SAM's OET Listening Book

Test No.
Audio page Questions page Answers page

2 13
14 27
28 39
40 53
54 69
71 84
86 100
101 114
115 131
132 143
144 156
157 167
168 180
181 192
193 205
206 216
217 228
229 240
241 256
253 265
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1
2
This test has three parts. In each part you'll hear a number of different extracts. At
the start of each extract, you'll hear this sound: --beep-
You'll have time to read the questions before you hear each extract and you'll hear
each extract ONCE ONLY.
Complete your answers as you listen.
At the end of the test you'll have two minutes to check your answers.
Part A
In this part of the test, you'll hear two different extracts. In each extract, a health
professional is talking to a patient.
For questions 1-24, complete the notes with information you hear.
Now, look at the notes for extract one
3
Patient Martin Gregory
Background
• had a reverse total shoulder arthroplasty surgery on (1)_____six weeks ago

• has a (2)_______ for past four weeks
• patient can't lift anything
• has no (3)_______and demands only rehabilitation from the surgery
• Impact on everyday life
• incapable to support own bodyweight
• unable to drive and can't do many (4),________ (like fishing with grandson)
• find it hard while doing things with left hand
Medical History
• had a (5)_______ 15 years ago
• has a (6)_______
• non-smoker
• on Saturdays
• has (7)________ and is taking medication for that.
Medications
• takes anti-inflammatory drugs
• NSAIDs -(8)______per day for pain
• (9)________ - twice a day
Social History
• lives with his wife Gretchen
• was a (10)_______ for 28 years
• retired and now do things 1nainly for leisure
• go for a half-mile walk with his dog every (11)________
Concerns Expressed
• pain (12)_________and most of the time, it's around four on a scale of ten
• most painful in the mornings
4
Extract 2
Questions 13-24
You hear a dietitian talking to a patient called Naomi Myers.
For questions 13-24, complete the notes with a word or short phrase.
You now have thirty seconds to look at the notes.
Patient : Naomi Myers
• Last week found out having (13)_______

Occupation
• has three jobs
• does (14)_______at County Medical Examiner's Office on Mondays and
Tuesdays
• works as (15)______at Belmond 's Hospital rest of the week
• also a bartender and a server at (16)______
Diet
• takes only (17)_______for breakfast
• prefers (18)_________ for lunch
• eats (19)______ after work
• working hours have a stress around (20) _______on a scale from one to ten,
ten being the most stressful
• the stress has no (21) ______on diet
Information Given
• lives with boyfriend
• used to run (22) ______ but currently isn't doing any exercises
• • patient's father is taking (23) _______ for high cholesterol
• • (24) ______ of patient 's father also has high cholesterol
5
Part B
In this part of the test, you'll hear six different extracts. In each extract, you'll hear
people talking in a different healthcare setting.
For questions 25-30, choose the answer (A , B or C) which fits best according to
what you hear. You'll have time to read each question before you listen. Complete
your answers as you listen.
Now look at question 25
6
Question 25
Which one of the following statements is not correct?
A) systematic review and meta-analysis are crucial for antidepressants' trials
B) All antidepressants were more effective compared with the placebos
C) antidepressants are used more than psychological interventions
Question 26.
You hear a nurse briefing, a colleague at the end of her shift.
What is the plan for the patient today?
A) to keep her blood pressure in check
B) prepare her for stress and enzymes tests tomorrow
C) give her IV fluids till midnight.
Question 27.
You hear a dietician talking to a patient.
What type of information does the dietitian want to provide?
A) describing the relation between obesity and other diseases
B) correcting the patient's misconception about obesity
C) stressing importance of a positive attitude ror weight loss
7
Question 28.
You hear a monologue by a physician explaining about lupus disease.
Which of the following statements defines lupus disease more precisely?
A) results in inflammation, swelling and damage to skin, joints, kidneys, heart and
lungs
B) forces immune system to make proteins to tum hyper active and attack healthy
tissue
C) takes away ability of immune system to distinguish healthy tissue from the
antigens
Question 29.
You hear a consultant talking to a trainee about a patient's eye condition.
What are the factors that can worsen the patient's condition?
A) the leakage of the fluid before the retina
B) the factors are uncertain at the moment
C) influence of stress and usage of steroids
Question 30.
You hear part of a hospital management meeting where a concern is being
discussed.
What is the biggest challenge faced by the hospital staffing?
A) maintaining full cover on the wards
B) recording lower rates of staff turnover
C) filling vacant positions across sector
8
Part C
In this part of the test, you'll hear two different extracts. In each extract, you'll
hear health professionals talking about aspects of their work.
For questions 31-42 , choose the answer (A, B or C) which fits best according to
what you hear. Complete your answers as you listen.
Now look at extract one.
9
Extract one
31. Which one of the following statements is incorrect?
In the case study sent to Dr Gibbons, at the first time the patient was not
A) hospitalized for panic attacks
B) treated with narco analysis
C) treated with antidepressant
32. According to Dr Gibbons, among readers case histories

A) had neutral impacts
B) provided morale-boosting
C) were used to identify depression
33. What disadvantage of doctors using case stories does Dr Gibbons identify?
A) inclination to make quick conclusions
B) disregarding results of controlled trials
C) psychiatrists loosely supported descriptions
34. What is the most important benefit of case stories?

A) guiding role as true illustration
B) having a narrow focus on data
C) building hypothesis for practice
35. How does Dr Gibbons feel about randomized medical trials?

A) doubts the efficiency of the entire process
B) questions how data are collected for the method
C) doubts when the values are used independently
36. According to Dr Gibbons, in the future case stories will be?

A) published more widely
B) widely accepted in medicine
C) used to inform research
10
Now look at extract two.
Extract 2
Questions 37-42
You hear the monologue of Dr Thaddeus Roxby, giving a lecture on the types of
eczema.
You now have 90 seconds to read questions 37-42.
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37. Which one of the following types of eczema happen due to inhalant allergies?
A) Allergic contact dermatitis
B) Atopic dermatitis
C) Irritant dermatitis
38. Poison Ivy causes

A) Allergic contact dermatitis
B) Scabies
39. What occurs due to poor blood circulations in the veins of the legs?
A) Irritant dermatitis
B) Atopic dermatitis
C) Stasis dermatitis
40. Tiny blisters on the sides of the fingers or toes and palms or soles are the
symptoms of?
A) Scabies
B) Pompholyx
C) Fungal infections
41. Eczema that produce thickened plaques on the shins and neck is
A) Seborrheic dermatitis
B) Dyshidrotic eczema
C) Lichen simplex chronicus
42. Oozy rash behind the ears is caused by

A) Seborrheic dermatitis
B) Dyshidrotic eczema
C) Lichen simplex chronicus
12
13
14
the start of each extract, you'll hear this sound. --beep--
You'll have time to read the questions before you hear each extract and you'll
hear each extract ONCE ONLY. Complete your answers as you listen.At the
end of the test, you'll have two minutes to check your answers.
Part A.
professional is talking to a patient. For questions 1 to 24, complete the notes with
information you hear. Now, look at the notes for extract one.
15
Extract 1
Questions 1-12.
You hear a physician talking to a patient called Mr.Victor Rosario.
You now have 30 seconds to look at the notes.
Patient: Victor Rosario Age: 67
Patient's description of symptoms:
• has frequent nausea & vomiting with aspiration pneumonia and (1)_______.
• endoscopy exposed a small ulcer after dropping hematocrit and feels
(2)________now.
• last week CT scan revealed pneumatosis, cecum worrisome for ischemic
colitis, bilateral hydronephrosis and(3)_____.
• had multiple bowel movements, passing flatus and heavy gastric pain
(4)______.
• chronic alcohol user, quitted (5)_________long ago.
• Past medical history:
• has chronic obstructive pulmonary disease
• has history of pneumonia and aspiration pneumonia, osteoporosis, alcoholism
& (6) _______.
•
Physical examination:
• He is afebrile, heart rate- 100s-120s at times with (7) _______
• respiratory rate- 17-20, bp- 130s-150s, 60s-70s abdomen is distended with
tenderness, mainly in the upper abdomen, very hard to (8) _________
16
Diagnosis
• CT scan shows pneumatosis in the cecum enlarged &
• filled with stool & (9)______. chronically dilated small bowel.
• has a possibility of ischemic cecum with (1O)________, bilateral
hydronephrosis on atrial fibrillation, aspiration pneumonia, chronic alcohol
abuse, acute renal failure,chronic obstructive pulmonary disease, anemia with
gastric ulcer.
• Further diagnosis:
• (11)_________to assess it further to see if there's worsening pneumatosis
versus resolution to further evaluate liver lesions & make decisions regarding
planning at that time.
• has frequent desaturations secondary to aspiration pneumonia,so any surgical
procedure or any surgical intervention would definitely need
(12)___________& then require long-term ventilator care.
17
Extract 2.
Questions 13-24.
You hear a doctor talking to a patient called Noah Baxter.
For questions 13-24, complete the notes with a word or short phrase. You
now have thirty seconds to look at the notes.
Patient: Noah Baxter Age: 36

Symptoms & diseases: Allergies
• intolerance to inhalant and (13)_____
• no anaphylaxis or angioedema Past medical history:
• was under dialysis due to (14)_______, 6 months ago
• during that time, had acute event of perioral swelling
• etiology uncertain
• diagnosis showed allergic reaction was because of (15)______ , used to treat a
cellulitis dialysis shunt infection
Medications:
• Atenolol for controlling blood pressure
• Sodium bicarbonate, Lovaza & (16)____Previous treatments:
• corticosteroid therapy, antihistamine therapy &monitoring
• Permcath insertion (17)_______ in peritoneal dialysis Allergies:
• heparin causes thrombocytopeni a Family history of illness:
• family members have severe heart disease,(18)_________and food allergies.
18
• blood pressure-128/78, pulse-70,

• temperature-97 .8,weight- (19)________, height-5'7" Impression: has
developed (20)__________
Further diagnosis:
• require radioallergosorbent test to investigate (21)_______ to determine
allergic substances Further treatment:
• avoid the (22)________that test report shows
• stop further usage of (23)__________
• use EpiPen in the event of acute angioedema or (24)___________or sensation
of impeding allergic reaction
That is the end of Part A. Now look at Part B
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Part B.
For questions 25 to 30, choose the answer A, B or C which fits best

according to what you hear.
You'll have time to read each question before you listen. Complete your answers as
you listen
20
Now look at Question 25.
You hear a doctor briefing his colleague about a patient.
25. What does he warn his colleague about?
A) patient has ruptured appendix with free air under the diaphragm.
B) patient has worsening abdominal pain, nausea and vomiting.
C) patient might need to be transferred to ICU if condition worsen
26. You hear part of a surgical team's briefing.

The male surgeon suggests that the patient could
A) require a C-section in her second stage.
B) be at risk of persistent late decelerations.
C) require a C-section in case of fetal distress.
27. You hear a radiologist talking about a new initiative that has been introduced.
What objective was it intended to achieve?
A) make patients proactive during CT and MRI
B) eliminate delay in services to patients
C) make the reports readily available
28. You hear a pharmacist talking to a doctor regarding a patient's medication.

They agree to choose the method which will
A) be less sedating and tolerable for patient.
B) impact on patient 's participation in therapies.
C) let patient go home as early as possible.
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29. You hear an optometrist talking to a patient.
The optometrist suggests that the patient could
A) require a surgery for her condition.
B) benefit from eye drops for few months.
C) need glasses with more powerful lenses.
30. You hear a podiatrist talking about a proposal to offer help with dialysis patients'
foot care.
What problem was it intended to solve?
A) high risk of complications with patient's feet.
B) struggle experienced by patient to attend dialysis.
C) difficultly faced by patient to access the service.
That is the end of Part B. Now look at Part C.
22
Part C
In this part of the test, you'll hear two different extracts In each extract, you'll hear
health professionals talking about aspects of their work.For questions 31-42, choose
the answer A, B or C which fits best according to what you hear. Complete your
answers as you listen. Now look at extract one.
Extract 1
Questions 31-36.
You hear the lecture given by a physician on the topic white blood cell disorders.
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31. Which of the following statements is correct? The range of white blood cell is
affected by
A) age and gender
B) age and race
C) gender and race
32. Which of the following white blood cells fight viral infections?
A) Neutrophil
B) Monocytes
C) Lymphocytes
33. While naming disorders white blood cell is suffixed with philia, if
A) one type of white blood cell is abundant
B) one type of white blood cell is scarce
C) there is too much types of white blood cell
34. What is the popular cause of leukophilia?

A) infection medications like prednisone
B) secretion of antibodies by the body
C) increased number of white blood cells
35. Which one of the following is not caused by genetic mutation?

A) Severe congenital neutropenia
B) Cyclic neutropenia
C) Autoimmune neutropenia
36. White blood cells are unable to function in

A) Leukocyte adhesion deficiency
B) Chronic granulomatous disease
C) Chronic lymphocytic leukemia
24
Questions 37-42
You hear an interview with a neurosurgeon called Dr Ian Marsh, who specializes
in the treatment of concussion in sport.
37. What is the aim of these new guidelines? To provide a resource for
A) everyone who are either players or coaches of any sport the top-level
B) professional sports people and their coaches
C) parents. teachers and coaches of young people playing sport
38. How do we know when someone is suffering from concussion?

If the person is
A) disorientated following a hard knock to the head
B) actually knocked out on the ground
C) all of the above mentioned
39. What is the minimum interval required before playing again after a
concussion?
A) two weeks
B) less than two weeks
C) more than two weeks
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40. Who has more chance to get a concussion?
A) anyone who takes part in any outdoor sports
B) people playing sports with more bodily contact
C) likely to affect kids as same as professional
players
41. According to Dr Ian Marsh, having specialist concussion doctors on hand for
youth sports is
A) Unnecessary
B) advisable
C) essential
42. Chronic traumatic encephalopathy occurs when the players use their helmets
and heads to
A) make a blow
B) receive a blow
C) avoid a blow
26
27
28
the start of each extract, you'll hear this sound. --beep--
each extract ONCE ONLY. Complete your answers as you listen. At the end of the
test, you'll have two minutes to check your answers.
Part A.
professional is talking to a patient. For questions 1 to 24, complete the notes with
information you hear. Now, look at the notes for extract one.
29
Extract 1
Questions 1-12.
You hear a physician talking to a patient called Pamela Erickson.
Patient: Pamela Erickson (21 years old)
Symptoms & disease: itchy, red rash on feet
Patient's description of symptom:
• itchy red rash on feet tingling persistently for (1) -----------right great toe,2nd
toe, 3rd toe and 4th toe
• onset of itching starts after (2)-----------doesn't smoke
• drinks regularly
Past medical history :

• (3)______and frequent ear infections has (4)_______
• no medications
• gets (5)_______while accessing adhesive tape
• Family history :
• paternal grandmother has cataract (6) __has migraines
Diagnosis:
• physical examination reports show:
• blood pressure 110/64, respiratory rate is (7) ____heart rate is 66,
temperature is 98.6
• (8)_______is warm to cool, proximal to distal the dorsalis pedis artery pulse
palpable bilateral the posterior tibial artery pulse palpable bilateral
• No (9)______ observed and varicosities are not observed.
• right great toe, 2nd toe, 3rd toe and 4th toe shows erythema and (10)-------
• muscle strength for all groups tested and muscle tone is normal.
• inspection and palpation of bone, joints and muscles unremarkable.
30
Assessment:
• Tinea Pedis, a (11)______of skin from right toes KOH test shows no
visible microbes.
Further treatment:
• Lotrimin AF 1% cream to apply four times a day Griseofulvin 250 mg
PO, once in (12)________for four weeks
31
Extract 2. Questions 13-24
you hear a doctor talking to a recently admitted patient admitted patient called Roy
Miller.
For questions 13-24, complete the notes with a word or short phrase. You now
have thirty seconds to look at the notes.
Patient: Roy Miller
Reason for referral: shortness of breath
Patient's description of condition:
• getting up (13)_________are difficult due to pauses to catch breath
getting worse now because of longer pauses
• while doing activities feels (14)_______and has barking kind of cough
• worse at night as it keeps awake at night
• cough is quite thick and (15)-------------- in color
• feels feverish
Medical history:
• Diagnosed with (16)_______ last year
• Used to be a smoker, but quitted (17)________
• worked in very dusty (18)_________
• gets gout time to time and takes (19)_____
• also has arthritis is in (20)________
• has prescription for (21)_______and is taking a lot more over last week
• also takes statin for cholesterol and
• paracetamol when (22)_______is high
• is allergic to (23)_______, gives rash and itches
Effects of condition on everyday life:

• thinking about moving into a (24)__________ as stairs make it worse
• thinks it might be a chest infection
That is the end of Part A. Now look at Part
32
Part B
In this part of the test, you'll hear six different extract In each extract, you'll
hear people talking in a differed healthcare setting. For questions 25-30,
choose the answer A, B or C which fits best according to what you hear. You'll
have time to read each question before you listen. Complete your answers as
you listen.

