus.(B)takeprecautionstopreventothersfrombecomingill.(C)
37. DrHoughtonsaysthatpatientsintheEDaremorelikelytobeagitatedastheyarelikelyto
sufferfromuntreatedhealthproblems.(A)havebeengivenbadnewsrecently.(B)requiremedicalhelpfrequently.(C)
38. DrHoughtonexplainsthatcreatingspacebetweenthepatientandtheprovider
enablesbothpartiestoremaincalm.(A)encouragesthepatienttoexittheroom.(B)reducesthelikelihoodoftheproviderbeinginjured.(C)
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ENDOFLISTENING
39. WhydoesDrHoughtonencourageproviderstospeakslowly?
toensurethepatientunderstandswhatisbeingsaid(A)togiveothermembersofstafftimetoprepare(B)togivethepatientanopportunitytospeak(C)
40. WhatapproachdoesDrHoughtonsuggestforpatientssufferingfromdelusions?
agreewiththepatientcompletely(A)acknowledgethepatient’semotions(B)explainwhytheirdelusionsarefalse(C)
41. DrHoughtonsuggeststhatchoicesgiventothepatientshould
avoidupsettingthepatientbyremainingpositive.(A)maintainthepatient’strustbybeingrealisable.(B)belimitedinordertopreventconfusion.(C)
42. DrHoughtonrecommendsthatwhenthepatientiscalmtheyshould
beremovedfromtheEDward.(A)understandwhytheirbehaviourwasinappropriate.(B)beencouragedtoexplainwhatcausedtheirreaction.(C)
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THEPRACTICETEST
OET
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ReadingSection
PartA
TIME:15minutes
Asthma:Questions
Questions1–6
Foreachquestionbelow,1–6,decidewhichtext(A,B,CorD)theinformationcomesfrom.
Youmayuseanylettermorethanonce.
Inwhichtextcanyoufindinformationabout
Lookatthefourtexts,A–D,intheTextBooklet.Foreachquestion,1–20,lookthroughthetexts,A–D,tofindtherelevantinformation.WriteyouranswersinthespacesprovidedinthisQuestionPaper.Answerallthequestionswithinthe15-minutetimelimit.
1. relaxationtechniquesforthosesufferingfromanasthmaattack?
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Questions7–12
Completeeachofthesentences,7–12,withawordorshortphrasefromoneofthetexts.Eachanswermayincludewords,numbersorboth.Youranswersshouldbecorrectlyspelled.
2. measuringtherespirationabilitiesinpatientswithasthma?
3. identifyingtheintensityofasthmaattacksinpatients?
4. theproceduretofollowwhentreatinganasthmaattack?
5. symptomsofasthmainpatients?
6. howtodiagnoseasthmainpatients?
7. Tounderstandhowsevereanasthmaattackis,(7)mustbemeasured,inadditiontoPEF.
8. Forpatientswhodonotrespondtotherapy,anIVof(8)canbeusedtotreatsevereasthmaattacks.
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Questions13–20
Answereachofthequestions,13–20,withawordorshortphrasefromoneofthetexts.Eachanswermayincludewords,numbersorboth.Youranswersshouldbecorrectlyspelled.
9. Nitricoxidetestingcanbeusedtodetermine(9)inpatients.
10. Apatientsufferingfromarrhythmiaandapeakexpiratoryflowofgreaterthan33%wouldbediagnosedwith(10)asthmaattacks.
11. Spirometryteststhatcontain(11)typicallylastforhalfanhour.
12. (12)cancauseneutrophilicinflammationinpatientswithasthma.
13. Howoftenshouldpatientsbeadvisedtopracticebreathingexercises?
14. Howoftenshouldpatientswithapeakexpiratoryflowoflessthan75%begiven10mgofsalbutamol?
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15. Whenshouldpatientsbegiven2mgofmagnesiumsulfate?
16. Whichpatientswilltypicallyneedtorunwhencompletingspirometrytests?
17. Whatshouldstaffdowhenassessingapatientsufferingfromalife-threateningpanicattack?
18. Whichlungfunctiontestishelpfulforunderstandinghowthepatientrespondstotreatment?
19. Whatsortofnoisemightpatientswithasthmamakewhenbreathing?
20. Whatisusedtomeasurepeakexpiratoryflowrate?
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ASTHMA:TEXTS
TextA
Establishingtheseverityofanacuteasthmaattack
Moderateasthma Severeasthma Life-threatening
asthma
Adults MeasurePEFandarterialsaturation
PEF>50-75%predicted PEF33-50%predicted PEF<33%predicted
Asthmasufferersofanyseveritymayalsoexperiencethefollowing:
SpO2≥92%
PEF>50-75%predicted
Nofeaturesofacutesevere
asthma
SpO2≥92%
PEF<50%
predicted
RR≥25/min
HR≥110/min
difficultytalking
SpO2≥92%
silentchest
cyanosis
poorrespiratoryeffort
arrhythmia
hypotension
exhaustion
alteredconsciousness
shortnessofbreathcoughingtightnessorpaininthechestawhistlingsoundwhenexhaling
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TEXTB
LungFunctionTestsinAsthma
Asthmatestsshouldbeundertakentodiagnoseandaidmanagementofthecondition.Thisisparticularlyimportantinasthma,becauseitpresentsslightlydifferentlywitheachpatient.Spirometryisthemostimportanttest,howeverseveraldifferenttypesoftestareavailable:
Peakexpiratoryflowrate(PEFR):thisisthemaximumflowrateduringexhalation,afterfulllunginflation.DiurnalvariationinPEFRisagoodmeasureofasthmaandusefultothelong-termmanagementofpatientsandtheresponsetotreatment.MonitorPEFRover2-4weeksinadultsifthereisuncertaintyaboutdiagnosis.Itismeasuredwithapeakflowmeter-asmall,handhelddevice-intowhichthepatientblows,givingareadinginl/min.Spirometry:measuresvolumeandflowofairthatcanbeexhaledorinhaledduringnormalbreathing.Asthmacanbediagnosedwitha>15%improvementinFEV1orPEFTfollowingbronchodilatorinhalation.Alternatively,considerFEV1/FVC<70%asapositiveresultforobstructiveairwaydisease.Aspirometrytestusuallytakeslessthan10minutes,butwilllastabout30minutesifitincludesreversibilitytesting.
Directbronchialchallengetestwithhistamineormethacholine:inthistest,patientsbreatheinabronchoconstrictor.Thedegreeofnarrowingcanbequantifiedbyspirometry.Asthmaticswillreacttolowerdoses,duetoexistingairwayhyperactivity.Exercisetests:theseareoftenusedforthediagnosisofasthmain
children.Thechildshouldrun6minutes(onatreadmillorother)ata
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workloadsufficienttoincreasetheirheartrate>160/min.Spirometryisusedbeforeandaftertheexercise-anFEV1decrease>10%indicatesexercise-inducedasthma.
Allergytesting:canbeusefulifyear-roundallergiestriggerapatient’sasthma.Thiswillberecommendedifinhaledcorticosteroidsarenotcontrollingsymptoms.Threedifferenttestsareusedtomeasurethepatient’sreactiontoallergens:nitricoxidetesting,sputumeosinophilsandbloodeosinophils.
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TEXTC
Patientswithasthmaofanyseveritymayfindtheirattackspanic-inducing.Rememberthatthepatient’sstruggletobreathecancausestress,panicandafeelingofhelplessness.Thereisastronglinkbetweenpeoplewhosufferfromasthmaandthosewhoexperiencepanicattacks.Staffmustkeepthisinmindwhentreatingpatientswithasthma,assomesuffererswillrequireadditionalemotionalsupport.
Patientsmayfindbreathingexercisesbeneficial.Advisepatientstopracticedaily,toallowtheseexercisestobecomehabitual.Whenexperiencinganattack,patientsshouldmakeaconsciousefforttorelaxtheirmusclesandmaintainsteadybreathing.Advisepatientstobreathedeeplyinthroughthenoseandoutthroughthemouth.
Smokersareatahigherriskofdevelopingbothpanicattacksandasthma.Inaddition,smokingcanirritatetheairwaysinpatientswithasthma,causingneutrophilicinflammation,andexacerbatingbreathingproblemsinthosewithasthma.Ensurethatpatientswhosmokearefullyawareoftherisksofsmokingwithasthma.
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TEXTD
ManagementofAcuteAsthma
Rapidtreatmentandreassessmentisofparamountimportance.Itissometimesdifficulttoassessseverity.Maintainingacalmatmosphereishelpfultoresolvinganacuteasthmaticattack.
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PARTB
Inthispartofthetest,therearesixshortextractsrelatingtotheworkofhealthprofessionals.Forquestions1to6,choosetheanswer(A,BorC)whichyouthinkfitsbestaccordingtothetext.
1. Thenoticeremindsstaffthatpatientswhoaredying
willneedtobeprescribedanti-emetics.(A)mightnotneedtocontinuewithcertainmedication.(B)shouldbeencouragedtodiscusstheirconditionwithloved
ones.(C)
End-of-LifeDecisionMaking
Rememberthefiveprioritieswhencaringforadyingpatient:
Recognisethattheendoflifemaybeapproaching.1.Communicatewithpatients,families,carersandstaff.2.Involvepatientsandthoseclosetothemindecision-
making.3.
Supporttheneedsoffamiliesandcarers.4.Developanindividualisedplanofcareforthepatient.5.
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Anend-of-lifecareplanmustensurethephysical,psychological,socialandspiritualcomfortofthepatient,andshouldstriveforthebestpossiblequalityoflifeforthepatient’sremainingtime.Thisincludesprescribinganticipatorymedicationswhichcanbegivenasrequired,fallingunderthefollowingcategorieswhichstaffareencouragedtorememberasthe‘FourAs’:Analgesia(painrelief),Anxiolytics(anti-anxiety),Anti-emetics(fornauseaandvomiting),andAnti-secretory(forrespiratoryandairwaysecretions).Anyunnecessarymedications,suchaslong-termdiabetescontrolandbloodpressuremedicationscanbestopped.ADo-Not-Resuscitate(DNACPR)decisionalsoneedstobemade.
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2. Theguidelinesinformusthatmultipleanaestheticscanbeused
toincreasethenumbingeffects.(A)topreventbleedingthroughouttheprocedure.(B)tomoreaccuratelycontrolhowlongitwilllast.(C)
AnaesthesiauseatHarlowDentalCentre
Atthispractice,preferenceisgiventotheuseoflocalanaestheticsincombinationwithconscioussedation.
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Manylocalanaestheticsmaybeusedinordertoreversiblyblockspecificpainpathwaysand/orcauseparalysisofmuscles.Themostcommonlyusedlocalanaestheticatthecentreislidocaine-rememberthatthehalf-lifeoflidocaineinthebodyisabout1.5to2hours.Otherlocalanaestheticagentsincludearticaine,bupivacaine,prilocaineandmepivacaine.Often,acombinationoflocalanaestheticsmaybeused,sometimeswithadrenalineoranothervasoconstrictortomodulatethemetabolismofthelocalanaestheticandcontrollocalbleeding.
Sedationduringproceduresshouldmostlybelimitedtoconscioussedation.Benzodiazepinesenhancetheeffectofneurotransmittergamma-aminobutyricacid(GABA)attheGABAAreceptor.Thisresultsinasedative,hypnotic,anxiolytic,anticonvulsantandmusclerelaxantproperties.
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3. Thepurposeofthismemoistoexplain
howtotreatmulti-resistantpathogens.(A)thecausesofbacterialinfections.(B)whentoprescribeantibiotics.(C)
Fortheattentionofallmedicalstaff:
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Microbialresistancetoantibioticsisontheriseandinfectionwithmulti-resistantpathogens,suchasClostridiumdifficileandMRSAamongstothers,isbecomingmorecommon.
Patientsreceivingantibioticsareatincreasedriskofsuchinfections.Assuch,pleasebeawareofourantimicrobialprescribingguidelines,whichensurethatantibioticsareonlyprescribedwithclear,clinicaljustification;evidenceofinfection;and/orguaranteedmedicalbenefit.
Itisrecommendedthatspecimensshouldbeculturedandresultsobtainedbeforecommencingtreatmentwithantibiotics,thusonlyprescribingthetherapytowhichthemicrobeissensitive.Prescriptionofbroad-spectrumantibioticsshouldbeavoidedwherepossible,asthesenotonlydamagethenormalbacteriaofthehumanbody,butalsoincreasemicrobialexposuretoanti-microbialmedications,increasingtheirpotentialfordevelopingresistance.Reviewnarrow-spectrumantibioticprescriptionswithin5days,andbroad-spectrumprescriptionswithin48hours.
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4. Thisguidelinesonautisminyoungpeopleinformusthat
thedisorderismoredifficulttoidentifyinpatientswithADHD.
(A)
mostchildrenwithautismarediagnosedbeforetheageof(B)
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three.youngpeoplewithautismaremorelikelytosufferfromother
conditions.(C)
AutisminYoungPeople
Morethan1%oftheUKpopulationhasanautismspectrumdisorder.Signscanvarywidelybetweenindividualsandatdifferentstagesofanindividual’sdevelopment.WhenchildrenpresentwithotherconditionssuchasADHD(attentiondeficithyperactivitydisorder)orotherlearningdifficulties,autismspectrumdisordersoftengoundiagnosed.
Inchildrenwithautismspectrumdisorders,symptomsarepresentbeforethreeyearsofagebutdiagnosiscanbemadeafterthisagetoo.Individualswithautismspectrumdisordertendtohaveissueswithsocialinteractionandcommunication,includingdifficultywitheyecontact,facialexpressions,bodylanguageandgestures.Often,childrenwithautismspectrumdisordersmaylackawarenessorinterestinotherchildrenandtendtoplayalone.
Thecausesofautismspectrumdisorderareunknownbutarelinkedtoseveralcomplexgeneticandenvironmentalinteractions.
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5. Thememoremindsallstafftoavoid
challengingapatient’scriticisms.(A)handlinggrievancesofasensitivenature.(B)recordingcomplaintsthatarenotlegitimate.(C)
Subject:FieldingPatientComplaints
Fortheattentionofallhospitalstaff:
AtCountyGreenHospital,weendeavourtoprovideourpatientsandfamilieswiththehighestqualityofservices.Unfortunately,theremaybetimeswhereperformancedoesnotmeetexpectation.Weroutinelysurveyourpatientsonhowwecandobetter,butmembersofthetreatmentteammayalsobeapproachedwithpatientfeedback,soallemployeesmustbeawareofthecorrectprocedureforhandlingpatientcomplaints.Thefirststepistolistentowhatpatientshavetosayanddocumentdetailsappropriately.Whetherornotyoufeelthereisalegitimategrievance,itisimportanttokeeparecordforlaterexamination.Whilelisteningtothecomplaint,theemployeeshouldvalidatethepatientorfamilymember’sexperience.Thisdoesnotmeanthereneedsbeagreementaboutthenatureofthecomplaint,butthattheemployeedemonstratesaclearunderstandingofwhythepatientorfamilymembermightbefeelingthisway.
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6. Patientswithdeliriumaremorelikelytorecoverquicklyif
keptinadarkenedenvironment.(A)staffchangesarekepttoaminimum.(B)treatmentensurestheyreceiveadequaterest.(C)
DiagnosticCriteriaforDelirium
Deliriumaffectsupto87%ofpatientsinintensivecareandisparticularlycommonamongtheelderly.Deliriumcanhaveseriousadverseeffectsandevenleadtomortalityandmustthereforebetreatedasamedicalemergency.
Allhospitalstaffmustknowhowtoprevent,detect,andrapidlyassessandtreatdeliriumonthehospitalwards.Riskfactorsfordevelopingdeliriuminclude:changeofenvironment,lossofvision/hearingaids,inappropriatenoiseorlighting,sleepdeprivation,severepain,dehydration,drugwithdrawal,infectionsofanykind,recentsurgery,andoldage.Forpatientsatriskofdelirium,thinkofthemnemonicDELIRIUMwhichindicatesthecommoncauses:DrugsorDehydration,ElectrolyteImbalance,Levelofpain,InfectionorInflammation(suchaspost-surgery),Respiratoryfailure,Impactionoffaeces(severeconstipation),Urinaryretention,Metabolicdisorder(suchasliverorrenalfailure).
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Managementrequiresre-orientationofthepatienttowheretheyareandwhoeverybodyaroundthemis,aswellasre-assuranceandanon-confrontational,empatheticapproachtowardsagitatedanddistressedpatients.Pleaserefrainfromchangingthestaffofthemedicalteamresponsibleforadeliriouspatient’scare,inordertoensureconsistencyforthepatient.Avoidunfamiliarnoises,equipmentandstaffintheimmediatevicinityofthepatient,andfacilitatevisitsfromfamilyandfriendsasmuchaspossible.
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PARTC
Inthispartofthetest,therearetwotextsaboutdifferentaspectsofhealthcare.Forquestions7to22,choosetheanswer(A,B,CorD)whichyouthinkfitsbestaccordingtothetext.
Text1:Work-RelatedStress&MedicalErrors
Stressisatermthatcropsupalltooofteninmodernconversation,usedtodescribeeveryunfortunatecircumstance,everyout-of-sequenceevent,andeveryfootoutofline.Whatisstress?Mostdefinitionsofstresscoveranyinternalorexternalstimuluswhichresultsinanegativeresponseordisturbanceinone’sphysical,socialormentalwellbeing.Unfortunately,stressiscommon,anditcanbedevastatingtopeople’slivesandhealthwhenitismaintainedoverlongperiodsoftime,andwhenitgainsthecapacitytooverwhelmone’scopingabilitiesandmechanisms.
Inthemedicalprofession,dailystressisalmostguaranteed.Recently,changestomanyhealthcareworkers’contractsintheUKhaveresultedinlongerandmoreantisocialworkinghours,aswellasanincreasedworkload,greaterbedcrisesinhospitalsandlargerbudgetcuts,sostresslevelsamongstUKhealthcareprofessionalsareontherise.A1996questionnairestudyintheLancetreportedthat27%ofdoctorsintheUKbelievedthatthestresstheyexperiencedwastriggeredbypoormanagement,lowjobsatisfaction,financialconcerns,andpatients’suffering,amongstotherfactors.
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Overtwodecadeslater,theseproblemsstillexist;somehealthcareworker’sarguethatconditionshaveactuallydeteriorated.A2013reportbytheBritishMedicalAssociationstatedthatover50%ofUKdoctorshadexperiencedanincreaseinwork-relatedstressovertheprecedingyear,inadditiontoanincreaseinthecomplexityoftheirwork.25%ofjuniordoctorsinhospitalsalsoreportedareducedqualityofcareforpatientsduetohighlevelsofstressandthepressuresputonindividualmembersofstaff,withlevelsofstressexacerbatedbylongerworkinghours.Inmanyhealthcarejobs,stressistheelephantintheroom,particularlywithjuniorstaff,whomayfeelunabletovoiceconcernsabouttheirworkload.Unfortunately,however,thesefactorshavethepotentialtoleadtomedicalmistakes,whichcouldbedetrimentaltopatientlives.Insuchacircumstance,whoisreallytoblame?Theoverworkedmedicalstaff,orthepoormanagementofmodernhospitals?
Wedonotneedtolookfartoexaminetheeffectthatstresscanhaveondoctorstoday.In2015,DrHadizaBawa-Garbawasfoundguiltyofmanslaughterafterfailingtoprovidelife-savingtreatmenttoapatientwhenneeded,resultingintheunfortunatedeathofasix-year-oldchild,JackAdcock.In2018,thisexperiencedseniorpaediatricianwithapreviouslyunblemishedrecordwasstruckoffthemedicalregister,unabletoeverpracticeagainasadoctor.ThecaseofDrBawa-Garbainfuriatedmanyinthemedicalprofession,asfingerswerepointedatanoverworkeddoctorworkingunderimmensepressurewhowasblamedforgrossnegligence.Butwhoisthetrulynegligentoneinourcurrenthealthcaresystem?WhilethedeathofyoungJackisextremelysaddening,itisimportanttoexplorethecircumstancesaroundhisdeathinordertopreventsuchtragediesfromreoccurring.Onthedayoftheincident,DrBawa-Garbawascoveringherownworkloadaswellasthatoftwoseniorcolleagueswhowereaway,acrosssixwards,spanningfourfloors,withmalfunctioningITsoftwareandout-of-orderresultssystems.DidDrBawa-Garbamakedetrimentalmistakes?Yes.Butonemustask,arewecreatingarecipefordisasterwhenwerequireourmedicalstaff
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toworkundersuchimmensepressures?Couldthisbeonetragiceventofmanywaitingtohappen?Suchmistakesruinlives.