25-You hear a doctor explaining to his patient about a bone-marrow biopsy
Bone marrow samole can be obtained from
A) the blood forming portion of thinner core of bone
B) both sternum and front of pelvic bone near groin
C) pelvic bone near the lower back side of the hip
Question 26.
You hear two hospital managers talking about an information session for people
who want to do voluntary work.
26. What problem do the managers discuss?
A) issues with event management systems
B) Difficulty in finding a good catering service
C) issues with contacting the participants
Question 27.
You hear a discussion between a nurse and a doctor on different categories of
chemotherapy drugs.
27. Antimetabolites
A) imitate as nutritional sources for cells
B) Starve the essential cells to their death
C) prevent cancer cells from reproductio
33
Question 28.
You hear a discussion between a doctor and a nurse about pancreatic
neuroendocrine tumors.
28.Which of the following tumors is not usually located at the head of pancreas?
A) Glucagonoma
B) insulinoma
C) Gastrin
Question 29.
You hear a monologue by a physician explaining about gall stones.
29. Which is the common type of gall stones?

A) blue-green gall stones
B) pigment gall stones
C) cholesterol gall stones
Question 30.
You hear a doctor briefing junior doctors about trigger point injections.
30. Which one of the following is not a complication of trigger point injection?
A) skin irritation
B) mild healing
C) skin infection
34
Part C
In this part of the test, you'll hear two different extracts. In each extract, you'll hear
health professionals talking about aspects of their work
For questions 31-42, choose the answer (A, B or C) which fits best according to
35
Extract one.
31. The symptom showed by Tucker prior to admission was
A) yelping with severe neck pain.
B) signs of lack of coordination.
C) slipping on the tiled floors.
32. The information revealed by Tucker's diagnostic tests was

A) last 3 neck vertebrae compressing inward.
B) 3 cervical vertebrae pressing outward.
C) false suspicion of a cervical deformation.
33. TI1e first signs of wobblers syndrome is seen

A) early in Doberman compared to Great Dane
B) early in Great Dane compared to Doberman
C) between 4 to 6 years in Doberman and Great Dane
34.The efficient cure for wobblers syndrome in dogs is

A) feeding low calcium diet.
B) steroids and restricted activity.
C) modified dorsal laminectomy.
35. The spine surgery in dogs helps to

A) uncompressed the spinal cord.
B) function with extreme pressure.
C) reconstn1ct the affected vertebrae.
36. Tucker's case study is not a perfect example for

A) how pet health insurance really pays the owner.
B) how early detection of the disease helps in cure.
C) how much deteriorating is wobblers syndrome.
36
Extract 2
Questions 37-42
You hear an ophthalmologist called Dr Ralph Peterson giving a presentation.
37. What is the benefit of integrating genetics into medical care?

A) helps in post-symptomatic evaluation of a disease
B) helps to intervene before the symptom manifests
C) helps to relay progression and severity of disease
38. Which one is a systemic disease that is not mentioned by Dr Peterson?

A) Hypothyroidism
B) Hypertension.
C) Diabetes
39. According to Dr Peterson, what does result in disease?

A) mutations that occurs in Rhodopsin
B) Rhodopsin responding tremendously to light
C) Rhodopsin responding abnormally to light
40. According to Dr Peterson, whom do the public recognize as viable health care
providers in terms of ocular disease?
A) Optometrists
B) Ophthalmologists
C) Opticians
41. According to Dr Peterson, which healthcare professionals ru·e doing genetic

testing most?
A) Optometrists
B) Ophthalmologists
C) Opticians
37
42. Which is not a factor that is pushing genetic testing into clinical care?
A) decrease in the costs to do the analysis
B) increase in time taken to do an analysis
C) insurance companies are paying to do an analysis
38
39
40
the start of each extract, you'll hear this sound: --beep--
each extract ONCE ONLY. Complete your answers as you listen.
At the end of the test you'll have two minutes to check your answers
41
Extract 1
Questions 1-12
You hear a physiotherapist talking to Linda, a woman who has lower back pain.
Patient: Linda Maxwell

Symptoms :
• having pain on the left side of (1)
• . also felt around hip and buttocks
• . experienced mostly during (2)
• . had on and off for years
• . kicked off as a sort of (3)___________
• . hurts while putting (4)____ on the left leg
• feel a (5)______while roll during sleep
• move down to (6)___________ through back of knee
• pain aggravates while doing exercises
Background
• employed as a (7) -------------
Details
• walk every day to work
• (8)---------------probably 4 or 5 times a week
• run likely around 40 km a week
• normally (9)------------- a twice a week (hasn't lately due tight work schedule)
42
Medical History:
• had injury playing (1o)_________ when young

• located where hip is dislocated
• did a lot of (11)_______
• had lower back pain for couple of years
Initial
• been to a (12)_____ twice Treatment

• did exercises for a while
• usually take anti-inflammatory drugs like Nurofen if pain is high
43
Extract 2 :
Questions 13-24
Your hear a General Practitioner talking to a patient called Xavier Murphy.
For questions 13-24 , complete the notes with a word or short phrase.
Patient Xavier Murphy
Background
• experienced discomfort for the past week

• to condition
• .had a fever for (13)_________
• has been feeling nauseous even in the (14)__________
Effects of .
• vomited in (15)________ both yesterday and today
• condition on
• everyday life .
• doesn't feel hungry and not able to complete meals
Concerns expressed
• feels tired along with (16)_______________and stiff

• in the mornings.
• skin is turning (17)______________
• urine is turning (18)________________in color
Background
• married, father of two children(son - 7 y.o and daughter - 10 y.o)
44
Details
• employed as (19)_____________
• works on (2o)_______________ overseas
• returned lately from Dubai (21)___________
• .heavy smoker (smokes (22)________cigarettes a day)
• .also has a couple of beers most days
Family History
• father retired a (23)________ago (in good health)
• Mother has high blood pressure and takes (24)_________
• .also has three sisters
That is the end of Part A. Now look at Part B.
45
Part B
For questions 25-30, choose the answer A, B or C which fits best according to
what
you hear. You'll have time to read each question before you listen. Complete your
answers as you listen.

You hear a monologue of a doctor briefing about rubella disease.
25. 12.5 million rubella cases were reported in the US,___
A) between 1946 to 1956
B) since 2004
C) between 1964 to 1965
Question 26
You hear a discussion about different types of kidney cancers.
26. Which is not a common type of kidney cancer among adults?
A) transitional cell carcinoma
B) Wilms tumor
C) Inverted papilloma
46
Question 27
You hear a nurse briefing his colleague about a patient.
27. Which one of the following is not correct about the patient?
A) has an extreme limitation of the ability to walk
B) is following a strict heart healthy diet
C) his wife has Alzheimer's and is allergic to penicillin
Question 28
You hear a discussion about common types of neuropathic pain.
Which one of the following is not caused by nerve compression?
A) Phantom limb pain
B) Pudenda! neuralgia
C) Carpal tunnel syndrome
Question 29
You hear two doctors discussing about a new device to ease breathing difficulties
in patients with chronic obstructive pulmonary disease.
29. Which one of the following is incorrect about the new device?
A) looks like a valve
B) reduces lung volume
C) Helps to breathe long
47
Question 30
You hear members of a hospital committee discussing problems in the X-ray
department. .
30.What is the main reason for the congestion?
A) break down of an X-ray machine
B) X-ray department is always a busy department
C) delay in the paperwork for the repair
That is the end of Part B. Now look at Part C
48
Part C
In this part of the test, you'll hear two different extracts In each extract, you'll hear
health professionals talking about aspects of their work. For questions 31-42,
choose the answer A, B or C which fits best according to what you hear.
Complete your answers as you listen. Now look at extract one.
Extract 1
Questions 31-36.
You hear the monologue of a physician, giving a lecture on the different types of
non-Hodgkins lymphoma.
31. Which one of the following statements is not correct?

A) b-cells and t-cells aid in killing infectious agents
B) Lymphomas may arise from t-cells
C) Two types of lymphomas are t-cells and b-cells
32. Which one of the following statements is correct?

High-grade lymphoma cells
A) are easily distinguishable from normal cells
B) have the ability to destroy aggressively
C) have exponential rate of grading cells
49
33. Which one of the following statements is not correct?
Aggressive non-Hodgkin lymphoma
A) always responds better to treatment
B) is cured early after the diagnosis
C) is either high or intermediate grade
34. Which is the most common kind of lymphoma?

A) Follicular lymphoma
B) Diffuse large b-cell lymphoma
C) Nodal lymphoma
35. When lymphomas arise from the lymph nodes, it is called as

A) Nodal disease
B) Extra nodal
C) Nodal lymphoma
36. Which one of the following lymphoma does not look like being in spherical
clusters?
A) low-grade non-Hodgkin lymphoma
B) intermediate -grade non-Hodgkin lymphoma
C) follicular lymphoma
50
Extract 2: Questions 37-42
You hear a physiotherapist called Chris Maloney, giving a presentation about
treating a high jumper with a knee injury. You now have 90 seconds to read
questions 37-42.
37. When Chris first met the patient, he found out that she was _
A) forced to pull out of an event.
B) thinking about quitting the sport.
C) reluctant to various therapists.
38. During the assessment of the patient's knee, Chris concluded that
A) her body type was totally unfit as an athlete
B) she lacked strength in some key muscles.
C) her pain was exclusively located in one area.
39. In the first stage of her treatment, Chris ____

A) was keen on describing the causes in detail
B) took aid from MRI to support his approach
C) was able to clear some pain in therapy
40. Why did Chris discourage taping?

A) the patient was keen on getting taping for relief
B) the treatment aimed to succeed without taping
C) taping does not offer any benefit for the patient
51
41. In the gym activities of patient, Chris's main concern was to ensure that she
was able to
A) manage her own without any additional external support
B) try out a wide range of fitness exercises for more strength
C) focus on following the techniques precisely without error
42. What was the reason behind the changes in patient's run-up technique?
A) to minimize the stress developed on take-off leg
B) to help her achieve more strength before the jump
C) to make her compete without the support of taping.
52
53
54
This test has three parts. In each part you'll hear a number of different extracts.
At the start of each extract, you'll hear this sound: --beep--
hear each extract ONCE ONLY. Complete your answers as you listen.
55
Extract 1
Questions 1-12.
You hear a physician talking to a patient
called Mr. Kevin Chamberlin.
For questions 1-12, complete the notes
with a word or shod phrase.
You now have 30 seconds to look at the
notes.
Patient: Mr. Kevin Chamberlin
Symptoms & disease: persistent cough for the past two weeks and shortness of
breath
• has coronary artery disease and (1)________ with prior stent
supported angioplasty
• has persistent cough for the past two weeks and shortness of breath
• was also treated for (2)___________
• doesn't drink, but smokes regularly
• Past medical history:
• has coronary artery disease since (3)_________
• has peripheral vascular disease for over 10 years
• has chronic obstructive pulmonary disease & (4)____________
Past surgeries:
• had right fem-popliteal bypass about eight years ago
• had neck fusion in the remote past stent supported angioplasty to
(5)_________ in heart.
56
Medications:
• Aspirin 81mg/day, Clopidogrel 75mg/day, Allopurinol 100mg/day,
Levothyroxine (6)_______/day, Lisinopril
10mg/day, Metoprolol 25mg/day, Atorvastatin 10mg/day
Diagnosis:
• cardiovascular studies normal upstroke, distal pulse symmetrical, heart
regular with normal S1 with (7)__________
S4 at the apex & lungs with decreased air entry
• Echocardiogram shows mild bilateral enlargement, left ventricle normal
thickening, mildly dilated ventricle
• EF of 40%, mild mitral regurgitation & (8)______, grade 2
• Nuclear stress study shows fixed inferolateral defects
(9)___________identified
• laboratory data shows normal white cells, hemoglobin11 BUN of 12.1,
creatinine of 0.8. troponin of 0.04. BNP of 5700, had no syncope
Impression:
• (10)________, ischemic with exacerbation of symptoms
•
Further treatment:
• electrophysiology study is required for (11) ________
• defibrillator will be determined at a later stage
• to continue Metoprolol with a little higher dose of 25 mg twice a day, also
continue Atorvastatin
• increase Lisinopril to 20 mg daily to improve (12)__________
• take Hydralazine 50mg
57
Extract 2.
Questions 13-24.
You hear an obstetrician talking to a patient called Vanessa Gordon.
For questions 13-24, complete the notes with a word or short phrase. You now
have thirty seconds to look at the notes.
Patient: Melissa Gordon
• works as a (13) ________
Medical history:
• has occasional (14) ______
• is allergic to penicillin
• has a (15) _______ , non-smoker
• this will be her second child
• took (16) _______ before first pregnancy
• first baby presented as (17)_______
• (18) _________ required during intervention
• after giving birth, had problems with (19)__________
• helped by midwife
• Baby's father
• family history of (20) __________
• child from previous marriage has (21)___________
Points raised:
• not keen on (22)__________
• enquired about the possibility of (23)__________
• provided her with (24)_______ on preparing sibilings for new baby.
58
Part B.
In this part of the test, you'll hear six different extracts. In each extract, you'll
hear people talking in a different healthcare setting.
For questions 25 to 30, choose the answer A, B or C which fits best according
to what you hear.
You'll have time to read each question before you listen.
59
You hear a pharmacist talking to a patient. What does he warn the patient
about?
patient has a prescription from the hospital.
Tylenol affect the functioning of the kidneys.
Ibuprofen reduce blood flow to the kidnys.
Question 26.
You hear a discussion between a nurse and a physician explaining about Nipah
virus
26. Nipah virus was identified in
A) village in Malaysia
B) Singapore
C) Malaysia and Singapore
Question 27.
You hear a radiographer talking to a patient about her MRI scan.
27. What makes the scan easier for the patient?
A) large diameter of equipment
B) the brand new equipment
C) bell that patient can squeeze
60
Question 29.
You hear a pharmacist talking to a doctor about a patient's medication.
29. She says that the medication is making
A) the patient dozy
B) the patient's face dry
C) the patient sloppy
Question 30.
You hear two doctors doing an activity at a staff training day.
30) The references made should be based on
A) evidences from the case notes
B) severity of the symptoms
C) the matter of priority
61
Part C
In this part of the test, you'll hear two different extract In each extract, you'll
hear health professionals talking about aspects of their work. For questions 31-
42, choose the answer A, B or C which fits best according to what you hear.
Extract 1
Questions 31-36.
You hear a geriatrician called Dr Claire Cox, giving a presentation on the
subject of end-of-life care for people with dementia.
You now have 90 seconds to read questions 31-36
62
31. Which one of the following is a correct statement about dementia?
A) is a remediable disease with certain problems
B) is the highest cause of death in Australi a
C) has incalculable course unlike other conditions
32.Why did Dementia Australia decide to examine the issue of end-of-life dementia
care?
Because they
A) lead campaigns ondementia issues and have funds to do researches
B) have many informal proofs that the current system is not efficient
C) need a new Initiative for dementia patients, their families and carers
33.Who were the pollsters of the survey conducted by Dementia Australia?

A) doctors. nurses and others working with patients
B) researchers appointed by Dementia Australia
C) care professionals, family members and carers of the patients
34. Which one of the following is not a finding of the survey conducted by
Dementia
Australia?
A) patients,their family members, carers might be unaware of available services
B) dementia patients are at times reluctant to take pain medications like morphine
C) care professionals are unaware of legal matters related to end-of-life dementia
care
63
35. The patients are legally entitled to
A) adequate pain control only if it did not hasten death
B) refuse food and hydration even in end-of-life care
C) refuse antibiotics only in the end-of-life care
36.Which is the most efficient method to reduce the headache of making decision
on carers?
A) discussing and documenting preferences
B) respecting the wishes of the patients
64
Part C
In this part of the test, you'll hear two different extract In each extract, you'll hear
health professionals talking about aspects of their work. For questions 31-42,
choose the answer A, B or C which fits best according to what you hear.
Extract 1
Questions 31-36.
You hear a geriatrician called Dr Claire Cox, giving a presentation on the subject
of end-of-life care for people with dementia.
31. Which one of the following is a correct statement about dementia?

A) is a remediable disease with certain problems
B) is the highest cause of death in Australi a
C) has incalculable course unlike other conditions
32.Why did Dementia Australia decide to examine the issue of end-of-life dementia
care?
Because they
A) lead campaigns ondementia issues and have funds to do researches
B) have many informal proofs that the current system is not efficient
C) need a new Initiative for dementia patients, their families and carers
33.Who were the pollsters of the survey conducted by Dementia Australia?