Studieshaveshownthatthemostcommoncauseofmedicalerrorsistheuseofheuristicsinmedicaldecision-making,leadingtobias.Heuristicsareshortcutstakentoreachdecisionsquickly,basedonpreviouspatternsofdiseaseandsimilarcasesseenbythedoctor.Mistakesaremorelikelywhensuchshortcutsareusedbyjuniordoctorswholacktheexperiencenecessarytomakesuchfastdecisionsaccurately.TverskyandKahnemanoutlinedseventypesofheuristicsintheir1974article:Availabilityheuristicsarebasedonhoweasyspecificdiagnosesaretorecall,resultinginover-diagnosisofrarebutmemorableconditions;Representativenessheuristicsarebasedonsimilarityofpatientpresentationstoprevioustypicalcases,leadingtodelayedormisseddiagnosesinatypicalornon-characteristicpatients;Anchoringheuristicsoccurwhenadiagnosisisbasedononepieceofinformationonly,leadingtorapidconclusionswhichlackevidenceandearlydiagnosiswithoutconsiderationofallavailableinformation;Confirmationbiasoccurswhenadiagnosisisbasedonapre-conceivedidea,wherethedoctorpaysattentiontotheinformationthatsupportstheirtheory,andevidencewhichchallengesthediagnosisisconsciouslyorsubconsciouslyignored;Commissioningbiaswhereadoctoractstoosoonratherthanwaitingtogatherandreviewalltheinformationfirst;Gambler’sFallacywhichiswhereconsecutivepatientshavethesamediagnosisandsothedoctorassumesasimilarpatientwhofollowsmustalsohavethesamediagnosis;FundamentalAttributionErrorwhichisthetendencytoblamepatientsratherthantheircircumstancesfortheirpoorhealth.
Researchshowsthatthebestwaytoavoidmedicalerrorsindiagnosisistoconsiderseveralhypotheses,knownas“differentialdiagnoses”,andinvestigatethemallequallyuntiltheonewiththemostsupportingevidenceisfoundandagreedupon.Useofheuristicsandtheresultantflaweddecision-makingcould
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bepreventedbyreducingworkstressesandpressuresonmedicalprofessionals.Onewaytoachievethiswouldbetoreduceworkinghoursandshiftdurationsinordertopreventsleepdeprivationinmedicalstaff,whichisknowntohinderfocus,thuscreatingasafermedicalenvironmentforbothstaffandpatients.
Text1:Questions7to14
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7. Thefirstparagraphexplainsthatstress
isusuallycausedbyafactorthancannotbecontrolled.(A)isinterpretedinvariouswaysbydifferentpeople.(B)isunusualwhenitlastsforanextendedtime.(C)generallyimpactspeople’sbehaviour.(D)
8. Inthesecondparagraph,doctorsaresaidtoclaimthatstress
isoftenimproperlymanagedbychronicsufferers.(A)couldbeimprovedbyincreasingthewelfarebudget.(B)generallyresultedintheirhavingtoworklongerhours.(C)wascausedbyanumberofissuesincludingmoneyworries.(D)
9. Thewriterusesthephrase‘theelephantintheroom’toemphasisethefactthat
levelsofstressexperiencedbystaffhasdeclined.(A)seniorstaffgenerallyexperiencelessstressthantheirjuniors.(B)manyhealthcareprofessionalsdonotdiscussthestressthey(C)
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experience.juniordoctorshavereportedalowerqualitypersonallifeasa
resultofstress.(D)
10. WhydoesthewritercommentonDrHadizaBawa-GarbaandherpatientJack?
tosuggestthatdoctorsaremorelikelytomakesignificanterrorswhenstressed
(A)
tooutlineascenariowhereadoctor’sconcernsaboutstresswereignored
(B)
todemonstratethatstressinhealthcareprofessionalsisunacceptable
(C)
toemphasisetheimpactthedeathofapatientcanhaveonstress
(D)
11. ThewritersuggeststhatJackAdcock’sdeathwaspartlycausedby
technologythatwasoutofdateandfaulty.(A)ahospitalwardovercrowdedwithpatients.(B)aninsufficientnumberofnursingteamstaff.(C)alackofexperienceamongtheclinicalteam.(D)
12. Whymightdoctorswhouseheuristicsbeatagreaterriskofmakingclinicalerrors?
heuristicsaremorelikelytobeusedbyjuniordoctors(A)
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doctorsmighttaketoolongtocompletetheirtasks(B)doctorsmightskipovertherelevantinformation(C)thedifferenttypesofheuristicsareconfused(D)
13. Thewriterclaimsthatconfirmationbiasmightcausedoctorstoignorerelevantinformationif
theyhaverecentlytreatedapatientwiththesamecondition.(A)theyareveryfamiliarwiththeevidencebeingpresented.(B)thepatientdisplaysextremesymptoms.(C)itdoesnotsupporttheirexistingtheory.(D)
14. Whatdoestheword‘them’refertointhefinalparagraph?
theteamofhealthcarestaff(A)avarietyofpossiblecauses(B)themistakesinpatientcare(C)anumberofdifferenttexts(D)
Text2:Electroconvulsivetherapy(ECT)
Electrodes.Wires.BiteBlocks.Formanythesetermsbringtomindasinistermentalasylumandtheforebodingimageofapatientabouttosufferatortuouselectricshock.Literaturewritteninthe20thcenturydidmuchtocriticisethispractice,withwritersfrequentlydescribingelectroconvulsivetherapy(ECT)asaformoftorture,reservedforthemostvulnerablemembersofsociety.Interestinglyenough,ECThasactuallybeenusedinthehealthcarefieldfor
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hundredsofyears.Beforetheadventofeffectiveantipsychoticmedications,awidevarietyoftherapiesweretrialledforseriousmentalillnesses.Oneoftheseinvolvedthetherapeuticuseofinducingseizuresinpatients.AsearlyasBenjaminFranklin’s(1705–1790)time,anelectrostaticmachinecouldbeusedtocuresomeoneof‘hystericalfits’.
Throughthe19thcentury,Britishasylumsbegantoemployelectroconvulsivetherapyinawidespreadefforttocurediseasesofthemind.Intheearly20thcentury,aneuropsychiatristbythenameofLadislasJ.Medunapromotedtheideathatschizophreniaandepilepsywereantagonisticdisorders,andthatprecipitatingseizurescouldserveasapotentialtreatmentofschizophrenia.Therewereseveralmethodsusedtoinduceseizures,includinginsulincoma,seizure-inducingmedications(metrazol),andmostfamously,ECT.
Whilemanyofthesepracticesarenowseenasbarbaric,therewereveryfewoptionsforpsychiatrictreatmentbeforethedevelopmentofantipsychotics,moodstabilisers,andanti-depressants.Withtheriseofthesenewtreatmentoptionscameanincreaseinthepublicawarenessoftheofteninhumanconditionsofelectroshock.Therevelationsresultedinwidespreadbacklash,andtheuseofECTtherapybegantoswiftlydecline.However,inthelaterpartofthe20thcentury,aftermuchdebateandresearch,theNationalInstituteofMentalHealthintheUScametoaconsensusthatECTwasbothsafeandeffectivewhenproperguidelineswereimplemented.IntheUStoday,ECTtreatmentisroutinelycoveredbyinsuranceforsevereandtreatment-resistantformsofmentalillness.
TheexactmechanismofactionforECTisunknown,butthereareseveralhypotheses:Firstly,increasedreleaseofmonoamineneurotransmitterssuchasdopamine,serotonin,andnorepinephrine;secondly,enhancedtransmissionofmonoamineneurotransmittersbetweensynapses;thirdly,releaseof
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hypothalamusorpituitaryglandhormonesandfourthly,anticonvulsanteffect.ECThasseveralindications,themostnotablebeingrefractorymajordepression,catatonia,persistentsuicidality,andbipolardisorder.Itisalsousedinpregnancyasitiseffectiveanddoesnothavetheteratogeniceffectsofsomeotherpsychiatricmedications.Whiletherearenoabsolutecontraindications,itgoeswithoutsayingthatwhenusingECT,therisksinvolvedwillcarrymoreweightwithcertainpatients.Thosewithunstablecardiovascularconditions,thosewhohaverecentlysufferedastroke,andthosewithincreasedintracranialpressure,severepulmonaryconditions,orahighriskinanaesthesiamaynotbesuitablecandidatesforECT.TofurtherexploretheappropriatenessofusingofECTonspecificpatients,considerthefollowingcasestudy.
Thepatient,let’scallherDana,isa35yearoldfemalewhohasahistoryofschizophrenia.Shewastakentothehospitalbyambulancebecauseherparentsfoundhermotionlessinherbed,staringblankly,notrespondingtoexternalstimuli,andnoteatingordrinkingfortwodays.Thepsychiatristcaringforherisunderstandablyconcerned,becausethisrepresentssymptomsofcatatonia.IfDanadoesnoteatordrink,shemaydeveloplife-threateningnutritionaldeficienciesandelectrolyteimbalances.Ifshedoesnotmove,Danamayendupdevelopingabloodclotthatcouldresultinafatalpulmonaryembolism.Thefirst-linetreatmentisbenzodiazepines,butinthisparticularcase,thereisnoimprovementinhercondition.ThepsychiatristdecidesthatthatECTisthenextbestoption.Thereistheissueofinformedconsent.Legaljurisdictionhandlesthisdifferentlythroughouttheworld,butifapatientlackscapacityoristooilltoprovideconsent,acourtmustprovidesubstituteconsenttoensureadequatelegaloversight.Oncethishappens,Danaismedicallyscreenedandpreppedfortreatment.