A) doctors. nurses and others working with patients
B) researchers appointed by Dementia Australia
C) care professionals, family members and carers of the patients
65
34. Which one of the following is not a finding of the survey conducted by
Dementia
Australia?
A) patients,their family members, carers might be unaware of available services
B) dementia patients are at times reluctant to take pain medications like morphine
C) care professionals are unaware of legal matters related to end-of-life dementia
care
35. The patients are legally entitled to

A) adequate pain control only if it did not hasten death
B) refuse food and hydration even in end-of-life care
C) refuse antibiotics only in the end-of-life care
36.Which is the most efficient method to reduce the headache of making decision
on carers?
A) discussing and documenting preferences
B) respecting the wishes of the patients
66
Extract 2
Questions 37-42
you hear the lecture given by a Dr Aaron Broderick on the topic blood type
classifications.
37. What is the reason behind the various types of blood?

A) cells and the yellow liquid plasma present in blood
B) ABO antigens and rhesus antigens present in blood
C) difference in the blood composition among individuals.
38. Cross-matching of blood types is vital because, _

A) the old red blood cells will attack the new red blood cells
B) antigens in patient's blood will reject new red blood cells
C) it ensures safe red blood cell transfusion in patient
39. Which blood group have antigen in the surface of

red blood cells and antibody in plasma?
A) AB
B) B
C) O
40. In the US, people of which blood group are above five per cent of the
population?
A) AB+
B) B+
C) AB-
67
41. According to Dr Broderick, what determines the blood group of the child?
A) inhered genes
B) genes of both parents
C) genes of the father
42. Which one of the following statements is not correct about anti-0
immunoglobulin?
A) is the cure for severe jaundice and brain damage in fetus
B) inhibits antibodies in the mother to nullify a sensitizing event
C) effect of the medication will remain as far as twelve weeks
68
69
70
71
This test has three parts. In each part you hear a
nun1ber of different extracts. At tl1e tart of eacl1extract, you'll hear this sound:
--beep--
You’11 have time to read the questions before you hear each extract
ONCE ONLY and you’11 hear each extract. Complete your answers
as you listen. . At the end of the test you'11 have two minutes to check
your answers.
72
Extract 1: Questions 1-12.
You hear a physician talking to a patient
called Mr. Medehgui.
For questions 1-12, complete the notes with a word or short phrase. You
now have 30 seconds to look at the notes.
Patient: Medehgui (80 years old)
Symptoms & disease:
• possible idiopathic normal pressure hydrocephalus

Patients description of symptoms:
• 12 months ago he had (1)________ gait

• impairment and incontinence
• had CSF drainage via temporary spinal catheter
Medical history
• has (2)____________ and had a cervical lam1nectomy fusion six

months back
• patient is unable to walk, need a walker and a supporting assistant lo walk
(3)__________is worsened.
Medications
• Mcept 10 mg in the evening

• Carbidopa 25 mg levodopa 100 mg (4)_______Citalopram 40 mg daily
• (5)_________100 mg twtoe a day Finasteride 5 mg once a day
• Flomax (6)________ once a day MuHivit.am n with iron
73
once a day Omeprazole 20 mg once a day
• Senna 8.6 mg twice a day
• Both ty1enol 650 mg and prorncthaz100
• 25 mg (7)____________
Clinical findings:
• The cranial nerve exam shows no upgaze

• Down gaze and horizontal gaze are (8)__________
• Gait is severely impaired
• (9)__________appear larger
• The frontal horn span was previously about 55cm and now it is 6 cm
• The (10)__________ is 15 mm
Impression:
• idiopathic normal pressure hydrocephalus

• Possibility of (11)______________
• incontinence and urinary urgency
Further treatment
• repeat CSF drainage by a spinal catheter

• also recommend (12)_________
Previous illness:
• had skin cancer on arm and bac
74
Extract 2.
Questions 13-24.
You hear a doctor talking to a patient called Selena Ramirez.
Patient: Selena Ramirez (44 years old)
Symptoms and diseases:
• severe headache and pulsatile tinnitus.

• severe headaches and pulsatile tinnitus for the (13)__________________.

• gets pulsations in the head with heartbeat sounds feels pain on upper regions
of (14)______________.
• no nausea or vomiting, no past history of headaches gets pulsating sounds in
(15)______________ear pulsations started after a flight trip
• no drop or change in (16)______________ and vision had dizzy
episodes in the past with nausea
• used to smoke (17) _____________, doesn't drink & smoke now
• Tylenol, Excedrin, a multivitamin and (19)_________ Allergic to
codeine and penicillin
75
Family history of illness:
• father has cancer, hypertension and (20)______
Diagnosis:
• blood pressure at 120 over 78, pulse 64 and regular, temperature is 97.4
• cardiovascular test shows (21)__________and rhythm without murmur

• an old mastoidectomy scar on your left ear.
• (22)________is midline, grossly hearing is intact.
• has pulsatile tinnitus, left ear with eustachian tube disorder as the etiology,
has a possibility of (23)------------ deviated nasal septum, dizziness,
probably due to possible Meniere disease
Further treatment:
• to start a 2 gram, less sodium diet.

• a (24)____________ as a part of workup and evaluation Nasacort AQ nasal
spray, one spray each nostril daily use hearing protection devices at all times
• revaluation in 3 weeks.
That is the end of Part A. Now look at Part B
76
Part B
In this part of the test, you'll hear six different extracts. In each extract, you'll
hear people talking in a different healthcare setting. For questions 25-30 ,
choose the answer A, B or C which fits best according to what
you hear. You'll have time to read each question before you listen.
Complete your answers as you listen. Now look at Question 25.
Question 25
You hear a physician explaining the issues involved in treating lower back
25.The most constructive way to treat back pains issues are using __
A) imaging, spinal injections, opioids and surgery _
B) integrated care and occupational interventions with prevention
strategies
C) bio-psychosocial strategy with initial non-pharmacological treatment
Question 26.
You hear a discussion about melasma and different types of melasma.

Which one of the following types of melasma is characterized by the
presence of excess melanocytes?
A) unnamed type found in people with dark complexion
B) dermal melasma
C) epidermal mel
77
Question 27
You hear a discussion between 2 doctors about VX and its effects.
Which one of the following statements is correct?
Sarin is
A) less toxic by inhalation
B) more toxic by entry through the skin
C) more volatile nerve agent than VX
Question 28
You hear a nurse in the emergency department discussing the care of a
patient with a doctor.
What do they agree to do first?
A) put the patient's arm in a sling
B) wait until the patient calms down
C) treat patient's pain to relax the arm
78
Question 29
You hear a discussion between a doctor and nurse about the cause of
glioma.
Which one of the following types of glioma does not involve
oligodendrocytes?
A) astrocytoma
B) oligoastrocytoma
C) oligodendroglio
Question 30
You hear a doctor explaining to his nurse about functional
gastrointestinal disorders.
30. Which one of the following is the most serious symptom of
functional gastrointestinal disorders?
A) hematochezia
B) Acid reflux
C) abdominal hypersensitivity
79
Part C.
In this part of the test, you'll hear two different extracts. In each
extract, you'll hear health professionals talking about aspects of their
work
.For questions 31to 42, choose the answer A, B or C which fits
best according to what you hear.
Now look at extract one
Extract one
31. What was the evidence received from the spree trial by giving low dose
aspirin to the elderly?
A) no harms and some benefits
B) no harms and no benefits
C) some harms and no benefits
32. What was the endpoint of the study led by Professor John McNeil?
A) ability for the survival
B) how long the elderly remained sound
C) how long the elderly stayed disable
33. Which one of the following statements is not a finding of the study?
A) low dose aspirin did not seem to raise survival
B) low dose aspirin did not prevent stroke
C) high dose aspirin did prevent heart attack
80
A) Aspirin prevents cancer
B) Aspirin heightens bleeding
C) Placebo prevents cancer

Number of people who were diagnosed with dementia
A) was higher in those who took aspirin
B) was lower in those who took aspirin
C) was equal in both cohorts of the study
36. According to Professor John McNeil, among different age

groups
A) the effect of aspirin varied significantly.
B) the effect of aspirin remained the same.
C) the effect of aspirin was negligible.
81
Now look at extract 2.
Extract 2.
Questions 37-42.
You hear a physician, giving a lecture on ankle fractures.
37. The lateral malleolus fracture require surgery if

A) the anklejoint remains stable
B) the ankle joint is unstable
C) fibula fracture is around 4 cm.
38. Which of the following statement is incorrect?

A) Medial malleolus fractures happens at the end of tibia
B) A displaced medial malleolus fracture does not need surgery
C) An isolated lateral malleolus fracture is not very rare
39. Which of the following fractures can lead to arthritis?

A) Bimalleolar equivalent fracture
B) Bimalleolar ankle fracture
C) Displaced medial malleolus fracture
82
40. Which one of the following explains bimalleolar equivalent fracture?
A) has a ligament tear on inner side of ankle

B) is a fracture involving only fibula
C) All of the above mentioned.
41. Which of the following fractures involves only tibia?

A) Posterior malleolus fracture
B) Bimalleolar ankle fracture
C) Maisonneuve fracture
42. Syndesmosis is the

A) force of injury passing through the large ligament
B) large ligament that connects the two bones of leg
C) force of injury passing through supporting ankle ligament
83
84
85
86
the start of each extract, you'll hear this sound:--beep--
each extract ONCE ONLY. Complete your answers as you listen.
At the end of the test you'll have two minutes to check your answers
87
You hear a cardiologist talking to Sarah a patient with a pacemaker. For

questions l- 12 complete the notes with a word or short phrases.
Patient: Sarah
Sarah's medical history:

• 1. Had surgery in _______to correct her heart problem.
• 2. Her parents tried to explain that she had_______
History of surgery and Sarah's memories:
• 3. It was _________after surgery.

• 4. Her lips and nails were __________
• Patient's exercise and fitness:
• 5. She kept________consistently as she was getting older.
• 6. She used to dance for________a Week.
• 7. She is still __________regularly .
• 8. She gets _______every now and then.
• Drinking habits and heart condition:
• 9. She has ________drinks once a week .
• 10. Has________ chest pain
• 11. Noticed _______easily.
• 12. Her family history of heart diseases is _________
88
You hear a GP talking to Kevin about his accident. For questions 13-24,
complete the notes with a word or short phrases.You now have 30 seconds to
look at the notes.
Patient: Kevin
Patient's general medical history, exercise and lifestyle:
13. He is -----------years old.
14. His ----------is lower than average.
15. He ---------for about 100-150 kilometers a week.
Family medical history:

16. His mother is a ----------
17. His father had a --------
Kevin's health problems and medical treatment in West Africa:
18. Had a lot of________ troubles.
19. Had _________constantly.
20. He received____________ medical care.
Patient's bicycle accident and onset of pain :

21. Smashed himself on _______
22. After the accident they went to the __________
23. Pain started after having ___________
24. Pain appeared after____________ level went down.
89
Part B
In this part of the test, you will hear six different extracts. In each extract, you
will hear people talking in a different healthcare setting.
what you hear. You will have time to read each question before you listen.
Now look at question 25.
90
25. Which of the following information is INCORRECT regarding the patient's
condition?
A) His dose of morphine has been increased
B) He is on Amoxi-clav
C) He takes hypertension medication
26. According to the brief given by the nurse

A) It took 10 mins of CPR to reach Return Of Pulse
B) On arrival, the patient's 02 sat was 69°/o
C) He has a history of parathyroid cancer
27. According to to extract

A) The patient is 65 years old
B) Her presenting features were suggestive of pneumonia
C) The patient is to be commenced on antibiotics and steroids
91
28. According to the extract
A) The patient was diagnosed with lung cancer for the first time in 2009
B) When he arrived to the ER, his P02 sat was 68°/o
C) The patient has a history of shortness of breath since one month
29. Regarding the patient's analgesia

A) The pain is well controlled
B) The patient is not allowed to take analgesia anymore
C) Her last dose of analgesia was 3.30 mg

A) The patient is diagnosed as a case of stroke
B) His daughter reported that he was speaking irregularly
C) The patient is showing non-compliance regarding taking his antihypertensives
92
Part C
In this part of the test,you'll hear two different extracts. In each extract, you'll hear
health professiona ls talking about aspects of their work.
93
You hear an interview with Professor Grobman,who's a Professor of Obstetrics
and Gynecology.
94
31. What does professor Grobman believe to be the problem with Induced labor?
A) That it inevitably leads to cesarean section.
B) That a belief was built on the basis of misunderstanding of certain results.
C) That the procedure has not been performed correctly.
32. The population undergoing induced labor are described as biased because
A) There was a greater number of women who underwent induced labor when
compared with those who did not.
B) The difference in the gestational age between the two groups.
C) They had a medical problem that made inducing labor an indication.
33. What point does professor Grohman make by comparing induced to

spontaneous labor?
A) Induced labor is optional.
B) Induced labor precedes cesarean section.
C) Spontaneous labor s safer.
95
34. What is the concern with regard to caesarean delivery truly about?
A) The patient being experiencing child birth for the first time.
B) The patient having co-morbid conditions.
C)The bad outcome when it comes to the babies health.
35. What would professor Grohman like to decrease the rate of?
A) Cesarean sections.
B) Vaginal deliveries.
C) Unnecessary interventions.
36. Women who were randomized to normal vaginal delivery had

.....................outcomes when compared to those going through induced labor
A) worse.
B) better.
C) the same.
96

You hear an interview with Serge Negus and Kathleen Bainbridge, about
Phantom smells.
97
37. Serge states that he lost his sense of smell as a result of
A) a fractured skull.
B) a broken nose.
C) nerve damage.
38. Why didn't Serge mind experiencing phantom smells?

A) The experience wasn't that bad.
B) He realized that it is common and could happen to anyone.
C) It is untreatable anyway.
39. What is Serge telling us about the slightly bad smell that he had?
A) he couldn't find the place where it is coming from.
B) It was unfamiliar to him.
C) He would choose never being able to smell again.
40. According to Kathleen's definition of phantosmia, which of the following is

true?
C) It is always perceived as of something is burning.
B) The patient is considered to be hallucinating.
C) It is not a true phenomenon.
98
41. What does Kathleen say about the study that she participated in?
A) They used batteries as the source of odour.
B) They included a question about phantom smells within the already established
survey.
C) Over 7000 people reported experiencing phantom smells at least once.
42. What is the interviewer's opinion regarding the study?

A) Its results might be somehow inaccurate.
B) It was tested on a small number of subjects.
C) Its outcomes were surprisingly predictable.
99
100
101
the start of each extract, you'll hear this sound: --beep--
each extract ONCE ONLY.
102
Part A
Now, look at the notes for extract one:
you hear Rose, a neonatal intensive care nurse, talking to Peter about his newborn
twin. For questions 1-12 , complete the notes with a word or short phrases.
Father's name: Peter Initial
details:
1. Twin babies born _------------------Weeks early.
2. Olive is named after________________
Olive's current situation:

3. She is small and does not have a lot of-----------------------_____________
4. She was taken to a ____________________
5. She does not have enough _____________ fat to keep her warm.
Nurse’s comment regarding the incubator stay:
6.They will start by giving fluids and trial for __________feed will be initiated
7. She will get out when she can maintain her ______________
103
8. No set weight or ____________________
History of pregnancy and Olive's condition:
9. They started scan by the_____________week.
10.They missed a couple of scans because it was _________________.
11.Olive's placenta contained less
12.Her oxygen saturation is _____________________ which is normal.
104
You hear an optometrist talking to Michael, a man with macular degeneration. For
questions 13-24, complete the notes with a word or short phrases.
Patient: Michael
Patient's comments on his eyes and previous optometrist visits:
13.His last visit to the optometrist was ______________________ago.
14.He purchased his most recent glasses _____________________ago.
15.He has difficulty reading printed_______________ books.

16.In 2006, he noticed ____________________ in reading lines.
17.Ophthalmologist referred him to a ___________________ specialist.
18.Specialist noticed __________________________ in front of retina.