AcourseofECTtreatmentsdoesnothaveastandardregimen.Generally,mostpatientsrequirebetweensixtotwelvetreatments,buttheactualendpointis
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determinedbythelevelofimprovement.ECTisoftengiventwotothreetimesaweek,usuallyonaMonday/Wednesday/Fridayschedulewithpsychiatricsymptomsandtestingcarriedoutonaregularbasistomonitorprogress.DanastartsMondaybybeingNPO(nothingbymouth)exceptforanynecessarymedications.Thisreducesthechanceforaspirationunderanaesthesiaduringtheseizure.ShewillbetakendowntotheECTsuitewhereananaesthesiologist,psychiatrist,andnursewillgreether.ShewillbeplacedinasupinepositionwithEEGmonitoringtodeterminethequalityoftheseizuregiven.Shewillhaveelectrodesplacedonherheadbitemporally,bifrontally,orunilaterallyontheright.Inthiscase,givenherlife-threateningcatatonia,wewillusethebitemporalposition.Theanesthesiologistwilltheninduceanaesthesia,firstpreoxygenatingthepatient,thenadministeringanticholinergicagenttoreduceoralsecretions,anaesthesicmedication,musclerelaxationmedication,andanycardiovascularprophylaxisasneeded.
Oncethepatientissufficientlysedated,abrief(0.5to2.0milliseconds)electricalpulsewillbeintroducedataleveldeterminedtoreliablycauseaseizure.AtherapeuticECTseizureshouldlastatleast15secondsbutnomorethan180seconds.Danawillbemonitoredforthirtytosixtyminutesoncethishasfinished,toensureherrecovery.Thegoalisforfurthertreatmentstoreducehersymptomsandenablehertoeat,drink,communicate,andmoveagain.Ofcourse,thereareadverseeffectsthatmustbeconsidered.Anaesthesiacancausenausea,aspirationpneumonia,dentalandtongueinjuries.Theseizureitselfcancausecardiovascularissues,andfracturesinpatientswithosteoporosis,andcantemporarilyimpaircognitionandmemory.ItisadvisedthatpatientsdonotmakeanymajororfinancialdecisionsduringorafterECTtreatment,andpatientsmustrefrainfromdrivinguntilafewweeksafterthelastsession.
Formostpatients,onetreatmentmaybeallthatisneeded.Forsome,continuationofECTasasinglesessioneverycoupleofweeksmayhelpto
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preventrelapse.Maintenancetreatmentforpatientswithchronicallyrecurringpsychiatricillnessmayalsobeappropriate.Theschedulingofthesesessionsgenerallydependsonthepatient’sneedsandepisodes,sometimesevengoingonindefinitely.InDana’scase,afewtreatmentsareallthatisneededtoresolvehercatatoniaandsoonshewillbehealthyenoughtobedischargedhomewithoutpatientfollow-upforhermentalhealthmanagement.
Text1:Questions15to22
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15. Inthefirstparagraph,thewritermentionstheroleof20thcenturyliteraturein
informingpatientsofthesideeffectsofantipsychoticmedication.
(A)
preventingthemistreatmentofdefencelesspeople.(B)increasingthenumberofpatientsreceivingECT.(C)promotinganegativeimageofECT.(D)
16. Whatdowelearnaboutschizophreniainthesecondparagraph?
Itwaslessprevalentinpatientswhoexperiencedseizures.(A)Ithadasignificantimpactonthetreatmentofepilepsy.(B)ManyasylumsintheUKwerenotpreparedtotreatit.(C)Themedicationmetrazolcouldbeusedtoinduceit.(D)
17. WhatdidtheUSNationalInstituteofMentalHealthdecideinthe20thcentury?
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PractitionersmustfollowidenticaltreatmentplanswhenusingECT.
(A)
PatientsshouldbegiventherighttorefuseECTtreatment.(B)ECTshouldonlybeusedasatreatmentinseverecases.(C)ECTwasacceptedasasafetreatmentforpatients.(D)
18. Inthefourthparagraph,whatideadoesthewriteremphasisewiththephrase‘itgoeswithoutsaying’?
SomewomenfindECTtreatmentssuccessfulwhilecarryingachild.
(A)
ItiswellknownthatsomepatientswillnotrespondwelltoECT.
(B)
FewpatientsrealisethattheycouldbenefitfromECTtherapy.(C)TherisksassociatedwithECTarerarelydiscussed.(D)
19. Inthecasestudy,thepsychiatristdecidestouseECTonDana
despiteDana’sparents’concernsaboutthistypeofprocedure.(A)becausethepatientexpressesapreferenceforthistreatment.(B)aftertreatmentwithbenzodiazepinesprovesineffective.(C)asshehasdevelopedanelectrolyteimbalance.(D)
20. Inthesixthparagraph,whyisn’tDanagivenfoodbeforeherECTtreatment?
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ENDOFREADINGTEST
tolowerthelikelihoodofanaesthesia-relatedaspiration(A)toreducethelikelihoodofvomitingduringtreatment(B)asmedicationcaninterferewiththetreatment(C)asthecatatonicstatemakeseatingdifficult(D)
21. Intheseventhparagraph,whatdoestheword‘this’referto?
atreatmentplan(A)aseizurecausedbyECT(B)anabnormalreactiontomedication(C)animprovementtothepatient’scondition(D)
22. Inthefinalparagraph,thewritersuggeststhatDana’streatment
wascompleteafteronlyoneECTsession.(A)willultimatelycurehercatatoniausingonlyECTsessions.(B)willcontinueforanumberofweeksbeforeimprovementcan
beseen.(C)
willconsistoftwoECTsessionseachweekfortheforeseeablefuture.
(D)
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THEPRACTICETEST
OET
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WritingSection
Readthecasenotesbelowandcompletethewritingtaskwhichfollows.
Notes
Mr.JacobMcCarthy,an82-year-old,isapatientinthemedical-surgicalunitofwhichyouareaphysician.
Hospital: JeffersonCountyHospital,35FranklinStreet,Knox
PatientDetails
Name: MrJacobMcCarthy
Nextofkin: BarbaraMcCarthy(76,spouse)
Admissiondate: 06April2018
Dischargedate: 26April2018
Diagnosis: Rightbelowkneeamputation(BKA)statuspostrightfoot
diabeticulcer
Pastmedicalhistory: Benignprostatichyperplasia,diabetesmellitusType2(non--
compliantwithmedication),age-relateddementia,essential-
hypertension,peripheralvasculardisease,osteoarthritis
Socialbackground: Retiredconstructionworker
Wifeprimarycarer
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Moderatecognitiveimpairment
Needsassistancewithmedicationandactivitiesofdailyliving
(ADL’s)
Onadmission: Longhistoryofnoncompliancewithdiabeticmedication.
Admittedforinfectedrightdiabeticfootwoundofatleasttwo
weeks,didnotnoticeinjury→diabeticneuropathy.
Obvioussigns–gangrene,pus,abscess.
Fever,chills,Rfootnon-weightbearing.
Bloodculturespositiveforgram-positivecocci.
Medicalprogress: GivenIVantibiotics,vascularsurgeonconsultedtoassess
wound.
RecommendedBKA.
Surgeryperformedwithoutcomplication.
Transitionedtooralantibioticsandopiates.
Currentlyafebrile–woundisclean,dry,intact.
RequiresassistanceforADLs+wheelchairformobility.
Nursingmanagement: Monitorsurgicalsiteforinfection/drainage.
Checkforfever/chills+othersignsofinfection.
Encourageoralfluids,nutrition.
AssistwithADLsandmobility.
Changedressingsdaily.
Ensuregoodurinationandbowelmovements.
Frequentturning–avoiddecubitusulcers.
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Assessment: Goodprogressmade,painundercontrol,nofurtherinfection
noted.
Bloodculturesnownegative.
Mobilityseverelyreducedafteramputation–requiresassistance
forADLsandroutinecare.
Dischargeplan: DischargetoSkilledNursingFacilityforacutecareand-
physiotherapy.
Canreassesslaterforstabilitywithhomenursingvs.long-term
carefacility.
Continueantibioticsandpainmedication.
Willneedtofollow-upwithvascularsurgeonin2weeks.
Ofnote,wifewanteddischargetohomeinhercare–
physiotherapyandoccupationaltherapyassessmentindicatethis
wouldnotbeasafedischarge.
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MedicalWritingTask
Usingtheinformationgiveninthecasenotes,writeadischargelettertoDr.ShannonMeccam,MedicalDirectorofKnoxSkilledNursingFacility,25HarrowfieldAvenue,Knox.
Inyouranswer:
ExpandtherelevantnotesintocompletesentencesDonotusenoteformUseletterformat
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Thebodyofthelettershouldbeapproximately180–200words.
NursingWritingTask
Usingtheinformationgiveninthecasenotes,writeatransferlettertothereceivingnurseattheskilledcarefacility,ShannonMeccam,KnoxSkilledNursingFacility,25HarrowfieldAvenue,Knox.
Inyouranswer:
Thebodyofthelettershouldbeapproximately180–200words.
ExpandtherelevantnotesintocompletesentencesDonotusenoteformUseletterformat
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THEPRACTICETEST
OET
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SpeakingPracticeSet
Youhave5minutestocompletethetasksinthecandidatecard,whiletalkingwithapatient.
Readthecandidatecardnow,andtake2-3minutestoprepareforyourconversation.
MedicalTaskCardSet1
CANDIDATECARDNO.1 MEDICINE
SETTING SuburbanClinic
DOCTOR Youarespeakingtoa50-year-oldpatientwhohascometo
findouttheresultsofacoreneedlebiopsy(removalof
cellsandtissue)fromthelymphnodeofaswellingintheir
rightarmpit.He/shehasahistoryofcancer(previous
thyroid),buthasbeeninremissionfortwoyears.Thetest
resultsindicateHodgkinlymphomaandfurthertestsare
neededtodeterminethestaging(thespreadofthecancer).
TASK Findoutwhatresultthepatientisexpectingfromthe
test.
Findouthowmuchinformationthepatientwantstoday.
Sensitivelyexplainthetestresults(e.g.thebiopsy
indicatesHodgkinlymphoma(cancerofthelymph
nodes)andfurthertestingisneeded,likeCTscans,to
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Youhave5minutestocompletethetasksinthecandidatecard,whiletalkingwithapatient.
ROLEPLAYERCARDNO.1 MEDICINE
SETTING SuburbanClinic
PATIENT Youarea50-year-oldwhohasrecentlyfoundalumpin
yourrightarmpit.Asamplewastakenandyouhave
cometofindouttheresults.Youhavehadthyroidcancer
beforeandhavebeeninremissionfortwoyears.Youare
worriedthatitiscanceragain.
TASK
assessstaging–thespreadofthecancer,etc.).Checkfor
understandingandreassureifneeded.
Explainthatthestageisunclear,sofurtheradvicewill
begivenlater.
Summarisetheinformationgivenandfindoutwhat
furtherinformationisneeded.
Explainthatyouarenotsurewhattheresultsare,but
youareworriedthatthelumpiscancer.
Explainthatyouhavehadcancerbefore,soifitis
cancer,youwantalltheinformationpossible.
Bealittleshockedandworried.Findoutwhatthe
prognosisisandifyouhavetostopworking.
Beunclearwhythishashappenedtoyou.Explainthat
youwouldliketoreadmoreinformationonthe
disease.
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Readthecandidatecardnow,andtake2-3minutestoprepareforyourconversation.
MedicalTaskCardSet2
CANDIDATECARDNO.2 MEDICINE
SETTING SuburbanGeneralSurgeryPractice
DOCTOR A42-year-oldpatienthascometoseeyouforapost-
operativeappointmentafterhavinganopen
cholecystectomy(removalofthegallbladderwithone
incision)performedfivedaysagoforacutecholecystitis
(inflammationofthegallbladder).Recoverywas
uncomplicated,However,he/sheisworriedabouttheir
futureandkeenonunderstandingwhythisoccurredand
whatchangesmustbemadetoavoidthishappeningagain.
TASK Findouthowthepatienthasbeenrecovering.Goovera
recoverytimelineandexplainthelevelofphysical
activityhe/sheshouldbeabletoperform(4-6weeksto
fullyrecover;lightexerciseonly).
Discussthepatient’scurrentdietandbestpracticesnow
thathehashadacholecystectomy(avoidhigh-fat/spicy
foods,eatsmallmealstostartwith,trackdiet,etc.).
Explainpossiblefuturecomplications(e.g.post-
cholecystectomysyndrome)andthesignsofsymptoms
tolookoutforandwhentogototheEmergency
Department(ED)(e.g.ifacutepaininthe
abdomen/diarrhoea).
Givethepatientanestimationofhowlongtheywill
needtohavefollowupappointmentsfor(onceevery
twoweeksforsixweeks).
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Youhave5minutestocompletethetasksinthecandidatecard,whiletalkingwithapatient.
ROLEPLAYERCARDNO.2 MEDICINE
SETTING SuburbanGeneralSurgeryPractice
PATIENT Youare42andrecoveringfromacutecholecystitis
(inflammationofthegallbladder,oftencausedby
gallstones)thatbeganoneweekago.Youwere
dischargedfromthehospitalafteranopen
cholecystectomy(removalofthegallbladderwithone
incision)fivedaysago.Youareunsurehowmuch
physicalactivityisappropriateanddonotwanttorisk
tearingoutanystitches.Youalsowanttoknowwhatthis
meansforyourdiet,andifthereisanythingyouneedto
watchoutfor.
TASK Explainyourconcernsaboutphysicalactivityandfind
outhowlongyouneedtowaitbeforeyoucanreturn
towork.
Explainthatyoulivealoneanddon’tliketocook,so
yourdietisprimarilypre-packedfrozenmealsorfast
food.Askthedoctorwhatcouldhappenifyoudonot
followtherecommendeddiet?
Askwhataresomefuturecomplicationstobeaware
of?
Askhowoftenshouldyouschedulefollow-up
appointmentswiththeclinic?
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Readthecandidatecardnow,andtake2-3minutestoprepareforyourconversation.
NursingTaskCardSet1
CANDIDATECARDNO.3 NURSING
SETTING SuburbanClinic
NURSE Youarespeakingtoaparentofa4-year-oldboy,Max,who
hasAutismSpectrumDisorder(ASD)andhascometosee
youfordietaryadvice.Heisgloballydelayed(mentally,
physicallyandemotionally)anddisplaysdifficult
behavioursatthechildcarecentreheattends(e.g.becomes
upsetifaskedtositwithotherchildrenatmealtimes,etc.).
TASK
ROLEPLAYERCARDNO.3 NURSING
SETTING SuburbanClinic
CARER Youaretheparentofa4-year-oldboy,Max,whohas
Exploretheparent’sperceptionoftheproblem.
Findouthowtheparentisstructuringmealtimesat
home.
Createsomerealisticgoalswiththeparent(e.g.provide
regularmealsandsnacks–every2-3hours,changethe
mealtimeenvironment–graduallymovefromtheTVto
thetable,etc.).
Findoutwhatotherservicestheparentneeds(e.g.
speechtherapy–oralmotordevelopment,integration
aideforthechildcarecentre,supportgroup,etc.).
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Youhave5minutestocompletethetasksinthecandidatecard,whiletalkingwithapatient.
Readthecandidatecardnow,andtake2-3minutestoprepareforyourconversation.
AutismSpectrumDisorder(ASD)andisaveryfussy
eaterandwillonlyeatbabyfood,smoothyoghurtand
mashedpotatowithyouatmealtimes.Youareworried
thatheisnotgettingenoughnutrients,andthatheisnot
progressingsociallywithhispeers.Hebecomesangryat
thechildcarecentrewhenaskedtoeatwiththeother
children.
TASK Explainthattheproblemstartedasaresponsetoa
viralinfectionat2yearsold,buthasnowbecomea
habit.Maxonlyeatsmushyfoodwithyouinfrontof
theTV.
AskthenurseifMaxwilldevelopavitamin
deficiency.
Describemealtimes:youhavetopromptMaxtoeat
whileyouholdthespoon,andMaxisangryifyou
changethebrandoffood.Heofteneatslateintheday,
andself-feedssweetbiscuits.
Beresistanttoanybigchangesinroutine.Youcould
probablyonlychangeonething.
Ifasked,youwouldliketoseeaspeechpathologist
andattendasupportgroup,butthechildcarecentre
doesn’thavefundingforintegrationaides.
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NursingTaskCardSet2
CANDIDATECARDNO.4 NURSING
SETTING Hospital
NURSE Youarespeakingtoa90-year-oldpatientwhowasrecently
admittedtohospitalduetovomiting,nauseaandabdominal
pain,whichwaslaterdiagnosedasacutepancreatitis.The
doctorhasorderednofoodbymouth(NPO),soa
nasogastric(NG)tubehasbeeninserted.Intravenous(IV)
fluidwithpotassiumchloride(KCI)andhis/herpain
medication,meperidine(Demerol),havebeenordered.
TASK
ROLEPLAYERCARDNO.4 NURSING
SETTING Hospital
PATIENT Youarea90-year-oldwhowasrecentlyadmittedto
hospitalduetovomiting,nauseaandabdominalpain,
ExplainthereasonsfortheNGtube(toalleviatepain
fromeating,andtoallowfeedinguntilnauseaand
vomitingsubside).Likelytostopaftertwodays.Check
thatthepatientunderstandsyourexplanation.
TactfullyexplainwhytheNGtubeisinsertedwithmore
detail(e.g.largemealsrequireadditionalworkbythe
pancreasfordigestion,theinflammationstopsthis,and
causespain,etc.).
Reassurethepatientaboutthefurthertesting(CTscans
–non-invasive,relativelysafe,involvesx-rays,ableto
detectcomplicationse.g.necrosis–tissuedeath).
Validatethepatient’sconcernsbutexplainthelowlevels
ofradiation(e.g.lessthanfromaflight).Reassurethe
patientthatthetestsareneeded.
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whichwaslaterdiagnosedasacutepancreatitis.You
haveatubeinyournoseandhaven’tbeengivenany
food.Youareanxiousanddon’tunderstandwhatis
happeningtoyouandwantanswersfromthenurse.
TASK Askthenursewhyyouhaveatubeinyournoseand
haven’tbeenallowedtoeatsolidfood.
Explainthatyoustilldon’tunderstandwhyyoucan’t
eat.Thetubeisuncomfortable,andyoumissyour
favouritefoods.
Whenasked,explainthatyouwanttoknowwhat
happensnext.Youdon’tknowwhattestsyouwill
havetodo,andyouareworried.
Continuetobeworriedaboutthetests;youdon’twant
radiationandyoujustwanttogohome.Eventuallybe
reassured.
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THEPRACTICETEST
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Answers
Listening
PartA:Questions1to12
1.upthestairs
2.barking
3.lyingdown
4.(dirty)green
5.feverish
6.COPD
7.smoker
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Questions13to24
8.allopurinol
9.knees
10.(blue)inhaler
11.cholesterol
12.penicillin
13.stuck(init)
14.watering
15.swollen
16.concentrate
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PartB:Questions25to30
17.fluoresceineyestain
18.infection
19.(numbing)eyedrops
20.cornealabrasion
21.antibioticeyedrops
22.healingointment
23.ibuprofen
24.brightlight
25. AbetransferredfromtheEmergencyDepartment
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PartC:Questions31to36
26. Bwhetherhiscommunicationissueswillimprove
27. Aexplaininghowtousethemcorrectly
28. Ctheavailabilityofamedicine.
29. Ctheimportanceofprovidingadequateemotionalsupporttopatients
30. Aidentifyingthepatientsatgreatestrisk
31. Bmistaketheillnessforsomethingelse.
32. Bproximitytonewpeople.
33. CHewastryingtofinishhisassignments.
34. Atheillnessprogressesrapidly.
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Questions37to42
35. Bpatientsdonotseektreatmentquickly.
36. Ctakeprecautionstopreventothersfrombecomingill.
37. Asufferfromuntreatedhealthproblems.
38. Creducesthelikelihoodoftheproviderbeinginjured.
39. Atoensurethepatientunderstandswhatisbeingsaid.
40. Backnowledgethepatient’semotions
41. Bmaintainthepatient’strustbybeingrealisable.
42. Cbeencouragedtoexplainwhatcausedtheirreaction.
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READINGSECTION
PartA:Questions1to20
1.C
2.B
3.A
4.D
5.A
6.B
7.arterialsaturation
8.magnesiumsulfate
9.allergies
10.life-threatening
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11.reversibilitytesting
12.smoking
13.daily
14.everyhour
15.inseverecases
16.children
17.warnICU
18.peakexpiratoryflowrateORPEFR
19.awhistlingsound
20.apeakflowmeter
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PartB:Questions1to6
PartC:Questions7to14
1. Bmightnotneedtocontinuewithcertainmedication.
2. Ctomoreaccuratelycontrolhowlongitwilllast.
3. Cwhentoprescribeantibiotics.
4. AthedisorderismoredifficulttoidentifyinpatientswithADHD.
5. Achallengingapatient’scriticisms.
6. Bstaffchangesarekepttoaminimum.
7. Bisinterpretedinvariouswaysbydifferentpeople.
8. Dwascausedbyanumberofissuesincludingmoneyworries.
9. C
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manyhealthcareprofessionalsdonotdiscussthestresstheyexperience.