19.Prescribed lucenitus _____________________ to be taken monthly.
20.He visits specialist every _________________ .
Patient's treatment and outcomes:
21.Doctors were ___________________________ .
22.He had _______________________ injections.
Optometrist’s explanation of Amster chart:
23.Most of the time, people do not use it
24.He needs to ________________________ one eye when using it.
105
Part B
In this part of the test, you will hear six different extracts. In each extract, you will
hear
what you hear. You will have time to read each question before you listen.
Now look at question 25.
106
25. Which of the following information is INCORRECT regarding the patient's
condition?
A) He is on amiodarone
B) Has a wounded right sacrum
C) His glucose was high, so he received insulin
26. What is this nurse's opinion regarding the new nurses

A) They want to be given everything without effort
B) They cannot manage 40 beds effectively
C) They want to work hard but they do not have the experience
27. According to to extract

A) The charge nurse had personal problems
B) The new nurse felt respected
C) They were both stressed at work
28. Regarding the patient's vital data

A) Oxygen saturation is 90%
B) Heart rate is 131 bpm
C) Respiratory rate is 11
107
A) Patient's condition is un-usual
B) The bleeding is resulting from the uterine contraction
C) The targeted oxygen saturation is 96%

A) The patient is shocked
B) The patient had been vomitting blood
C) The patient was started on blood transfusion
108
Part C
health professionals talking about aspects of their work.
You hear an interview with Professor John McNeil, who's an expert of preventive
medicine.
109
Extract 1:Questions 31-36
you hear an interview with professor John McNeil, who’s an expert of preventive
medicine.
you now have 90 seconds to read questions 31-36
31. What important information does professor McNeil point up to regarding the
study ?
A) The Increasing number of people taking Aspirin every morning.
B) The longer life-span of those administering Aspirin every morning.
C) That participants had no history of cerebrovascular events.
32. What does professor McNeil say regarding the results of the results of the trails
concerning the link between Aspirin and Cancer?
A) More Clinical trials are needed in order to come to answer.
B) The exact effect is not yet confirmed.
C) it proves that people who take Aspirin are more liable to die of cancer.
33. How does professor McNeil describe the course of bleeding as a complication?
A) Progressive.
B) Continuous.
C) Regressive.
34. What aspect of the study is considered important and needs further research ?
A) Effects of Aspirin on the course of some diseases on the long run.
B) the fact that people who are overweight might require larger doses.
C) The similarity of odds regarding the development of dementia when comparing
the two arms of the study.
110
35. The study was conducted over a period of five years to notice if the patient’s age
is related to
A) The long-term complications.
B) Patient’s compliance.
C) The influence of Aspirin.
36. Which of the following reasons does not require daily intake of Aspirin
as to professor McNeil opinion?
A) Upon doctor’s advice.
B) prophylaxis from the occurrence of some diseases.
C) prophylaxis from the reoccurrence of some diseases.
111
Now look at extract two
You hear an interview with Dr. Miranda Davies-Tuck, who's a perinatal

epidemiologist. You now have 90 seconds to read questions 37-42.
37. "planned home-birth" is a choice made by some women upon

A) their financial status.
B) personal preference.
C) previous experience.
38. Which of the following does not categorize a women as being at high risk?
A) high birth weighted babies.
B) fetal mal-presentations.
C) previous elective caesarian section.
39. In low risk women, The lower rate of morbidity in home delivered babies is a
result of it being
A) well planned.
B) performed in a more friendly environment.
C) less likely to involve advanced medical equipment.
40.What does Dr. Davie-Tuck mention as the reason behind the higher mortality
rates in home deliveries of high-risk women?
A) The co-morbid conditions.
B) The barriers that hinder their transfer to the hospital.
C) Not yet identified.
112
41.What is Dr. Davie-Tuck excited about regarding the studies in her country?
A) That they are mimicking those from international studies.
B) That they are growing in number and effectiveness.
C) That it helped a lot in the process of risk assessment.
42.Which of the following is a method that was used to overcome the barriers
involving transferring high risk women to the hospital?
A) Providing more experienced midwives.
B) Establishing for a more appropriate midwife-obstetrician interaction.
C) Maintaining continuous after-birth follow-up.
113
114
115
This test has three parts. In each part you'll hear
a number of different extracts. At the start of each extract, you'll hear this
sound:--beep--
hear each extract ONCE ONLY.
116
Part A
Now, look at the notes for extract one
117
Extract 1: Questions 1 to 12
You hear a doctor talking to a patient called Mrs. Garcia.
For questions 1 to 12, complete the following notes with a word or short
phrase.
Patient : Mrs. Gracia
Age : 51
Symptoms & disease :
• weakness on the left leg and numbness in the left hand, shortness of
breath
• persistent mild weakness on the left leg and occasional

(1)________________ shortness of breath often.
• : had repeat (2)____________- and further imaging studies that showed.
• no further increased stenosis in my left internal carotid artery.
• is ambulating with: a cane
Past medical history :
• had a (3) _________ and treated

Past surgeries :
• none
Family history of illness : none
118
Medications :
Plavix. aspirin. (4)_________lisinopril hydrochlorothiazide , Lasix ,insulin and
(5)________________
Allergies :
• none
• blood pressure 170'66. heart rate 66. (6)_______ weight 254 pounds.
temperature is 98.0.
Diagnosis :
• Normocephalic and atraumatic. No dry mouth. No palpable cervical

lymph nodes. (7)________ are clear.
• Cranial nerves shows mild decrease in the(8)____________

• that is a (9)_____________ in the left upper extremity.
• Deltoids shows 5-'5. The rest showed full strength.
• (10)____________The rest showed full strength. is was mildly
Reflexes were hypoactive and symmetrical.
• Gait is was mildly Abnormal. No ataxia noted . Wide based.
Impression :
• Status post cerebrovascular accident involving the right upper pons

extending into the (11)_________- with a mild left hemiparesis.
has been clinically stable with mild improvement.
119
Further treatment :
• continue with (12)_________ to reduce the risk of future strokes.

patient should control blood sugar level, optimizing cholesterol
and blood pressure control. regular exercise and healthy diet.
surgical intervention for the internal carotid artery
120
Extract 2:
Questions 13 to 24
You hear a physician talking to a patient called Andrea Jeremiah.
For questions 13 to 24, complete the following notes with a word or short
phrase.
Patient : Andrea Jeremiah

Age : 17
Symptoms & disease :
• tonsil problem with throat pain.
• has tonsil problem for many years and having throat pain.
• swallowing.
• Getting (13)_________________No difficulty in
• no sleep apnea (14)___________ at night tunes
• gets about (15)___________ 1 every year
Past surgeries :
• had (16)______________
Medications :
• none
Allergies :
• none
121
Family history of illness :
• sister has (17___________ and other family members have cancer.
diabetes. heart disease. and hypertension.
Physical examination :
• pulse is 80 and regular. temperature 98.4. weight is 184 pounds.
Diagnosis :
• tongue. lip, floor of mouth are noted to be normal. (18) _______ does
reveal very large tonsils (19)_________
• they were (20)________Minor examination of
• (21)_________________reveals some mild edema of the larynx. You have
enlarged tonsils.
• Impression : adenotonsillitis with (22)______________
• (23)______________ I with mild acute laryngitis. obesity
• Further treatment : (24)__________________
122
Part B
For questions 25 to 30, choose the answer A, B or C which fits best according to
what you hear. You'll have time to read each question before you listen.
123
Question 25.
You hear a nurse in the emergency department discussion the care of a patient with a
doctor.
What do the speaker agree to do?
A) Put the patient's arm in a sling
B) Wait for the patient to calm down.
C) Treat the patient's pain to relax the arm.
Question 26.
You hear a trainee doctor discussing a patient diagnosis with a tutor
What is the diagnosis?
A) Coeliac disease
B) Constipation
C) Bilateral lower abdominal pain
Question 27
. You hear a hospital nurse briefing a colleague about a patient recovering from
elective surgery.
What does he want his colleague to do?
A) Review post-op information with the patient
B) Provide pain relief for the patient
C) get the patient a medical certificate
Question 28.
You hear two hospital managers talking about an information session for people
who want to do voluntary work
What problem do the managers discuss?
A) How difficult it is for participants to get to the event.
B) Technical issues with the event management systems.
C) Finding good quality food and drinks for the event.
124
Question 29. You hear a pharmacist talking to a doctor about a patient's medication.
What is the pharmacist doing?
A) Reporting side effects
B) Checking the dosage
C) recommending an alterative
Question 30. You hear a doctor advising a patient about a change in medication.
What condition is the patient being treated for?
A) hay fever
B) drowsiness
C) hives
125
Part C
In this part of the test, you'll hear two different extracts. In each extract, you'll
hear health professionals talking about aspects of their work.
126
Extract 1:
Question 31 to 36
You hear the doctor briefing his staff about the pathology report.
You have 90 seconds to read question 31 to 36.
31.Which of the following pieces of information is included in the general

information?
A) Special requests made to pathologist
B) Unique number of the specimen
C) Medical history
32. Gross description is very short for;

A) Cytology
B) Small biopsy
C) Larger biopsy
33. The gross description of a mastectomy biopsy of

breast cancer will not include;
A) How many lymph nodes were detected in the underarm area
B) Particulars of the non-cancer tissues
C) The extent of invasion to the nearby tissues
34. The size of the cancer tumor is mentioned in;

A) Microscopic descriptions
B) Gross descriptions
C) Diagnosis
35. The flow cytometry information is obtained through;

A) Larger biopsy
B) Cytology
C) Microscopic diagnosis
127
36. On which part of the pathology report is used to diagnose further?
A) Microscopic descriptions
B) Additional notes
C) Additional diagnosis
128
Extract 2: Question 37 to 42
You hear the doctor giving a lecture to the junior doctors on Lung Carcinoid
Tumors. You have 90 seconds to read question 37 to 42
37. Tiny blood vessels run through;

A) Trachea
B) Alveoli
C) Bronchioles
38 The part that protects the lungs is

A) Pleura
B) Alveoli
C) Diaphragm
39. The muscle that separates the chest from the abdomen is
A) Pleura
B) Diaphragma
C) Alveoli
40. People living at higher altitudes will have;

A) A large pleural cavity
B) Increased lung neuroendocrine cells
C) A thin diaphragm
41. Which of the following types of cancer does not

grow aggressively?
A) Small cell lung cancer
B) A typical lung cancer
C) Typical lung cancer
129
42. Peripheral carcinoids form;
A) In the bronchioles toward the outer edges of the lungs
B) In the bronchial walls near the center of the lungs
C) Beyond the lungs.
130
`
131
132
This test has three parts. In each part you'll hear a
number of different extracts. At the start of each extract,
you'll hear this sound:
--beep--
You'll have time to read the questions before you hear
each extract and you'll hear each extract ONCE ONLY.
At the end of the test you'll have two minutes to check
your answers.
133
You hear an obstetrician talking to a new patient called Aidan Fitzpatrick. For
questions 1 to 12, complete the notes with a word or short phrase.
Patient Aidan Fitzpatrick
Symptoms
• first noticed difficulty reading two weeks ago
• describes his vision as ‘(1)_____________’
• has difficulty reading printed letters
• needs increasingly (2)_____________ to read in evenings
• found he was having to hold object closer to see
• purchased glasses from (3)_________________
• often finds that he's (4)_________ his eyes, even when wearing glasses
• when struggling to see, can also experience (5) ______________
• Aidan treats pain with (6)__________ (fast-acting)
Background Details
• wore glasses as a child
• brother also wears glasses, possibly (7) ___________
Medical History
• recently suffered from (8) ____________
• treated with antibiotics
• still experiencing symptoms of (9) _______________________
• lost excess weight following a (10) ____________(describes as 'wakeup call')
• Next steps
• isn't willing to wear (11) ____________
• must be given (12) ____________(never had one)
134
You hear an obstetrician talking to a new patient called Hilary Johnson. For
questions 13 to 24, complete the notes with a word or short phrase.
Reason for referral

• glucose in (13)__________indicates risk of diabetes
• describes herself as (14)___________sugary foods
• noticed extra (15)____________which may be unrelated to pregnancy
Family history of diabetes

• her (16)__________suffers from diabetes (Type 2, controlled through diet)
Pregnancy – symptoms
• morning sickness — pain in her (17) ________,
• but vomiting (18)____________controlled with medication
• recently suffering from backache, described as 119)' pain
• has been feeling increasingly (20) ____________
• problems sleeping
• concerned about diet (talking a (21)_____________)
Occupation
• Secondary school teacher
• felling (22) ________ , increased workload
Next appointment
• will take an (23)________ glucose test (she's familiar with the
• procedure, a friend's had the test).
• has been given a (24)__________to consult ahead of her blood test
135
Part B
what you hear. You'll have time to read each question before you listen.
25. You hear an ED nurse talking to the relative of apatient who has been recently
admitted.
What is the relative doing?
A) describing her father's medical history
B) suggesting ways to interact with her father
C) explaining that her father can become violent
26. You hear an obstetrician describing a caesarean section to a pregnant patient.

He says that the procedure will
A) be shorter and less painful than a traditional birth.
B) be carried out while the patient is conscious.
C) not be necessary in the patient's case.
27. You hear a GP and his practice nurse discussing their yearly schedule.
They agree that the practice should
A) hire agency staff to help during the busier weeks.
B) avoid taking holiday in the beginning of September.
C) look after their health, to lower the likelihood of sickness.
136
28. You hear a nurse preparing a patient for a flu shot. What is the nurse doing?
A) explaining why the flu shot is necessary
B) discussing why the flu shot causes reactions
C) describing common side effects of the flu shot
29. You hear a doctor talking to a patient about her injury. What will happen when
the patient returns to the surgery?
A) She will have her stitches removed.
B) The doctor will stitcup her wound
C) They will see if the wound will scar.
30. You hear a trainee nurse asking a senior colleague about the treatment for a
patient with chronic obstructive pulmonary disease, or COPD.
The senior colleague is explaining that giving such patients normal levels of oxygen
A) can inhibit breathing rate.
B) will cause light-headedness.
C) lowers carbon dioxide levels.
137
Part C
health professionals talking about aspects of their work.
For questions 31 to 42, choose the answer (A, B or C) which fits best according to
what you hear.
138
You hear an interview with Dr Tadita Hussein, who's talking about treating patients
with cystic fibrosis.
31. Dr Hussein says that patients with cystic fibrosis

A) may find the side effects alarming.
B) tend to require treatment from a young age.
C) can improve their condition with frequent hospital visits.
32. What does Dr Hussain say is difficult when treating patients who are not in
hospital?
A) They often find the exercises too complicated.
B) They tend to have difficulty socialising with other people.
C) They don't always understand the importance of their treatment.
33. What does Dr Hussein say about the role of 'distraction therapy' in cystic fibrosis
treatment?
A) It can be related to the treatment being provided.
B) It allows patients to complete their activities more quickly.
C) It provides staff with more information about the patient's condition.
34. What changes did Dr Hussein observe in one of her patients?

A) He showed respiratory improvement.
B) He deteriorated rapidly following a change in treatment.
C) He began to enjoy aspects of their treatment.
35. Dr Hussein plans to use technology to help cystic fibrosis patients to

communicate
A) with other patients who suffer from the condition.
B) with family members who cannot visit them in hospital.
C) with patients of a similar age suffering from different conditions.
139
36. Dr Hussein suggests that future treatments for cystic fibrosis
A. will always incorporate lengthy procedures.
B. could prevent breathing difficulties in sufferers.
C. might be less painful than the current options available.
140
You hear a presentation given by Dr Hubert Johnson, who's talking about ways to
improve efficiency.
37. Dr Johnson explains that delays are increased when patients believe
A) their appointment will not begin on time.
B) staff are not concerned about late-arrivals.
C) being late for appointments will not impact others.
38. Dr Johnson uses an example of poor efficiency to illustrate the point that
A) healthcare professionals should assist staff during busy times.
B) practices should avoid limiting appointment booking options.
C) staff should be trained to handle demanding situations.
39. Dr Johnson explains that, in order to improve efficiency, healthcare practices

must
A) sanction patients arriving later than 10 minutes.
B) avoid booking appointments in the morning.
C) show patients that they can run on time.
40. Dr Johnson says healthcare professionals often forget that patients who book
appointments must first
A) feel that they need a consultation.
B) find a time and date that works for them.
C) consider what might be causing their issue.
41. What happened when Dr Johnson began giving weekly presentations to patients?
A) Dr Johnson was able to work fewer hours.
B) The general health of patients was increased.
C) The number of appointments at the practice decreased.
141
42. How does Dr Johnson feel about the use of technology when booking
appointments?
A) Practices should begin to encourage all patients to make bookings online
B) It can increase efficiency if other booking methods are continued.
C) Elderly people are most likely to struggle to use it.
142
`
143
sound:
--beep--


your answers.
144
You hear a doctor talking to a patient called Magtanggol. For questions 1 to 12,
complete the following notes with a word or short phrase.
You now have thirty seconds to look at notes.
Patient: Magtanggol
Age: 51
Symptoms & disease:
• Diplopia
• Since last year, having double vision when waking up in the morning :
• this lasts for one hour.
• : when closing hiseyes the (1)________
• : the problem worsened recently
• : recently, the object started (2) _____________
• : recently developed (3) ___________
• : no dysphagia,
• : no difficulties in speaking or (4) _____________-
• : no weakness, numbness, tingling or any neurological issue!
• : doesn't drink, but smokes
• mother died of a stroke when she was ninety

• : father had (5)______________
• BP 124/76 (6)______________
145
Diagnosis:
• MRI report shows a questionable (7)__________________

• of the medial left supraclinoid internal carotid artery.
• : no abnormalities on the right side
• : blood flow patterns are normal there is no
Impression:
• developed a condition of (9)____________ or
• other disorder right lid (10)_________ left gaze diplopia
• possibilities of other (11)_____________horizontal diplopia in both directions,
no vertical diplopia. Monocular diplopia.
Further treatment:
• (12)_____________ to treat the aneurysm
146
You hear a physician talking to a patient called Mr. Medehgui. For questions 13 to
24, complete the following notes with a word or short phrase.
Patient: Medehgui Age: 80
Symptoms & disease:
• possible idiopathic (13)_________________
• twelve months ago she had severe

• cognitive impairment, (14)__________and incontinence
• : had CSF drainage via a (15)_________________
Medical history:
• has cervical stenosis had a (16)_________________

• and instrumented fusion six monts back
• : patient is unable to walk using a walke and a supporting assistant to walk.
• : memory is worsened
Medications:
• Aricept 10 mg in the evening, carbidopa 25 mg or levodopa 100 mg
• three times a day, (17)________Colace 100 mg twice a day,
• finasteride 5 mg once a day, (18)__________ once a day,
• multivitamin with iron once a day, omeprazole 20 mg once a day, senna 8.6
mg twice a day, (19)____________ as needed, and promethazine 25 mg as
needed.
• : The (20)__________ shows thre is no upgaze
• : The down gaze and (21)___________ are intact.
• : gait is severely impaired
• : ventricles appear larger
• : The (22)___________was previously about 5.5 cm and now it is 6 cm. The
3rd ventricular span is 15 mm.
147
Impression:
• idiopathic normal pressure hydrocephalus :

• possibility of (23)____________
• : incontinience and urinary urgency
Further treatment:
• (24)____________________
148
Part B
people talking in a different healthcare environment.
what you hear. You'll have time to read each question before you listen to the
audio. Complete your answers as you listen the audio.Now look at Question 25.
25. You hear a monologue by a physician explaining

about Lupus disease.
Lupus disease;
A) Causes the antibodies to act against antigens.
B) Leads the immune system to act against antibodies.
C) Causes antibodies to act against the healthy tissues
26. You hear a discussion between a doctor and a nurse

on leukopenia disease.
The white blood cell that can mend the damaged tissue is;
A) Lymphocytes
B) Monocytes
C) Basophils
27. You hear a discussion between a doctor and a nurse

on different stages of gout.
In which of the following gout stages the joints are irritated
by calcium phosphate crystals?
A) Pseudogout
B) Intercortical stage
C) Chronic tophaceous stage
149
28. You hear a discussion between a doctor and a nurse on
different types of gum graft surgery.
Which gum graft surgeries is performed for individuals with inadequate gums?
A) Pedicle grafts
B) Gingival grafts
C) Connective tissue grafts
29. You hear a discussion between a doctor and a nurse about medical conditions
that cause undigested food to appear in the stool In which of the following diseases
the patient becomes incapable to digest gluten in grains?
A) Celiac disease
B) Crohn's disease
C) Pancreatic insufficiency
30. You hear a discussion between a doctor and a nurse about

different procedures to detect blood clots.
Which of the following procedures uses catheterization technique?
A) Endocardiography
B) Ventilation-perfusion
C) Angiography
150
Part C.
health professionals talking about specific aspects of their work.
what
you hear. Complete your answers as you listen.
151
Extract 1
Question 31 to 36
You hear the lecture given by a physician on colectomy surgery. You have 90
seconds to read questions 31 to 36
31. What is an ileostomy?

A) Removal of rectum in surgery
B) A procedure to dispose the stool
C) Sewing of terminal ileum together
32. The last part of the small intestine is sewn together in;
A) Proctocolectomy surgery
B) Total Colectomy surgery
C) J-Pouch surgery
33. Rectum is not removed in;

A) Proctocolectomy
B) Total colectomy
C) Partial colectomy
34. Rectum is not removed in;

A) Ileoanal Anastomosis
B) Total colectomy
C) Partial colectomy
35. The surgery that is not done for the patients with ulcerative colitis is;
A) Partial colectomy
B) Total colectomy
C) Hemicolectomy
152
36. Which of the following surgeries doesn't require a stoma?
A) Partial colectomy
B) Hemicolectomy
C) Total colectomy
153
Extract 2
Questions 37 to 42
You will hear the monologue of a physician giving a lecture on ankle fractures You
have 90 seconds to read questions 37 to 42
37. A surgery will be required in lateral malleolus fracture if;

A) The fibula fracture is within 4 centimeters of the end of the bone
B) The inner part of the ankle is injured
C) The fracture involves lateral malleolus
38. Which of the following statements is correct?

A) Medial malleolus is also called tibia
B) Lateral malleolus fractures involve only tibia.
C) An isolated lateral malleolus fractures are very rare compared
with an isolated medial malleolus fracture.
39. Which of the following fractures can lead to arthritis?

A) Trimalleolar ankle fracture
B) Bimalleolar Equivalent Fracture
C) Bimalleolar ankle fracture
40. Which of the following fractures involves only fibula?

A) Bimalleolar equivalent fracture
B) Posterior malleolus fracture
C) Medial malleolus fractures
154
41. Which of the following ankle fractures doesn't
involve both fibula and tibia?
A) Maisonneuve fracture
B) Bimalleolar equivalent fracture
C) Posterior malleolus fracture
42. The impact of the fracture damages the syndesmosis in;

A) Bimalleolar Equivalent Fracture
B) Maisonneuve Fracture
C) Posterior Malleolus Fracture
155
156
157
sound:
--beep--


your answers.
158
You hear a GP talking to a patient called Daniel Anderson.
For questions 1 to 12, complete the notes with a word or short phrase. You now
have 30 seconds to look at the notes
Patient Daniel Anderson
• 2wks/ (1)_____ than usual

Presenting Symptoms
• Short of breath
• Cold/sore throat
• Last (2)_________months
• Ongoing condition
• Patient managed conditions
• Bad sore throat and (3)______________
• Fatigue
• Shortness of breath — becoming more (4)_________________
Recent History
• Breathing normal (5)________________________

• No history (6)_________________ /chest problem
• Non-vegetarian
• Describe diet as (7)_________________
• Low fruit and vegetable intake
• Drinks (8)_______________ of coffee a day
• Ongoing mild indigestion
• Bowel Funtion -(9)____________________
• No family history (10)______________________
• Parents — healthy
Family History
• (11)_________________ - no know healthy problem
• Patient suspects (12)____________
159
You hear a GP talking to a patient called Mrs Wringht.
For questions 13 to 24, complete the notes with a word or short phrase. You now
have 30 seconds to look at the notes
Patient Mrs. Wringht
• Follow up consultation
• Patient has (13)________
• Initial episode (14)__________months ago
• Prescribed (15)________for 5 days
• Alopurinol
• Recurrence of gout just (16)___________
• Gout originates at bottom of (17)_____________
• On the (18)______________foot
Background
• Swelling radiates across toes towards (19) _______ of foot
• Hot and inflamed
• No swelling in (20) ______________
• Responded well to medication
• Swelling settled within (21) _______________
• Ongoing (22) ________ in toe
• Suspected (23) ________________
X-ray clear
• Patient has some concerns
Treatment•
• Patient agrees medication effective

• Clinical Decision (24) _____________with current medications
160
Part B: In this part of the test, you'll hear six different extracts. In each extract,
you'll hear
audio. Complete your answers as you listen the audio.
25. You hear two doctors discussing the new device to ease breathing difficulty
in patients with chronic obstructive pulmonary disease.
Which of the following statement best suits this extract?
A) Reducing the volume of lungs is emphysema patients will help them to breathe
more easily
B) Shortness of breath is the point when you find it difficult to take a deep breath in.
C) A new device is to be introuced to the patients to descrease the volume of their
lungs.
26.You hear a doctor explaining to his nurse about Functional

Gastrointestinal Disorders
Which one of the following is a severe symptom?
A) Abdominal distention
B) Hematochezia
C) Acid reflux
27. You hear two doctors talking about the differences between
conductive and sensorineural hearing impairment
Impairment of which of the following part of the ear causes conductive hearing loss?
A) Cochlea
B) Myringa
C) Vestibulocochlear nerve
161
28. You hear a doctor briefing a junior doctor about Eczema. Which of the following
statements is incorrect?
A) Eczema is caused when the inflamed skin retains enough moisture.
B) The disease is aggravated by moisture from sweating or humidity
C) Stress can also cause eczema.
29. You hear a doctor's dialogue on the vaccine for hepatitis B virus. What if the
patient doesn't develop a protective antibody titer?
A) Should be vaccinated again.
B) Target titer of 10 international unit or 10 ml should be repeated.
C) The hepatitis B surface antibody titer should be monitored again.
30. You hear a doctor explaining to his patient about a bone marrow biopsy.
Bone marrow aspiration is taken from;
A) The center bone in the chest called ilium.
B) Pelvic bone.
C) Lower back, near the hip.
162
Part C.
what
Extract 1 Question 31 to 36
You hear the lecture given by a physician on the topic white blood cell disorders.
You have 90 seconds to read question 31 to 36
A) Caucasians have less white blood cells
B) White blood cells decrease as the infant grows
C) Red blood cells fights infections
32. Which of the following white blood cells fight parasitic infections
A) Eosinophils
B) Lymphocytes
C) Basophils
33. Neutrophils fight against;

A) Fungal infections
B) Bacterial infections
C) Viral infections
163
34. The white blood cells involved in inflammatory reactions is;
A) Eosinophils
B) Basophils
C) Neutrophils
35. Which of the following conditions is genetically caused?

A) Autoimmune neutropenia
B) Leukophilia
C) Cyclic neutropenia
36. Patients with which of the following conditions have recurrent bacterial
infections?
A) Severe congenital neutropenia
B) Cyclic neutropenia
C) Autoimmune neutropenia
164
Extract 2
Question 37 to 42
You hear the monologue of a physician giving a lecture on The Different Types of
Non-Hodgkin's Lymphoma.
You have 90 seconds to read questions 37 to 42

A) More common type lymphoma is T-cell Hodgkin Lymphoma
B) Hodgkin lymphoma is a larg group of diseases.
C) B-cell non-Hodgkin Lymphoma is more common type.
38. Which of the following statements is incorrect?

A) High-grade lymphoma cells look quite similar from normal cells
B) Low-grade lymphoma cells appear similar to the normal cells
C) High-grade lymphoma cells look multiply gradually.

A) Aggresive non- Hodgkin Lymphoma responds better to treatment
B) Low-grade lymphoma often responds better to treatment
C) B-cell lymphoma is the most common low-grade lymphoma
40. Which of the following type of lymphoma doesn't give rise to many symptoms?
A) Aggresive non-Hodgkin Lymphoma
B) Indolent non-Hodgkin Lymphoma
C) Diffuse non-Hodgkin Lymphoma

A) Lymphomas originate in the brain is a nodal lymphoma.
B) Lymphomas originate in the stomach is an extranodal lymphoma.
C) Nodal lymphoma never arises only from the lymph nodes
165
A) In diffuse non-Hodgkin Lymphoma, the cells are spread around in spherical
clustering.
B) A high-grade non-Hodgkin Lymphoma appears follicular
C) Most of the low-grade non-Hodgkin Lymphoma are in spherical clusters.
166
167
168
sound:
--beep--


your answers.
169
You hear a doctor talking to a patient called Bryan Harris. For questions 1 to 12,
complete the notes with a word or short phrase. You now have 30 seconds to look at
the notes
Patient: Bryan Harris
Age: 42
Symptoms & disease:

• several hyper granulation tissue developed from previous wound
• he had a traumatic injury to his left posterior last year. Got hit from a boat
while he was in the water, had an extensive surgery, still having an
(1)_____had full thickness (2)________________ close to defect in his
posterior thigh. In several areas along the graft site and low in the leg, there are
several hypergranulation tissue developed.
• : no bleeding
Past medical history:

• (3)___________________
Medications:
• Cipro and (4)__________

• Family history of illness: maternal grandmother had (5)________ father had
prostate cancer, and he has having heart disease and diabetes.
170
Diagnosis:
• Cardiology reports are regular. There is no (6)___________There is no
murmur. Abdomen is soft. It is nontender. There is no mass or organomegaly.
• : right lower extremity is unremarkable. Peripheral pulse is good.
• : left lower extremity is significant for the (7)______________
• : of a large defect in the posterior thigh, which is nearly healed.
• : Hypergranulation tissue both on (8)_______________
• : one small area right essentially within the graft site, and there is
• : one small area (9) ___________There is an external fixation
• : on that (10) _________ The pin sites look clean.
Impression:
• several multiple areas of hypergranulation tissue on the left posterior leg
associated with a (11)__________
Futher treatment:
• series of treatment with (12)________ of these areas till these are Closed
171
You hear a physician talking to a patient called Thomas Andrew. For questions 13
to 24, complete the notes with a word or short phrase. You now have 30 seconds to
look at the notes
Patient: Thomas Andrews

Age: 52
Symptoms & disease:

• Hypertension, chronic intermittent bipedal edema, and recurrent leg venous
ulcers.
• Patient's description of symptoms: patient with hypertension, chronic
intermittent bipedal edema, and recurent leg venous ulcers, had a
(13)_________ for nonhealing right ankle stasis ulcer.
• : doesn't drink or smoke
• : No nausea, vomiting or diarrhea

• hypertension, (14)___________in 2016 for abdominal obstruction,
(15)__________ in 2017, chronic intermittent bipedal edema, venous
insufficiency, chronic recurrent stasis ulcers. Medications: Primaxin,
(16)___________ clonidine, furosemide, potassium chloride, lisinopril,
metoprolol, ranitidine, (17) __________ amlodipine, zinc sulfate, Lortab,
multivitamins with minerals.
Allergies: none
Diagnosis:
• There is (18)_____________ involving the distal calf of both legs. There is an
open wound on the (19)____________
• measuring 9 x 5 cm with minimal serous drainage. Periwound is
hyperpigmented with a hint of (20)_____________to the medial aspect, distal
third of the right lower leg. There is warmth, but minimal tenderness on
palpation of this area. There is also a wound on the right lateral malleolar area
measuring 4 x 3 cm, another open wound on the left medial malleolar area
measuring 7 x 4 cm, (21)_______________
172
Laboratory results:
• show white blood cell count is 5.8 with (22)_______________ H & H
11.3/33.8, and platelet count 176,000. BUN and creatinine 9.2/0.52, Albumin
3.6, AST 25, ALT 9, alk phos 87, and total bilirubin 0.6.
Chest x-ray:
• shows chronic bibasilar subsegmental atelectasis likely related to elevated
hemidiaphragm secondary to chronic ileus.
Impression:
• multiple previous wound cultures positive for (23)____________
Enterococcus, and Stenotrophomonas,
• Fevers, Right leg/ankle cellulitis. Chronic brecurrent bilateral ankle venous
ulcers, Hypertension.
Further diagnosis & Treatment:

• 2 sets of blood cultures, Injection with (24)______________________
173
Part B
25. You hear a monologue by a physician explaining about Gallstones. Which of the
following statements is correct?
A) Pigment stones are yellow-green in color
B) Pigment gallstones are made of bilirubin
C) Patients with cholesterol gallstones will have cirrhosis of the liver, biliary tract
infections, and hereditary blood disorders, including sickle cell anemia
26. You hear a discussion between a nurse and a doctor on Crohn's Diseases.
Crohn's disease that effects the colon and adjacent ileum is;
A) Ileocolitis
B) Ileitis
C) Jejunoileitis
27. You hear a discussion between a nurse and a doctor on diagnosis methods for
endometrial cancer and its stages.
Endometrial cancer is within the pelvie area during;
A) Stages 1 to 2
B) Stages 3 & 4
C) Stages 1 to 3
174
28. You hear a discussion between a nurse and a doctor on types of hemorrhoids and
their effects.
Which of the following statements is correct?
A) Internal hemorrhoids are indentified by a lump on the surface of the anus.
B) Pain occurs if the internal hemorrhoid begins to prolapse.
C) Pain becomes severe when internal hemorrhoid clots.
29. You hear a discussion between a nurse and a doctor on different categories of
chemotherapy drugs.
Navelbine comes under which type of type drug?
A) Alkylating agents
B) Plant Alkaloids
C) Antimetabolites
30. You hear a discussion between a nurse and a doctor on different types blood
disorders.
In which of the following blood disorders bone marrow make excessive number of
red blood cells?
A) Neutropenia
B) Polycythemia
C) Immune thrombocytopenic purpura
175
Part C.
what
You hear the lecture given by a physician on the topic blood type classifications.