10. Atosuggestthatdoctorsaremorelikelytomakesignificanterrorswhenstressed
11. Atechnologythatwasoutofdateandfaulty.
12. Cdoctorsmightskipovertherelevantinformation
13. Ditdoesnotsupporttheirexistingtheory.
14. Bavarietyofpossiblecauses
Questions15to22
15. DpromotinganegativeimageofECT.
16. AItwaslessprevalentinpatientswhoexperiencedseizures.
17. D
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ECTwasacceptedasasafetreatmentforpatients.
18. BItiswellknownthatsomepatientswillnotrespondwelltoECT.
19. Caftertreatmentwithbenzodiazepinesprovesineffective.
20. Atolowerthelikelihoodofanaesthesia-relatedaspiration
21. BaseizurecausedbyECT
22. Cwillcontinueforanumberofweeksbeforeimprovementcanbeseen.
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WRITINGSECTION
MedicalSampleResponse
26/04/2018
Dear.Dr.Meccam,
Re:JacobMcCarthy(aged82)
MrMcCarthywasadmittedon6April2018witharightdiabeticfootulcer.Avascularsurgeonwasconsulted,whorecommendedthatheundergorightbelowthekneeamputation,whichwasperformedwithoutcomplication.
Followingsurgery,MrMcCarthywasplacedonIVantibioticsandpainmedications,thesehavebeensuccessfullytransitionedtooralantibiotics.Hiswoundhasbeenhealingwellandhisrepeatbloodcultureshavebeennegative.
MrMcCarthyisnowstable,andcanbedischargedtoyourfacilityforfurthercare.HewillcontinuetoneedassistanceforADLsaswellasawheelchairformobility.Hissurgicalsiteshouldbeassessedforinfectionandhisdressings
Dr.ShannonMeccamMedicalDirectorKnoxSkilledNursingFacility25HarrowfieldAvenueKnox
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mustbechangeddaily.Heshouldalsoreceivefrequentturningtopreventpressureulcers.
Ofnote,hiswifewantedhimtobedischargedbacktohishomeunderhercare;however,wefeelthatgivenhisdementiaanddecreasedmobilityfollowingtheamputation,thiswouldnotbeconsideredasafedischarge.Ourphysiotherapyandoccupationaltherapystaffagreedwithourassessment.Wefeelthataftersometimeatyourfacilityhemayshowsufficientimprovementtoreturnhome.
Ifyouhaveanyqueries,pleasecontactme.
Yourssincerely,
[185words]
NursingSampleResponse
26/04/2018
DearNurseMeccam,
Re:JacobMcCarthy(aged82)
ShannonMeccamNurseKnoxSkilledNursingFacility25HarrowfieldAvenueKnox
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Mr.McCarthywasadmittedon6April2018withaninfectedrightdiabeticfootulcerandpositivebloodcultures.Pastmedicalhistoryincludesbenignprostatichyperplasia,diabetesmellitusType2,dementia,hypertension,andperipheralvasculardisease.
Avascularsurgeonwasconsulted,whorecommendedarightbelowthekneeamputation,whichwasperformedwithoutcomplication.Followingsurgery,MrMcCarthywasplacedonIVantibioticsandpainmedicationswhichhavebeensuccessfullytransitionedtooraladministration.Hiswoundishealingwellandrepeatbloodculturesarenegative.
Mr.McCarthyisnowstablefordischargetoyourfacility.HewillcontinuetoneedassistanceforADLsandawheelchairformobility.Hissurgicalsiteshouldbeassessedforinfection,withdailydressingchanges.Heshouldalsoreceivefrequentturning,topreventpressureulcers.
Ofnote,hiswifewantedhimtotheirbedischargedbacktohomeunderhercare;givenhisdementiaanddecreasedmobilityfollowingtheamputation,physiotherapyandoccupationaltherapystaffdidnotbelievethiswasasafedischargeplan.Aftersometimeatyourfacility,hemayshowsufficientimprovementtoreturnhomeoradecisionmadeforlong-termcareplacement.
Ifyouhaveanyqueries,pleasecontactme.
Yourssincerely,
[199words]
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LISTENINGSCRIPT
PartA
N: I’mgoingtogiveyoutheinstructionsforthistest.I’llintroduceeachpartofthetestandgiveyoutimetoreadthequestions.
Thistesthasthreeparts.Ineachpartyou’llhearanumberofdifferentextracts.Atthestartofeachextract,you’llhearthissound:---***---.You’llheareachextractONCEonly.Remember,whileyou’relistening,writeyouranswersonthequestionpaper.Attheendofthetest,you’llhavefiveminutestotransferyouranswersontotheseparateanswersheet.
PartA.Inthispartofthetest,you’llheartwodifferentextracts.Ineachextract,ahealthprofessionalistalkingtoapatient.Forquestions1to24,completethenoteswithinformationyouhear.Nowturnoverandlookatthenotesforextractone.
Pause:5Seconds
N: Extractone.Questions1to12.
YouhearafoundationdoctortalkingtoarecentlyadmittedpatientcalledRoyMiller.Forquestions13to24,completethenoteswithawordorshortphrase.
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Pause:30Seconds
---***---
F: So,Roy,Iseefromyournotesyou’vebeenadmittedbecauseofshortnessofbreath.Canyoutellmemoreaboutthatplease?
M: Yeah...wellitstartedlastweek.InoticedthatgettingupthestairswasmoreofaneffortandIfoundthatIhadtopauseontheway,tocatchmybreath.Ididusedtogetalittleoutofbreath,butit’sdefinitelygottenworse.Inormallymanagetogoshoppingwithmywifeandwewalktotheshopsandback.I’dgenerallyhavetohavealittlerest,butnow,everythingisjusttakingmelonger.Ifeelweary,youknow?AndI’vegotthiscough,it’slikeabarkingthingthatIjustcan’tshift.It’sworseatnightwhenI’mlyingdownandIgetabitwheezy.I’mjustreallytiredbecauseitkeepsmeawakeformostofthenight.Mywifehasbeensleepinginthespareroombecauseit’skeepingherawake...I’vealsosortofbeenbringingupthingswhencoughing...Withoutbeingtoographic,it’squitethick,itsasortofdirtygreencolour,Isuppose.Itwasn’tlikethatatthebeginningoflastweek,itwasjustclearbutoverthelastcoupleofdaysI’venoticedit’schangedcolourandI’mcoughingupalotmore.Mywifewasstartingtogetworriedsoshemademeanappointmentwithourdoctorandthenhesentmehere.
F: OKRoy.Doyouhaveanyothersymptoms?M: Yeah,IwasreallyhotyesterdayandIthoughtitwasbecausethe
heatingwason,butmywifehadn’tturnediton.ThenthenextminuteIwasshivering.IguessI’mfeverish?
F: Itsoundslikeyou’vebeenreallysuffering.Haveyougotanyothermedicalconditions?
M: WellIwasdiagnosedwiththislungconditionlastyear,I’veforgotten
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thenameofit,holdon.....CO,CO,hangonI’llgetit,COPD,isthatit?Wellanywaytheytoldmethatmylungsweren’tworkingaswellastheycouldbebecauseIusedtobeasmoker,butIquitabout6yearsago.TobehonestIthinkitwasbecauseIworkedintheminesanditwasreallydusty.EitherwayI’vegotitanditmakesmeabitbreathlessbutnothinglikethis.OhandIalsogetgoutfromtimetotimeandItakesomethingcalledallopurinolorsomething.I’vealsogotarthritisinmykneesbutthat’sjustbecauseofmyagesoIjustputupwiththat.
F: Youmentionedtakingallopurinol.Areyouonanyothermedication?M: Well,thedoctorgavemeinhalers,andI’musingthose.I’mgetting
betterattakingthembecauseIfounditabitconfusingatfirst.I’vestartedtotakemyblueinhaleralotmoreoverthislastweekbecauseI’vebeensobreathless.ItakethestuffImentionedbefore,astatinformycholesterolandthentheoddparacetamolwhenmyarthritisstartstoplayup.Idon’treallyliketakingpillsbutifitkeepsmegoingthenit’sworthit...Also,I’mallergictopenicillin.Igetanawfulrashallovermybodyandit’ssoitchywhenevertheygiveittome.Don’tgivemeanyofthat!
F: Wewon’tRoy.Youmentionedyoulivewithyourwife,areyoubothmanagingathome?
M: Ohyes,westillgetaroundthetowntogetourshoppingandseethefamily.Thestairsarestartingtogetabitmuchnowsowe’rethinkingaboutmovingintoabungalow,butwehaven’tstartedlookingyet.
F: OKthat’sgood.Haveyougotanyideasastowhatmightbegoingon?M: WellIthinkitmightbeachestinfectionbecauseit’sjustgettingworse.
Ijustwanttostartfeelingbetter.F: OfcourseRoy,itdoessoundlikethatmightbethecase,butwe’llstart
doingsometeststomakesureandbegintreatment.
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Pause:10Seconds
N: Nowlookatthenotesforextracttwo.
Extracttwo.Questions13to24.
YouhearanoptometristtalkingtoapatientcalledMarshaSamarina.Forquestions13to24,completethenoteswithawordorshortphrase.
Pause:30Seconds
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M: Hi,MarshaSamarina?I’mDrKulshaw.Iunderstandthatyou’vebeenexperiencingsomeissueswithyourlefteye?