A) Viruses and bacteria are antigens
B) Red blood cell antigens are protein molecules
C) Red blood cells produce antibodies
32. In which of the following blood groups the plasma does

not contain anti-A antibodies?
A) B group
B) AB group
C) A group
33. What is the criterion that makes the blood type for transfuring to the patient with
any blood group?
A) Having none of A or B antibodies
B) Having none of A or B antidgens
C) Having A antigen and anti-B antibody
176
34. In the US 39 percent of the population are with;
A) A positive blood
B) RHD-positive blood
C) 0 positive blood
35. Which of the following blood types is considered as 'Universal Donor Type'
A) 0 negative
B) 0 positive
C) AB positive
36. What is a sensitization during pregnancy?

A) If the antibody from the mother attacks red blood cells of the fetus
B) If the RhD from the fetus attacks the red blood cells of the mother
C) If the RhD from the mother attacks the red blood cells of the fetus
177
Extract 2
Question 37 to 42
You hear the monologue of a physician giving a lecture on Types of Eczema.
You have 90 seconds to read questions 37 to 42
37. Which of the following types of eczema occurs due

to inhalant allegies?
A) Irritant dermatitis
B) Allergic contact dermatitis
C) Atopic dermatitis
38. What occurs due to poor blood circulations in the veins of the legs?
A) Atopic dermatitis
B) Staisis dermatitis
39. Poison Ivy is;

A) An irritant dermatitis
B) Allergic contact dermatitis
C) Scabies
40. Tiny blisters on the sides of the sides of the fingers or toes and palms or soles are the
symptoms of
A) Fungal infecttions
B) Scabies
C) Pompholyx
41. Eczema that produces thickened plaques on the shins and neck is;
A) Lichen simplex chronicus
B) Seborrheic dermatitis
C) Dyshidrotic eczema
178
42. Oozy rash behind the ears is caused by
A) Lichen simplex chronicus
B) Seborrheic dermatitis
C) Dyshidrotic eczema
179
180
181
a number of different extracts. At the start of each extract, you'll hear this sound:
--beep--


your answers.
182
You hear a doctor talking to a patient called Tainatongo. For questions 1 to 12, complete
the following notes with a word or short phrase. You now have 30 seconds to look at the
notes
Patient: Tainatogo
Age: 36
Symptoms & disease:

Allergies

• intolerance to grass allergies, (1)____________no anaphylaxis or angioedema

• when the patient was under dialysis due to renal failure six months back, had an
• : acute event of (2)_________________
• : etiology uncertain
• : diagnosis results showed allergic reaction was due to (3)______________
• : cellulitis dialysis shunt infection.

• family members have severe heart disease, carcinoma, and food allergies
Medications:
• taking (4)______________for controlling blood pressure, (5)______________,
Lovaza& Dialyvite.
Previous treatments:
• corticosteroid therapy and antihistamine therapy and monitoring.
• Allergies: Heparin causes (6)___________________ Physical examination: blood
pressure 128/78, pulse 70, temperature is 97.8, weight is 207 pounds, and height is
feet 7 inches.
183
Inpression:
• (7)____________________
Further diagnosis:
• (8)__________ test, to investigate specific (9)_________
• to determine the substances a subject is allergic to.
Further treatment:
• further treatment and medications upon the test results
• stop further usage of (10)______________
• (11)____________ in the event of (12) ___________or allergic reaction or
sensation of impending allergic reaction
184
You hear a physician talking to a patient called Ndamukong. For questions 13 to 24,
You now have 30 seconds to look at the notes
Patient: Ndamukong Age: 29
Symptoms & disease:

• Toothache
Patient's descriptsion of symptoms:

• has multiple issues with teeth due to severe dental disease.
• had many of his (13)_______________
• having severe tooth pain to both (14)__________for the past three days.
• doesn't drink, but (15)__________________
Family history of illness: none

Medications: (16)__________ and Vicodin for (17)______________
Previous treatments: had removed many of his teeth
Allergies: penicillin and (18)____________

• Temperature 97.9, blood pressure is (19)__________________ pulse is 74,
respiration is16, (20)____________98% on room air and interpreted as normal
• tenderness to (21)____________gums are normal no (22) _____________ or
swelling no purulent or other discharge noted.
• floor of the mouth is normal without any abscess, no surggestion of Ludwig's
syndrome.
Impression:
• (23 )___________ and Multiple Dental Caries
185
Further treatment:
• (24)________________
• intramuscular: Teeth Filling
• Complications: None
186
Part B
25. You hear a physician explaining Micro Laparoscopic Pain Mapping procedure to the
nurse.
This extract concludes that;
A. Further reseach is required on this issue
B. A placebo is always safe though it is less effective than antidepressants
C. Antidepressants are more efficacious
26. You hear a physician explaining the issues involved in treating lower back pain.
Which of the following statements best suits this extract?
A. Most of the lower back pain cases are unrelated to particular indentifiable spinal
abnormalities
B. The impact of lower back pain are extreme in low-income and middle-income
countries
C. Recommendations are mainly based on the trial exclusively from high-income
countries.
27. You hear a doctor explaining to the nurses about the growth hormone test.
The growth hormone reseve is defined by the peak serum concertration after stimulating
with;
A. Clonidine
B. Secretagogue
C. Argine
187
28. You hear the announcerment of a new milestone in cancer treatment.
A genetically engineered protein cell is better known as;
A. A Vascular Endothelial Growth Factor
B. A carinogenic cell
C. A cancer tumor
29. You hear a physician explaining how to treat an intermittent explosive disorder.
Which on of the following methods can cure the intermittent explosive disorder?
A. Anticonvulsant mood stabilizers
B. Antidepressants
C. Cognitive exercises
30. You hear a doctor briefing the junior doctors about trigger point injection.
A Trigger Point Injection is given the muscle
spasm doesn't respond to;
A. Conrticosteroids
B. Muscle relaxants
C. Local anesthetic medications
188
Part C.
For questions 31 to 42, choose the answer A, B or C which fits best according to what
You hear the discussion between a senior doctor and junior

doctors about Pemphigus.

A. Pemphigus is an autoimmune disease
B. Pemphigus is a gennetic disease
C. Pemphigus disease can spread person to person
32. Crusty sores are formed in?

A. Pemphigus vulgaris
B. Pemphigus foliaceus
C. All types os pemphigus diseases
33. The type of pemphigus that affects the mucous membranes is;
A. IgA pemphigus
B. Pemphigus foliaceus
C. Pemphigus vulgaris
189
34. The disease that affects the scalp is;
A. Pemphigus foliaceus
B. IgA pemphigus
C. Paraneoplastic Pemphigus
35. Which of the following is characteristics

of Paraneoplastic Pemphigus?
A. Forming crusty sores on the scalp and face
B. Eyelisd becoming cut and scarred
C. Affecting mucous membranes
36. Pus-containing bumps are formed in

A. IgA pemphigus
B. Vegetans
C. Paraneoplastic Pemphigus
190
37. In acute pericarditis, the pain increases?
A. During expiration
B. While sitting
A. Lying down
38. Which of the following symptoms is not seen in the patients with chronic
pericarditis?
A. Chest pain
B. Tiredness
A. Coughing
39. Which of the following conditions is caused due to gradual accumulation of fluid
within the pericardial cavity?;
A. Chronic pericarditis
B. Pericardial effusion
C. Constrictive pericarditis
40. The condition caused due to thickening of pericardial layer is;

A. Cardiac tamonade
C. Constrictive pericarditis
41. The condition caused when the pericardial fluid volume increases about 80 ml is;
A. Cardiac tamponade
C. Purulent pericarditis
42. The type of pericarditis commonly seen in the patients with Hodgkin's disease is;
A. Malignancy pericarditis
B. Traumatic pericarditis
C. Radiation Pericarditis
191
192
193
--beep--


your answers.
194
You hear a doctor talking to a patient called Mr. Chong Walton. For questions 1 to 12,
Patient: Mr. Chong Walton
Age: 48
Symptoms & disease:

• severe pain on left knee and stiffness

• A patient with severe bilateral knee degenerative joint disease, left greater than
right, with significant pain and limitations because of both, had (1)_______two
times winthin the duration of past eighteen months, long-standing conservative
course of these including nonsteroidals, narcotics, and injections, want to go for a
total joint surgery on the left side hes arthritic (2)__________he was working as a
driver with a beverage company, but now he has retired due to his condition.
Past surgeries:
• (3) __________ on the left. Baker's cyst. Colon cancer removal. Bilateral knee
scopes. Right groin hemia. (4)___________ status post colon cancer, second
surgery.
Medications:
• Ambien 12.5 mg bed time, (5) ________ Lisinopril 10 mg daily. Demerol for pain.
Allergies:
• (6)___________ cause rashes, ibuprofen cause his throat to swell.
• Fortaz (7)_________
195
Diagnosis:
• Musculoskeletal examination of left knee reveals a (8) ______extension, 126

flexion. Extensor mechanism is intact.
• There is mild varus. Has good stability at (9)___________
(10)________________ are negative Has good muscle turgor. Dorsalis pedis
pulse 2+. X-rays reveal severe bilateral knee degenerated joint disease with joint
space narrowing medially as well as the (11)___________left greater than right.
Impression:
• paresthesias down into thighs (12)________________ bilateral knee degenerative
joint disease, significant back pain, status post lumbar stenosis surgery
196
You hear a physician talking to a patient called Mr. David Goggins. For questions 13 to
24, complete the following notes with a word or short phrase.
Patient: Mr. David Goggins Age: 67
Symptoms & disease:

• frequent nausea and vomiting with an aspiration pneumonia and abdominal
Discomfort

• frequent nausea and vomiting with an aspiration pneumonial and abdominal
discomfort had an endoscopy which revealed a (13)_______ Now he feels anemic.
Had a CT scan last week that showed (14) __________ worrisome for
(15)__________ bilateral hydronephrosis and multiple liver lesions. Yesterday he
had (16)____________ and passing flatus and has (17) __________
• chronic alcohol user, stopped smoking long back.

• (18)_________ history of pneumenia, and aspiration pneumonia, osteoporosis,
alcoholism, (19) _________________
• He is afebrile. Heart rate in the 100s to 120s at times
• with (20) ____________Respiratory rate is 10-20, blood pressure 130s-150s &
60s-70s. Abdoment is distended with tenderness mainly in the upper abdomen but
very difficult to localize.
Diagnosis:
• CT scan shows (21)___________ with an enlarged cecum filled with stool and air
fluid levels with chronically dilated small bowel.
• Further dilated small bowel.
197
Further diagnosis:
• a repeat CT scan to assess it further to see if there is (22) _________ versus
resolution to further (23)___________ and make decisions regarding planning at
that time. Since he has frequent desaturations secondary to his aspiration
pneumonia, any surgical procedure or any surgical intervention certainly require
(24) _________that would then necessitate long- term ventilator care. Decisions on
further treatment will be based on the repeat CT scan.
198
Part B

25. You hear a discussion between a nurse and a physician explaining about Nipah virus
Fevers
The genus of Nipah virus is;
A. Paramyxoviridae
B. Henipavirus
C. Pteropus
26. You hear a monologue of physician explaining about the use of Thimerosal in
vaccines.
A. Thimerosal contains methylmecury
B. Ethylmecury causes severe side effects to humans
C. Ethylmecury is the most widely used form of organic mercury
27. You hear a discussion between two doctors on adjuvants used in vaccines.
A. Aluminum gel are used in Cervarix vaccine
B. Mono phosphoryl lipid A has been used as an ingredient in vaccine since 1930
C. Cervarix doesn't contain aluminum salts
199
28. You hear a monologue of physician explaining about Typhus Fevers
Sylvatic typhus is also known as:
A. Scrub typhus
B. Louse-borne typhus
C. Murine typhus
29. You hear a discussion between two doctors about VX and its effects.
Which of the following statement is correct?
A. Sarin is much more toxic by entry through the skin.
B. Syptoms will start appearing within few seconds of exposure to the liquid form of VX
C. The least volatility makes the VX as short-term threat as well as long term threat.
30. You hear a monologue of a doctor briefing about Rubella disease.

A. Mumps
B. Measles
C. Shingles
200
Part C.
You hear a medical podcast on the Guidelines for Coping With Prader-Willi Syndrome.
31. Which one of the following is not one of the

complications of Prader-Willi Syndrome?
A. Hyperplasia
B. Deletion of chromosome 16
C. Damage to the two primary areas of the brain
32. Weak muscle tone is also known as;

A. Hypertonia
B. Hyperplasia
C. Hypotonia
33. Prader-Willy Syndromes also develops;

A. Types 2 diabetes
B. Type 3 diabetes
C. Type 1 diabetes
201
34. Which of the following is not a distinctive facial
feature of Prader-Willi Syndrome
A. Triangular mouth
B. Small feet and hands
C. Almond-shaped forehead
35. Which of the following is the suitable treatment

to improve the speech of the patient?
A. Physical therapy
B. Growth hormone test
C. Medications of reuptake inhibitors
36. Who can treat the patients having trouble getting

their eyes to focus together?
A. Optometrist
B. Ophthalmologist
C. Ophthologist
202
You hear a medical podcast on the Guidelines for Coping With Prader-Willi Syndrome.
37. Which of the following statements is corect?

A. Rejection of transplant is reversible if diagnosed carly.
B. Immunosuppressant results in severe side-effects.
C. Causes of a chronic rejection are not yet identified.
38. Which of the following is not one of the

side-effects of immunosuppressant?
A. Low blood pressure
B. Cancer formation
C. Weight gain
39. Which of the following vaccines is not suitale

after the kidney transplant?
A. Haemophilus influenzae B
B. Nasal influenza vaccine
C. Diphtheria-pertussis-tetanus
40. Which of the following vaccines should be

given before traveling?
A. Hepatitis A
B. Hepatitis B
C. Pneumovax
41. A flu shot can be given;

A. After five years of transplant
B. Yearly
C. After six months of transplant
203
42. Which of the following cancer types doesn't
develop in women?
A. Cervical cancer
B. Prostate cancer
C. Colon cancer
204
205
206
--beep--


your answers.
207
You hear a physician talking to a new patient called Bernardito. For questions 1 to 12,
Patient: Bernardino
Feeling:
• (1)______and severe pain For the past two months: stomch hurts after every meal

• The painpersits even during the nights
• didn't eat any heavy food for the past two months : pain is only fleeting
• it hurts every time while eating food
• eat alot of (2)__________ at home
• pain moves across the (3)____________
• feels a (4) ________while burping
• pain increases while lying down
• eat no spicy food
• bowel is (5)______________
• no blood in bowel movement
• feeling a (6)____________ while having orange juice
Initial treatment:
• takes Alka Seltzer (7) _____________and Tylenol regularly
Further treatment:
• examine (8)_____________ for any kind of parasites.
Diagnosis:
• of upper (9)___________ through X-rays and (10)_____________
• X-ray test or an ultrasonic study of (11) ____________
• (12) ____________ if the pain continues after having some antibiotics
208
You hear an optometrist talking to a patient called Dominika. For questions 13 to 24,
Patient: Dominika
Reason for the referral:

• a suspected case of (13)___________
Occupation:
• (14)__________ Accountant
History of condition:
• first experienced (15)___________ back
• having a family history
• (16)__________ is thicker than the usual
Initial diagnosis:
• (17)___________and OCT
Patient's descriptsion of condition:

• appearance of a few black, (18)__________ before the eyes that don't disappear
even after closing the eyes.
Information given:
• the eyes of the patient are affected by floaters.
• floaters may become very (19)_________ and affect eyesight & in such cases, a
surgical procedure called (20)___________ may be suggested to
• remove floaters from the (21) _____________________
• intake of vitamins to improve the eyesight and reduce the (22) _____________
• to take a Vitamin A supplement that includes selenium, (23) _________ and DHA
• include green leafy vegetables like spinach, kale, and (24) _____________ in your
meals
209
• Part B
25. You hear two doctors discussing the topic of keeping the immune system under
control
A. Drugs used for autoimmune diseases blocks the energy pathway to deactivate the
disease
B. Energy pathways are feasible targets to treat certain diseasea that involve dietary
measures
C. Diets are goign to play a prominent role in disease management
26. You hear physicians discussing the topic of coping with a peanut allergy.
A. Children with eczema should not ingest peanuts.
B. Children with eczema should eat peanuts at an early stage.
C. Parents should avoid feeding every kind of food that can cause an allergic reaction
to their children
27. You hear the discussion between physicians on the importance of food challenge
A. Food challenge test becomes inevitable with patients with food allergies
B. Food allergy tests are an alternative to the food challenge test
C. Food allergy tests carry lots of false positives
210
28. You hear a discussion between doctors on fake Stop the Bleed kits
A. Counterfeit tourniquets would probably cost between 25 to 35 dollars.
B. Genuine tourniquets range from 25 to 35 dollars.
C. One should not buy Stop the Bleed kits for a cost lesser than 25 dollars.
29. You hear a physician explaining to his nurse about causes of obesity.
Which of the following is the main cause for obesity?
A. The interaction between genes and the bacteria in our guts
B. The interaction between the diet we eat, our genes, and our bacteria in our body.
C. Genes colonized with bacteria that produce more nutrients for the host.
30. You hear a physician briefing staff about the Herpes virus infection.
Which of the following is not a symptom of the Herpes virus infection.
A. Tingling
B. Bleeding
C. Swollen lymph nodes
211
Part C.
You hear the lecture given by a senior physician to junior doctors on the risk factors of
osteoporosis disease You have 90 seconds to read question 31 to 36
31. A person is considered drunk when the blood alcohol level reaches;
A. 0.08
B. 2.08
C. 0.28
32. Thirty days of a rat's life are equivalent to;

A. Three months
B. Thirty human months
C. Three years

A. Dual-energy X-ray absorptiometry test costs lesser than the Peripheral test.
B. The peripheral test can show normal results of the patient with osteoporosis in
backbone or hips
C. Dual-enegy X-ray test measures only heel, the wrist, the bones between finger
joints.
212
34. The mineral density of the bones of all parts will be same;
A. When a woman reaches fifty years.
B. In Caucasian females over seventy years of age.
C. When a woman reaches seventy years of age.
35. The calcium intake per day in people over fifty years should be;
A. 1200 milligrams per day
B. 800 to 1000 international units per day
C. 2500 milligrams per day

A. Salmon has soft bones
B. Vitamin D absorbs calcium
C. Individual over 50 should take 1200 milligrams of or vitamin D
213
You hear the brief instruction given by a physician to his staff on the abnormalities in
thyroid functioning.
*You have 90 seconds to read question 37 to 42
37. Which of the following is not a symptom of hyperthyroidism?