F: Yeahthat’sright.M: Okay,areyouabletotellmeabitaboutwhat’sbeenhappening?F: Yeahsure.So,lastFridaywasourofficeparty,andsoIwasoutquite
late,andI’dhadacoupleofglassesofwine.Anyway,whenIcamehomeImusthavebeenabitrecklesstakingoutmycontactlenses.Ididn’tnoticeanythingthen,butwhenIwokeupinthemorningIhadthispaininmylefteye...itfeltliketherewassomethingstuckinit.Also,Ihadaheadache,I’mnotsureifthat’sbecauseIwasstrainingmyeyes.Myeyewasalsowateringloads,itwaskindoflikewhathappenswhenyouchopuponions.Anyway,IthoughtI’djustsortofkeepblinking,andwhateverwasinmyeyewouldworkitswayout...so,wellIdidthatforabit,butIwasgettingmoreandmoreworried.Iwenttoaskmyroommateifshecouldseeanythinginmyeye,andshe
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saidmyeyewasswollenandshethoughtweshouldgotothehospitalandgetitcheckedout.SowewenttotheED...Thankfullymyroommatewasabletogetthedayoffwork,soshedrovemethere.ThepainwasalsosoterriblethatIcouldn’tconcentrate.Idon’tknowwhatI’dhavedonewithoutherhelp.
M: Ah,okay...sowhathappenedwhenyouwenttothehospital?F: SowewaitedaroundattheEDforabit,andthenIwasseenbyaGP..
.umm...Itoldhimaboutthepain,andhowIthoughtIhadsomethingstuckinmyeyesoheopenedmyeyeandtriedtoseeiftherewasanythingintherethatshouldn’tbe.Itmusthavebeenquitedifficultforhimtoseeanything,sohedidafluoresceineyestaintest...thenhetookmetoadarklaboratoryroomtolookintoeyeswithoneofthose,um,microscopethings.Whenhestillcouldn’tfindanythingheseemedtothinkthatitcouldbeaninfection.That’swhenIstartedpanicking!
M: Andafterthat,youwerereferredtoanoptometrist?F: Yes,that’sright.Theysentmetothisdepartmentafterthat,andthe
optometristusedsomenumbingeyedropsonme–Iwasincrediblythankfultoherforthat!Myeyesfeltbetterverysoonafterwards.Thenshelookedatmyeye,andbecauseIwasn’tsquintingfromthepainanymore,shecouldseethattherewasacornealabrasion,shesaidthatImusthavescratcheditwhenItookmycontactsoutthenightbefore.
M: Isee,socanyoutellmehowyou’vebeentreatingyoureyeathome?F: Yes,shetoldmenottowearmycontactlensesuntilthisfollowup,and
sheprescribedmeacoupleofthings...I’musingtheantibioticeyedropsshegaveme–Iputthoseininthemorningsandevenings...andtheotherthingshegavemeisreallyhorribletouse,it’sahealingointment,butitfeelsgrossinmyeyesoIjustuseitonceaday.Unfortunately,theycouldn’tgivemeanyoftheirpainrelieftotake
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home,soI’vejustbeentakingibuprofenwhenithurts.M: Andhow’syoureyefeelingnow?F: Muchbetter,thanks.Itstillhurtswhenthere’sbrightlightthough,andI
wasn’tsureifthatwasnormal?Theoptometristsaiditwouldtakequiteawhiletoheal,soIguessIneedtohangonabitlonger?
M: Yes,atthispointitwillmostlikelystillberecovering.DoyoumindifItakeacloselookatyoureyenow?Ifyoucanjusttakeyourglassesoff...
Pause:10Seconds
N: ThatistheendofPartA.Now,turnoverandlookatPartB.
Pause:5Seconds
N: PartB,questions25to30.Inthispartofthetest,you’llhearsixdifferentextracts.Ineachextract,you’llhearpeopletalkinginadifferenthealthcaresetting.
Forquestions25to30,choosetheanswerA,BorCwhichfitsbestaccordingtowhatyouhear.
NowlookatQuestion25.Youheartwodoctorsdiscussthetransferofcareforapatient.Nowreadthequestion.
Pause:15Seconds
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M: Hello,DrSalvos?ThisisDrBroderickfromtheEmergencyDepartment.I’mcallingyouwithregardstoanadmissiontothehospitalmedicineservice.
F: Right,yes.HelloDrBroderick...I’mtheadmittingphysicianforhospitalmedicine...Umm,Canyoutellmemoreaboutthepatient,andwhyheneedstobeadmittedfromtheemergencydepartment?
M: Sure...Sothepatientisa68-yearoldmanwithapasthistoryofCHF,DM2andachiefcomplaintofshortnessofbreathforthreedays.ChestX-Rayshowsarightlowerlobarpneumonia.HisvitalsignsarenormalbuthisBUNis36.
F: Isee...ItsoundslikehemeetsCURB-65criteriaforaninpatientadmission.Haveyoustartedhimonanymedicationsintheemergencydepartment?
M: Yes,wehavegivenhimsupplementaloxygenandstartedhimonbreathingtreatments.Hewillalsobegettingempiricalantibioticcoverage.Ifthereareanyotherordersyouwouldlikemetoplace,letmeknowandI’lldoso.
Pause:5Seconds
N: Question26.Youheartospeechpathologisttalkingtothewifeofapatientwhohasrecentlysufferedastroke.Nowreadthequestion.
Pause:15Seconds
F: Ijustdon’treallyunderstandwhymyhusbandcan’tspeakproperlyanymore.Isitaresultofbraindamage?
M: Problemsofthistypearearesultofdamagetothebrain,yes,butit’simportanttonotethattheseissueshaven’taffectedyourhusband’s
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intelligence.F: No,ofcourse.Iknowit’sstillhim.It’sjustfrustratingwhenwecan’t
talklikeweusedto.Willhegetbettereventually?M: Yourhusbandhasshownimprovementalready,andwe’reconfident
thatthiswillcontinuewithregularsessionsandpractice.Patientstendtoshowthegreatestchangewithinthefirstsixmonths,whichiswhywe’veplannedsuchanintensivescheduleforhimduringthistime.We’reconfidentthatwe’llseegreatstridesinyourhusband’sconditionoverthecomingmonths.
Pause:5Seconds
N: Question27.Youhearatraineedoctoraskingaseniorcolleagueaboutchesttubes.Nowreadthequestion.
Pause:15Seconds
F: I’mstilljustabitunsureaboutchesttubes...Iwashopingyoumightbeabletogivemeabitmoreinformation?
M: Okay,sure.Soyouknowaboutthethreechambersonthechesttube,right?
F: Yep.There’sthecollectionchamber,thewatersealchamber,andthewetordrysuctionregulator.
M: Right.Soastheairfromthepleuralspacepassesthoughthewater-sealchamber,youshouldseegentlefluctuationinthewatereverytimethepatientbreathes.Thisiscalledtidaling.Ifyounoticethattidalingisnolongerpresent,thetubingmaybekinkedorobstructed,orthepatient’slungmayhavere-expanded.
F: Ahh,okay
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M: Youshouldalsomakesurethechestdrainageunitremainsbelowthelevelofthepatient’schestatalltimes.
Pause:5Seconds
N: Question28.Youhearapharmacisttalkingtoacustomeraboutpainrelief.Nowreadthequestion.
Pause:15Seconds
F: Hello,canIhelpyou?M: Yes.Igetterriblebackache,andmyfriendsaidyoucouldgiveme
somecodeineforit?F: Doyouhaveaprescriptionfromyourdoctor?M: No.ButIdon’twantthefullstrengthstuff.Ionlyneedtheweakerone.
Y’know,theymixitwithibuprofenorparacetamol,soit’snotasstrong.
F: Ahokay.Well,firstofall,there’sbeensomeresearchdonerecentlythatsuggeststhatlowdosecodeinedoesn’toffermuchmorepainreliefthanparacetamoloribuprofenalone.We’renotactuallyauthorisedtoprovidecodeinewithoutaprescriptionanymore,soI’drecommendpickingupsomealternativepainrelieffromthefirstaislebythefrontdoor.
Pause:5Seconds
N: Question29.Youhearatraineenursereceivingfeedbackfromhistutor.Nowreadthequestion.
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Pause:15Seconds
F: Howdoyoufeelyouhandledthepatient’sconcerns?M: Well,IthinkIwasokay.MaybeIwasn’tasconfidentasIcould’ve
been?I’mstillquitenervousaboutadvisingpatients.IguessIjustneedmoreexperiencetogainconfidence.
F: Maybe,butIactuallydon’tfeelthatwasanissueforyou.Doyouthinkthere’sanythingelseyoucould’vedoneforthepatientduringyourexamination?Youcould,perhaps,havetriedtobemorereassuring,ratherthanjuststatingthefacts?Sometimespatientsneedtofeelliketheiranxietiesarebeingheard.
M: Yeah...IactuallythinkIdidcoverthiswiththepatient,though.HetalkedthroughhisconcernswhileIwasexamininghim.
F: It’snotenoughforthepatienttosaythey’refeelingworried,youhavetoshowthatyou’relistening,andreassurethemthatyou’reworkingwiththeirbestinterestsinmind.
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PAUSE:5SECONDS
N: Question30.Youheartwodoctorsplanningtheirpatient-carescheduleNowreadthequestion.
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PAUSE:15SECONDS
M: Wehavetwentyfourpatientsintotaltoseetoday,acrosstwobays...andunfortunately,weonlyhavefourstaffmembers...Ithinkweshoulddivideourselvesintotwoteams.Wouldyouagree?
F: Absolutely!Also,IthinkweshouldseepatientsaccordingtotheirNationalEarlyWarningScore,thatway,we’llgetthroughallthosewhohaveurgentrequirementsbeforelunch...thenwecanbesurethatthemostpressinginvestigationsareperformedearliest,andthesoonerwegetthoseorganisedthebetter.Phlebotomistswillbecomingtothewardataroundhalfone,soanybloodformsshouldbegiventothemthen.
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PAUSE:10SECONDS
N: ThatistheendofPartB.Now,turnoverandlookatPartC.
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PAUSE:5SECONDS
N: PartC,questions31to42.Inthispartofthetest,you’llheartwodifferentextracts.Ineachextract,you’llhearhealthprofessionalstalkingaboutaspectsoftheirwork.