A. Depression
B. Weight loss
C. Tremors
38. Which of the following disease has an inflamed gland?

A. Hasimoto's disease
B. Thyroiditis
C. Autoimmune disorder
39. Which of the following is an autoimmune disorder in

hypothyroidism?
A. Hasimoto's disease
B. Grave's disease hormones with the help of the pituitary gland.
C. Thyroiditis
40. Which of the following is not a cause for hypothyroidism?

A. a malfunctioning hypothalamus
B. a radioactive treatment for hypothyroidism
C. a malfunctioning pituitary gland
41. In which of the following diseases does the autoimmune

system mimic the thyroid stimulating hormone?
A. Hashimoto's disease
B. Thyroiditis
C. Grave's disease
214
A. Goiter can be unnoticeable in certain cases.
B. The nodules or lumps in the gland starts secreting more
C. Certain medications take to treat hypothyroidism result in
hyperthyroidism
215
216
217
--beep--


your answers.
218
You hear a doctor talking to a patient called Eugeniusz. For questions 1 to 12, complete
the following notes with a word or short phrase.
Patient: Eugeniusz
Age: 12
Symptoms & disease: Fell off from bicycles & having neck pain
Patient's description of symptoms: fell off his bicycle. He was not wearing a helmet.
There was a (1)_________ He is complaining neck pain
Family history of illness: none
Medications: none
Allergies: none
• his blood pressure 150/75, pulse rate 80, respirations 18, temperature 37.4, (2)
___________on room air. He is moderately obese.
Diagnosis:
• His neck is symmetric, the trachea is in the midline, and there are no masses. No
crepitus is palpated. The thyroid is palpable,
• not enlarged, smooth, moves with swallowing, and has no palpable masses.
Normal respiratory effort. There is no (3)___________ or action by
• the accessory muscles. Normal breath sounds bilaterally
(4)_______________wheezing or rubs.
• The point of maximal impulse is palpable at the (5)__________ no thrills on

palpation. (6)______________ no audible S3, S4, murmur, click or rub.
219
• (7)__________ no audible abdominal bruits (8)_______________ bilaterally
without audible bruits. Extremities show no edema or (9)__________________
• :Gastrointestinal investigation shows no palpable tenderness or masses. Liver and
spleen are percusses but not palpable under the costal margins. No evidence for
• (10) _____________ no lymphatie nodes over 3 mm in the neck, axilla or groins.
Musculoskeletal test shows normal
• gait and station. Symmetric muscle strength and normal tone, without signs of
atrophy or abnormal movements.
• There is a (11) ____________and one in the occipital scalp, and there are abrasions
in the upper extremities and abrasions on the knees. No
• induration or subcutaneous nodules topalpation.
Impression:
• has concussion, facial abrasion, (12)____________and knee abrasions.
• Further treatment: to admit the patient today and he will be medicated and under
observation for 24 hours.
220
You hear a physician talking to a patient called Mr. Gregorius. For questions 13 to 24,
Patient: Mr. Gregorius

Age: 55
Symptoms & disease:
• Abnormal stress test with severe chest pain
• Patient's descriptsion of symptoms:
• had a markedly abnormal stress test with severe chest pain after 5 minutes of
exercise on the
• standard Bruce with horizontal ST depressions and moderate (13)___________ on
stress imaging only.
Allergies: none
• his (14) _______________ today shows mild-to-monderate left main distal disease
of 30%, moderate (15) ____________ with a
• severe mid-left (16)______________ of 99%, and a mid-left (17)___________
with normal (18)__________- and some mild (19)_____________-in the right
• coronary artery with some moderate (20)______________ seen in the mid to distal
right (21)_____________
Impression:
• has (22)___________- symptoms, as well as nocturnal angina symptoms, and
especially given the severity of the mid left anterior
• descending lesion, with a markedly abnormal stress test.
Further treatment:
• Aspirin 325 mg once a day, (23) ____________Zocor 40 mg once a day.
• (24) __________ given tonight.
• transfer the patient for percutancous coronary intervention
221
Part B
25. You hear a discussion between a doctor and nurse about common types of
neuropathic pain.
Pain caused by an outbreak of shingles is;
A. Pudendal neuralgia
B. Postherpetic neuralgia
C. Sciatica
26. You hear a discussion between a doctor and nurse about Bronchodilators used to
treat chronic obstructive
pulmonary disease.
Which of the following bronchodilators works by blocking the neurotrasmitter?
A. Methylxanthines
B. Anticholinergic
C. Beta-agonists
27. You hear a discussion between a doctor and nurse about pancreatic neuroendocrine
tumors.
Which of the following tumors is not malignant?
A. Glucagonoma
B. Gastrinoma
C. Insulinoma
222
28. You hear a discussion between a doctor and nurse about melasma and different types
of melasma.
Which of following statements is correct?
A. The epidermal melasma is characterized by presence of melanophages.
B. Melasma appears only on face
C. The dermal melasma is defined by the presence of excess melanin.
29. You hear a discussion between a doctor and nurse about possible causes of arthritis.
Which of following conditions is developed when the immune system dysfunctions?
A. Osteoarthritis
B. Reactive arthritis
C. Rheumatoid arthritis
You hear a monologue of a physician on granulomas.

30. Which of following statements is incorrect?
A. The chronic activation of the metabolic sensor is responsible for the granulomas
formation.
B. Granulomas are tissue nodules of immune cells that can protect many organs.
C. Target Of Rapamycin inhibitors belong to a group of drugs that are licensed for
clinical
223
Part C.

You hear the lecture given by a physician on the topic Amyotrophic lateral sclerosis
disease.
31. Which of the following is incorrect?

A. Amyotrophic lateral sclerosis is also known as Lou Gehrig's disease, after famous
basketball player who was diagnosed with this condition.
B. The lifespan of the patients with Amyotrophic lateral sclerosis is about 3 to 5 years
after the apperance of the symptoms.
C. There is no cure to amyotrophic lateral sclerosis and treatment is aimed to relieve
symptoms.
32. Which of the following is in correct?

A. About 20 percent of patients will live 5 years or more after diagnosis
B. About 50 percent of patients will live for 20 years
C. Just 10 percent of the patients will live for 10 years or more.

A. About 90 to 95 percent of patients are with sporadic amyotrophic lateral sclerosis
B. About 5 to 10 percent of patients are with inherited amyotrophic lateral sclerosis
C. About 5 to 10 percent of patients are with sporadic amyotrophic lateral sclerosis
224
34. Higher levels of glutamate secretion occurs due to;
A. Chemical imbalance.
B. Disorganized immune respone.
C. Mishandling of proteins.
35. Which of the following is not of the early symptom of amyotrophic lateral sclenosis;
A. Emotional lability
B. Slurred speech
C. Abnormal limb fatigue
36. Which of the following is an upper motor symptom?

A. Muscle atrophy
B. Twitching
C. Stiffness
225
Extract 2
Question 37 to 42
You hear a doctor giving a lecture on Tests used on biopsy and cytology specimer
diagnose cancer. You have 90 seconds to read question 37 to 42
37. Which of the following statements suits best with this extract 40. Cytometry is
used to diagnose the cells from
A. Adenocarcinomas can produce mucus A. Lungs
B. Mucicarmine stain leaves a pink-red appearance to mucus B. Colon
C. Pink-red appearance of mucus is an indication of lung cancer C. Bone Marrow

A. Histochemical stain tests can diagnose only different kinds of cancer tumors.
B. Special stains are used to identify microorganisms.
C. Some infections cause lumps similar to cancer tumor.
39. Immunohistochemical stains are significant to;

A. Find out whether the antibodies have been attracted to the cells.
B. Find out the origin of the cancer.
C. Find out whether the tumor is cancer or not
40. Cytometry is used to diagnose the cells from

A. Lungs.
B. Colon
C. Bone Marrow.
41. The cells are diploid if;

A. The DNA amount is abnormal
B. The DNA amount is normal
C. The cancer grow and spread aggressively
226
42. The S-phase fraction measurement in cytometry test will measure;
A. Size of the cancer cell S-Phase
B. Size of the cancer cell tumor in S-Phase
C. Amount of cells in S-Phase
227
228
229
--beep--


your answers.
230
You hear a neurologist talking to a new patient called Mr. Lizaveta. For questions 1 to
12, complete the following notes with a word or short phrase. You now have 30 seconds
to look at the notes
Patient: Mrs. Lizaveta

Age: 71
Symptoms & disease:

• suspected case of (1) _______________

• She has been walking in a strange manner for the past three months. Has a
broadened base and has developed (2)_______________
• Her balance is declinin. Not using any assistive device.
• Normal bowel & bladder movements. No headache.
• Memory is slowing down.
Medical history:
• No trouble with (3) _________but she has vertigo.
• She was diagnosed for (4)_____________ in 2014 but no snoring or apnea.
• Arthritis since 2000 and (5)_____________ since 1975.
Past surgeries:
• Had a (6)___________ in 1992, and a wrist operation in 1972
Family history:
• Mother had (7) ____________________
Medications:
• Premarin 0.625 mg, Aciphex 20 mg daily, Toprol 50 mg daily, Norvasc 5 mg
daily, multivitamin, (8)______________ B-complex vitamins calcium,
magnesium, and vitamin C daily.
231
• Blood pressure 154/72, (9)_______________ and weight 153 pounds
• Spin is straight and nontender. Has a mild kyphosis, but no scoliosis : Gait
assessment shows she has some unsteadiness and a widened base
• A (10)____________ with trace expansion into the temporal horns
• The (11)______________ is patent
• Corpus callosum is bowed and effaced
• Developed a couple of small T2 signal abnormalities no changes in periventricular
signal.
Further diagnosis:
• (12)_____________ test through lumbar puch method.
232
You hear a physician talking to a patient. For questions 13 to 24, complete the following
notes with a word or short phrase.
Patient: Mrs. Jamila
Age: 45
Reason for referral: Mantle Cell Lymphoma
• Had abdominal pain eight
• months back. Treated for suspected pneumonia with (13)___________
• Admitted to emergency ward as her pain worsened dexamethasone,
• Further diagnosis detected (14)_____________ and was medicated with Per
cocet.
• Further diagnosis showed (15)________________ and a spleen of 19 cm.
• Positron emission tomography showed (16) _________________ of 1 to 2 cm
diameter, and an enlarged hypermetabolic spleen.
• Lymph node biopsy last month detected mantle cell lymphoma bone marrow
biopsy showed bone marrow involvement with lymphoma and has circulating
lymphoma cells on (17)______________
Medical history:
• (18) _________in 2001, cyst from left neck was operated in 2005
• : had tonsillectomy
• : Gets occasional (19) _________________
• Family history: Father had (20)_______________ and colon cancer.
• : Mother has hypertension and (21) ________________--
• Medications: Estradiol/Prometrium 200 mg, Ultram when gets
• pain, Baby aspirin (22)______________ for sleeping and iron supplements.
• Further treatment: Chemotherapy with hyperfractionated,
(23)__________doxorubicin, vincristine
• : Discontinue aspirin and continue with Estradiol/Prometrium. Ativan as and when
feeling anxiety.
• : to start (24) ____________from today and hydration, to advoid tumor lysis
syndrome. Plan to add Rituxan a litter later, since the patient has circulating
lymphoma cells.
• : to be evaluated for bone marrow transplant in first remission.
233
Part B:
25. You hear a dietitian to a patient.

What i she doing?
A. corecting the patient's misconception about obesity
B. describing the link between obesity and other diseases
C. stressing the need for a positive strategy aimed at weight loss
26. You hear members of a hospital committee discussing problems in the X-ray
department.
The problem are due to delay in
A. buying a replacement machine.
B. getting approval for a repair to a machine.
C. identifying a problem with a particular machine.
27. You hear a senior nurse giving feedback to a trainee after a training exercise
The trainee accepts that he failed to
A. locate the CPR board quickly enough
B. deal with the CPR board on his own
C. install the SPR boarded correctly
234
28. You hear a trainee nurse asking his senior colleague about the use of anti-embolism
socks (AES) for a patient.
The patient isn't wearing the socks because
A. she's suffering from arterial disease in her legs.
B. there is senscry loss in her legs
C. her legs are too swollen
29. You hear a vet talking about her involvement in the management of the practice
where she works.
How does she feel about her role?
A. She accepts that it's become surprisingly complex.
B. She wishes her boss took more interest in the finances.
C. She values the greater understanding it gives of her work.
30. You hear a physiotherapist giving a presentation about

a study she's been involved in.
She suggests that her finding are of particular interst because of
A. The age of the subjects
B. The type of disorder involved
C. The length of the covered by the study
235
Part C.
You hear an interview with Dr Cristine Ericson, who's talking about her research
supporting non-fasting lipid blood tests for cholesterol.
You now have 90 seconds to read question 31 to 36
You hear an interview with Dr Cristine Ericson, who's talking about her research
supporting non-fasting lipid blood tests for cholesterol. You now have 90 seconds to
read question 31 to 36
31. What is Dr Cristine Ericson's opinion about fasting before blood tests?
A. It's is not supported by scientific evidence.
B. It's is superior to non-fasting blood tests.
C. It is supported by convention not data.
32. What does Dr Cristine Ericson's say about the reseach on non-fasting blood tests
A. The majority comes from Copenhagen.
B. More studies should focus childen.
C. It includes data from multiply countries.
33. What is Dr Cristine Ericson's opinion on the difference between the results of fasting
and non-fasting tests?
A. The small differences are unimportant.
B. There is no didfference in the results.
C. There is small but significant difference.
236
34. Dr Cristine Ericson states that everyone in Copehagen was happy with the
introduction of non-fasting blood tests.
What evidence does she provide to support this claim?
A. Data showing an increase in test attendance.
B. Increased public demand for non-fasting tests.
C. Positive stories from other medical professionals.
35. According to Dr Cristine Ericson, why are non-fasting bloodtests popular with the
public?
A. Because of the strong research evidence in the report.
B. Because of positive publicity in the newspaper and on TV.
C. Because they are more convenient for busy lifestyles.
36. Which of the following statements best summarises Dr Cristine Ericson position on
the use of fasting blood tests?
A. In rare cases fasting before a blood test is necessary.
B. Fasting before a blood test should no longer be recommended.
C. New research is needed on the use of fasting an non-fasting tests.
237
Extract 2
Question 37 to 42
You hear a presentation in which a researcher called Dr Milan Patrecivich is talking

about the relationship between new technology and medicine in the furture. You have 90
seconds to read question 37 to 42
37. Dr Patrecivich suggests that in the furture medical technology will