Forquestions31to42,choosetheanswerA,BorCwhichfitsbestaccordingtowhatyouhear.
Nowlookatextractone.Questions31to36.
YouhearaninterviewwithaphysiciancalledDrMatthewLeach,who’stalkingaboutmeningitis.
Younowhave90secondstoreadquestions31to36.
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PAUSE:90SECONDS
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F: Helloeveryone,I’mherewithDr.MatthewLeach,anexpertoninfectiousdisease,who’sgoingtotellusaboutmeningitis.Thankyouforbeingwithustoday,Dr.Leach.Canyoutellmemoreaboutthedisease?
M: Sure.Wellfirstoff,noteveryonewhoisexposedactuallydevelopsmeningitis,buttherearesomecommonsymptomstolookoutforinthosethatareatrisk.Itcanbequitedifficultforpatientstorealisetheyhavemeningitisintheearlystages,asthesymptomscanleadthemtobelievethattheyaredevelopingtheflu,they’llsimplyfeeltiredandacheyforafewdays...Asthisinfectiondevelops,patientsmaythennoticeasuddenonsetoffever,headache,andinparticular,neckstiffness.Otherpossiblesymptomsincludenauseaorvomiting,confusion,sensitivitytolight,noappetiteorthirst,orevenaskinrash.Ifleftuntreated,bacterialmeningitisisverydangerous,quicklyprogressingtoseizures,shock,andevendeath.
F: Thatsoundsprettyserious.Youmentionedthatcertainpeoplemaybeatrisk.Whichpeoplearethemorelikelytodevelopmeningitis?
M: Well,therearemanycausesofmeningitis,butoneofthemostsevereiscausedbythebacteriaNeisseriameningitides.Thebacteriaarespreadbyrespiratorydroplets,andareoftenseenincollegestudents.Thisislargelybecauseofthesuddenchangeintheirlifestyle.Collegestudents,particularlythosewholiveoncampus,areexposedtoahotbedofdifferentinfectionsthattheyhaven’tpreviouslyencountered–allthesekidsfromdifferentpartsoftheUSandtherestoftheworld
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gettogether,liveinsmalldormswitheachother,gotoparties...allthatclosecontactreallyisabreedinggroundforinfection.
F: Okay,thatmakessense.Now,canyoutellusaboutaspecificpatientwhohadthistypeofmeningitis?
M: Ofcourse.Itreatedan18yearoldmaninhisfirstyearofcollegewhowaslivinginthedormitories.Therewasaflugoingaround,andhestartedtofeelthesamesymptoms.Hewasworkinghardtotrytocompleteacoupleofimportantessaysbeforethedeadline,andheplannedtodelaygoingtothedoctorsuntilhehadsubmittedthem.Soonaftertheinitialsymptoms,however,hisroommatefoundhiminseverepainandfeverish,andbroughthimtotheemergencydepartmentwherewediagnosedmeningitis.Wetookasampleofspinalfluid,butstartedhimonantibioticsbeforewegottheresultsback.
F: So,youmentionedthatyoustartedantibioticsbeforeyougotthespinalfluidtestresultsback.Canyoutellmewhy?
M: Right.AsImentioned,therearemanycausesofmeningitis,likeviruses,funguses,parasites,andbacteria.However,itcantakesometimetodeterminetheexactcause,andwaitingfortheanswerwithouttreatmentwillmakethepatientworse.Instead,weusethepatient’spresentation,age,andourdeterminationofthemostlikelycausetostartantibioticsthatwouldkillmanyofthecauses.Oncewegettheresultsbackonthecause,wecanchangetheantibioticstobemorespecific.Bydoingthiswedon’tdelaytreatment,andareabletoreducethechanceofcomplications.
F: AhrightIsee...sohowisyourpatientdoingnowafterbeingtreated?Willheexperienceanylongtermafter-effects?
M: Well,heiscurrentlydoingmuchbetter.Herespondedwelltoantibiotictreatmentandregainedhismentalstatewithinafewdays.Unlessthe
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patienthasadiseaseofhisimmunesystem,meningitisisunlikelytorecur.Becausethispatienthadsomedelaybeforeseekingtreatment,hemaystillhavesomesideeffects,butitwilltakesometimetoseewhatlongtermeffectitwillhaveonhim.Bacterialmeningitisrequiresurgentmedicaltreatment,andcancauseseriouscomplicationssuchashearingloss,memorydifficulty,braindamage,gaitproblems,orkidneyfailure.
F: Well,let’shopehemakesafullrecovery.Asidefromseekingimmediatemedicaltreatment,whatadvicecanyougivetoourlistenerstodayaboutbacterialmeningitis?
M: So,firstoff,thereisavaccinethatiseffectiveatpreventingthisdisease,soanyoneinclosecontactwithalargegroupofpeople,suchasthoselivinginamilitarybaseoronacollegecampus,shouldasktheirdoctoraboutit.Finally,ifyouhavenothadtheshotandhavespentalotoftimewithsomeonewhoislaterdiagnosedwithmeningitis,wearamasktopreventspreadingthebacteria,andgoandseeadoctorimmediately.Therearemedicationsthatcanreduceyourriskofdevelopingmeningitis,andgettingtreatedimmediatelywillreduceyourrisksignificantly.
Pause:10Seconds
N: Nowturnoverandlookatextracttwo.Questions37to42.
YouhearaclinicalpsychiatristcalledDrEvalinaHoughtondiscusstreatmentforagitatedpatientsinanemergencysetting.
Younowhave90secondstoreadquestions37to42.
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Pause:90Seconds
F: Helloeveryone!MynameisDrEvalinaHoughtonandinmypresentationtodayI’dliketodiscussanissuethatIdealwithdaily,de-escalatingagitatedpatientsinanemergencysetting.Toprovidesomeperspectiveontheissue,mostpatientswhoenterthehospitaldosoviatheemergencydepartment(ED).Manywon’thavereceivedmedicaltreatmentyet,andthatcanmakeitmorelikelyforthesepatientstobecomeagitated.Thiscanbeexacerbatedbytheirmedicalcondition,apsychiatricillness,orotherstressfactors.GiventhechaoticandcrowdednatureoftheED,it’simperativethatweidentifyagitatedpatientsearlyandapplynon-physicalde-escalationtechniquesassoonaspossible.
Theproviderwhoisgoingtoinitiatethede-escalationprocessshouldmakesurethattheycreateaconsiderableamountofspacebetweenthemselvesandthepatient,andmakesurethatnooneelseisclosertothepatientthantheyare.Thisnotonlygivesthepatientspace,butalsokeepstheprovidersafeintheeventofattemptedphysicalviolence.Ideally,boththepatientandprovidershouldalsobeabletoleavetheareawithouttheotherblockingtheirexit.Bodylanguageandtoneofvoiceconveyoverallemotionalstatetoapatient,soprovidersshouldremainoutwardlycalmthroughouttheencounter.
Whenspeakingtothepatient,youshouldstartbyintroducingyournameandroleintheteam.Youshoulddeterminehowthepatientpreferstobeaddressedanderronthesideofbeingrespectful.Useshortsentencesandsimplevocabularytoenhanceunderstanding.Leaveasuitableamountoftimebetweenstatementstoallowpatientstoprocesswhatisbeingsaid–sometimesrepetitionandenunciationmaybe
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necessary.Eyecontactshouldbeintermittent,sothepatientdoesnotthinkyou’restaring,andverbalresponsesshouldbecalmwithoutanyhintofinsultsorchallenges.Onlyoneprovidershouldinteractwiththepatient,asmultiplespeakerscanconfuseanagitatedpatient.
Whenthepatientspeaks,it’simportanttoidentifywhattheirwantsandfeelingsare,eveniftheymaybeimpossibletoaddressatthistime.Trytoconsiderthingsfromthepatient’sperspective.Althoughtheymaybesufferingunderaparticulardelusion,suchasparanoia,trytounderstandhowthepatientmightfeelorreactifthatdelusionhappenedtobetrue.Whilewedonotwanttoendorsethesedelusions,it’simportanttofindcommonground.Forinstance,ifthepatientisagitatedbecausetheythinktheyarebeingfollowed,theprovidercanagreewiththegeneralprinciple,sayingsomethinglike“Iunderstandthatyoursuspicionofotherpeoplecanmakeithardtogetthetreatmentyouneedhere.”Itisalsookayforaprovidertoagreethatwhiletheymaynotbehavingthesameexperienceasapatientwithanobviousdelusion,theycanbelievethepatientishavingthatexperienceandreactingtoit.
Inaddition,patientsshouldbeencouragedtomakechoices,inordertogivethemasenseofcontroloverthecurrentsituationanddefusetheiroverallaggressiveness.Thesechoicesshouldberealistic,however,anddeliverable,asunfulfilledpromisesmaybackfireandirreparablydamagethetherapeuticalliance.Someofthesechoicescanincludemedicationstohelpcalmthepatient.Agoodwaytostatethisis“It’simportantforyoutostaycalmsowecantalk.Canweprovideyousomemedicationtohelpyoufeellessanxious?”Offeringpatientsachoicebetweendifferentmedicationsorroutesofdeliverymayalsoprovideafeelingofcontroltothepatient.
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Lastly,whenthecrisisisover,akeytechniqueisdebriefingboththepatientsandstaffonhowthesituationwent.Thepatient,nowcalm,maybeabletoprovidemoreinsightsonwhattheywerethinkingandhowtheywerefeelingatthetime.Theprovidercandiscusscopingskillsoralternativeoptionsinordertopreventanotheraggressiveincidentinthefuture.Itisalsoimportanttotalktostaffaswell,togainanythird-partyfeedbackontheprovider-patientinteraction,whatwasappropriate,whathelpedde-escalatethepatient,andanyotherchangesthatcouldbemadetoensurepatient,staff,andbystandersafety.
Thesetechniquescanbeapplicabletoawidevarietyofpatientsinnumeroussettings,they'renotjustrestrictedtotheemergencydepartment.Ourhopeisthatproviderswillbeabletodeescalatepatientssafelyandeffectivelywithouthavingtoresorttotheuseofphysicalorchemicalrestraints,whichshouldbeconsideredonlywhenallotherapproacheshavefailed.