A. continue to replace human doctors.
B. give doctors freedom to express core skills.
C. become more accurate and reliable that doctors.
38. According to Dr Patrecivich, how will wearable sensors and smartphones help GPs?
A. They will allow doctors mobility to visit patients in remote locations.
B. They will allow doctors to check if patients are following their advice.
C. They will allow doctors to monitor their patients will real-time data.
39. Dr Patrecivich believe that

A. radiologists currently spend too much time checking through images.
B. technology like IBM's Medical Sieve isn't yet capable of doing a radiologist's job.
C. radiography algorithms should be designed by professional radiologists
40. Arcoding to the talk, both sports medicine and oncology

A. will use technology to make their processes faster and cheaper.
B. will use technology to fitter data and individualise therapy.
C. will use technology like Xbox to treat patients from a distance
41. What does Dr Patrecivich suggest about the effect of technology on cancer
treatment?
A. Artificial intelligence technology will eventually cure cancer.
B. Oncologist will keep patients informed using social media.
C. Technology will have a powerful and positive effect on oncology.
238
42. What is Dr Patrecivich's conclusion about the furture of medicine and technology?
A. Medical technology will give doctors more time and better data to care for patients.
B. Physicians will have amazing opportunities to develop new medical technologies.
C. Automated and robotic systems will gradually replace humans in medical practice
239
240
241
--beep--


your answers.
242
You hear a physician talking to new patient called Mrs. Dalilah. For questions 1 to 12,
complete the following note with a word or short phrase.
Patient: Miss Elissa

Age: 19
Symptoms & disease:

• (1)_______________

• getting acne on chin, right temple and left temple and the condition is still
worsening. : menses commenced at the age of thirteen cycle once in 24 days, light
flow, lasts for six days
• Medical history: has been talking Alesse-28, 20 mcg-0.10 mg tablet since
(2)___________ and (3)________________
• drinks socially
• (4)_____________4 servings a day
Family history:
• her mother has (5) _______________ and anxiety
Allergies:
• (6) _________________ causing difficulty in breathing
• periodic reddening of face, acne problems and allergies
• face shows (7)__________________
Further treatment:
• (8) _______________ capsule
• (9)____________ therapy with (10)______________ 100 mg a day
243
Dietary suggestions:
• should avoid processed sugar, caffeine, dairy products and processed foods
• should eat foods that are rich in (11) _________ anti-inflammatory compounds and
other acne-fighting nutrients.
• blueberries, sweet potatoes, green tea, carrots, cilantro, (12)_________ oats,
apples, barley and mustard greens.
244
You hear a physician talking to a patient. For questions 13 to 24, complete the following
notes with a word or short phrase.
Patient:
• (13)_________________
Age: 36
Symptoms started:
• three months ago

• tiresome, (14)____________ and an upset stomach. (15)___________ for
the last three weeks.
• No fever. Feeling sleeplessness
• Stress at workplace
• lost (16)___________ recently.
• Further investigation: blood test and (17)___________ to identify the bacteria
(18)__________ & (19) __________ pneumohila.
• Further treatment: (20)__________ orally every 24 hours for (21) _____________
• (22)___________ pneumonia vaccine
Dietary suggestions:
• plenty of fruit juice and fresh fruits, (23)_____________ milkshakes,
smoothies, plenty of full-cream milk or
• yoghurt, or even ice cream, with light meals of (24)_______________ fish or eggs
and cooked vegetable
245
Part B

25. You hear a physician explaining to his nurse about Skin Cancer.
Which of the following is not a less common type of skin cancer?
A. Kaposi sarcoma
B. Merkel cell cancer
C. Squamous cell carcinoma
26. You hear a physician explaining to his patient about Depressive Disorder.
Which of the following is not a symptom of depressive disorder?
A. hopelessness
B. aggressiveness
C. Irritability
27. You hear the discussion of two doctors about the frailty score concept in aged
patients.
Which of the following statement suits this extract best?
A. The frail patient and their loved ones should consider the consequences of surgery
before it
begins.
B. Frailty score is a good concept that may dictate the objective of the surgery.
C. Decline of physiologic reserve is a normal consequence of the aging process.
246
28. You hear the discussion between two doctors about Epidermolysis Bullosa in
children.
Abnormal fingernails and toenails are the symptoms of;
A. Dystrophic Epidermolysis Bullosa
B. Junctional Epidermolysis Bullosa
C. Epidermolysis Bullosa Simplex
29. You hear the physician briefing to his staff about Clonus disease.
Clonus is caused when;
A. The muscle cells are damaged
B. The nerve cells are damaged
C. The muscle pulses for an extended period
30. You hear the discussion between two doctors about how to cope with delirium in
patients in ICU.
A. Haloperidol is unsuccessful to prevent delirium in ICU patients.
B. Delirium is associated strongly with cognitive impairments for a long term.
C. Medications aren't the right approach always.
247
Part C.
You hear the lecture given by a senior surgeon on the Role of Diabetes in the End-Stage
Renal Disease You have 90 seconds to read question 31 to 36
31. Microalbuminuria is detected after 5 years in;

A. Type 1 diabetes
B. Type 2 diabetes
C. Microvascular complications
32. Which one of the following in the first-line agent in diabetes patients?
A. Diuretics
B. Angiotensin Receptor Blockers
C. Dihydropyridines
33. Which is the recommended protein intake in the case of declining glomerular
filtration ratio?
A. 2.3 grams per kilogram weight per day
B. 0.8 grams per kilogram weight per day
C. 0.6 grams per kilogram weight per day
248
34. The evidence of microalbuminuria should trigger the investigation of;
A. Abnormal levels of albumin in the urine
B. Vascular disease
C. Glomerular filtration ratio
35. The end-stage renal disease is higher in

A. Cardiovascular patients
B. Type 2 diabetics
C. Type 1 diabetics
36. Which is the primary factor that accounts for the pathophysiology of diabetic
nephropathy?
A. Formation of advanced glycosylation end products by irreversibly binding to
proteins in kidney
B. Anatomical and structural changes in the kidney
C. Narrowing of the efferent arteriole in the glomerulus
249
You hear the instruction given by a physician to his staff about a senior surgery on
Alpha and Beta Thalassemia.
37. In newborns, alpha thalassemia produce;

A. Excess beta chain
B. Excess gamma chain
C. Unstable tetramers
38. Hemoglobin H disease is caused due to;

A. Missing of three loci
B. Missing of two loci
C. Missing of four loci
39. Stillbirth is caused due to;

A. Missing of two loci
B. Missing of four loci
C. Missing of three loci
40. If the red blood cells are smaller than normal, the condition is called;
A. Erythrocytes
B. Hemoglobin Barts
C. Microcytosis

A. Beta thalassemia trait occurs when two beta globin genes are mutated
B. Alpha globin is made on chromosome 11
C. Beta thalassemia train patients can pass on thalassemia to their children
250
42. In which of the following diseases do children start developing symptoms within two
years of their life?
A. Beta thalassemia intermedia
B. Beta thalassemia major
C. Beta thalassemia trait
251
252
253
--beep--


your answers.
254
You hear a doctor talking to a patient called Mr. Jonathan. For questions 1 to 12,
complete the following notes with a word
or short phrase. You now have 30 seconds to look at the notes
Patient : Mr. Jonathan
Age : 50
Symptoms &disease :
• jaw pain. (numbness and tingling alongthe jaw. teeth and tongue)

• pain and numbness in jaw for the past six months
• dental evaluations were normal
• diagnosed for throat infection and prescribed (1)_________
• taking cough drops
• lost the (2) _______________
• numbness on the left (3)___________ I and jaw extends from
• the angle of jaw to lip
• gained about 20 pounds of weight
• getting headaches (4) ___________________
• no spasm on jaw
• habitual to chewing tobacco. but stopped recently. Using Nicorette gum.
Medical history :
• had a (5) ______________
Medications :
• Tylenol
Allergies :
• allergic to (6)__________________ Feels dizzy or lightheaded.
255
• Blood pressure is 138/82. pulse 64,
• temperature 98.3, weight 191 pounds
• (7)_____________ is normal with good moisture
• decreased sensation to left jaw extending to the left lateral tongue
• and Left (8)______________
Diagnosis :
• The (9)______________ shows a moderately deviated
• nasal septum to the left, (10)________________
Impression:
• (11)_______________ of left manual teeth and tongue
• suspected for neoplasm within the mandible
• developed hypogeusia with loss of taste
• (12) _______________ (dry mouth syndrome
256
You hear a physician talking to a patient called Mr. Tulensru. For questions 13 to 24,
Patient : Mr. Tulensru:

Age : 63
Symptoms &disease :
• symptoms of heart failure, stress & fatigue, shortness of breath

• shortness of breath with exertion. feeling stressed and fatigued
• attacks of severe shortness of breath and coughing while sleeping
• developed (13)___________ and had a mild leg swelling
• no angina, palpitations or syncope. Irregularity in pulse
• symptoms have worsened over past ten months
• gained weight about 20 kg over past one year
• doesn't smoke, but drinks, no diabetes mellitus or heart murmur
Medical history :
• had (14)___________ surgery 7 years ago.
• Had trauma to his (15)___________________
Medications :
• Aspirin 81 mg daily and (16)_________ pill at 5 mg
• or 2.5 mg 1 tablet daily for stress
Allergies : none
• blood pressure is 120/70 in each arm, pulse is 80 beats per minute
• breathing is two times per minute and unlabored : lungs are clear to (17)________
• first and second heart sounds are normal. has a fourth heart sound and a
(18)________________ Precordial impulse is enlarged
257
Diagnosis :
• electrocardiogram shows (19) _________________
• (20)____________ was 19.7 milliliters per kilogram of body mass
• per minute, that is consistent with mild cardiopulmonary disease.
• hyroid stimulating hormone - 1.33, glucose is 97 and creatinine is 0.9 potassium is
4.3
• echocardiogram shows a dilated cardiomyopathy with (21 of 15%)
• post-stress ejection fraction is 33% & left ventricular cavity appears enlarged
Impression :
• dilated cardiomyopathy of uncertain etiology and (22)______________
Further treatment :
• (23)__________ lisinopril 2.5 mg daily,
• and a beta-blocker, carvedilol 3.125 mg twice daily
• :a loop diuretic, furosemide 20 mg daily.
• echocardiogram ordered after three months
• if the left ventricular function has not improved then a Prophylactic use of an
• (24) ______________
258
Part B
For questions 25 to 30 choose the answer A, B or C which fits best according to what
you hear. You'll have time to read
each question before you listen to the audio. Complete the answers as you listen the
audio.
25. You hear a physician explaining to his staff about Azotemia. Insufficient flow of
fluid through the kidney results in;
A. Intrinsic azotemia
B. Prerenal azotemia
C. Postrenalazotemia
26. You hear a physician explaining to his nurse about bilirubin blood level. Which of
the following statements best suits this extract?
A. Increased level of bilirubin causes icterus.
B. Enzyme deficiency increases the bilirubin level resulting in icterus.
C. Enzyme deficiency results in Gilbert's syndrome, making the
sclerae appear yellow.
27. You hear a physician explaining to his nurse about celiac disease. Which of the
following statements best suits this extract?
A. Only 1% of people worldwide actually develop celiac disease.
B. About 40% of people worldwide develop celiac disease.
C. Gluten free diets are the best method to get rid of celiac disease.
259
28. You hear a physician briefing his junior staff about Precision Medicine.
A. Precision medicine strategy is in increase to treat the disease based on the
genes and environment of each patient.
B. Precision medicine is not a new strategy, it has been in practice for many
years, for instance, in blood transfusion.
C. The role of precision medicine in disease treatment has been very rare so far.
29. You hear a physician briefing his junior staff about alopecia areata. If the entire scalp
becomes harless, the condition is called;
A. Alopecia totalis
B. Alopecia universalis
C. Alopecia areata
30. You hear a physician briefing his junior staff about cytochrome c oxidase deficiency.
Which of the following diseases is caused by severe cytochrome c oxidase deficiency?
A. Hepatomegaly
B. Myopathy
C. Hypotonia
260
Part C.
For questions 31 to 42, choose the answer A. B or C which fits best according to what
you hear. Complete your answers as you listen the audio.
You hear the doctor briefing his staff about the Different types of Biopsies used in
Cancer Diagnosis.

A. A small cylinder of tissue is removed in fine needle aspiration.
B. The diagnosis in fine needle biopsy can be made on the same day at times.
C. Needle used in fine needle aspiration are slightly larger than that used in core
aspiration.
32. Which of the following is also known as the cytology test?

A. Core biopsy
B. Usage of a special vacuum tools in biopsy
C. Fine needle aspiration
33. Removal of complete tumor is called;

A. Excisional biopsy
B. Larger core aspiration
C. Incisional biopsy
261
34. A vertical cut is made from the upper to lower abdomen to remove samples through;
A. Laparotomy
B. Mediastinoscopy
C. Laparoscopic biopsy
35. A squamous cell cancer is removed through;

A. Laparotomy
B. Excisional biopsy
C. Shave biopsy

A. Lymph nodes are the primary parts that are affected due to cancer metastasis.
B. Shave biopsies are used for suspected melanomas of the skin.
C. Sentinel lymph node mapping helps to decide which lymph nodes to remove for
biopsy.
262
You hear the doctor giving a lecture to the junior doctors on different types of Kaposi
Sarcoma.
37. Which of the following type of blotches are not

formed by abnormal cells of Kaposi sarcoma?
A. Purple blotches
B. Black blotches
C. Brown blotches
38. Often skin lesions of Kaposi sarcoma appear on the;

A. Neck
B. Leg
C. Hands

A. A patient is considered to have AIDS when Kaposi sarcoma
occurs in the HIV patients.
B. AIDS outbreaks occur only when the virus completely
damages the immune system.
C. HIV infected patients are AIDS patients.

A. Classic Kaposi sarcoma occurs in Eastern Europe.
B. Classic Kaposi sarcoma is more common in women than men.
C. The lesions in classic Kaposi sarcoma do not grow quickly.

A. Endemic Kaposi sarcoma occurs in younger people, under 40.
B. Malaria is a cause of Endemic Kaposi sarcoma.
C. Endemic Kaposi sarcoma occurs in people over 40.
263
A. Discontinuing immunosuppressive drugs is a cause of latrogenic
Kaposi sarcoma.
B. Organ recipients should not take immunosuppressive drugs after
transplant.
C. Immunosuppressive drugs increase the chances of the herpes virus
infection.
264
265

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Test No.

Audio page Questions page Answers page

2- Listen to the record and follow.

3- Answer questions as you listen.

To reach all the needed OET material,

Be updated day by day though following

Now, look at the notes for extract one

• had a reverse total shoulder arthroplasty surgery on (1)_____six weeks ago

• Last week found out having (13)_______

Now look at question 25

Now look at extract one.

32. According to Dr Gibbons, among readers case histories

34. What is the most important benefit of case stories?

35. How does Dr Gibbons feel about randomized medical trials?

36. According to Dr Gibbons, in the future case stories will be?

38. Poison Ivy causes

42. Oozy rash behind the ears is caused by

Patient: Victor Rosario Age: 67

Patient's description of symptoms:

You hear a doctor talking to a patient called Noah Baxter.

Patient: Noah Baxter Age: 36

• blood pressure-128/78, pulse-70,

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

For questions 25 to 30, choose the answer A, B or C which fits best

26. You hear part of a surgical team's briefing.

28. You hear a pharmacist talking to a doctor regarding a patient's medication.

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

34. What is the popular cause of leukophilia?

35. Which one of the following is not caused by genetic mutation?

36. White blood cells are unable to function in

38. How do we know when someone is suffering from concussion?

Past medical history :

Effects of condition on everyday life:

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

Now look at Question 25.

29. Which is the common type of gall stones?

Now look at extract one.

32. The information revealed by Tucker's diagnostic tests was

33. TI1e first signs of wobblers syndrome is seen

34.The efficient cure for wobblers syndrome in dogs is

35. The spine surgery in dogs helps to

36. Tucker's case study is not a perfect example for

37. What is the benefit of integrating genetics into medical care?

38. Which one is a systemic disease that is not mentioned by Dr Peterson?

39. According to Dr Peterson, what does result in disease?

41. According to Dr Peterson, which healthcare professionals ru·e doing genetic

Patient: Linda Maxwell

• had injury playing (1o)_________ when young

• been to a (12)_____ twice Treatment

Patient Xavier Murphy

• experienced discomfort for the past week

• feels tired along with (16)_______________and stiff

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

Now look at Question 25.

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

31. Which one of the following statements is not correct?

32. Which one of the following statements is correct?

34. Which is the most common kind of lymphoma?

35. When lymphomas arise from the lymph nodes, it is called as

39. In the first stage of her treatment, Chris ____

40. Why did Chris discourage taping?

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

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

SAM's OET Listening Book

SAM's OET Listening Book